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Access Health
Muskegon County, Michigan
Community Size: Approx.168,747
Program Started: September 1999

Overview & Structure:

Access Health was created to help small and mid-size businesses provide health care benefits to employees and their dependents. Businesses may participate if they are located in Muskegon County, have a median wage of $10 or less per hour, and have not offered health benefits in the previous 12 months. The Muskegon County Health Project spearheaded the initiative, beginning with surveys of businesses and uninsured individuals to identify the target market and appropriate cost thresholds. Businesses, providers and consumers worked together to develop a basic benefit plan. The State of Michigan and Muskegon’s two hospitals agreed to allow the use of Disproportionate Share Hospital (DSH) funds to help finance the program, and Muskegon County set up a corporation to accept DSH community match donations. Access Health Inc. was established in September 1999 as an independent 501(c)(3) corporation. Access Health contracts directly with providers. It maintains its own sales staff and also works through local insurance agents, who donate their time, to identify and enroll eligible businesses and members. Claims and payments are managed through two third-party administrators.

Features:

• Comprehensive mainstream benefit plan includes local physician services, in-patient hospitalization, outpatient services, ambulance service, prescriptions, diagnostic lab and x-rays, home health, hospice care and behavioral health.
• Individuals with pre-existing conditions are not excluded from coverage, nor do they pay a different rate.
• Co-pays are low (typically $5 per primary care visit) to encourage basic care and wellness.
• Members can choose their own primary care provider.
• Innovative three-way financing encourages buy-in: employers and employees each pay 30% of the cost (only $42 per month per member) with the remaining 40% covered by the community.

Outcomes (March 2000-June 2001):

• Over 300 businesses currently enrolled with 1,300 individuals served. Over 300 SCHIP and Medicaid eligible children were also identified and enrolled.
• Important economic development incentive for small business development/expansion.
• 97% of local providers (over 200 physicians) and both county hospitals participate.
• Every $1 of public money leverages $2 of private funds.
• Generates $2.0 million annually in new revenue to pay for local health services for previously uninsured (slow pay/no pay population).
• State of Michigan encouraging replication of program through new planning grants and $10 million appropriation of tobacco settlement funds.

Full-time and part-time workers, and their dependents, in businesses with median wage of $10 or less are eligible. Over 300 businesses are currently enrolled serving 1,300 individuals (70% are working women between the ages of 18 and 40); more than 300 SCHIP and Medicaid eligible children also identified. Current enrollment represents roughly one-third of the target population of up to 3,000 uninsured workers in eligible businesses in Muskegon County. A separate indigent health care program, Muskegon Care, provides a more limited benefit package to 2,000 unemployed adults annually.

The $2.0 million annual budget is financed by a three-way split with employers and employees each contributing 30% with a community match of 40%. Community match is comprised of federal DSH funding, and state and local funding. Small co-payments are required for most services. Funding from all three sources represents new revenue for health providers.

• Businesses want to be part of the solution. Reach out and make them partners. Too many programs are crafted solely by providers and consumers.
• Separate the working uninsured (largest segment) from the indigent, unemployed population. They are different populations with different needs and resources.
• This market niche cannot afford commercially available coverage. Coverage is appealing because it helps reduce employee turnover and associated costs.
• Many of these workers have children eligible for SCHIP. Use adult enrollment to introduce and highlight coverage available for dependents.
• Look for innovative funding solutions and combine local resources and partnerships to maximize impact.
• Survey your community to determine what will work. Every community is different and your plan needs to reflect local values and beliefs.
• Believe you can do it! No obstacle is insurmountable.

Vondie Woodbury
Director
Muskegon Community Health Project
565 W. Western Ave.
Muskegon, MI 49440
PH: 231-728-3201
FAX 231-728-8404
Email: vwoodbury@mchp.org

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