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Health Access and Health Department Resources Becky Brumley, RDH, MPH Care Coordination Director Tennessee Chapter of the American Academy Pediatrics

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Presentation on theme: "Health Access and Health Department Resources Becky Brumley, RDH, MPH Care Coordination Director Tennessee Chapter of the American Academy Pediatrics"— Presentation transcript:

1 Health Access and Health Department Resources Becky Brumley, RDH, MPH Care Coordination Director Tennessee Chapter of the American Academy Pediatrics

2 TennCare Medicaid TennCare Medicaid is for Tennesseans who are eligible for a Medicaid program. You can apply anytime for TennCare Medicaid. There are several different groups of people that may qualify. And, each group has different income limits. Some of the groups also have limits on how much you own-your "resources." These are things like bank accounts, cars, and land. The number of people who live in your household count too.

3 TennCare Medicaid covers are: Children under age 21 that are financially eligible, income limits vary by age of child Low income pregnant women Parents or caretakers relatives of a minor child(ren) Newborns-children who are born to Medicaid eligible women Medically Needy –low income person who are also one of the following: Some children up to age 21 A pregnant woman or child under age 18 Supplemental Security Income (SSI) - low income age, blind and/or disabled individuals. Low income persons who require care in a nursing facility or intermediate care facility for the mentally retarded r who receive Home and Community- based Services Tennessee women who are uninsured or whose insurance does not cover treatment for breast or cervical cancer, who are under age 65, and who have been determined by the County Health Department to need treatment for breast or cervical cancer need of treatment for breast or cervical cancer

4 TennCare Standard Uninsured - is only available for children under age 19 whose TennCare Medicaid eligibility is ending, who o not have access to insurance through a job or a family’s member job, and whose family incomes are below 212% poverty. Medically eligible – is available only to children under age 19 whose TennCare Medicaid eligibility is ending and whose family income equals or is greater than 212% of poverty. To be medically eligible, the child must have health conditions that make the childe “uninsurable.” The family is unable to purchase healthcare insurance for the child in the private market because of the child’s health conditions. Eligibility is determined by TennCare

5 Medicare Cost Sharing Programs Cost sharing assistance for low income Medicare beneficiaries. Low income disabled working individuals under 65 who are entitled to Medicare Part A. Low income persons eligible for Medicare Part A. Low income Medicare beneficiaries All categories must meet one of the other Medicaid categories for low income and resource limits. Applications are provided from the Tennessee Health Connection at

6 How to Apply for TennCare If you need assistance with TennCare Tennessee Health Connection Health Insurance marketplace can apply online at the Health Insurance marketplace https://www.healthcare.gov Print an application and-articles/marketplace-application-for-family.pdf and-articles/marketplace-application-for-family.pdf

7 Cover Kids Age 18 or younger Household income up to 250% of federal poverty level (FPL) Buy-in is available for children with higher incomes A Tennessee resident U.S. citizen or qualified legal alien (babies born in the U.S. will be considered U.S. citizens)qualified legal alien (babies born in the U.S. will be considered U.S. citizens) “Go Bare” (without health coverage): three months. Waived for newborns up to 4 months of age, waived for children moving to CoverKids from TennCare or from another state SCHIP program Screened first for TennCare eligibility or access to other state-sponsored insurance Federal guidelines prohibit children of state em-12 teachers and full-time support staff from participating in this program Maternity coverage available for pregnant women at or below 250% of the federal poverty level who meet other eligibility criteri. CoverKids must be your only health plan. To get benefits, your child cannot be part of any other plan. You cannot use CoverKids as a second health plan HealthyTNBabies covers pregnant women who do not have maternity health benefits, you cannot use CoverKids HealthyTNBabies as a second health plan.

8 Cover RX To be eligible to participate in CoverRx, applicants must meet the following eligibility guidelines. Tennessee resident (six months) Age U.S. citizen or qualified legal alien Household income below the federal poverty level (FPL) Cannot have pharmacy coverage such as TennCare or employer insurance Cannot have Medicare (any part including A, B, C or D) CoverRx members may participate in other discount drug programs, such as those offered by retail stores Effective January 1, 2014, income guidelines for eligibility changed and only individuals with a household income below 100% federal poverty level will be eligible to apply for CoverRx benefits.

9 To Apply for Cover TN programs

10 Federal Poverty Rates

11 HEALTH INSURANCE MARKETPLACE Health Insurance marketplace can apply online at the Health Insurance marketplace https://www.healthcare.gov Print an application and-articles/marketplace-application-for-family.pdf and-articles/marketplace-application-for-family.pdf

12 HEALTH INSURANCE MARKETPLACE 2014 Enrollment ended March 31, Open Enrollment November 15, February 15, 2015 Special Enrollment 60 days following certain life events Change in life status Marriage Birth of a child Loss of other health coverage

13 Health Assist Tennessee Help LineToll FreeLocal (Nashville) English Spanish Kurdish/Arabic Bosnian Help the uninsured receive medical care, dental, vision and medications Screening all callers for federal medical programs such as TennCare, QMB, and SLMB; and state programs such as Cover Kids and Access TN Counsel Medicare recipients on Part D and other Medicare related issues, and give accurate summaries of available pre-existing plans Language Services/Medical Interpretation continues to help providers and organizations when dealing with language barriers in any setting

14 1-855-CRISIS The ONE Number to call for Mental Health and Substance Abuse Crisis Services in Tennessee Triage Prevention Crisis Assessment & Evaluation Early Intervention Diversion Stabilization TENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

15 Tennessee REDLINE Clearinghouse (800) Training TAADAS Tennessee Association of Alcohol, Drug and other Addiction Services

16 Patient Assistant Programs (PAP) NeedyMeds RX Outreach Drug Companies

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29 Dispensary of Hope The Dispensary of Hope works with healthcare providers, clinics, and pharmaceutical companies nationwide to provide patients with necessary prescription care. They do this by distributing unused sample medications and surplus medications generated within the manufacturing process-- medications that would otherwise be thrown away--to people without prescription coverage HOPE

30 Access Sites Centerville Chattanooga Hohenwald Jackson Johnson City Maryville Memphis Murfreesboro Nashville

31 Sight for Students is a Vision Sight Plan charity that provides free vision exams and glasses to low-income, uninsured children. The program operates nationally through a network of community partners who identify children in need and VSP network doctors who provide the eyecare services. Community Partners Boy and Girls Clubs National Head Start Association National Association of Community Health Centers National Association of School Nurses Communities in Schools Prevent Blindness America National Council of La Raza

32 Tennessee Department of Health Resources

33 Family Health and Wellness Adolescent and Young Adult Health Initiative Adolescent and Young Adult Health Initiative Adolescent Pregnancy Prevention Adolescent Pregnancy Prevention Asthma Management Initiative Asthma Management Initiative Breastfeeding Breast and Cervical Cancer Screening Breast and Cervical Cancer Screening Child Fatality Review Child Nutrition and Wellness Child Nutrition and Wellness Children and Youth with Special Health Care Needs (CYSHCN) Children and Youth with Special Health Care Needs Diabetes Family Planning Farmers Market Nutritional Program Farmers Market Nutritional Program Fetal Infant Mortality Review Fetal Infant Mortality Review Governor's Council on Physical Fitness and Health Governor's Council on Physical Fitness and Health Home Visitation Injury Prevention Maternal and Child Health Maternal and Child Health Newborn Genetic Screening Newborn Genetic Screening Newborn Hearing Screening Newborn Hearing Screening Nutrition Services Tobacco Use Prevention and Control Tobacco Use Prevention and Control Women, Infants and Children Women, Infants and Children

34 Women, Infants and Children (WIC) Federal program through USDA Provides a combination of nutrition education, supplemental foods, breastfeeding promotion and support, and referrals for health care. Effective in preventing and improving nutrition related health problems. Provides supplemental food to low-income pregnant, postpartum and breastfeeding women, infants and children until the age of five. Types of foods include fruits and vegetables, whole grain foods, low fat milk, cheese, eggs, peanut butter and dry beans and special foods like soy beverages and tofu. Vouchers are issued to participants and can be used to purchase approved food items at any of the 900+ participating WIC authorized grocery stores and pharmacies.

35 Qualifications for WIC Household gross income must be equal to or less than these WIC income guidelines (185% of Federal poverty). Income eligibility is determined at the county health department. Must be a Tennessee resident For women you must be pregnant or breastfeeding Children must be present for certification and recertification

36 Breast and Cervical Cancer Program (BCS) Provides breast and cervical cancer screening to eligible women and diagnostic follow up tests for those with suspicious results. Women diagnosed with breast or cervical cancer or pre-cancerous conditions for these cancers are enrolled for treatment coverage through the state’s TennCare Program.

37 Eligibility Requirements for BCS All women must meet the following general eligibility requirements: Age: between 40 and 64 Income: 250% FPL or less Insurance: uninsured or underinsured Mammograms are only available for women If a woman has family history of breast cancer she can receive screening services starting at age 40. Women 40 and older can receive Pap tests and other needed cervical services. Women younger than 40 who meet these general eligibility requirements can be enrolled for diagnosis and/or treatment services when they have suspicious results from screening services.

38 State Hemophilia Program Participants must be financially eligible (300% of the Federal Poverty Guideline) and meet the medical criteria. Services covered directly associated with the bleeding disorder include: Blood and blood products (maximum program expenditure for a 12- month period per patient is $15,000) Recombinate clotting factors Emergency room services Professional fees Clinic fees and Laboratory Special medical services (i.e., orthopedic appliances, dental and other extraordinary services, limited to $3000 for a 12-month period). Insurance premiums: TennCare or COBRA Inpatient, must be bleed related, with prior authorization Ancillary Supplies (i.e., syringes, needles, swabs, etc., when related to bleeding)

39 Tennessee Renal Disease Program Financially eligible at or below 200% of the federal poverty level Cost of prescription/over-the-counter drugs required for treatment of end stage renal disease and not covered by a participant’s third party insurer. In center dialysis services for patients who do not have health insurance and are ineligible for TennCare during the waiting period before Medicare eligibility begins Payment of Medicare insurance premiums for eligible program participants including both “Part A” and “Part B” payments Costs of a dental evaluation and up to $ on recommended restoration work with prior approval Medicare co-insurance of a participant to dialysis out-of-state for a maximum of six (6) treatments per year

40 Program eligibility Breast and Cervical>250% TennCare>200% WIC>185% Hemophilia>300% Renal>200%

41 Help Us Grow Successfully (HUGS) is a targeted case management program that provides home-based intervention services to pregnant/postpartum women, children birth through the age of five (5) years and their primary caregivers. Home visitors screen for and identify potential problems, provide education, and connect families with resources in their communities. Home visitors form a unique and voluntary relationship with a family. Is available in all counties in Tennessee

42 Family Planning provides the following medical services: physical exams, cervical cancer screening, breast/testicular cancer screening, sexually transmitted infection testing, STI treatment, high blood pressure screening, anemia screening, pregnancy testing and contraceptive methods. also provides counseling and education regarding reproductive and other health related topics.

43 Traumatic Brain Injury (TBI) Toll Free Service Coordinators are located in various non-profit agencies across the state providing assistance to survivors and family members. Service coordinator works with survivors and their families to assess their current resources and needs. The service coordinator: develops a comprehensive plan of care provides referrals to available resources coordinates services for individual client advocacy bridges gaps in the service delivery system. provide grants to county and municipal governments and/or non-profit organizations for home and community based programs to serve the needs of traumatic brain injury survivors and their families.

44 Communicable and Environmental Disease and Emergency Preparedness (CEDEP) Appropriate Antibiotic Use Emergency Preparedness Emerging Infections Surveillance and Epidemiology Reportable Diseases Immunizations Sexually Transmitted Infections Tuberculosis

45 Health Statistics Health Professional Licensure Data Behavioral Risk Factor Surveillance Hospital Discharge Data Traumatic Brain Injury Data CODES (TN Crash Outcome Evaluation System) Health Information Tennessee Searchable Database Births Deaths Population Facilities

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