Family Access to Medical Insurance (FAMIS)

 Enrollment Plan

What is FAMIS:

The Family Access to Medical Insurance (FAMIS) Plan was created to meet the health care needs of Virginia's uninsured children, up to age 18, in working families whose earnings are above the maximum requirements for Medicaid, with incomes too low to afford private health insurance.

Fauquier County's Enrollment Experience:

Delegate Lingamfelter recently provided up to date enrollment information, which indicated that 57% of Fauquier County's estimated eligible children were registered for FAMIS. The state average is 54%.

Perceived Barriers to Enrollment:

Real and Perceived Distance to Richmond:

Enrollment and maintenance are currently handled from a central point in Richmond.

Difficulties in Communicating with Richmond Office:

Clients and staff indicate difficulties in speaking with appropriate persons in Richmond, the persons they often talk to are clerical and are unable to directly help them, and that there is a problem with follow-through.

Monthly Fees:

There has been a monthly fee of $15 per child, up to a maximum of $45, in addition to co-pays for services. This fee has been temporarily waived by the State.

Lack of Information (i.e. Forms and Information in Spanish):

The State has some forms and instructions in Spanish; however, there are not readily available to local agencies.

Social Services Stigma:

Some potential client families are reluctant to enroll their children because they do not want to be associated with a "welfare" program, with Social Services or governmental assistance in general. Potential enrollees are required to screen for Medicaid first.

Shortage of Providers:

There is a lack of doctors in the County that accept Medicaid (FAMIS). Those that do often have established quotas and are not accepting new patients. There is also a need for additional participating dentists.

Getting the Word Out:

Like all governmental programs, a good, sustained public awareness and outreach campaign is essential to maximizing service delivery to the intended target group.

Suggested Strategies to Address Each Barrier:

Real and Perceived Distance to Richmond:

Effective September 2002, the responsibility of screening and enrollment was given to local Social Services agencies. This will reduce or eliminate this barrier for the initial process. At present, the State is continuing to provide maintenance; however, it is anticipated that this responsibility will also be delegated, in the future, to the local social services offices.

Difficulties in Communicating with Richmond Office:

Effective September 2002, local social services agencies became responsible for screening and enrollment. This should eliminate this problem for those phases of the process. It is hoped that the reduced workload on the central office will increase responsiveness. It is anticipated that local social services agencies will have this function delegated to them in the future. The local social services agencies will institute procedures to ensure that this state responsiveness problem does not duplicate itself at the local level following the transfer of responsibilities.

Monthly Fees:

This barrier represents a choice for many potential enrollee families. Unlike a co-pay, the nexus of which is easily understood, the $15 per month fee is paid even if the enrollee is healthy. As this fee is, at least temporarily, being waived by the State, no strategy is suggested at this time.

Lack of Information/Forms in Spanish:

New forms associated with the change in screenings and enrollments are due to be completed in September or October 2002, local social services agencies are requesting and will soon begin distributing new forms, etc. Should the County continue to have problems obtaining the appropriate forms/quantity, we will request assistance from Delegate Lingamfelter. If that strategy is not successful, the County may have to pay to have the forms developed and/or reproduced.

Social Services Stigma:

There are two strategies that may provide assistance to citizens:

        The Public Health Department has agreed to serve as a dissemination point for information and forms for screening and enrollment, as soon as it becomes local social services agencies responsibility. Social Services will still do the actual processing; however, it will be largely invisible to the client.

        Community awareness. If through a press conference, news release and community discussions, persons such as Delegate Lingamfelter, members of the Board of Supervisors and Social Services Board, promote the program as a vital and important safeguard for our children, it will help reverse any negative perception and increase awareness.

Shortage of Providers:

A good initial strategy is targeted outreach. Arranging for persons, such a Delegate Lingamfelter and BOS/DSS Board member Winkelmann, to speak to the Fauquier Medical Society to advise them of how important this plan is to the community and request their participation in the program will help.

Getting the Word Out:

There are several strategies available to us, as listed below:

        Work with the School Division Health Advisory Committee to increase awareness of the program and its importance.

        Work with the Schools to have FAMIS information sent home at the same time the free and reduced lunch information is sent home.

        Make sure that BRIGHT Stars/Head Start Children receive a targeted distribution.

        Attend at least one parent-teacher night or similar program at each elementary school each year.

        Speak to the local church association(s) to make sure they understand the program.

        In addition to new releases, the County could consider ad's in local papers to increase awareness, putting information on cable channel 3 and asking organizations like the hospital and the Town of Warrenton that have established newsletters to include information on FAMIS.

        As part of our enrollment campaign DSS will host, with Health Department participation, at least one community outreach/enrollment meeting in each magisterial district.