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Tips for Caring for the Uninsured: A Guide Based on One State’s Possibilities

Tips for Caring for the Uninsured: A Guide Based on One State’s Possibilities. American College Health Association Annual Meeting June 3, 2010 Bev McCoy, FNP Clinician/Clinic Manager Arizona State University Polytechnic Student Health Center.

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Tips for Caring for the Uninsured: A Guide Based on One State’s Possibilities

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  1. Tips for Caring for the Uninsured: A Guide Based on One State’s Possibilities American College Health Association Annual Meeting June 3, 2010 Bev McCoy, FNP Clinician/Clinic Manager Arizona State University Polytechnic Student Health Center

  2. Objectives for today’s session: The attendee will be able to: 1.Describe briefly some of the statistics about the uninsured college population. Identify how and where to look for health care for the uninsured. Identify examples of and sources for care for the uninsured.

  3. Background • 13.7 million uninsured in the 19 to 29 age group (2008 estimate), comprise about 30% of uninsured under 65 years old (per Commonwealth Fund, since 2003, it’s worse every year) • Many skip care (76% of uninsured, 2009) or accumulate debt due to care. Many often quit school. (in US News & World Report, Health website, posted 5/21/10)

  4. Uninsured Rates Among Nonelderly by State, 2007-2008 NH VT WA ME MT ND MN MA OR NY WI SD ID RI MI CT WY PA NJ IA NE OH NV IN IL DE UT WV VA MD CO CA KS MO KY DC NC TN OK SC AR AZ NM GA AL MS AK TX LA FL HI <14% Uninsured (18 states & DC) National Average = 17% 14 to 18% Uninsured (18 states) >18% Uninsured (14 states) SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 and 2009 ASEC Supplements to the CPS., two-year pooled data.

  5. Adults’ Health Insurance Coverage by Family Poverty Level, 2008 Number 300% + 94.1 M 28.7 M 200-299% 100-199% 30.4 M Under 100% 30.9 M NOTES: The Federal Poverty Level for a family of four in 2008 was $22,025. Family size and total family income are grouped by insurance eligibility. Adults includes all individuals aged 19-64. Data may not total 100% due to rounding. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2009 ASEC Supplement to the CPS.

  6. Barriers to Health Care Among Nonelderly Adults, by Insurance Status, 2008 Percent of adults (age 18 – 64) reporting: * In past 12 months.Respondents who said usual source of care was the emergency room were included among those not having a usual source of care.SOURCE: KCMU analysis of 2008 NHIS data.

  7. Adults’ Health Insurance Coverage by Family Poverty Level, 2008 Number 300% + 94.1 M 28.7 M 200-299% 100-199% 30.4 M Under 100% 30.9 M NOTES: The Federal Poverty Level for a family of four in 2008 was $22,025. Family size and total family income are grouped by insurance eligibility. Adults includes all individuals aged 19-64. Data may not total 100% due to rounding. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2009 ASEC Supplement to the CPS.

  8. Health Insurance Coverage of the Nonelderly and Low Income Population, 2007 All Nonelderly 261.4 Million Low Income Nonelderly 91.0 Million Note: Low-income includes those with family incomes less than 200% of the federal poverty level. ($42,400 per year for family of four in 2008); Medicaid/Other Public includes Medicaid, SCHIP, other state programs, Medicare and military-related coverage. Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2008 ASEC Supplement to the CPS.

  9. Insurance and College Students • 1.7 million uninsured, approximately 20% of college students • Characteristics of group similar to uninsured generally • $120-255 million in uncompensated care (2005) This and next 2 slides from Elizabeth Redden’s article in Inside Higher Education, March 31, 2008, based on 2008 GAO report on health insurance at colleges

  10. College Student Coverage (cont.) • 67% through employee-sponsored plans (usually parent’s) • 7% other private plans (including student health insurance) • 6% public programs

  11. Colleges Offering Health Plans • 57% offer insurance to students 82% of four-year public 71% of four-year private, nonprofit 29% of 2-yr public • Annual premiums range $30 to $2400 • Often there are limits such as $2500/incident or $1 million life-time maximum, no drug coverage, services may not be included.

  12. ACHA 2007: Colleges Requiring Health Insurance Coverage • 1/3 of public and nearly 80% of private colleges require insurance for full-time students • With the trend toward fee-for-service funding, many more are considering offering health insurance to students.

  13. ACHA 2007: Underinsured • 94% Public and 75% private schools are concerned about underinsured students: >$1000 deductible Inadequate prescription or mental health coverage, no catastrophic coverage and other concerns These 2 slides from ACHA Presentation at 2007 Annual meeting in San Antonio, TX “The State of Student Health Insurance: Implications for ACHA Standards by Donna Mills, MPH, Marquette University, 6/1/07

  14. STORIES • Lexapro 10 mg for pt with depression—$98.37 (from Costco) • Zofran 8 tabs from the ED-- $54! • Advair 250/50 for asthmatic who needs it: $216.86 (from Costco) • Your stories???

  15. Cover the Uninsured.com

  16. Arizona Statistics (per their site) • 81.9 % of population w/ health insurance • 55.0 % of employers offering health insurance to employees • 87.0 % of population that could get medical care when needed • 15.2 Patients served by FQHCs as a % of population under 200% FPL

  17. To find health coverage in your state • On the map, select your state • Get: • State Profile • Guide to Finding Health Insurance Coverage __________ (your state)

  18. Guide to Finding Coverage in AZ Step 1 COBRA Have you recently lost your job, had health insurance at your job and your employer had at least 20 employees: COBRA fewer than 20 employees: may get COBRA Must pay total premium.

  19. Guide to Finding Coverage in AZ Step 2 COBRA Have you recently had a change in family status (graduated, divorced, legally separated, widowed): --at least 20 employees—COBRA --fewer than 20 employees—may have a right to COBRA • www.dol.gov/ebsa/faqs/faq_consumer_cobra.html or toll-free 1.866.275.7922

  20. Guide to Finding Coverage in AZ Step 3 HCTC Have you recently lost your job because of trade policy (job moved oversees, increased imports): Health Coverage Tax Credit (HCTC) may pay up to 65% of premium for 1 yr Customer Contact Center by calling Toll free 1.866.628.HCTC or at www.irs.gov/individuals/index.html.

  21. Guide to Finding Coverage in AZ Step 4 HCTC If you are an early retiree and lost your insurance…. • 55+ years old • Lost pension that was paid by Pension Benefits Guarantee Corp: Health Coverage Tax Credit (HCTC) may pay up to 65% of premium for 1 yr (see contact info above)

  22. Guide to Finding Coverage in Az STEP 5 AHCCCS/Medicaid If you cannot afford health insurance… You may qualify for AHCCCS (Arizona’s Medicaid Program) http://www.ahcccs.state.az.us/ and http://www.ahcccs.state.az.us/Publications/Reference/IncomeLimits/EligibilityRequirements.pdf

  23. Guide to Finding Coverage in Az • How poor do you have to be for AHCCCS? *If working FT cannot earn more than $5.20/hr or if ½ time $10.40/hr (100% of Federal Poverty Level $10,830)

  24. Guide to Finding Coverage in Az • Be sure to ask about other available programs when you contact AHCCCS. • More Help Finding Your Way You may want help finding out what programs exist, if you qualify and how to work through the system: Community Legal Services at 800 852 9075.

  25. Guide to Finding Coverage in Az KidsCare (Az CHIP) Covers children up to 19th birthday (freshmen?) Must have been w/o insurance coverage for last 3 months Monthly premium based on income: $10-$35 *200% of FPL http://www.kidscare.state.az.us/English/Default.aspApplicationHelp@azahcccs.gov?subject=KidscareApplication

  26. Guide to Finding Coverage in Az • Serious medical condition or disability: perhaps Medicare Arizona Center for Disability Law at 520.327.9547 or 800.922.1447 or visit www.acdl.com.

  27. Guide to Finding Coverage in Az • Blind or disabled & have low income or spend most of income on medical care: Medicaid/AHCCCS NOTE: Often denied & need to appeal. For Help: Medicare in AZ 1.800.432.4040 Community Legal Services to find the nearest office 1.800.852.9075

  28. Guide to Finding Coverage in Az STEP 6 Private Insurance • Many private companies offer individual and family coverage • Brand name companies and unknowns, which can be found by going to an independent health insurance agent • Comparison shop CAREFULLY!

  29. Private Health Insurance Example 20 yr old woman in Maricopa County Deductible Monthly Premium $10,000 $29.66-90.60 7,500 $33.47-$86 5,000 $56.56-$135 2,500 $44.89-$162.93 1,000 $97.98-$408 none only 1: $136 *from ehealthinsurance.com: all have various co-pays, co-insurance amounts, deductibles and types of coverage (HMO, PPO)

  30. Private Health Insurance Example 20 yr old man in Maricopa County Deductible Monthly Premium $10,000 $28.39-$70.86 7,500 $32.20-$65 5,000 $46-$92.35 2,500 $43.62-$152.95 1,000 $85.28-$165.37 none $112.80-$297 *from ehealthinsurance.com: all have various co-pays, co-insurance amounts, deductibles and types of coverage (HMO, PPO)

  31. Guide to Finding Coverage in Az STEP 8 FQHC/CHC If you still can’t find coverage… Federally-funded Community Health Centers 17 Az Health centers provide health care regardless of ability to pay and even if there is health insurance coverage. Find the health center closest to you @ http//:ask.hrsa.gov/pc .

  32. Arizona Community Health Centers

  33. ASU Health Center Plans

  34. ASU Bridge Service Plan • For $129 per semester fall coverage 8/16/10-1/15/11 spring 1/16/11-8/15/11 Discount on services only at ASU health centers: $10 Office visit $20 lab/x-ray (at Tempe) Specialists at ASU-Tempe (derm, GYN, ENT & Ortho) $30

  35. Bridge Service Plan (cont.) Plan can be used: • alone for uninsured or • If private insurance (personal, parent’s employer’s) won’t cover services at on-campus health center • Greatly reduces price of care for students with high deductibles on their policies. When they enroll in the program, they can predict how much they will pay for services (membership + copay fees).

  36. Student Health Insurance Plan Arizona Board of Regents offers a policy to all University Students (ASU, NAU, U of A) 2009-2010 premium $1523 Fall $588 Aug. 16-Jan.3 Spring $935 Jan. 4-Aug. 15 $250 deductible annually HMO Services at ASU $10 office visit $10 lab copay $10 x-ray at ASU-Tempe No pharmacy coverage Referrals usu. required

  37. State Programs Check: • State’s Department of Health Services • Association of Community Health Centers • Center for Medicare and Medicaid @ www.cms.gov • Bureau of Primary Care @ www.bphc.hrsa.gov

  38. AdultBasic Program-Pennsylvania Adult without children: AdultBasic program Qualified adults pay $36/mo. per family member *Income levels after earned income and dependent care deductions (See plan website for more details) **18 yr olds may qualify for CHIP

  39. Veterans Veterans’ Assistance Iraq & Afghanistan Veterans entering college under the GI Bill • Health care & drug coverage through a VA medical facility. • Student may be eligible for assistance if he/she served on active duty and have an honorable or general discharge. • VA Health Benefits Service Center toll-free at 1.877.222.VETS or visit www.va.gov/health.

  40. County Health Departments Counties in Arizona (except Gila County) offer clinics for low-income residents.

  41. Guide to Finding Coverage in AZ Sliding Clinics Fee include primary care services, pediatrics, women’s health, dental services, behavioral health and sometimes specialty services. http://www.azdhs.gov/hsd/sfsclinics.htm

  42. Guide to Finding Coverage in AZ Sliding Fee Scale Clinics A sliding fee schedule (SFS) is used by providers offering discounted fees for services to persons without health insurance. The SFS determines, based on gross family income, the percentage or portion of billed charges that the uninsured client will be responsible to pay Phone:  (602) 542-1219 AzDHS, Bureau of Health Systems Development

  43. U.S. Sliding Fee Clinic Map @ www.needymeds.com The 11,071 clinics in this database are free or low cost with a sliding scale based on income. Find clinics two ways: • Enter the ZIP code to find clinics in your area or click on your state on the map AZ-161 clinics on list OR Menu on Left: Additional Programs—then Free/low cost clinics

  44. Links on www.needymeds.com

  45. Federal Poverty Levels 2010

  46. Tips for Caring For the Uninsured Other Sources of Care

  47. Indian Health Services Services comprehensive range from primary care (inpatient & outpatient) to tertiary care & specialty In addition: -dental services; -behavioral health; -public health nursing; -health education; and -environmental health services

  48. From www.ihs.gov Eligibility? • Member of a tribe (enrolled or not)or pregnant with an eligible member or in case of public health concern • Live on a reservation or in a clinic service area Where? • IHS or contracted health service • Few services in urban areas— • Phoenix: Native American Community Health Center. Check Urban Indian Health Program directory on web site.

  49. Private Entities Mission of Mercy (Maricopa Co.) Mobile clinic, primary care, 3 locations: Maryvale Church of the Nazarene Christ the King Catholic Church Community Center Shepherd of the Valley Lutheran Church

  50. More Private Entities • St. Vincent de Paul in Phoenix • John C. Lincoln Medical Center in Phoenix • Neighborhood Christian Clinic in Phoenix • Scottsdale Memorial Medical Center in Scottsdale

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