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MetroHealth leads the way with Medicaid expansion

10:55 PM, May 2, 2013   |    comments
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CLEVELAND --  Donna Hudson no longer goes to the Emergency Room for routine medical care.

For the first time in her life, the 57-year-old has health coverage and it's a good thing too.

"I have high blood pressure, I have high cholesterol, diabetes and thyroid," Donna says.

Like thousands of uninsured, Donna could barely afford her medications.

"I would skip or take a pill every other day or don't take a pill or I got to the point I was cutting them in half," Donna says.

That only made her sicker.

So this past February, she became the first patient to enroll in MetroHealth's Care Plus program.

"It's allowing people access to doctors and medications to control their chronic illnesses we're finding that people are getting healthy, returning to work," Dr. James Misak says.

The program is paid for by a $36 million subsidy MetroHealth gets from Cuyahoga County taxpayers.

Another $64 million comes in from annual federal Medicaid matching funds. No state dollars are used.

"As healthcare reform affects Metro, I think the Care Plus program shows the future of what expanding healthcare coverage will do for the community," Dr. Misak says.

There are 72,000 uninsured people in Cuyahoga County and Care Plus hopes to cover half of them.

Primary care will be provided by the MetroHealth System's 17 locations, Neighborhood Family Practice and Care Alliance, all of which carry the distinction of being designated as Level 3 Patient-Centered Medical Homes by the National Committee for Quality Assurance.

MetroHealth will also partner with other community agencies to help deliver the care, including Recovery Resources, Murtis Taylor Human Services System, Catholic Charities Services and Stella Maris, among others, as well as a network of ancillary service providers.

MetroHealth Care Plus claims processing and related support functions are being provided in conjunction with a third-party administrator vendor, Medical Mutual of Ohio Inc.

To be covered under MetroHealth Care Plus, Cuyahoga County residents must be:

  • 19 to 64 years old
  • Uninsured
  • Not eligible for regular Medicaid
  • Income at or below 133 percent of the Federal Poverty Level ($15,282 a year for a family of one)
  • U.S. citizen or legal resident of the United States for 7+ years 

Enrollees of MetroHealth Care Plus will be assigned to a primary care provider who will coordinate all of their health care. These patients can obtain covered benefits from network providers for such healthcare services as:

  • Preventive exams
  • Doctor visits
  • Prescription medications
  • Hospital care
  • Emergency services
  • Dental care
  • Physical and speech therapies
  • Home health care
  • Mental health services
  • Nutrition counseling
  • Podiatry
  • Alcohol and drug abuse services
  • Durable medical equipment
  • Transportation to MetroHealth medical appointments

To learn more about MetroHealth Care Plus and to apply for eligibility, call 216-957-2325.


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