Newsroom | Collaborative Care

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Helping Meet Basic Needs to Improve Health

Health insurance covers medical care, but some members need help with other needs that have a big impact on their health, such as simple transportation to doctor’s appointments, clothing — or even horse-assisted therapy for mental health. To help address these gaps, Health Care Service Corporation recently expanded its Member Care Fund program from its Illinois plan to qualifying Medicaid members in New Mexico and Texas.

The fund increases eligible members’ access to basic needs to improve their health and wellness and helps members with complex social and behavioral health conditions continue treatment and programs best suited for them. The goal is to prevent unnecessary hospital admissions, reduce costs and promote improved outcomes.

The New Mexico plan launched its Member Care Fund in April 2022 as part of its Behavioral Health Care Coordination Social Determinants of Health Program. It has helped members purchase clothing for job interviews, complete work certifications, and pay for auto repairs to travel to doctor’s appointments and pick up prescriptions.

“Our state has many low-income, high-need people who lack basic resources,” says Joanna Widman, associate clinical programs manager, New Mexico. “Our goal is to meet those needs and keep members from readmitting to the hospital.”

The fund is also closing gaps in care for babies and families enrolled in the Comprehension Addiction and Recovery Act (CARA) project, a national effort intended to ease access to medical treatment for pregnant women and their infants and keep families together.

New Mexico experienced a 324% jump in neonatal abstinence syndrome — a group of conditions associated with withdrawal symptoms when an infant has been exposed to a substance in utero —between 2008 and 2017. Nearly three-quarters of health care costs associated with those cases were covered by Medicaid, according to the New Mexico Department of Health.

Care coordinators work with CARA families to assess their individual needs. Once approved, funds help cover parents’ access to sober help and ensure children receive what they need physically and behaviorally to keep families intact.

In Texas, the fund launched in August 2022 and also supports vulnerable youth, including STAR Kids, a Texas Medicaid managed care program that provides benefits to qualifying Medicaid beneficiaries 20 or younger with complex medical or behavioral health needs.

The Texas plan’s fund has helped many members with autism and other neurological conditions continue hippotherapy, a form of physical, occupational and speech therapy that uses horses as part of a wider therapeutic strategy, says Clarissa Hyneman, a senior medical management specialist.

“There are times when we feel hopeless, like we can’t help a member because there’s not a community program that addresses their need,” says Hyneman, who works with STAR Kids members. “The Member Care Fund is an extra way to help those members; it can be like the light at the end of the tunnel.”

The Member Care Fund dates to 2020, when HCSC’s Illinois health plan established the program by reinvesting payments it receives from the Illinois Department of Healthcare and Family Services for providing quality care to Medicaid members.

The funds helped more than 3,400 unique Medicaid members across Illinois, New Mexico and Texas between June 2020 and December2022. Last year, it assisted nearly 1,200 members and saved a projected $1.3 million in costs associated with downstream care and adverse outcomes.

“This program takes a holistic view of our members and helps bridge care gaps to get people back on their feet,” says Liz Toussaint, clinical programs manager 

Health Care Service Corporation, a Mutual Legal Reserve Company.