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«Co-Principal Investigators Jerome Seliger, Ph.D. & Carl A. Maida, Ph.D. Department of Health Sciences California State University, Northridge August ...»

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During the implementation, approximately fifteen participants asked for help to write their answers. It was very difficult to provide assistance to all the participants simultaneously. Though they understood the questions, they did not have the competence to choose among the answers. Four participants completed the questionnaire in a few minutes and left before the end of the meeting.

At the end of the session, ten respondents had not completed the entire 26-item questionnaire. In a debriefing at the end of the session most of the participants expressed difficulty in interpreting the ranking scale for certain of the questions. None of the participants had any familiarity with the term “CalWORKs,” and many were uncertain about the meaning of “welfare reform.” During the debriefing phase of the group participants made general comments about the Medi-Cal program and their experience in it. Those remarks were captured on newsprint and a few are reproduced here for more

insight into the way this cohort experiences the health and welfare system:

–  –  –

The outcomes of the group administration of the Survey Questionnaire were disappointing. Only about one in ten respondents seemed to be able to fully comprehend the questions and the formatting of the questions. Cultural and linguistic issues and lack of prior experience with "opinion" questions no doubt posed barriers to the task, however an equally daunting barrier was inadequate reading, writing, or written comprehension skills. Fewer than one in eight respondents were able to handle the group method used in cognitive interviews.

Field Testing the Questionnaire and Evaluating Findings Following the cognitive interviews we revised the questionnaire and then field tested it with a sample of 24 individuals from the same congregation. Because of the significant impediments associated with administering the cognitive interviews in a group session, we arranged for the bilingual facilitator to meet individually and privately with respondents. We report responses to selected items contained in the TMC Survey Questionnaire.

Descriptive information about the respondents and how they answered the Questionnaire items are summed and reported in Attachment E. The profile of respondents is depicted in Table 1.

–  –  –

Tables 3 and 4 depict prior cash assistance experience and current Medi-Cal involvement. About 1/3 of respondents report having received AFDC for three or more years and 1/3 reported one or two years. Fully 80% of respondents are also current Medi-Cal recipients.

–  –  –

Only four of the 24 respondents reported retaining Medi-Cal after the cash assistance period and all reported being dropped from coverage thereafter. See Tables 5 and 6.

–  –  –

A majority of respondents felt that notices or notice of termination and periodic follow-up notices were the best way for persons such as themselves to learn about and respond effectively to TMC. Only 16% of respondents felt personal contact with their (former) worker would be helpful in obtaining TMC and 12% said classes would helpful and 12% wanted easy-to-read printed information.

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R.J. Baxter & R. E. Mechanic. The Status of Health Care Safety Nets. Health Affairs 16:4, July-August, 1997, 7-23.

F. G. Castro, J. Elder, K. Coe, H. M. Tafoya-Barraza, S. Moratto, N. Campbell, G.

Talavera. Mobilizing Churches for Health Promotion in Latino Communities -Companeros en la Salud. Journal of the National Cancer Institute Monographs 1995:

(18), 127-135.

M. Gold, M. Sparer & K. Chu. Medicaid Managed Care: Lessons from Five States.

Health Affairs 15:3, Fall, 1996, 153-166.

D.C. Hughes, N. Halfon, C.D. Brindis, P.W. Newacheck, Improving Children’s Access to Health Care: The Role of Decategorization. Bulletin New York Academy of Medicine, Winter, 1996.

N. Halfon, M Inkelas, D. Wood. Non-financial Barriers to Care for Children and Youth.

Annual Review of Public Health, 1995.

R. A. Moffitt & E. P. Slade. Health Care Coverage for Children Who Are On and Off Welfare. The Future of Children, 7:1, Spring, 1997, 87-98.

P.W. Newacheck, J.J. Stoddard, D.C Hughes, M. Pearl, Health Insurance and Access to Primary Care for Children. New England Journal of Medicine, 338-8,1998.

J. Riccio, D. Friedlander & S. Freedman. GAIN: Benefits, Costs, and Three-Year Impacts of a Welfare-to-Work Program. New York: Manpower Demonstration Research Corporation, 1994.

K. E. Thorpe. Incremental Approaches to Covering Uninsured Children: Design and Policy Issues. Health Affairs 16:4, July-August, 1997, 64-78.

R. Wyn & E.R. Brown. Key Issues in Access to Insurance Coverage and to Services Among Non-Elderly Women. In: Ronald M. Andersen, Thomas H. Rice & Gerald F.

Kominski, editors. Changing the U.S. Health Care System: Key Issues in Health Services, Policy, and Management. San Francisco: Jossey-Bass, 1996, 255-272.

–  –  –

Respondents are assembled in a conference type room and assured of no outside distractions such as telephone noise or persons unrelated to the Focus Group walking through the meeting room. The Focus Group experience will take about 1.5 hours to

administer. The following are the activity steps to the process:

Step 1 Facilitator makes name tags ("hello my name is") in advance of the meeting distributes them to respondents as they enter the room.

Step 2 Facilitator introduces herself and any observers; she explains the

purpose behind the activity:

(1) Get some ideas about what it is like trying to obtain or keep health insurance;

(2) Determine whether they still have Medi-Cal;

(3) Get a sense of whether they will have any problems in getting Medi-Cal after leaving AFDC/TANF;

(4) Determine whether their employer, if they are working yet, offers health insurance;

(5) Conclude by stating that findings will be used to develop a questionnaire to be used with other people later in the spring and that the findings of the Focus Group and later meetings will be given to the State Legislature to consider whether new laws are needed to help people get Medi-Cal or other insurance.

Step 3 Facilitator puts newsprint on wall and begins to brainstorm the audience --- one question at a time --- when each question is complete she tapes it on the opposite wall for later reference

Step 4 Facilitator begins the questioning phase of the Focus Group:

First Set of Questions (and newsprint) (1) How many people have health insurance today? (show of hands; record on newsprint) (2) How many people have insurance through their job or through someone else?

(show of hands; record on newsprint);

(3) How many have Medi-Cal today? (show of hands; record on newsprint);

(4) To those with Medi-Cal -- How come you still have it? What happened?

(brainstorm; answers on newsprint) (5) To those without Medi-Cal -- What happened? (brainstorm; answers on newsprint) Second Set of Questions (and newsprint) (1) What kind of insurance is most important to you?

–  –  –

(c) coverage for your husband or significant other (d) coverage for your other family members (2) How many of you have health insurance through your job? (show hands) (a) For those of you who do, do any of you pay any part of the insurance premium? (show hands; brainstorm amount paid and put on newsprint) Third Set of Questions (and newsprint) (1) For those who do not have any insurance today, i.e. Medi-Cal or insurance through your job, why don't you have it? (brainstorm answers on newsprint) (2) Of the reasons we just came up with (pointing to the newsprint), which of these was the biggest reason that kept you from obtaining health insurance? (put an * next to "biggest reasons") Fourth Set of Questions (and newsprint)

Prepare the newsprint with these words on it in a column just like this:

–  –  –

(1) When you think of why you no longer have Medi-Cal, which of these persons were involved in your decision? (Place checkmarks next to items as they are brainstormed) For example, did you rely on any of these people for information about health insurance?

(2) What did they do to discourage you? (Brainstorm items without comment) (3) Did you know that you could (can) keep receiving Medi-Cal after you leave AFDC or TANF? (Show of hands....put # of persons responding on newsprint) (4) What kind of information would help people to know that they can keep Medi-Cal...any ideas? (Brainstorm responses without comment).

(5) How important is health insurance to you and your family?...point to

newsprint as you write 5 numbers on the newsprint:

Say: number one means not very important and number five means very important; ask for show of hands for 1 and 5....put number of respondents for each below #1 and #5.

Say: those of you who did not say one or five...how do you feel... How does having health insurance rank with other necessities that are important to you?

(Brainstorm answers and put answers on newsprint without comment) Fifth Set of Questions (newsprint) (1) Imagine the governor and the legislature were here now, what would you like to tell them about what Medi-Cal or other types of health insurance mean to you today?

Post two pieces of newsprint. one labeled "Medi-Cal" and one labeled "other health insurance."

Brainstorm comments re: Medi-Cal and other health insurance without comment.

Ask respondents to complete a questionnaire with five questions. Read each

question slowly out loud so as not to embarrass anyone who cannot read:

–  –  –

Thank the people, collect the questionnaires, distribute $15 respondent fee, GET


End of session.

–  –  –

Focus Group #1 Location: Pacoima Urban Village March 19, 1998 Respondent N = 14

Brainstormed Questions and outcomes:

(1) How many people have health insurance today?

(2) How many people have insurance through their job?

(3) How many have Medi-Cal today?

10 (Two have regular Medi-Cal and eight are in a Medi-Cal managed care plan.) (4) To those with Medi-Cal--How come you still have it? What happened?

Seven said because they have low incomes. One said she cannot work because of health problems.

(5) To those without Medi-Cal--What happened?

Three have no Medi-Cal nor other insurance.

All three said the Social Worker (sic) (Eligibility Worker) at DPSS told them they did not qualify.

“I applied for myself but never received my card.” “I lost Medi-Cal because I’m not participating in the GAIN program because I’m caring for my elderly, ill mother.” Two said they did not qualify because they are non-residents.

Second Set of Questions (1) What kind of insurance is most important to you?

(a) coverage for only yourself (b) coverage for your children (c) coverage for your husband or significant other (d) coverage for your other family members All 14 said (b) coverage for their children is most important. Their second choice was coverage for themselves, and their third choice was coverage for older adults/parents.

(2) How many of you have health insurance through your jobs?

–  –  –

(5) How important is health insurance to you and your family on a scale of 1 (not very important) to 5 (very important)? For those who did not say one or five, how do you feel?

–  –  –

(2) Brainstorm comments regarding Medi-Cal and other health insurance.

“Regular Medi-Cal is better because you can use it anywhere you go.” “You can only use Health Plans in some clinics and hospitals.” “It takes a long time to see a doctor when you’re in a Health Plan.” “The Health Plans don’t have classes to teach you about your health.”

–  –  –

Focus Group #2: Plaza Community Center April 8, 1998 n = 13 ____________________________________________________________

First Set of Questions (1) How many people have health insurance today?

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