ASCEND BLO
The health of Roots’s members is inextricably linked to the food most accessible to them: fast food and corner store packaged and prepared food with high fat, salt and sugar content. East Oakland is at once a food desert and a food swamp – with sparse access to fresh fruits and vegetables, coupled with an array of accessible fast food and junk food. Roots runs a food pantry and hosts a farmer’s market to expand access to nutrition. We now seek to re-purpose dis-used East Oakland parcels to grow diverse crops; sell local crops to residents through local groceries, farmers’ markets, and delivery services; draw upon the knowledge of community elders to teach folks how to select and prepare fresh food for nutritious meals; educate residents about how food choices impact health and the environment; establish local kitchens to create pre-packaged locally-sourced meals for sale and delivery to the homebound; train residents for food industry jobs; and engage residents in matters of food policy. $280,000/year (depending on scope). Many TA connections already established.
ref. ASCEND BLO Accelerator Application_FINAL.docx – Dan Abrahamson
Core Care Model:
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Themes, Keywords & Tags: Healthy Food
Bridging the Gap: Reducing Disparities in Diabetes Care
Finally, at the Health Policy level, project partners, including community leaders and promotoras, as time and interest allow, will also coordinate with ACPHD’s ongoing health policy promotion efforts. ACPHD’s Health Equity Policy and Planning Unit is engaged in advocacy for local and state policies that will improve healthy food access at neighborhood stores and that invest in safer, more walkable neighborhoods. ACPHD’s Healthy Retail Program works to improve the health of our community by engaging and supporting little corner stores to become a full service groceries that offer fresh fruits and vegetables to their shoppers. ACPHD contracts with two community-based organizations to implement the work including: identifying the small stores located in ‘food deserts’ (areas far from full service groceries); supporting store owners in identifying healthy snack distributors; educating store staff how to shelve fresh produce; and hosting community and in-store events to promote the healthy food choices (e.g., “Taste-Test-Tuesdays,” showcasing healthy recipes) to the community. We are currently working with six stores in Oakland and plan to engage a total of ten stores by the end of this fiscal year.
Core Care Model:
Program: ACDDRI
Themes, Keywords & Tags: Diabetes; Health; Health Policy; Food Access
Bridging the Gap: Reducing Disparities in Diabetes Care
Key ACDDRI partners ACPHD, Roots, and TVHC all share a commitment to “addressing the root causes of health care disparities and empowering our community” (in the words of TVHC’s vision statement). Clinicians and paraprofessionals will assist ACDDRI participants in accessing healthier food and physical activity options either through direct services or through “prescriptions” for healthy food, exercise, or other supports. Proposed services include:
- Healthy Food Access: The ACPHD Chronic Disease Program will coordinate with food distribution partners to provide diabetes-friendly food access interventions. Building on and leveraging current and past initiatives, we will develop place-based food access strategies, including tours of farmer’s markets and healthy retail options; low-cost or no-cost community supported agriculture (CSA) bags of fresh, locally-grown produce; cooking and/or gardening demonstrations; and healthy food prescriptions,” coupons, and vouchers.
During the initial six-month planning period, while the paraprofessionals are being trained, we will work will work with staff and patients at each clinic to identify the most appropriate way to structure healthy food access opportunities at the site, based on how best to incentivize consistent participation in DSME classes and other program components; logistics of food storage and distribution; participants’ current familiarity with ways to use fresh, seasonal produce; and the capacity of existing and planned markets. Additional food distribution sites may include Roots, TVHC clinics, farmer’s markets, or affordable housing sites in the Ashland neighborhood where ACPHD provides community health services. We will also seek to leverage existing collaborations, such as the food that Roots already picks up from the Alameda County Community Food Bank for distribution to clinic patients one to two times per week. ACPHD’s Nutrition Services will provide cooking workshops. The clinics will also continue to enroll eligible participants in federal nutrition programs for which they are eligible, particularly the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) and the Women, Infants, and Children (WIC) Nutrition program.
Core Care Model:
Program: ACDDRI
Themes, Keywords & Tags: Diabetes; Healthy Food; Food Access
Bridging the Gap: Reducing Disparities in Diabetes Care
Key partners in ACDDRI—including ACPHD, Roots, and TVHC—have extensive expertise in deploying paraprofessionals into these communities, supporting underserved patients and families in navigating health insurance and access to care, as well in finding needed nutrition and economic supports. Roots has focused on the needs of African Americans who are homeless and/or re-entering the East Oakland community from incarceration. Roots’ multidisciplinary teams include Patient navigators who assist clients in affordable housing options, employment, benefits and health coverage enrollment, as well as in accessing health care. TVHC has centered its community outreach through its Promotoras de Salud program in the Latino community of Southern Alameda County, including the Ashland/Cherryland area, an area that has one of the County’s largest re-entry populations. TVHC recruits and works with a network of promotoras who serve as health promoters in their neighborhoods and schools, largely serving a monolingual Spanish-speaking population. While paraprofessionals in the targeted clinics and communities have extensive experience with helping families navigate a range of health and social service systems, they have not yet been trained or deployed as full members of diabetes or chronic disease care teams. To fill this unmet need, ACDDRI will expand on these demonstrably successful models to train a cross-agency cohort of paraprofessionals in diabetes self-management. In terms of food access, ACDDRI will build on and adapt a range of innovative programs focused on nutrition and health equity developed by ACPHD in partnership with a range of community-based clinics and partners. ACPHD’s Community Health Services Division includes not only the Chronic Disease Program (including the Diabetes program) but also Nutrition Services and the WIC program. ACPHD has long convened the County Nutrition Action Plan for Alameda County, coordinating nutrition education activities, especially those that prioritize low-income communities such as the targeted neighborhoods, among public agencies and community-based partners.
For example, in 2011-2014, ACPHD’s health equity and nutrition services teams coordinated a large-scale effort called Food to Families (F2F), an innovative partnership project, funded for three years by the Kresge Foundation, with overarching goals to 1) transform the food landscape; 2) provide local economic and employment opportunities for young adult residents; and 3) to reduce the risk of obesity and overweight in West Oakland and Ashland/Cherryland. ACPHD partnered with the County-run social enterprise Dig Deep Farms and Produce and TVHC in Ashland Cherryland and with Mandela Marketplace and another FQHC in Oakland. F2F developed interventions including Produce Rx, a clinic-based program to provide pregnant women with produce “prescriptions” connecting them with local food access points and consumer training developing skills around food purchase, preparation, storage and healthy life skills. Successes included strong partnerships between community-based organizations, the FQHC’s, and ACPHD; enhanced interventions; strong participation by pregnant women and their families; the creation of one model adapted to serve two different communities; integration of young adults into staffing of partner organizations. For ACDDRI, we envision adapting the Produce Rx model to meet the needs of people with diabetes, working with a similar range of community-based food distribution, farm stands/farmers markets, and community-supported agriculture partners.
Core Care Model:
Program: ACDDRI
Themes, Keywords & Tags: Diabetes; WIC; Paraprofessionals; Housing; Employment; Food Access
Piloting a Flexible Mechanism for Reentry Engagement in Local Public Process
We are also achieving great success enrolling “hard to reach” reentry and homeless individuals into Medi-Cal and CalFresh, through a relationship with Social Services Agency, and also have held/currently hold workforce and Probation contracts. Building on our shared commitment to serve the most marginalized across the County with high quality, culturally sensitive services and programs, we welcome the opportunity to offer continued value to county initiatives by participating in this effort to increase overall stability of justice involved individuals.
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Themes, Keywords & Tags: Reentry, Medi-Cal, CalFresh, Partnerships
Proposition 47 Housing Assistance Support Services
Securing basic needs including food, stable shelter, safe environments, and social connectedness are necessary for effective behavioral/mental health self-management and avoidance of unnecessary health services utilization. Roots Community Health Center has established intake and assessment tools and processes that evaluate social determinants of health, establishing a baseline and enabling ongoing monitoring of the stability of each client. In addition to administering the intake and life assessment tools, Navigators are trained to administer Screening, Brief Intervention, and Referral to Treatment (SBIRT), the Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST), and the PHQ-9 depression screening instruments to assist in identifying mental health challenges, substance use disorders and corresponding need for supports. Navigators use results to proactively connect patients with community resources as well as internal or external referrals. Information gleaned from the assessment assists in determining frequency and intensity of services, appropriate assignment of clients to Navigators, and efficient monitoring of client progress. For this scope of work, we will utilize our data systems to correlate baseline status with eligibility requirements, develop prioritization and interventions, and evaluate with respect to health/mental health and housing outcomes in an effort to achieve the greatest impact.
Core Care Model:
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Themes, Keywords & Tags: Housing; Reentry; Employment; Substance Abuse; Food Access; Whole Health
Mental Health Prevention & Early Intervention (PEI) Services in Sobrante Park
Securing basic needs including food, stable shelter, safe environments, and social connectedness are necessary for effective behavioral self- management and avoiding unnecessary health services utilization. Roots has established intake and assessment tools and processes that evaluate social determinants of health, establish a baseline, and enable ongoing monitoring of the stability of each client. Upon intake, Navigators utilize our Vital Signs screening tool to examine individuals and families in 9 domains of wellness and four stages of risk. This tool delineates strengths and protective factors as well as risks and barriers the families and individuals face. In addition to administering our intake and life assessment tools, Navigators administer Screening, Brief Intervention, and Referral to Treatment (SBIRT), the Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST), and the PHQ-9 depression screening instruments to help identify mental health challenges, substance use disorders and corresponding need for supports. For this scope of work, Roots will integrate prevention and early intervention family case management into our already robust intake and assessment processes. Family Navigators are trained to perform developmental screenings utilizing the Ages and Stages Questionnaire – Third Edition (ASQ-3) and ASQ: Social-Emotional Milestones and other holistic measures to determine environmental factors and barriers to family wellness.
Core Care Model: Navigation
Program:
Themes, Keywords & Tags: Intake; Assessment; Food Access; Housing; Mental Health
Mental Health Prevention & Early Intervention (PEI) Services in Sobrante Park
Roots Navigators offer a wide array of services, including: case management, service navigation, Medi-Cal enrollment/renewal, CalFRESH (food stamp) enrollment/renewal, screening for and connection to onsite legal services including record clearing remedies, and distribution of essentials and basic supplies, such as bus passes, diapers (adult and child), car seats, and hygiene kits. Our Empowerment Center, co-located with our East Oakland clinic, includes a computer lab for resume development, job search and housing search, and onsite hiring events hosting a broad range of employers. Roots will soon launch a food pantry in collaboration with the Alameda County Community Food Bank to address high levels of food insecurity encountered by our clients. We propose adding the Time Banking platform to our economic empowerment services to promote meaningful engagement, and to earn social capital and time-based currency as ways to achieve economic stability.
Core Care Model: Navigation
Program: Empowerment Center
Themes, Keywords & Tags: Food Access; Mental Health; Whole Health; Economic Stability
Mental Health Prevention & Early Intervention (PEI) Services in Sobrante Park
Securing basic needs including food, stable shelter, safe environments, and social connectedness are necessary for effective behavioral self-management and avoiding unnecessary health services utilization. Roots has established intake and assessment tools and processes that evaluate social determinants of health, establish a baseline, and enable ongoing monitoring of the stability of each client. Upon intake, Navigators utilize our Vital Signs screening tool to examine individuals and families in 9 domains of wellness and four stages of risk. This tool delineates strengths and protective factors as well as risks and barriers the families and individuals face. In addition to administering our intake and life assessment tools, Navigators administer Screening, Brief Intervention, and Referral to Treatment (SBIRT), the Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST), and the PHQ-9 depression screening instruments to help identify mental health challenges, substance use disorders and corresponding need for supports. For this scope of work, Roots will integrate prevention and early intervention family case management into our already robust intake and assessment processes. Family Navigators are trained to perform developmental screenings utilizing the Ages and Stages Questionnaire – Third Edition (ASQ-3) and ASQ: Social-Emotional Milestones and other holistic measures to determine environmental factors and barriers to family wellness.
ref. RFP#HCSA-900218_Sobrante Park_narrative.pdf, March 2018 – Dan Abrahamson
Core Care Model: Navigation
Program: Navigator Initiative
Themes, Keywords & Tags: Intake; Assessment; Food Access; Housing; Mental
Mental Health Prevention & Early Intervention (PEI) Services in Sobrante Park
Securing basic needs including food, stable shelter, safe environments, and social connectedness are necessary for effective behavioral self- management and avoiding unnecessary health services utilization. Roots has established intake and assessment tools and processes that evaluate social determinants of health, establish a baseline, and enable ongoing monitoring of the stability of each client. Upon intake, Navigators utilize our Vital Signs screening tool to examine individuals and families in 9 domains of wellness and four stages of risk. This tool delineates strengths and protective factors as well as risks and barriers the families and individuals face. In addition to administering our intake and life assessment tools, Navigators administer Screening, Brief Intervention, and Referral to Treatment (SBIRT), the Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST), and the PHQ-9 depression screening instruments to help identify mental health challenges, substance use disorders and corresponding need for supports. For this scope of work, Roots will integrate prevention and early intervention family case management into our already robust intake and assessment processes. Family Navigators are trained to perform developmental screenings utilizing the Ages and Stages Questionnaire – Third Edition (ASQ-3) and ASQ: Social-Emotional Milestones and other holistic measures to determine environmental factors and barriers to family wellness.
…Navigators use results of the intake and assessment process to proactively connect patients with internal as well as external resources. Information gleaned from the assessment helps Navigators determine the appropriate frequency and intensity of services, choose which clients to pair with which Navigators, and how best to monitor client progress. We utilize our data systems to correlate baseline status with service eligibility requirements, develop prioritization and interventions, and evaluate health/mental health and housing outcomes to assess (and improve) our impact.
ref. RFP#HCSA-900218_Sobrante Park_narrative.pdf, March 2018 – Dan Abrahamson
Core Care Model: Navigation
Program:
Themes, Keywords & Tags: Intake; Assessment; Food Access; Housing; Mental
Medi-Cal & CalFresh Renewal Assistance & CalFresh Enrollment Project
Since our inception in 2008, Roots staff and board have included outreach, Medi-Cal and ACA enrollment as critical in stabilizing under-served Oakland residents who have less access to insurance and public benefits, including CalFresh. Because 94% of our patients are on Medi-Cal, and because we are implementing a community-centered approach to improving health for people historically without a primary care medical home, we see it as vital to integrate outreach and enrollment into all patient activity. As a result, we have eight years’ experience in successfully signing up the so-called “hard to reach” in Oakland’s low-income neighborhoods. As detailed below, Roots is well positioned to successfully complete deliverables in this RFP: we have demonstrated experience in carrying out the activities to re-enroll Medi-Cal qualified individuals and sign up these clients simultaneously with CalFresh, and track all required reporting data; we are knowledgeable regarding the requirements to gain resources for the undocumented; our previous outreach and enrollment contract with ACSSA resulted in 749 submitted applications over 11 months; thus far, 474 Medi-Cal applications and 430 CalFresh applications have a legitimate CalWin status. Roots has all required permits, licenses and professional credentials in place.
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Themes, Keywords & Tags: Medi-Cal; CalFresh; About; Mission
Medi-Cal & CalFresh Renewal Assistance & CalFresh Enrollment Project
Since our formation in 2008, Roots has successfully enrolled patients in Medi-Cal and CalFresh, while also offering medical services to all patients regardless of insurance status, financial limitations or immigrant status. Roots has integrated ongoing enrollment activities into job descriptions for front line staff (Medical Receptionists, Medical Assistants, Peer Health Navigators, Outreach and Enrollment Workers, Site Supervisors) to encourage our patients to enroll in Medi-Cal and CalFresh. Because the populations we serve are low- income, including formerly incarcerated and homeless individuals, it is imperative – for our own sustainability along with theirs – that patients obtain and maintain benefits as they receive Roots’ health services. Prior to the enrollment campaign initiated through roll-out of the Affordable Care Act, Roots aligned with ACSSA in 2012 through a formal Memorandum of Understanding, so our patients could enroll in both Medi-Cal and CalFresh at the clinic. Roots staff members assisted patients with paper applications and were able to verify eligibility and/or coordinate connection with SSA eligibility workers through our working relationship with SSA.
When the Affordable Care Act became law, Roots registered as a Certified Enrollment Entity (CEE) and subsequently initiated the process of certifying 22 staff members to become Certified Enrollment Counselors. This process, which included Department of Justice clearance, finger printing, three full days of training, and an average of four months to complete, required significant oversight from Roots administrative staff. Despite a host of unanticipated challenges with Covered California’s process followed by a discontinuance of CBO reimbursement for Covered CA enrollment, Roots is dedicated to maintaining the integrity of our comprehensive outreach and enrollment campaign, including Exchange enrollment that complements Medi-Cal sign-ups.
And as our patient base has increased, outreach and enrollment efforts have expanded as well. Integration of outreach, Medi-Cal and Covered California enrollment services with our primary medical home provides a bridge to health care and wraparound services for our patients. In addition, our contract with ACSSA for Medi- Cal Outreach and Enrollment (“MCOE”) targeting reentry, homeless and Limited English Proficient (LEP) populations has resulted in 749 enrollments in the last year. Today, 12 Roots staff members are able to enroll qualified individuals on-site and through mobile outreach efforts utilizing the Benefits CalWin portal.
Core Care Model:
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Themes, Keywords & Tags: Medi-Cal; CalFresh; ACA
Medi-Cal & CalFresh Renewal Assistance & CalFresh Enrollment Project
Through our past ACSSA contract to enroll “hard to reach” populations, Roots submitted 478 applications for patients in CalFresh; currently 430 have an active CalWin status and 221 have been approved thus far. Roots outreach and enrollment workers have been particularly successful in educating those previously denied CalFresh due to a drug sale-related felony that they are now eligible for the benefit since the lifetime ban for drug felons was lifted in April 2015. We have found that information about the end of this prohibition is still not widely-known; Roots’ culturally competent and situationally sensitive outreach and enrollment workers continue to disseminate this critical information to those who need it most.
Core Care Model:
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Themes, Keywords & Tags: CalFresh
Medi-Cal & CalFresh Renewal Assistance & CalFresh Enrollment Project
In 2014, Roots Community Health Center contracted with ACSSA to provide Medi-Cal and CalFresh outreach and enrollment specifically to “hard to reach” populations. Roots was selected to reach all three priority groups – the reentry, homeless and LEP populations – to educate, screen for eligibility and enroll into benefits. Roots conducted 249 distinct outreach activities (e.g., health fairs, block parties, resource fairs), and performed routine outreach activities at a total of 119 locations (e.g., neighborhood hangouts, CBOs, local businesses, etc.). During the contract period, Roots was required to enter data collected in the field into an SSA-created database (CAMOC) and consistently demonstrated a high degree of accuracy and completion. In order to fulfill data collection requirements for ACSSA and to facilitate data-driven process improvements, we created tools for real-time collection of relevant information which was entered and analyzed by our data specialist on an ongoing basis. Outcomes were reviewed at weekly team meetings in order to rapidly refine our outreach strategies, resulting in increasingly effective outreach and enrollment activity over the contract period.
Roots demonstrated its commitment to integrating Medi-Cal and CalFresh enrollment into our organization’s daily workflow by training a total of 16 staff members to perform enrollment utilizing Benefits CalWin. As a result, benefits enrollment is performed by “embedded” frontline healthcare workers including Medical Assistants, Medical Receptionists, and Community Health Outreach Workers/Health Navigators, in addition to dedicated Outreach and Enrollment workers. These embedded staff members also integrate outreach strategies into their work in the community and participate in outreach at numerous health fairs and other events.
During the 11-month performance period, Roots screened 3,980 individuals for Medi-Cal / CalFresh eligibility and submitted a total of 749 applications via the Benefits CalWin system. While many of these applications remain pending, currently 474 Medi-Cal applications and 430 CalFresh applications have a legitimate CalWin status. Thus far 306 have been approved for Medi-Cal and 221 have been approved for CalFresh. Although the contract ended 60 days ago, we continue to provide assistance to these individuals to ensure that they receive their benefits. ACSSA’s review of Roots’ satisfaction surveys reveals that 97% of our clients report moderate to high levels of satisfaction with Roots’ application assistance, and 100% report increased knowledge of how to get or maintain benefits.
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Themes, Keywords & Tags: CalFresh; Medi-Cal; Data; Evaluation; Partnerships
Medi-Cal & CalFresh Renewal Assistance & CalFresh Enrollment Project
In the past year, approximately 525 immigrants received medical services through Roots; all families obtaining these services were screened for Medi-Cal/CalFresh and enrolled when possible.
Core Care Model:
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Themes, Keywords & Tags: CalFresh; Medi-Cal; Immigration; Immigrants
Medi-Cal & CalFresh Renewal Assistance & CalFresh Enrollment Project
Comprehensive Outreach, Renewal and Enrollment Approach Roots proposes a comprehensive strategy for renewal assistance and enrollment, integrating these activities into our existing infrastructure for outreach, enrollment, health system navigation and clinical care at our three fixed sites, two mobile sites, and in the community. Roots has three sites in Oakland: our main primary care clinic at 99th and International, our pediatric primary care clinic at 27th and International, and our workforce site at 41st and Broadway. We also have two mobile sites – an enrollment bus and a mobile clinic – both of which serve locations throughout Alameda County, targeting traditionally “hard to reach” members of our community. In addition, Roots staff are consistently deployed to community events, transitional housing facilities, and other community-based organizations to provide on-site application assistance.
With the proposed funding, Roots will complete a minimum of 3,813 Medi-Cal renewals and 750 CalFresh applications, utilizing a combination of dedicated staff as well as incumbent front-line healthcare workers who will incorporate renewal assistance into their existing workflows. Two dedicated Eligibility and Enrollment Specialists will perform renewal assistance over the phone, in neighborhoods, at group enrollment sessions, during office hours, and via home visits when needed. Incumbent frontline healthcare staff (Clinic Supervisors, Medical Receptionists, Medical Assistants and Community Health Outreach Workers) will incorporate renewal assistance into their current workflows. Variances in processing timelines will be tracked and managed on a flow basis through this coordinated, multi-site approach.
Roots Eligibility and Enrollment Specialists will be responsible for receiving and managing the list of recipients from ACSSA. Lists will be duplicated and distributed to our three fixed and two mobile sites for their reference. With the assistance of a Roots data specialist, the list will then be sorted by language preference, case status and neighborhood. Cases at risk of being terminated soonest (i.e., those nearing the end of their 90-day cure period) will be prioritized for targeted outreach as soon as possible. Phone calls. Attempts will be made to call all recipients on the SSA-provided list to inform them of their case status, advise them of potential CalFresh eligibility (if applicable), inquire about other potentially eligible household members such as children, and provide them with options for renewal. These calls will be made in the language indicated on the SSA-provided list. In the event that the language is not one of the six languages within our capacity at Roots (English, Spanish, Chinese, Vietnamese, Amharic and Tigrinia), we will utilize SSA’s language line.
Whenever possible/appropriate, the Eligibility and Enrollment Specialist will complete the renewal application over the phone with the client. In the event that this is not possible/preferable – such as non- verified MAJI recipients who have a pre-populated form, or those in need of a CalFresh application – the Eligibility and Enrollment Specialist will suggest the following options for Medi-Cal renewal and CalFresh application assistance: one-on-one or group renewal appointment at the most convenient of Roots’ three fixed sites; or neighborhood enrollment, home visits, or an event, if applicable. On the initial phone call, staff will be trained to obtain the preferred method of communication, including text message and email. If phone calls are not successful, Eligibility and Enrollment Specialists will send the appropriate mailers and ultimately make a home visit when in the vicinity for neighborhood enrollments. The date/time and outcome of phone calls will be documented, as will the planned and completed follow-up activities.
Renewal/Application Assistance at Roots: Renewal and application assistance will occur at all three Roots fixed sites (99th and International; 27th and International; 41st and Broadway). Based on the list characteristics (language, location and case status), a group visit schedule by site will be created to facilitate the completion of Medi-Cal renewals and CalFresh applications. Group visits can be conducted in any of the six languages for which Roots currently has capacity, and can be held at any of the three sites. Group visit information and scheduling information will be disseminated by telephone calls/text message/email, postcards and inreach at the fixed and mobile sites.
While group visits are highly encouraged, one-on-one appointments will be accommodated as well. These may occur by appointment (e.g., scheduled during the initial phone contact), or at a drop-in visit at any of the three fixed sites. Both group and in-person visits represent ideal opportunities to disseminate information regarding the newly eligible population under SB 4. Based on our experience with the target population, several contacts may be required before they will feel comfortable enrolling; as such, Roots will embed information about eligibility under SB 4 into all enrollment and renewal materials and scripts we utilize.
Neighborhood enrollment: A critical component to Roots’ success with new Medi-Cal and CalFresh enrollments is use of the Roots Enrollment Bus which has raised our visibility in Oakland communities, and allowed for comfortable, efficient and confidential enrollment in virtually any location. For Healthy Connections 2.0 we propose utilizing the Roots Enrollment Bus in a more targeted manner, scouting sites within the neighborhoods with a high density of recipients on our SSA list. Neighborhoods – including the site for the bus – will be identified with sufficient lead time to advise community members of the upcoming support in their neighborhood. If phone contact has been made but renewal is not accomplished during the initial contact(s), the Eligibility and Enrollment Specialist will inform the recipient via their preferred communication method of the date and location that the Roots Bus will be in their neighborhood. In addition, postcards and/or flyers with the Neighborhood Enrollment schedule will be distributed. A list of required/acceptable identification and supporting documents will be provided to the recipient in preparation for their appointment. Reminder calls will go out in the days leading up to the Neighborhood Enrollment day. Home visits will also be accommodated, particularly for recipients with childcare needs, mobility issues, or other barriers to being seen at a Roots fixed or mobile site.
*See original document for additional comprehensive detail of project plan and outlines details
Core Care Model:
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Themes, Keywords & Tags: CalFresh; Medi-Cal; Outreach; Enrollment