Meeting Information


Meeting Type
Friday Provider Meeting
Date
Friday, 3/8/2019
Start
9:00 AM
End
11:00 AM
Agenda
Agenda
Summary
Census presentation and Charity Care at local hospitals
Minutes

Welcome

Brandon Chun, Community Member

Presentation

US Census Bureau - https://census.gov/

  • Lorraine Ralston, US Census Bureau, m.ralston@2020census.gov
  • Kim Beckham, US Census Bureau.
  • Presentation - https://coalitionfiles.blob.core.windows.net/files/The%20Road%20to%202020%20(Tacoma%20Homeless%20Coalition--8%20Mar%2019).pptx
  • Washington Counting for Dollars - https://coalitionfiles.blob.core.windows.net/files/Washington%20Counting%20for%20Dollars%20(GWU%20Report).pdf
  • Partnership Fact Sheet - https://coalitionfiles.blob.core.windows.net/files/Partnership%20Fact%20Sheet.pdf
  • 2020 Census, at a glance - https://coalitionfiles.blob.core.windows.net/files/The%202020%20Census%20at%20a%20Glance.pdf
  • 50 ways Census data are used - https://coalitionfiles.blob.core.windows.net/files/50%20Ways%20Census%20Data%20Are%20Used.pdf
  • Thanks for having us here
  • Our objective is to count every person in the Country once and only one, and in the right place (but hopefully not trying to put folks in their place – that never ends well.-ed)
  • Census day is April 1st, 2020. Sounds like a long time away (when I was a younger man, that would have seemed like a long time away, but as I age…not so much –ed). 
  • The Census is in the Constitution – founding fathers thought we should count everyone every 10 years. In 1790, the Census was done by US Marshalls and they counted 4 million people (Washington thought it was an undercount – complaining of poor transportation, limited technology, and a disinterest in being counted –ed.
  • Why do the census
    • We divvy up the 435 House of Representatives using Census counts. In 2010, Washington State, based on the census numbers, gained a representative.
    • $675B are dispersed using census data – food stamps, section 8 housing, transportation funding,
    • The state of Washington gets some $1,914 per person per year for everyone that is counted. If they aren’t counted, we don’t get the funding
    • Used for transportation planning, hospital and school locations, businesses use census data – we all use it to some extent.
  • New in 2020
    • We are going on-line – most of the population will answer the census using the internet. Hoping some 45% of the country will respond via the internet
    • The more who self-respond, the lower the cost.
    • Can also call a toll free number to fill out the census – paper forms are available as well.
    • Re-engineering “Address Canvassing” – how we determine where people are living. We used to have people walk the streets to validate all residences.  Now will only do this with 30% - will use past census responses to determine where residential units are located (have you heard about google maps?  Just a little time-saving suggestion…-ed)
    • Using data in the public system – use the mailing list from the Post Office to validate where people live. This will be a huge cost savings.
    • Our field workers will use tablets to capture census information, instead of on paper forms. This will be a cost savings and allow for faster counting.
  • In 2019 – will be determining where people need to be counted – understand where new construction has happened, changes in municipality borders. Also need to find where people who were displaced by natural disasters are living
  • In 2020, will be working to motivate people to get counted.
  • In March of 2020 – the online portal will open March 23rd, 2020. It will probably stay open till mid-April. 
    • We count people in prision, in the military, in transient locations, in nursing homes, in dormitories, all in different ways.
    • Some Alaskans will be counted in January, because ice melt prevents access to some communities.
  • By December 31st, 2020 data must be presented to the President.
  • What do we ask?
    • Short form and long form used to be used. Now have a new, annual American Communities survey, where they ask questions about income, technology ownership
    • The Census is just a count, with 10 basic questions (the first census was just 6 questions – 1) head of household name. Who is in the household – organized by: 2) free white male count age 16+ 3) free white male count under 16. 4) free white female count. 5) all other free person count. 6) Slave count.  If you’re wondering which category American Indians would fit it, the answer is none of them.  Not counted.    –ed.)   
      • Where do you live
      • Phone number
      • Count of people in household
      • Name
      • Gender
      • Age and Date of Birth
      • Race
      • Self-identified cultural background – for instance, able to identify as a white person, but culturally Italian Irish.
      • Ask who lives at that address but is somewhere else on the day of the count.
      • Ask relationships of household members
      • Citizenship question – this question was added by the Secretary of Commerce – is before the Supreme Court now and we are hoping they decide soon so we can print forms
    • Census available in 13 languages on-line, printed in English and Spanish, and language guide is available in 59 languages.
    • In March, 95% of folks will get a postcard in the mail and will ask you to participate. If we think you have good access to  the internet, you’ll get a code (which will automatically enter you address when you go on-line to fill out the survey). 
    • 5% will get a census worker visiting you to do the census – like rural areas in Maine, or location without addresses.
    • After April 1st, you’ll get a couple of reminders, and then if no response, a paper copy of the census.
    • If no response, we’ll make every attempt to physically visit and count.
    • Census data is confidential, it is only reported in aggregation. Never report personal data, just the aggregate data.  This is part of the census law (Title XIII).  This is a lifetime oath you take when you work at the census bureau.  There is no knowledge of the Census bureau having released personal identifying to anyone.  It will be released – by not for 72 years.  It is released 70 years after the census by law, but the census needs a couple years after a count to have time to do the release.
  • Partnership Program – part of our mission is to educate people that the census is coming.
  • We want to encourage people to self-respond
  • We want to engage with different organization to get to populations that are hard to count
  • Hard to count populations
    • Foreign born and immigrants – not realize they need to fill out the census, or are fearful of it (so maybe don’t ask the census question – just a thought. –ed.)   
    • Children under 5 - parents forget they have babies – this data is used for headstart funding and more.  One hospital is including a note on the diaper when kids go home reminding their parents to fill out info on the child on the census.
    • Seniors are not typically hard to count, but with the computer component, this may be a tougher group to count. One County is looking at some youth/senior combination events to have the tech savvy youth assist the seniors with the count.
    • Homeless
      • We are still working on how we will count the homeless populations
      • I don’t need to tell you how challenging of an issue this is.
      • We used “service-based” enumeration”. We count them at the place where they usually get service.  We count them where they are on census day on April 1st, 2020.  We don’t ask folks if they are homeless.  We also don’t publish any records about the percentage of people who are homeless.  There are other ways to count and estimate the homeless population.  The US Census bureau is not trying to count them different from anyone else.  Will count at soup kitchens and shelters.   Will do outreach to parks and such.  (“We shall count on the beaches, we shall count on the landing grounds, we shall count in the fields and in the streets, we shall count in the hills; we shall never surrender…” -ed).  Will hire an outreach team to come up with a list of service based locations and non-sheltered locations.  We’ll confirm all these locations. 
      • With folks experiencing homelessness, we do in person interviews.
      • We treat all with dignity and respect.
      • We will count over a 3 day period in the end of March (27, 30,31), 2020. These counts will be done at night.  Our enumerators will go out to the service based enumerators and
      • Please promote the census with your clients – the services they use may be impacted by the count. Let them know that the government will not use this data against them (that will be reassuring, no doubt. –ed.)  Please help the enumerators do their jobs.  We want to reassure them we keep the data confidential.  We don’t get SSN or credit card information.
      • How to partner
        • Put a link for jobs on your website
        • Put up posters or flyers
        • Hold a census event
        • Send an e-blast to employees
        • Celebrate 1 year to go on April 1st, 2019
        • Create a complete count committee – Pierce County has one
        • Have a Resolution/Proclamation
    • Migrant workers – not such a big concern in this part of Washington
    • Renters – very hard to count. People who rent don’t necessarily feel like a part of the community.  Reach out to tenant organizations and housing authorities
    • ROAM – new database on the census website – publicly available. http://www.census.gov/roam
      • I pulled up Pierce County – this shows all the census tracks in Pierce County – it is not typically a political boundary.
      • Quite a few different shades of blue – undercounted areas – are in Pierce County
      • One example – a tract east of Lakewood – is predicted to be hard to count. They think this census track will have 35% not self-respond to the census.  We’ll need to hire workers to go out and count these folks.  We can look at the demographics and see why this might be the case.  Some 30% of the tract is foreign born, and that might help us come up with a plan.  90% of the people in that tract are renting.  With that, we can come up with a plan to reach out to this community and make sure they get counted. 
  • This is a high level overview of our plans.
    • Area census office will be opening this summer
    • People will come to you
  • Question – why don’t you use the Point in Time count that the Counties do for the homeless. Lorraine – they will use that data in some way.
  • Maureen – given that you don’t track people who are homeless, what do they put in as an address? Lorraine – I’ll have to get back to you on what they put in when they live in an unsheltered location.  If they are in shelter, they’d put that in.
  • Theresa – can you say how you are changing how you count incarcerated folks. Lorraine – I misspoke, we didn’t change, we will get a list of who is incarcerated from the facilities on census day.
  • Maureen – what about people who are in the Northwest detention center, or on our side of the border. Lorraine – we will count them, but I’m not sure how.  If you are in the United States and spend the majority of your time here, we will count you. 
  • Martha – you count folks on April 1st. you said the 3 March dates – 2 are on weekends, where many services are not open.  Lorrain – I’ll see why those date where chosen.
  • Al – if I were Latino, and I encountered question 8 – the Hispanic origin, I might think it is targeting immigrants. Lorraine – we ask this because of federal rules.  We hope the concerns people have about these questions don’t impact the count.
  • Al – how will you count people who refuse to be counted on the homeless outreach night? If we can only get partial data, we will attempt to do that – estimate age and such.
  • Al – This is an area ripe for fraud – how do you know the postcard in the mail is legitimate? Lorraine – I’m not sure how we are going to do that.  We’ll have an outreach effort to educate on what a real worker looks like.
  • Al – you will be going out at night to dangerous areas. Will you pay organizations for staff time to accompany you?  Lorraine – I don’t know – but we’d have to go out into those areas with folks who know the area.
  • Patricia – Do you ask for names? Lorraine – yes, so we don’t duplicate counts.  There is a substantial quality control that would throw out duplicates.  Snow birds often fill out two.  We do lots of quality control.  Patricia – how can you be sure you don’t double count people.
  • Patricia – why do you ask relationships of household members. Lorraine – (I’m not sure which handout Lorraine was referring to, but I like this one - https://www2.census.gov/library/publications/decennial/2020/operations/planned-questions-2020-acs.pdf -ed) 
  • RoxAnne – if they choose to have citizenship on the form, if folks refuse to answer, what happens then? Lorraine – we will try and get any information that isn’t filled out.  If you leave it blank, we’ll try to collect complete information
  • Patricia – what are the gender options. Lorraine – just two, but you can choose whichever you want.  Some of these questions has to do with how the Federal Government tracks populations.
  • Question – will people not answer because they are non-binary? Lorraine - possibly
  • Brandon - Last census, I thought there was a way for LGBTQ to identify.  Or was it on the American Communities Survey.  Lorraine – I’m not sure the history of that question.
  • Lorraine – we are interested in coming and speaking to any group – our operations folks will probably be coming to talk with you as we get closer.

 

Presentation

Hospital Charity Care Policies and Practices

  • Al Ratcliffe, City of Tacoma Human Rights Commission - alratcliffe@gmail.com
  • Presentation - https://coalitionfiles.blob.core.windows.net/files/HospitalCharityCare.pptx
  • Worked with CHI and Multicare to find out what we can do
  • Clients should always ask for charity care – there is no penalty for asking (you can’t win if you don’t play… -ed)
  • The Human Rights Commission – coming soon, folks experiencing rental discrimination can seek remedy with the Tacoma Human Rights Commission
  • We asked organizations who work with people who do not speak English as a primary language, and we learned:
    • Most do now know charity care is offered
    • Many do not know how to apply for financial assistance (especially English language learners)
    • English language learners avoid medical care early, so they may have a condition that could have been treated much more easily earlier.
  • Charity Care
    • Definition: hospitals are supposed to provide free or reduced cost care for folks that can’t pay full freight – to make sure folks who can’t pay get needed care
    • Why –
      • It is a good exchange
      • Hospitals get tax breaks and such – exempt from taxes at all levels – this is a way they pay that back
      • Have to provide care to indigent persons – those who have exhausted all financial assistance and are under 200% of the federal poverty level
    • Multicare health System – Pierce County facilities
      • Tacoma General Hospital
      • Mary Bridge Children’s Hospital
      • Allenmore Hospital (used to have the best parking of any local hospital, but sadly, no longer. –ed)
      • Primary care clinics and urgent care clinics
    • Catholic Health Initiatives (CHI) Pierce County facilities
      • Saint Joseph’s Hospital (want some fun facts about St Joseph’s? I know you do.  I learned all this when I was a kid and I’ve never had it verified, so take it all with a grain of salt.  Anyway, St. Joe’s was built to withstand a nuclear blast – they figured the windows would blow out, so they have spares stored in the basement.  The building is built on springs, so it can handle powerful earthquakes.  I’m pretty sure the spare windows and the springs are myths, but the reinforced concrete “shell wall” does provide excellent strength and a lovely, open interior.  Because of superstitious patients, the building doesn’t have a 13th floor – it goes from 12th to 14th.  Doesn’t that make the 14th floor actually the 13th?  Apparently not.  There is a room 13 – it is the morgue.  Each floor has 4 quadrants, which were designed for 10 beds in each quadrant.  Each quadrant had a nursing station – and no bed was designed to be further than 5 feet from a nursing station.    
      • Rehabilitation hospital
      • Several Primary care and urgent care clinics
    • New Welfound Behavioral Health hospital, a partnership between CHI and Multicare, probably will follow CHI charity care policies, but not sure
    • Substitute Senate Bill 6273 (https://app.leg.wa.gov/billsummary?BillNumber=6273&Initiative=false&Year=2017 ) – now in effect
      • Requires hospitals to asses eligibility for charity care instead of waiting for the patient to apply
      • Must perform screening for charity care prior to attempting to collect payment
      • Provide written notice that free or reduced cost care may be available
      • Interpret charity care info so patients have better understanding
      • Ensure charity care application process is not burdensome
    • Hospital must post charity care information around patient areas and on the website.  Need plain language summaries (https://www.chifranciscan.org/billing-insurance-and-finances/financial-assistance-discounts-for-patients.html and https://www.multicare.org/financial-assistance/ )
    • Must provide translation for languages that are used by more than 10% of the population (only Spanish meets that criteria here).
    • All hospital bills must notify of eligibility for charity care and how to contact about it.
    • Establishing Eligibility
      • Screening for charity care is part of admission. Screening is completed before payment of deposits.
      • Needed documentation
        • W-2 or pay stuff or income tax return or forms approving or denying Medicaid eligibility
        • Income documentation can be submitted later
        • Hospital can also waive the documentation requirements and provide charity care.
      • Final decision has to be made within 14 days – no collections can be done prior to determination.
      • No sending patients to collections
      • Screening happens immediately (or nearly immediately)
      • Application links – (https://www.chifranciscan.org/content/dam/chi-franciscan/website-files/billing-and-finances/financial-assistance/English2018.07.25.pdf and https://www.multicareorg/financial-assistance-forms/ )
      • If you are very low income and go to SeaMar or Pierce County Project Access or Community Health Care, they can do the screening for charity care ahead of time and get application assistance from those organization.
      • CHI - You must reapply every 6 months. Multicare – annually, or after 6 months if income variers
    • If you are found to be eligible and paid a fee, the hospital will issue a refund.
    • Doctor Billing –
      • Multicare has a list of doctors that will accept charity care. Charity care qualification covers both hospital and doctors
      • CHI does not list the doctors, so you have to ask as the Doctor’s office. Also, doctors offices have a separate financial assistance application, qualification for hospital care does not carry over, you have to apply separately.
    • Urgent Care clinics
      • Multicare has urgent care in the same facility as doctor offices. Urgent care clinics do not provide financial assistance.  Doctor offices sometimes provide charity care.
    • Of concern to immigrants – HIPAA laws and hospital policies are very clear that they do no release information to ICE or law enforcement. If an ICE official has a court order signed by a judge identifying records for a named individual, the records must be provided.
  • Patricia – there is a lot on there about language. What about cognitive impairments that make filling out forms?  Al – I don’t know.  It is the hospitals problem to communicate with them.  Carrie – a care giver can help them fill that information out – at Molina, our navigators would assist.  At multicare, the link to information is on the bill.  Al – yes, they can get help with the forms. It is not supposed to be burdensome.
  • CHI – charity care starts with folks under 300% of federal poverty line. Multicare has a sliding scale from 500% to 300%, and charity care below 300%.  (see grid here: https://www.multicare.org/file_viewer.php?id=11807&title=Financial+Assistance+Eligibility+Grid )
  • Language Services
    • Have bilingual staff
    • Telephone access to interpretation
    • Video-remote – my accessible real time trusted interpreter (MARTTI)
  • Maureen – Thanks. We’ve talked about this in terms of clients – I am a recipient as is my husband.  You have got to go on-line and take a look.  The form is confusing – seems to be for a one-time event – it isn’t.  This is an amazing program, especially if you have high co-pays.  Those co-pays are covered at the level of charity care you are receiving.  Don’t assume you are not eligible – the income levels are much higher than you think.    Use this and tell all your friends.  Al – and remember, if you received a service and you did not apply at the time and you paid the bill and now you have income within the guidelines, you can apply retroactively. 
  • Carrie – for the Medicaid side, everything is probably already covered.
  • Martha – what about dental? We have lots of clients with Medicaid with a spend down, so they can’t afford dental.  Al – we didn’t look at dental.  Carrie- if it is a spend down, then it is Medicare. 
  • Theresa – anyone who is on the hilltop – the Tacoma Houing Authority (THA) is asking for help to design the hilltop – it is a chance to talk about affordable housing
  • Maureen – the state released the list of applicants for the next two years of housing trust fund projects. It is a huge file – let me know and I’ll send it to you. 

 

Reports

Legislative Bills – Speed Update

  • Maureen Howard, Housing Advocate - maureenhowardconsulting@gmail.com
  • Happy International Women’s Day
  • Tiny House bill 5383 (actually, the bill is normal sized, and you can read info about it at https://app.leg.wa.gov/billsummary?BillNumber=5383&Year=2019 – ed.)– passed the senate and is heading to the House – it prohibits cities from prohibiting or removing tiny houses with wheels in a mobile home community – applies mobile home tenant rights to folks with tiny houses.
  • Bills should be moving out of their house of origin.
  • I’ll pass on the Washington Low Income Housing Alliance ( https://www.wliha.org/ ) information.
  • We don’t talk much about the Federal Level – the Trump administration will probably try to cut entitlements in the coming budget cycle.
  • City of Tacoma – if you haven’t yet watched the Mayor’s state of the City – do so. The Mayor talks for about an hour.  She cites a success story from the Stability Site.  At the end of the talk, she highlights two prioritizes for the City in the coming year – one is in jobs.  She doesn’t mention the jobs that non-profits provide.  She spent a lot of time talking about housing – she talks about “attainable to all”, talks about the affordable action strategy, the 10 year plan, with 10,000 housing units created or maintained.  Talks about having housing that people working can afford to work in.  She talks about the Mayors inter-local taskforce that she and Connie Ladenburg established – this taskforce convenes local government Leaders and the Mayors – recently had a presentation by Dr. Boderas (not actually sure that is the right spelling –ed.)– who provides the data that this group and the city are using – much like data that we have seen – specific to Tacoma and Pierce County.
  • Theresa – thank you – I love that we are tying in to the legislative stuff – I also wanted to pitch to you all that whatever you are working in, both the City and the County have power in local issues and you can make change – look at what they are working on.
  • Theresa – the City is working on Accessory Dwelling Units at the planning commission, and they were talking about the under 30% AMI folks, identifying the difficulties they are having. We need to testify that this is important.  We’ll be at the City Council Tuesday to talk about where folks can stay – Tuesday 5pm at the City Council chambers. 

Good of the Order

  • March 16th, Saturday, 10am-2pm, Molina is sponsoring crossroads treatment center grand opening open house – invite everyone. Free event – catering with Picasso catering – heavy hors d’oeuvers – also health and wellness event, safe streets will be there as well.  More info at https://coalitionfiles.blob.core.windows.net/files/CrossroadsTreatmentCenterGrandOpening.docx
  • Salvation Army Starting an 8 week career counseling session for young ladies between 12 and 18 – limited to 20 folks -3 spots open. Targeting  girls in foster care – but open to anyone that can benefit from it.
  • This weekend is not too late to sign up for the women’s conference – it is a great event and a steal. Scholarship are also available – especially if you know folks that could benefit from it.  Over 40-50 classes and speakers in all different practices and traditions.
  • Gerrit – Aging into the future – cool PechaKucha event coming around housing and disability - https://www.co.pierce.wa.us/6159/Aging-into-the-Future

Coming Attractions

  • March 22nd – Rapid Rehousing overview and Landlord Liaison Project update
  • March 29th – Committee Work Time
  • April 3rd – Hire253
  • April 5th – Korean Women’s Association – programs overview
  • April 12th – the new The Coffee Oasis youth Shelter overview
  • April 19th – Is it a truth universally acknowledged, that a single man in possession of a good fortune, must be in want of a wife? Our panel of experts, including Mrs. Bennet, Mr. Collins, and Lady Catherine De Bourgh, debate this  singular pronouncement.  A picnic with Mr. Darcy, Miss Bennet, Mr. Bingley, Miss Bennet, Mr. Bennet, and The Gardeners will follow. 

Restaurant Review

I’m a sucker for a classic drive in.  I love going to Dicks in Seattle – the throngs of people, the limited menu – just what a drive in burger place should be.  In Tacoma, Frisko Freeze (1201 Division Ave, Tacoma WA) has been delivering on the promise of cheap and tasty burgers, fries and shakes since the 50’s.  The burgers are juicy, the fries crispy (unlike Dicks, which is hit and miss – mostly miss – with the fries), and they have blackberry shakes, the crown jewel of all possible shake flavors.  I like that they don’t stretch themselves with the menu – it is burgers, fried foods (chicken strips, fishwich, corndog), fries, onion rings, drinks, and a few ice cream options.  And you can be picky with your order, but you’re just wasting your time.  A bud in high school always asked for his burger without onions, they always said OK, and it always came with onions.  I like that in a restaurant.  You order a burger, they make the burger, you eat the burger.  No messing around with sauce selection and how the meat is cooked and can I have a few extra pickles.  Just eat the burger.  One down side to Frisko Freeze it that it is often packed and quite slow with your order.  Either order ahead or just understand that you’ll be hanging out there for a bit – so bring a book or some friends and enjoy some down time; wherever you are rushing to can wait.  They have a couple benches you can sit on to wait, but no tables.  There is technically a drive up window, but it is a bit silly.  They serve one car at a time – take the order, take the money, serve the food, next car.  It is so far from efficient that I love it in spite of myself.  But I’ve never used it.  At the walk up window, it is usually a 10 or 15 minute wait for the food, and sitting on the bench and people watching the slice of Tacoma flowing through Frisko Freeze is reward unto itself.  While the burgers and fries are satisfying, we’re not talking about healthy food in any way, shape or form.  Luckily, if that double cheeseburger was one unhealthy calorie too many, you’re just a stone’s throw from the Emergency Room at Tacoma General.  You can’t plan it better than that.  Anyway, if you have a late night urge for a snack, I’d recommend a trip to Frisko Freeze – you’ll leave satisfied.