Health Care Coverage for Kids

1. Sponsored by the: Statewide Health Insurance Benefits Advisors Health Care Coverage for Kids SHIBA

2. What is SHIBA? • Statewide Health Insurance Benefits Advisors (SHIBA) • We help with questions about: • Health insurance • Health care access • Prescription drugs • We serve all ages, all walks of life

3. SHIBA provides free, unbiasedinformation about health care coverage and access to help improve the lives of all Washington state residents.  We cultivate community commitment through partnership, service and volunteering. SHIBA mission statement

4. Do you know kids who don’t have health coverage? What do you do when your kids get sick or hurt, or need shots or checkups? What do other parents or grandparents do? Questions to think about

5. Today’s overview • Good News! Free or low-cost coverage for kids • Other options for kids • Options for adults too • How to find out more information • Help spread the word

6. Medical coverage from birth to age 19 • Free or low-cost insurance • Great benefits package • Kids can be eligible even if they are new to the USA

7. Kids’ medical • State Children’s Health Insurance Program (SCHIP) • Children’s Health Program (CHP) • Medicaid for Kids • All run by the Dept. of Social and Health Services (DSHS) Washington Apple Health for Kids:

8. Kids’ medical program benefits • They include: • Full medical, dental and Rx coverage • Well-child visits, immunizations, urgent & emergency care • Zero copayments for preventive care • Coverage for both citizen & non-citizen kids age 18 or younger

9. Washington state families (with kids) whose income is: Under 200% of the Federal Poverty Level (FPL): Kids qualify for medical, dental and vision services with no premium Kids who aren’t federally qualified immigrants pay a $98 premium Between 201 - 300% of the FPL: All kids at this level qualify for medical, dental and vision services with a: $20/month/child premium for families below 250% of the FPL $30/month/child premium for families below 300% of the FPL Premiums max out at 2 per family – no family pays more than $60/month in premiums Use the same application to apply for either program Kids’ medical programWho’s eligible?

10. Quick eligibility overview • Based on income and family size • Examples for 2012 (300%): Want to know if you qualify? Call 1-800-562-6900 to talk with a SHIBA volunteer advisor

11. Kids may qualify If they live: • With their parents • With friends or other family members • On their own

12. How can kids get this? • Call: • Washington Apple Health for Kids at:1-877-543-7669 • Woman Infants and Children (WIC) Family Health Line at: 1-800-322-2588 • Go to www.ParentHelp123.org • Complete an application • Submit proof of income and other information

13. What if kids aren’t eligible? • Will family income change? • Can the child enroll in a parent’s employer insurance? • Consider individual market insurance • Think about community or public health clinics • Talk with a SHIBA volunteer advisor about your options!

14. Options for adults too • Adults may qualify for the Basic Health Program • You must be age 19 – 64 • However, it’s not taking applications right now

15. Due to state budget cuts, Basic Health has a long wait list and is not processing new members. Excluded from the wait list includes the following groups of people: Foster parents Personal care workers People with health coverage tax credit Tribal sponsored accounts WA State National Guard or Reservists BH Plus & maternity applicants sent to DSHS, deemed ineligible for DSHS programs Former BH members disenrolled due to Medicaid coverage within 30 days Exclusions to the Basic Health wait list

16. Basic Health requirements • Subsidized insurance for people living in Washington state • Must be a U.S. citizen or qualified non-citizen • Have a gross family income at or below 200% of FPL • Examples of income guidelines in 2012: Want to know if you qualify? Call 1-800-562-6900 to talk with a SHIBA volunteer advisor

17. Basic Health requirements(continued) • Other requirements include: • You can’t be eligible for Medicare or be receiving medical services • You can’t be enrolled in the Washington Health Program • You can’t be institutionalized at the time of enrollment • You may not live in the U.S. on a student visa

18. If you’re not eligible, what then? • Call SHIBA – we can help you understand your options! • Review other suggestions: • Washington Health Program • Individual market plans • Association or discount plans • Hospital Charity Care • Assistance for certain groups

19. Don’t be a fraud victim • What is fraud? • Knowingly & willfully executing, or attempting to execute a scheme to deceive an insurance company • Billing for services or prescriptions not provided

20. Report fraud If you suspect fraud or abuse related to health care, gather the facts and report it by calling the Insurance Commissioner Hotline at: 1-800-562-6900

21. SHIBA volunteer opportunities • Do you want to help explain health care benefits or options to: • Friends? • Neighbors? • Community? • Do you want to help people become better informed consumers? • Volunteer with SHIBA!

22. For more information 1-800-562-6900 TDD: (360) 664-3154 www.insurance.wa.gov

23. Need help with other insurance questions? • The Office of the Insurance Commissioner can also help you with questions, information and complaints about all types of insurance, such as: • Call our Insurance Consumer Hotline • 1-800-562-6900 • Check us out at: • www.insurance.wa.gov • Homeowner • Auto • Life • Annuities • Health • And more!