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

Essex-Passaic Wellness Coalition Monday, December 9, 2013. Tanya Pagan Raggio-Ashley, MD MPH FAAP Senior Medical Officer Department of Health and Human Services Health Resource Service Administration Office of Regional Operations, Region II 26 Federal Plaza New York, New York 10278

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

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  1. Essex-Passaic Wellness Coalition Monday, December 9, 2013 Tanya Pagan Raggio-Ashley, MD MPH FAAP Senior Medical Officer Department of Health and Human Services Health Resource Service Administration Office of Regional Operations, Region II 26 Federal Plaza New York, New York 10278 Tel: 212-264-4624 Email: Traggio@hrsa.gov

  2. Geographic Diversity of the Uninsured NEW JERSEY Uninsured 1.3 Million Insured 7.8 Million Children 209,400 Adults 1,117,100 By Race White 414,700 African American 236,000 Hispanic 561,600 Other 114,100

  3. RutgersCenter 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

  4. New Jersey Uninsured Top 8 Counties

  5. The Health Care Law

  6. What the Law Means for You:5 Things to Know

  7. Consumer Protections

  8. 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)

  9. The Law Increases Your Access to Affordable Care

  10. Essential Heath Benefits by Law

  11. The Law Increases Your Access to Affordable CareIn many cases, you can get preventive services for free: Children, Women and Adults

  12. 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 deductible https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=3

  13. Preventive Health Services for Children • Autism screening • Behavioral assessments • Blood Pressure screening • Cervical Dysplasia screening • Depression screening • Developmental screening • Dyslipidemia screening • Fluoride Chemoprevention supplements • Gonorrhea preventive medication • Hearing screening • Height, Weight and Body Mass Index measurements • Hematocrit or Hemoglobin screening • Hemoglobinopathies or sickle cell screening • 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

  14. 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

  15. The Law Strengthens Medicare

  16. 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

  17. 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.

  18. 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

  19. Available 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

  20. Available 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

  21. Four Levels of Coverage

  22. Medicaid Expansion • Help adults and children get health benefits coverage through Medicaid and CHIP • One streamlined application for Medicaid or private health plans • Expands 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)

  23. Health Insurance Marketplace 10 Things to Tell Your Patients • 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)

  24. Eligibility 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

  25. How will consumers enroll?

  26. 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

  27. States Health Insurance Marketplace Decisions, May 10, 2013 VT WA ME ND MT NH MN OR MA NY WI SD ID RI MI CT PA WY NJ IA DE OH NE NV IN IL MD CO UT* WV VA CA DC KS MO KY NC TN OK SC AZ AR NM GA AL MS AK TX LA FL HI State-based Marketplace (16 states and DC) Partnership Marketplace (7 states) Federally-facilitated Marketplace (27 states) * In Utah, the federal government will run the marketplace for individuals while the state will run the small business, or SHOP, marketplace.

  28. Assistance – It’s Available If You Need It 1-800-318-2596 • Certified Application Counselors • Champions for Health

  29. 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

  30. Substance Abuse Mental Health Services Administration Resources SAMSHA REGION II OFFICE Dennis O. Romero, MARegional Administrator Region II (NJ, NY, PR, U.S. VI) Substance Abuse and Mental Health Services Administration (SAMHSA) 26 Federal Plaza, Suite 3337New York, New York 10278Phone: 212-264-8097Fax: 212-264-2673 E-mail: dennis.romero@samhsa.hhs.gov Website: www.samhsa.gov /1-877-726-4727

  31. 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

  32. Resources: https://www.healthcare.gov/ https://www.cuidadodesalud.gov/es/ 1-800-318-2596 Or TTY: 1-855-889-4325 http://www.hrsa.gov/index.html http://kff.org/

  33. THANK YOU, Gracias, Merci, Grazie

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