Tanya Pagan Raggio-Ashley, MD MPH FAAP Senior Medical Officer

Department of Health and Human ServicesHealth Resource Service Administration Office of Regional Operations, Region II

26 Federal PlazaNew York, New York 10278

Tel: 212-264-4624 Email: Traggio@hrsa.gov 1

Essex-Passaic Wellness Coalition

Monday, December 9, 2013

Geographic Diversity of the UninsuredGeographic Diversity of the Uninsured

NEW JERSEYUninsured 1.3 Million

Insured 7.8 Million

Children 209,400

Adults 1,117,100

By Race

White 414,700

African American236,000

Hispanic 561,600

Other114,100

Rutgers Center for State Health Policy 3 Number of Uninsured 0-400% FPG by County, Ages 0-64

Overall, 993,185 uninsured individuals with family incomes 0-400% FPG reside in New Jersey. Under the ACA, most of these will be eligible for Medicaid or subsidized coverage through the exchange. Essex, Hudson and Middlesex Counties each has over 100,000 uninsured residents, and 60% of uninsured residents of NJ reside in the counties shown in dark red. The seven counties shown in medium red are home to an additional 30% of uninsured residents. However, nearly 105,000 uninsured individuals live in the eight counties shown in light red, and the dispersion of these people over a large geographic area may present special challenges to outreach and education about new opportunities for coverage. Source: Uninsured in New Jersey by County: How Many are Eligible for New Coverage under the ACA? Dorothy Gaboda, M.S.W., Ph.D. Et al. May 2013 Preparation of this report was funded by the Robert Wood Johnson Foundation Data from 2011 American Community Survey

County Number of Uninsured

Essex 109,610

Hudson 94,173

Middlesex 90,782

Bergen 80,167

Passaic 69,105

Union 59,003

Camden 54,011

Monmouth 53,396

Total 610,247

Priority Counties

Other Counties

New Jersey Uninsured Top 8 Counties

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The Health Care Law

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What the Law Means for You:5 Things to Know

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Consumer Protections

Additional Consumer Protections

Health insurance companies selling plans through the Marketplace can’t deny you coverage or charge you more due to preexisting health conditions (hypertension, cancer and so on) They can’t charge women and men different premiums based on their gender

(Health Insurance Marketplace: Ten Things to Tell Your Patients)8

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The Law Increases Your Access to Affordable Care

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Essential Heath Benefits by Law

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The Law Increases Your Access to Affordable Care

In many cases, you can get preventive services for free:

Children, Women and Adults

Preventive Health Services for Children

• Most health plans must cover a set of preventive health services for children at no cost when delivered by an in-network provider. This includes Marketplace and Medicaid coverage.

• Coverage for children’s preventive health services All Marketplace health plans and many other plans must cover the following list of preventive services for children without charging you a copayment or coinsurance.

• This is true even if you haven’t met your yearly deductiblehttps://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=3

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Preventive Health Services for Children

• Autism screening • Behavioral assessments • Blood Pressure screening • Cervical Dysplasia screening• Depression screening • Developmental screening • Dyslipidemia screening • Fluoride Chemoprevention suppleme

nts

• Gonorrhea preventive medication • Hearing screening • Height, Weight and Body Mass Index

measurements • Hematocrit or Hemoglobin screening • Hemoglobinopathies or sickle cell scr

eening

• HIV screening• Hypothyroidism screening• Immunization vaccines • Iron supplements • Lead screening • Medical History • Obesity screening and counseling• Oral Health risk assessment • Phenylketonuria (PKU) screening • Sexually Transmitted Infection (STI)

prevention counseling and screening

• Tuberculin testing • Vision screening

See handout for age coverage

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Preventive Health Services for Women

• Preventive health services for women• Most health plans must cover additional preventive health

services for women, ensuring a comprehensive set of preventive services like breast cancer screenings to meet women’s unique health care needs.

• Comprehensive coverage for women’s preventive care• All Marketplace health plans and many other plans must

cover the following list of preventive services for women without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

• This applies only when these services are delivered by an in-network provider

• https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=2

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The Law Strengthens Medicare

Health Insurance Marketplace 10 Things to Tell Your Patients

• If you don’t already have health coverage, the Health Insurance Marketplace is a new way to find and buy health coverage that fits your budget and meets your needs (Also if you pay for your own health insurance)

• Open Enrollment started October 1, 2013, and ends March 31, 2013

• Coverage starts as soon as January 1, 2014 if you sign up by December 23, 2013

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What is the Health Insurance Marketplace/Exchange?

What is the Health Insurance Marketplace/Exchange?

• The Marketplace (or Exchange) is a new way to find health coverage that fits your budget and meets your needs.

• It simplifies your search for health coverage by gathering the options available in your area in one place. With one application, you can see all your options and enroll

• It uses the power of a large insurance pool, made up of individuals and small businesses, to generate competition among insurers to seek better quality plans at a lower cost.

What is the Health Insurance Marketplace/Exchange?

What is the Health Insurance Marketplace/Exchange?

1. It’s an easier way to shop for health insurance – One application, one time, and an individual or family

can explore every qualified insurance plan in the area

2. Most people will be able to get a break on costs– 90% of people who are currently uninsured will

qualify for discounted or free health insurance

3. Clear options with apples-to-apples comparisons– All health insurance plans in the Marketplace present

their price and benefit information in plain language

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Available financial helpAvailable financial help

• Premium tax credits:– Will reduce the premium amount the consumer owes each

month– Available to eligible consumers with household incomes

between 100% and 400% of the FPL and who don’t qualify for other health insurance coverage

• 100% FPL = $11,490 for an individual and $23,550 for a family of 4 in 2013

• 400% FPL = $45,960 for an individual and $94,200 for a family of 4 in 2013

– Based on household income and family size for the taxable year. Paid each month to the insurer

Available financial helpAvailable financial help

• Cost-sharing reductions:– Reduce out-of-pocket costs (deductibles,

coinsurance, copayments)– Generally available to those with income 250%

FPL or below ($28,725 for an individual and $58,875 for a family of 4 in 2013)

– Based on household income and family size for the taxable year

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Four Levels of Coverage Four Levels of Coverage

Medicaid ExpansionMedicaid Expansion

• Help adults and children get health benefits coverage through Medicaid and CHIPOne streamlined application for Medicaid or private

health plansExpands eligibility to 133% of the Federal Poverty

Level ($15,282 for an individual and $31,322 for a family of 4 in 2013)

Shifts to simplified way of calculating income to determine Medicaid/CHIP eligibility

• Known as Modified Adjusted Gross Income (MAGI)

• You can compare insurance options• One Simple Application• You can have options tailored to your personal

situation and find out if you might be eligible based on your income for financial assistance to lower your costs

• The Same Application will let you find out if you and your family might qualify for free or low cost coverage available through Medicaid or Children’s Health Insurance Program (CHIP)

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Health Insurance Marketplace 10 Things to Tell Your Patients

Eligibility and EnrollmentEligibility and Enrollment

• Marketplace initial open enrollment period starts October 1, 2013 and ends March 31, 2014

• Marketplace eligibility requires consumers to– Live in its service area, and– Be a U.S. citizen or national, or– Be a non-citizen who is lawfully present in the U.S. for

the entire period for which enrollment is sought– Not be incarcerated

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How will consumers enroll?

Health Insurance Marketplace:10 Things to Tell Your Patients

• Marketplaces are operated by:• Your state• The Federal Government New Jersey• Or a Partnership of the two (State and Federal)• Each Marketplace will give you the same

access to all of your Marketplace coverage options

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States Health Insurance Marketplace Decisions, May 10, 2013

Partnership Marketplace (7 states)

State-based Marketplace (16 states and DC)

Federally-facilitated Marketplace (27 states)

WA

OR

WY

UT*

TX

SD

OK

ND

NM

NV NE

MT

LA

KS

ID

HI

CO CA

ARAZ

AK

WI

WV VA

TN SC

OH

NCMO

MS

MN

MI

KY

IA

IN IL

GA

FL

AL

VT

PA

NY

NJ

NHMA

ME

CT

DE

RI

MD

DC

* In Utah, the federal government will run the marketplace for individuals while the state will run the small business, or SHOP, marketplace.

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Assistance – It’s Available If You Need It

1-800-318-2596

• Certified Application Counselors • Champions for Health

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OTHER HRSA RESOURCES

• HEALTH PROFESSIONS SHORTAGE DESIGNATIONS • PRIMARY CARE HEALTH CENTERS • HEALTH PROFESSIONS WORKFORCE, NATIONAL HEALTH

SERVICE CORP, STATE LOAN REPAYMENT, NURSE LOAN REPAYMENT

• RURAL HEALTH• AREA HEALTH EDUCATION CENTERS • RYAN WHITE HIV/AIDS PROGRAM• MATERNAL CHILD HEALTH VIA STATE TITLE V BLOCK

GRANTSAND SPECIAL PROJECTS OF REGIONAL AND NATIONAL SIGNIFICANTS, HOME VISITING, HEALTHY START…..

• HEALTH CARE SYSTEMS • HEALTH INFORMATION TECHNOLOGY

Substance Abuse Mental Health Services Administration Resources

SAMSHA REGION II OFFICEDennis O. Romero, MA

Regional AdministratorRegion II (NJ, NY, PR, U.S. VI)

Substance Abuse and Mental Health Services Administration (SAMHSA)

26 Federal Plaza, Suite 3337New York, New York 10278

Phone: 212-264-8097Fax: 212-264-2673

E-mail: dennis.romero@samhsa.hhs.govWebsite: www.samhsa.gov /1-877-726-4727

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SAMSHA Mental Health Resources • SAMHSA Website in Spanish: http://samhsa.gov/espanol/ • Publications in Spanish: http://store.samhsa.gov/espanoll • SAMHSA related information:

http://www.attcnetwork.org/regcenters/index_caribbeanbasinspanish.asp

• Web link dedicated to children’s mental health: http://www.samhsa.gov/children//

• Materials and Resources: http://www.samhsa.gov/children/materials.asp

• Short Report: “Promoting Recovery and Independence for Older Adolescents and Young Adults Who Experience Serious Mental Health Challenges”: http://www.samhsa.gov/children/SAMHSA_Short_Report_2013.pdff

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Resources:https://www.healthcare.gov/

https://www.cuidadodesalud.gov/es/1-800-318-2596

OrTTY: 1-855-889-4325

http://www.hrsa.gov/index.htmlhttp://kff.org/

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THANK YOU, Gracias, Merci, Grazie