Opinion Research and Strategic Plan for the Department of Health and Human Resources

Opinion Research and Strategic Plan for the

Department of Health and Human Resources

Table of Contents

Page

Overview 3

Quantitative Methodology 5

Quantitative Findings 9

Focus Group Methodology 45

Focus Group Findings 48

Target Audience 60

Conclusions 70

Marketing Strategy 73

Overview

• In March 2000, RMSR completed 523 telephone interviews with “participants or eligibles”

• From December 1999 through February 2000, RMSR conducted 8 focus groups with participants, eligibles and workers

• The results provide insights toward encouraging enrollment

Existing Situation

• Since July 1998, the CHIP program has enrolled 8,806 children in Phase II and 1,206 children in Phase I

• Some estimate there are 32,000 children without insurance

• Goal to reach an enrollment figure of 11,000 by September 2000

Quantitative Methodology

Quantitative Methodology

• Conducted March 6 - April 4, 2000

• 523 completed interviews

• + 4.3% margin of error at the 95% confidence level.

• Average length: 17.5 minutes

• Screened Out: Households without age 18 and younger, and households in which no one has been or is enrolled in a federal or state insurance program for 2 years.

• Sample - Households in WV earning less than $25,000 annually.

Sampling Criteria

100% FPL 150% FPL 200% FPL

MedicaidEligible

CHIPEligible

PotentialCHIPEligible

Households With Children 6 Through 18 years

FPL = Federal Poverty Level

Family of Four: $16,700 $25,050 $33,400FPL Guidelines

Sampling Criteria

133% FPL 150% FPL 200% FPL

MedicaidEligible

CHIPEligible

PotentialCHIPEligible

Households With Children Birth Through 5 years

FPL = Federal Poverty Level

Family of Four: $22,210 $25,050 $33,400FPL Guidelines

Quantitative Findings

WV Household Statistics

68%No

Households with Persons Age 18 or Younger

32%Yes

77% No

22% Yes

Households with Persons Age 18 or Younger Without Health Insurance

1%Dk/Na

[N=2859] [N=923]

10%

12%

12%

15%

51%

0% 20% 40% 60%

Program Participation

Medicaid[N=218]

CHIP[N=43]

TANF[N=62]

SLMB[N=52]

QMB[N=50] 29% participated in more than

one federal or state program in the past two years

[N=425]

Classification of Respondents

19%Eligibles

N=98 81%Participants

N=425

[N=523]

Awareness of Programs

A Lot Some Very Little Nothing At All Dk/Na

Medicaid

CHIP

TANF

SLMB

QMB

32% 29% 25% 13%

10% 17% 24% 47%

9% 13% 22% 54%

2% 7% 17% 69%

78%9%5%3%

1%

2%

3%

4%

4%

Rating the Programs

Excellent Good Fair Poor Dk/Na

Medicaid (N=319)

CHIP (N=142)

TANF (N=113)

SLMB (N=51)

QMB (N=45)

17% 46% 22% 12%

18% 47% 18% 7%

16% 39% 29% 6%

13% 40% 22% 17%

18% 8%38%18%

3%

11%

10%

8%

18%

Program Satisfaction

4.08

3.773.62

3.463.53

3.00

3.20

3.40

3.60

3.80

4.00

4.20

Aggregate Mean = 3.65

CHIP MedicaidQMB TANF SLMB

88% of CHIP participants are satisfied or better

Very/Somewhat Satisfied Very/Somewhat Dissatisfied Dk/Na

Program Aspects (Aggregate)

Completing the Application Process

Number of Health Care Providers

Level of Benefits Provided by the Programs

Information provided on Rules and Regulations

Fairness of Eligibility Requirements

Helpful and Courteous DHHR Personnel

75%

69%

71%

70%

66%

65%

11%

14%

18%

18%

22%

23%

14%

17%

11%

12%

11%

14%

[N=406]

Level of Benefits

85% 74%

19%

72%

19%

66%

22%

59%

22%

0%

20%

40%

60%

80%

100%

CHIP TANF Medicaid QMB SLMB

Very/Somewhat Satisfied Very/Somewhat Dissatisfied

85% of the participants in CHIP were very/somewhat satisfied with the program benefits

Helpful and Courteous DHHR Personnel

70%

20%

67%

26%

64%

21%

72%

20%

47%

30%

0%

20%

40%

60%

80%

100%



Overall, two out of three households (65%) find the DHHR personnel helpful and courteous

Information on Rules and Regulations

71%

15%

72%

19%

70%

21%

86%

8%

53%

20%

0%

20%

40%

60%

80%

100%



86% of the participants in QMB were very/somewhat satisfied with the information they received on the program


75%

15%

62%

32%

68%

21%

65%

28%

59%

18%

0%

20%

40%

60%

80%

100%



One out of three participants (32%) in TANF are very/somewhat dissatisfied with the fairness of the programs eligibility requirements

Previous Experience

Income too high

Asset level too high

They didn’t tell you

52%

10%

6%Didn’t understand Info4%

76%No

19%Yes

1 out of 5 households have been denied enrollment in a federal or state program

[N=523]

5%Dk/Na

Program Concerns (Aggregate)

44% 45%

44% 50%

54% 41%

61% 27%

63% 30%

70% 24%

0% 20% 40% 60% 80% 100%

A lot/Some Very little/Not at all

Fairness of financial eligibility requirements

Not enough outreach

Low householdasset eligibility

Lack of privacy and confidentiality

Limited DHHR office hours

Applications are completed in same office


74%

17%

72%

26%

63%

30%

70%

22%

64%

30%

73%

25%

0%

20%

40%

60%

80%

100%

Eligibles CHIP TANF Medicaid QMB SLMB


74% of respondents from the Southern region have a lot or some concern

Not Enough Outreach

64%

28%

70%

21%

65%

29%

60%

32%

64%

30%

58%

32%

0%

20%

40%

60%

80%

100%



70% CHIP participants have a lot or some concern about lack of outreach efforts

Low Household Asset Eligibility

62%

24%

68%

23%

68%

22%

60%

28%

56%

38%

58%

25%

0%

20%

40%

60%

80%

100%



38% of QMB participants have very little or no concern at all about asset eligibility

Barriers (Aggregate)

3.51

3.51

3.60

3.61

3.73

3.79

3.00 3.20 3.40 3.60 3.80 4.00

Too much red tape

Lack of awareness

Previously denied

Limited number of years

Required to find work

Resistant to utilize “welfare” programs

Barrier - Too Much Red Tape

3.88

3.67

3.80 3.773.71

3.86

3.00

3.20

3.40

3.60

3.80

4.00

4.20



69% of eligibles believe that too much red tape is one of the major reasons why people are not enrolling

Barrier - Lack of Awareness

3.81 3.84

3.57

3.70

4.08

3.49

3.00

3.20

3.40

3.60

3.80

4.00

4.20



62% of respondents believe that people are not enrolling due to lack of awareness.

Barrier - Previously Denied Benefits

3.67

3.453.53

3.59 3.58

3.86

3.00

3.20

3.40

3.60

3.80

4.00

4.20



63% of eligibles believe that households who were previously denied benefits will not enroll again.

Benefits (Aggregate)

Strongly/Somewhat Agree Neither Agree/Disagree Strongly/Somewhat Disagree

The welfare reform program has been a success in West Virginia

The CHIP program in an insurance program, not a welfare program

A partial assistance or co-payment plan should be available for purchase

Many West Virginians truly need and depend on the state

Many West Virginia families do not have access to affordable health insurance

No one should be without health insurance, especially children

95%

92%

90%

84%

56%

56%

1%

1%

3%

5%

10%

9%

2%

4%

4%

5%

4%

25%

Benefits

35%

15%

37%

11%

54%

9%

33%

5%

56%

10%

16%

18%

62%

6%

21%

11%

52%

6%

34%

8%

65%

13%

16%6%

0%

20%

40%

60%

80%

100%


Strongly/Somewhat Agree Neither Agree/DisagreeStrongly/Somewhat Disagree Dk/Na

The welfare reform program has been a success in West Virginia

Benefits

52%

6%10%

32%

81%

7%2%9%

58%

8%2%

32%

52%

12%3%

33%

68%

12%

20%

48%

12%6%

35%

0%

20%

40%

60%

80%

100%


Strongly/Somewhat Agree Neither Agree/DisagreeStrongly/Somewhat Disagree Dk/Na

The CHIP program is an insurance program, not a welfare program

Benefits

88%

3%3%

89%

7%2%

86%

6%3%

82%

3%7%

80%

8%8%

79%

10%6%

0%

20%

40%

60%

80%

100%


Strongly/Somewhat Agree Neither Agree/DisagreeStrongly/Somewhat Disagree

A partial assistance of co-pay plan for state health insurance programs should be available to households for purchase

Disseminating Information

0%

5%

10%

15%

20%

25%

30%24%

28%23%

17%

9%

19%

11%

16%

10%

13% 14%12% Direct Mail

Outreach Worker

TV Advertisement

School SystemAggregate Eligibles Participants

Messenger (Aggregate)

2.39

2.93

3.88

3.95

4.00

0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50

WV DHHR

Local DHHR Office

County HealthDepartment

Social ServiceOrganizations

WV Healthy Kids Coalition

Messenger - WV DHHR

3.70

4.024.15

4.05

4.34

3.90

3.00

3.20

3.40

3.60

3.80

4.00

4.20

4.40

4.60


Aggregate Mean= 4.00

82% of QMB participants have a favorable opinion of the DHHR

Messenger - Local DHHR Office

3.513.58

4.24

4.01 4.06

3.82

3.00

3.20

3.40

3.60

3.80

4.00

4.20

4.40

4.60



73% of the participants have a favorable opinion about their local DHHR office

Messenger - County Health Dept

3.95 4.00

3.80

3.984.14

3.78

3.00

3.20

3.40

3.60

3.80

4.00

4.20

4.40

4.60



83% CHIP participants have a favorable opinion of the county health department

Trust & Confidence (Aggregate)

3.12

3.27

3.33

3.55

3.69

2.80 3.00 3.20 3.40 3.60 3.80

Physician

Minister

Person who works at a health care facility

School Health Nurse

Program Enrollee

Media Habits - Television

Participants

Eligibles

Aggregate

75% Every day

71% Every day

76% Every day

11% >3 days

10%> 3 days

11%>3 days

9%1-2 days

13%1-2 days

8%1-2 days

Three out of five households or 60% watch TV between the hours of 4:00 pm and 11:00 pm

Media Habits - Weekly Newspaper

46%

19%13%

19%

0%

10%

20%

30%

40%

50%

60%

Frequently Occasionally Rarely Never

Two out of three households read the weekly newspaper frequently or occasionally

Media Habits - Daily Newspaper

44%

25%30%

37%31% 32%

44%

24%29%

0%

20%

40%

60%

Aggregate Eligibles Participants

Everyday/Every Other Once/Twice Week or Month Never

Almost one out of four households read the entire paper, while 21% read only the front page section

Media Habits - Radio

58%

26%

15%

68%

22%

9%

54%

28%

16%

0%

20%

40%

60%

80%

100%

Aggregate Eligibles Participants

Everyday/Every Other Once/Twice Week or Month Never

31% listen to the radio between the hours of 6:00 am to 10:00 am, and 25% listen between the hours of 10:00 am and 3:00 pm

Media Habits - Internet

62%19%

12%

41%26%

24%

58%20%

14%

0% 10% 20% 30% 40% 50% 60% 70%

No Home Library

Aggregate

Eligibles

Participants

37% of CHIP participants have access to the Internet at home

Focus Group Methodology

Focus Group Methodology

• Eight focus group sessions• Four venue regions of West Virginia– Charleston/Huntington

– Twin Falls

– Clarksburg

– Princeton • 8 to 10 participants per group• Two hours per group

Focus Group Schedule

Dec 15: Charleston State Caseworkers

Dec 15: Charleston Outreach workers

Jan 6: Twin Falls Americorps/Vista

Volunteers

Jan 11: Charleston Senior Service Workers

Jan 13: Clarksburg Participants & Eligibles

Feb 8: Princeton Participants & Eligibles

Focus Group Findings

Awareness

• Informational efforts need to be stepped up, especially for CHIP

• Enrolling in government insurance programs is perceived as “terribly complicated”

• Direct correlation between awareness and lack of/prominence outreach throughout West Virginia

• All agree there is a great marketing need

Administration & Structure

• There is sentiment for a stand alone CHIP program

• Even state workers cite inconsistencies in administration

• RAPIDS automatic screening confuses

• Hospitals and senior centers are assets to be used

Perceptions

• Some feel belittled by going to the welfare office, some don’t

• ‘The welfare stigma is alive and well’• ‘Hassle factor’ stereotype persists about local

DHHR offices• Need to reach parents who work• “Medicaid penalizes you for working - you

make money, you lose coverage”

Experiences

• Frustration over RAPIDS extends to workers as well as clients

• Those enrolled in CHIP view it quite positively

• DHHR is understaffed and overworked

• Hospitals are particularly well-versed on Medicare

Benefits

• The CHIPs application is seen as an easy application to mail

• Once explained and understood, there is tremendous interest in CHIP

• Coverage of surgery, equipment and medication for seriously-ill praised

• SLMB appeals to people because it helps with Rx bills

Barriers

• Lack of awareness is compounded by lack of outreach workers outside Kanawha County

• Gov’t employees are limited in their knowledge of insurance programs

• The rules are not the same everywhere

• Eligibility process is confusing

Information Sources

• Schools• Doctors’ offices• Clinics• Television• Bureau Sr. Services• DHHR office

• Libraries• Churches• Mail-in forms• Dental clinics• Neighbors• Health fairs

Marketing Vehicles

• Healthy Kids Coalition• School lunch program• Daycare centers• Health fairs• Head Start• Pediatricians• Teachers• Television

• Newspapers• Billboards• Talk shows• Newsletters• Direct mail• Posters in various

locations• Childbirth Kits

Messages

• ‘An insurance program, not a welfare program’• Tie to immunizations and physicians• ‘You can work and still get insurance for your

children’• ‘No one should be without health insurance,

especially a child’

Messengers

• For CHIP - use ‘real-life people whose kids have benefited from the program’

• For senior programs - use adult children of Medicare-age parents

• Doctors and working mothers

• Some consideration for a Kathy Mattea,

based upon Kentucky experience

Conclusions

• Confusion – over eligibility thresholds and asset tests– between Medicaid and CHIP eligibility

requirements– Screening: RAPIDS program

• Desire for plain-English marketing

Target Audience

Are There Eligible Households in WV?

19%Eligibles81%

Participants

33%CHIP Eligible

N=32

18%CHIP Potentials

N=18

49%Medicaid Eligible

N=48

Location of Target Audience

North Central RegionMedicaid Eligibles = 35%

CHIP Eligibles = 34%CHIP Potentials = 22% Eastern Mountains

Medicaid Eligibles = 10%CHIP Eligibles = 19%

CHIP Potentials = 28%

Southern RegionMedicaid Eligibles = 29%

CHIP Eligibles = 22%CHIP Potentials = 33%

ELIGIBLES POTENIALS

Medicaid CHIP CHIP

Age18-24 17% 0% 11%

25-34 23% 47% 28%

35-44 35% 22% 33%

45-54 19% 19% 17%

Education

Less High 8% 16% 11%

High School 60% 34% 67%

College 8% 25% 0%

Target Audience Profile

ELIGIBLES POTENIALSMedicaid CHIP CHIP

EmploymentFull-time 29% 44% 44%Part-time 15% 9% 17%Homemaker 31% 22% 28%

StatusMarried 65% 69% 72%Divorced 13% 19% 22%

Lived in AreaLess 10 years 31% 22% 28%10-20 years 27% 19% 22%More than 20 years 42% 59% 44%

Target Audience Profile

Probability of Enrollment

53%Very Likely

24%Somewhat

Likely

10% Somewhat Unlikely

8%Very Unlikely

4% Dk/Na[N=98]

Receive Information

2%

9%

16%

19%

21%

0% 5% 10% 15% 20% 25%

A friend or family member told you

[N=406]

You went to the DHHR office yourself

Hospital or health care provider

Social or outreach worker

School or child education effort

Media Habits - Television

CHIP Potential

CHIP Eligible

Medicaid Eligible

73% Every day

69% Every day

72% Every day

8% >3 days

13%> 3 days

11%>3 days

10%1-2 days

16%1-2 days

17%1-2 days

47% CHIP eligibles watch between 4:00 - 8:00 pm while 43% Medicaid Eligibles and 36% CHIP Potentials watch between 8:00 - 11:00 pm

ELIGIBLES POTENIALS

Medicaid CHIP CHIP

Weekly Newspaper

Frequently 40% 44% 39%

Occasionally 19% 13% 28%

Never 21% 28% 17%

Daily Newspaper

Everyday 27% 28% 22%

Once/Twice Week 23% 13% 17%

Never 25% 41% 33%

Media Habits - Newspapers

ELIGIBLES POTENIALS

Medicaid CHIP CHIP

Radio

Everyday 60% 66% 61%

Once/Twice Week 19% 13% 11%

Never 8% 13% 6%

Media Habits - Radio

52% of CHIP potentials listen between the hours of 6:00 - 10:00 amwhile the eligibles are split between the other hours during the day

from 6:00 am to 7:00 pm. 80% Medicaid eligibles, 89% CHIP eligiblesand 94% CHIP potentials listen to the radio weekdays.

Conclusions

Conclusion

• Lack of awareness is significant

Opportunity - Once enrolled, the CHIP satisfaction level is extraordinary -- 88%.

• The Medicaid Program has the largest number of households participating

Education and distribution of information

• “Lack of outreach” is reason program is missing several eligibles

Conclusion (cont’d)

• Schools, Direct Mail and Outreach are recommended as the best vehicles for reaching potential eligibles

• 84% favor co-pay concept

• 75% are favorable toward DHHR

• WV Healthy Kids Coalition -- 68% “unaware or don’t know” -- not yet well-known

• They watch TV, but prefer direct mail

Marketing Strategy

Recommendations

• Simplify the process -- plain English• Stress “no one should be without insurance,

especially a child.”• More outreach throughout West Virginia --

especially in south/north central• Communicate in a more aggressive way to

medical and social workers• Beef up efforts to standardize administration

of programs in the 55 counties

Promotion - Track 1 (Centralized)

TelevisionDirect Mail

DHHR or ADM

Medicaid Eligible8:00 - 11:00 pm

CHIP Eligible4:00 - 8:00 pm

Target Audience

Colorful brochure promoting free

health insurance for children

Physician

Audience

Method

Implementing Organization

Messenger

Track 1

• What can we do to increase awareness• Direct Mail - cost effective• Television Ads• One page handout on the programs at all DHHR

offices• New, plain-English brochures• Correct RAPIDS deficiencies

Promotion - Track 2 (Decentralized)

Outreach workers/Social Service Organization

Local (county)DHHR Office

Place

Implementing Organization

Method/Messenger

DHHR or ADM

Schools HospitalsCommunity Meetings

Overseeing Organization

Message Children should not be without health insurance.

Track 2

• Increase emphasis on outreach - – “Grass roots” Program• Coordinate immediately between F&A and DHHR• Step up training for DHHR persons in Charleston

and at the county level about the rules and regulations of federal and state programs• Repeat, repeat, repeat -- the message, the

messenger

Major Message Point

“The rules have changed for CHIP”

• Inform households that a co-payment plan is available - new annual income limit is between 150% - 200% FPL.

Projections

• In 1990 there were 398,167 households earning less than $25,000 annually.

• Based on research– 322,515 households are currently

participating in a federal or state program – 75,612 households are potentially eligible to

participate in a federal or state program

Documents

Opinion Research and Strategic Plan for the Department of Health and Human Resources