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:

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 ,700
African American 236,000
Hispanic 561,600
Other 114,100

3. 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

4. New Jersey Uninsured Top 8 Counties
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
NJ has opted to expand Medicaid to to 133% of the FPL for persons under age 65.
However, it did not opt to establish it’s own health insurance exchange –or Marketplace.
HHS responsible for establishing Marketplace in New Jersey ---responsibility of HHS/CMS Regional Office to provide the training, education and outreach for all aspects of the Marketplace.
We will begin with an 8 county focus, where about 60% of the uninsured reside. (.600,000)

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 Care In 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

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
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

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?
05/15/2013
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
1. It’s an easier way to shop for health insurance
Simplifies the search for health insurance
All options in one place
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 simple terms you can understand
Health Insurance Marketplace 101

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
05/15/2013
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
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
Health Insurance Marketplace 101

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, 2013WA OR WY
UT* TX SD OK ND NM NV NE MT LA KS ID HI CO CA AR AZ AK WI WV VA TN SC OH NC MO MS MN MI KY IA IN IL GA FL AL VT PA NY NJ NH MA ME CT DE RI MD DC
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.

29. Assistance – It’s Available If You Need It
Certified Application Counselors
Champions for Health

35. 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

36. Substance Abuse Mental Health Services Administration Resources
SAMSHA REGION II OFFICE
Dennis O. Romero, MA Regional Administrator
Region II (NJ, NY, PR, U.S. VI)
Substance Abuse and Mental Health Services Administration (SAMHSA) 26 Federal Plaza, Suite 3337 New York, New York Phone: Fax:
Website: /

37. SAMSHA Mental Health Resources
SAMHSA Website in Spanish:
Publications in Spanish: 
SAMHSA related information: 
Web link dedicated to children’s mental health:   
Materials and Resources:   
Short Report: “Promoting Recovery and Independence for Older Adolescents and Young Adults Who Experience Serious Mental Health Challenges”:   

38. Resources: https://www.healthcare.gov/ Or
TTY:

39. THANK YOU, Gracias, Merci, Grazie