1. Child Health and the ACA Kate Honsberger Child Health Insurance Program Manager Virginia Health Care Foundation October 2013

2.  Miss more school  Are less likely to have a consistent medical home  Are less likely to get treatment for childhood conditions like ear infections & asthma  Are less likely to get needed vision or dental care  Too often receive their necessary medical care in costly ERs Children Without Health Insurance

3.  According to the Journal of Public Health (October 2009)…  Uninsured children who are hospitalized (for any reason) are 60% more likely to die in the hospital than insured children.  Children who are hospitalized for complications that could have been avoided by preventive care (e.g. asthma, colds progressed to pneumonia) are also much more likely to die if they don’t have insurance. Children Without Health Insurance

4.  123,000 uninsured children in Virginia  56% or 69,000 of them are under 200% FPL  87% or 107,000 of them are under 400% FPL Uninsured Children in Virginia

5.  Many of Virginia’s uninsured children are eligible for:  Public health insurance through Virginia’s state-sponsored health insurance programs  Reduced-cost private health insurance through the Federal Marketplace Uninsured Children in Virginia

6.  Public Health Insurance  Medicaid  CHIP  Private Health Insurance  Purchased through the Federal Marketplace  Some people may be eligible for tax credits and subsidies to help make the private health insurance more affordable  Family coverage through an employer Public and Private Health Insurance Options for Children

7. FAMIS Plus (Children’s Medicaid)  Currently covers over 521,000 Virginia children  Children from birth to age 19  Family income up to and including 143% FPL  Approximately 46,000 uninsured children in Virginia are likely eligible for this program and not enrolled Virginia’s Public Insurance Options

8. FAMIS (CHIP - Children’s Health Insurance Program)  Currently covers more than 63,000 Virginia children  Children from birth to age 19  Family income eligibility ranges from 144% FPL up to 200% FPL  Approximately 23,000 uninsured children in Virginia are likely eligible for this program and not enrolled Virginia’s Public Insurance Options

9. Medicaid for Pregnant Women  Currently covers more than 16,000 pregnant women  Income up to 143% FPL FAMIS MOMS  Currently covers more than 1,500 pregnant women  Income 144% FPL to 210% FPL  Program being phased out  No new applications past December 31 st  Women on the program by that time will remain enrolled through the end of their pregnancies Virginia’s Public Insurance Options

10.  Virginia’s public health insurance options have been available to children and pregnant women for many years. However, the ACA has changed some of the eligibility rules - effective October 1 st !  Some families who have applied in the past and were denied, may now be eligible. Virginia’s Public Insurance Options

11.  The Affordable Care Act provides new health insurance options for those who may not have had access to affordable coverage in the past.  Beginning on October 1 st individuals can begin shopping for private insurance through the Federal Health Insurance Marketplace. New Private Health Insurance Options

12.  The Federal Health Insurance Marketplace is an online marketplace that gives consumers the opportunity to shop for private health insurance  Anyone can purchase private insurance in the Marketplace at full cost  Many lower income consumers will be eligible for Tax Credits and Subsidies to help make the private health insurance affordable Federal Health Insurance Marketplace

13.  Open Enrollment:  Starting on October 1, 2013 – individuals can begin shopping for private health insurance on the Federal Marketplace  Coverage purchased during this time will be begin on January 1, 2014.  In Virginia, the Marketplace can be accessed at www.healthcare.govwww.healthcare.gov  Open Enrollment ends March 31, 2014 Federal Health Insurance Marketplace

14.  Consumers will be able to view health insurance plans in their area and compare prices and rates to figure out which one will work best for them and their families  Health Insurance companies will have to publish their rates and explain in simple terms what their plans entail and cost  Health insurance companies can no longer charge women more than men for health insurance and they cannot charge more for pre-existing conditions (except tobacco use) Federal Health Insurance Marketplace

15.  All health insurance plans sold in the Federal Marketplace will have to contain Essential Health Benefits:  Doctor visits  Prescription drugs  Emergency services  Hospitalization  Laboratory services  Maternity and newborn care  Preventive services and chronic disease management  Mental health and substance abuse services  Pediatric services, including oral and vision care (pediatric oral services may be provided by stand-alone plan) Federal Health Insurance Marketplace

16.  Making private health insurance more affordable  Tax Credits will be available for Marketplace consumers between 100% FPL and 400% FPL  These Tax Credits can be used to help lower the cost of private health insurance premiums and can be applied right away (you don’t have to wait until you file your taxes)  Tax Credits are only available to consumers who do not have access to affordable employer sponsored coverage or any public health insurance options  Some families (between 100% FPL and 250% FPL) also might qualify for subsidies to reduce co-pays and deductibles Federal Health Insurance Marketplace

17.  Young adults allowed to stay on parents’ private health insurance up to age 26  No children can be turned down for health coverage based on pre-existing conditions  Starting January 1, 2014 – no adults blocked from coverage for pre-existing conditions  No more lifetime limits on health insurance and restrictions placed on annual limits (to be completely banned in 2014) Other ACA Impacts

18.  Foster Care children who age out of the system in Virginia at age 18 are now allowed to stay on Medicaid until they are 26 regardless of their income  In 2014 - Mandate that all Americans have insurance or must pay a penalty  Many exceptions to this rule, including: affordability, religious exemption, undocumented, incarcerated, below the tax filing threshold or eligible for Medicaid but living in an non-Medicaid expansion state (this applies in Virginia in 2014) Other ACA Impacts

19. How can School Nurses help connect uninsured children to health insurance?

20.  There are a lot of questions and mis- information out there about the new health insurance coverage options.  School nurses are a valuable resources for parents when it comes to trusted information about getting their children enrolled in health insurance. What can School Nurses do to help?

21.  Inform parents about the value of health insurance to their children’s well-being  Let them know about the options that are out there for providing their children with health insurance  Public  Private  Direct families to healthcare.gov or coverva.org for more information What can School Nurses do to help?

22.  Send home information about health coverage with children  Add health insurance questions to mandatory health forms or emergency contact forms  Follow up directly with families who indicate they do not have health insurance  Include permission to share this information with outreach organizations in your area for additional follow up and help What can School Nurses do to help?

23.  Partner with other school resources to draw attention to the importance of health insurance  Sports coaches  Guidance counselors  Teachers  PTA  Organize an event to provide parents with information about health insurance What can School Nurses do to help?

24.  If you have a family who is interested in applying for public health insurance or needs help, you can refer them to:  Local outreach workers and application assistors in your area  The Federal Marketplace Call Center  1-800-318-2596  The Cover Virginia Call Center  1-855-242-8282  Their local Department of Social Services What can School Nurses do to help?

25.  Materials to hand out to families are available free of charge for you to order at www.coverva.orgwww.coverva.org  If you are interested in knowing more about eligibility and enrollment into Virginia’s public health insurance programs – you can attend a SignUpNow training in your area  Establish a relationship with an outreach worker in your area to help get families connected to health insurance faster and easier Tools and Resources for School Nurses

26.  Income guideline charts to help you determine what public health insurance programs a family might be eligible for  Federal Marketplace materials available at - http://marketplace.cms.gov/ http://marketplace.cms.gov/  Questions? Contact me!  Kate Honsberger, Virginia Health Care Foundation  kateh@vhcf.org or 804-828-5804 kateh@vhcf.org Tools and Resources for School Nurses