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Seeking Access: Low-Income Women Access to Healthcare By: Jamille Fields, J.D., M.P.H. Reproductive Justice Fellow June 13, 2014.

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Presentation on theme: "Seeking Access: Low-Income Women Access to Healthcare By: Jamille Fields, J.D., M.P.H. Reproductive Justice Fellow June 13, 2014."— Presentation transcript:

1 Seeking Access: Low-Income Women Access to Healthcare By: Jamille Fields, J.D., M.P.H. Reproductive Justice Fellow June 13, 2014

2 The National Health Law Program National non-profit law firm committed to improving health care access and quality for low and limited- income individuals and underserved populations Offices in Washington, D.C., Los Angeles, and North Carolina. Seeking Access: Low-Income Women Access to Health Care2

3 Overview The Healthcare World Pre-ACA The Healthcare World Post-ACA How this affects different Populations o Women of Reproductive Age o Pregnant Women o Women Living with HIV/AIDs o Women with Disabilities o Women of Color Seeking Access: Low-Income Women Access to Health Care3

4 The World Pre-ACA Employer-Sponsored Insurance o In 2010, 56% of Americans had ESI o 92% of Americans under 65 with private insurance were insured through their employer Medicaid for some low-income individuals o Seven of ten Medicaid enrollees over 14 are women o Medicaid is the single-largest source of public funding for family-planning services and supplies o In 2010, 9.4 million women of reproductive age covered under Medicaid o Medicaid covers around 40% of births Seeking Access: Low-Income Women Access to Health Care4

5 Medicaid Eligibility: “Worthy Poor” Seeking Access: Low-Income Women Access to Health Care5 Person Characteristics Financial Condition Category of “Worthiness” State Residency Low Income Requirements for Eligibility Personal Characteristics Financial Conditions Categories Citizenship or Immigration Status State Residency Low Income Limited Resources

6 Traditional Medicaid Benefits: Seeking Access: Low-Income Women Access to Health Care6 Traditionally, Medicaid requires states to cover broad categories of services o States help define what is covered in each category Existing Buckets (list not exhaustive) o Inpatient hospital services (other than services in an institution for mental diseases) o Outpatient hospital services o Laboratory and X-ray services o Early and periodic screening, diagnostic, and treatment (EPSDT) services for recipients under age 21 o Pregnancy-related services and services for conditions that might complicate pregnancy o Family planning services and supplies o Physician services

7 The World Post- ACA Seeking Access: Low-Income Women Access to Health Care7

8 Marketplace Coverage Name of presentation goes in footer8

9 U.S. Supreme Court: An Option Created Name of presentation goes in footer9 Federal government cannot terminate a state’s Medicaid funding for not expanding 27 states, including the District of Columbia, have decided to expand Medicaid

10 Consequences of Failure to Expand Seeking Access:: Low-Income Women Access to Health Care10 http://kff.org/interactive/uninsured-gap/

11 Family Planning “Expansion” Option Seeking Access: Low-Income Women Access to Health Care11 Family Planning “waiver” programs o States option to provide family planning services to women (and men if the state chooses) who would otherwise be ineligible for Medicaid ACA created a new optional category of eligibility for states to cover women and men in need of family planning and related services o Family planning “SPA” option 29 states have expanded family planning services to otherwise ineligible individuals

12 ACA Required Benefits Name of presentation goes in footer12 Essential Health Benefits Again, Big Buckets: o Ambulatory patient services o Emergency services o Hospitalization o Maternity and newborn care o Mental health and substance abuse services, including behavioral health treatment o Prescription drugs o Rehabilitative and habilitative services and devices o Laboratory services o Preventive and wellness services and chronic disease management (more on this later) o Pediatric services, including oral and vision care

13 WHAT THIS ALL MEANS FOR WOMEN

14 Women of Reproductive Age Seeking Access: Low-income Women Access to Health Care14 “Reasonable medical management” allowed Women’s preventive services req are gender-specific Contraceptive req includes “as prescribed” frequency

15 Women Living with HIV/AIDS Seeking Access: Low-Income Women Access to Health Care15 Traditional Medicaid – “Catch 22” o Categories remain o Childless adults need AIDS diagnosis to qualify Medicaid Expansion States o New eligibility paths for childless adults o Nearly 60,000 uninsured persons with HIV living in states not expanding Medicaid o Out of 10 states with highest HIV diagnosis, 5 have not expanded

16 Pregnant Women Name of presentation goes in footer16 Abortion Coverage Restrictions in the Marketplace – Nelson Amendment o States can ban abortion outright o No “subsidy” funds can be used for abortion except for Hyde permitted Medicaid Restrictions Remain - Hyde Amendment o Rape, Incest or Life Endangerment

17 Pregnant Women: Maternity Care Seeking Access: Low-Income Women Access to Health Care17 Full-Scope Medicaid Coverage o Meets state income threshold Pregnancy-Related Coverage o Exceeds threshold, but below 133% of the FPL Medicaid Expansion o Not if pregnant at time of application Children’s Health Insurance Plan o State Option, State Discretion on upper-income threshold Health Insurance Marketplaces o Qualified Health Plans must include maternity coverage

18 ACA & Women with Disabilities Name of presentation goes in footer18 Pre-existing condition exclusions prohibited Medicaid Community First Choice Options o State option to cover HCBS for people up to 150% FPL or requiring institutional care Medicaid Removal of Barriers o State option to provide HCBS to people up to 3X the SSI rate who are in waiver programs (currently only up to 150% FPL)

19 Women of Color: Medicaid Seeking Access: Low-Income Women Access to Health Care19

20 Women of Color: Marketplace Seeking Access: Low-Income Women Access to Health Care20 Marketplace Enrollment -- Distribution by Race/Ethnicity of Marketplace Plan Selections and the QHP Eligible Population in the 36 FFM States Dep’t of Health and Human Servs.,Office of Assistant Secretary for Planning and Evaluation, Health Insurance Marketplace: Summary Enrollment Report For the Initial Annual Open Enrollment Period, For the period: October 1, 2013 – March 31, 2014 (May 1, 2014)

21 ACA Non-Discrimination: Sec. 1557 Name of presentation goes in footer21 Prohibits discrimination on basis of race, color, sex, national origin and disability in: o any health program or activity receiving Federal financial assistance; o any program or activity administered by a federal Executive agency; and o any entity established under Title 1 of ACA (e.g. Marketplaces) HHS clarified that discrimination based on sex includes discrimination based on gender-identity or sex stereotypes Based on existing federal civil rights laws

22 Conclusion ACA has brought many changes, but gaps still remain How implementation handled will make the difference Please feel free to use me as a resource throughout your summer Jamille Fields fields@healthlaw.org Name of presentation goes in footer22

23 Washington DC OfficeLos Angeles OfficeNorth Carolina Office 1444 I Street NW, Suite 1105 Washington, DC 20005 ph: (202) 289-7661 fx: (202) 289-7724 nhelpdc@healthlaw.org 3701 Wilshire Blvd, Suite #750 Los Angeles, CA 90010 ph: (310) 204-6010 fx: (213) 368-0774 nhelp@healthlaw.org 101 East Weaver Street, Suite G-7 Carrboro, NC 27510 ph: (919) 968-6308 fx: (919) 968-8855 nhelpnc@healthlaw.org www.healthlaw.org THANK YOU


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