seeking access: low-income women access to healthcare
DESCRIPTION
Seeking Access: Low-Income Women Access to Healthcare. By : Jamille Fields, J.D., M.P.H. Reproductive Justice Fellow. June 13, 2014. The National Health Law Program. - PowerPoint PPT PresentationTRANSCRIPT
Seeking Access: Low-Income Women Access to Healthcare
By: Jamille Fields, J.D., M.P.H. Reproductive Justice Fellow
June 13, 2014
Seeking Access: Low-Income Women Access to Health Care 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 Care 3
Overview• The Healthcare World Pre-ACA
• The Healthcare World Post-ACA
• How this affects different Populationso Women of Reproductive Ageo Pregnant Womeno Women Living with HIV/AIDso Women with Disabilitieso Women of Color
Seeking Access: Low-Income Women Access to Health Care 4
The World Pre-ACA
• Employer-Sponsored Insuranceo 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 individualso Seven of ten Medicaid enrollees over 14 are womeno Medicaid is the single-largest source of public funding for
family-planning services and supplieso In 2010, 9.4 million women of reproductive age covered
under Medicaido Medicaid covers around 40% of births
Seeking Access: Low-Income Women Access to Health Care 5
Medicaid Eligibility: “Worthy Poor”
Person Characteristics
Financial Condition
Category of “Worthiness”
State Residency
Low Income
Requirements for Eligibility
Personal Characteristics
Financial Conditions
Categories Citizenship orImmigration Status
State Residency
Low Income
Limited Resources
Seeking Access: Low-Income Women Access to Health Care 6
Traditional Medicaid Benefits: • 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 serviceso Laboratory and X-ray serviceso Early and periodic screening, diagnostic, and treatment
(EPSDT) services for recipients under age 21o Pregnancy-related services and services for conditions
that might complicate pregnancyo Family planning services and supplieso Physician services
Seeking Access: Low-Income Women Access to Health Care 7
The World Post- ACA
Name of presentation goes in footer 8
Marketplace Coverage
Name of presentation goes in footer 9
U.S. Supreme Court: An Option Created• Federal government
cannot terminate a state’s Medicaid funding for not expanding
• 27 states, including the District of Columbia, have decided to expand Medicaid
Seeking Access:: Low-Income Women Access to Health Care 10
Consequences of Failure to Expand
http://kff.org/interactive/uninsured-gap/
Seeking Access: Low-Income Women Access to Health Care 11
Family Planning “Expansion” Option• 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
Name of presentation goes in footer 12
ACA Required Benefits• Essential Health Benefits
• Again, Big Buckets:o Ambulatory patient serviceso Emergency serviceso Hospitalizationo Maternity and newborn careo Mental health and substance abuse services, including
behavioral health treatmento Prescription drugs o Rehabilitative and habilitative services and deviceso Laboratory services o Preventive and wellness services and chronic disease
management (more on this later)o Pediatric services, including oral and vision care
WHAT THIS ALL MEANS FOR WOMEN
14
Women of Reproductive Age
Seeking Access: Low-income Women Access to Health Care
• “Reasonable medical management” allowed
• Women’s preventive services req are gender-specific
• Contraceptive req includes “as prescribed” frequency
Seeking Access: Low-Income Women Access to Health Care 15
Women Living with HIV/AIDS• Traditional Medicaid – “Catch 22”
o Categories remaino Childless adults need AIDS diagnosis to qualify
• Medicaid Expansion Stateso New eligibility paths for childless adultso 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
Name of presentation goes in footer 16
Pregnant Women• Abortion Coverage
• Restrictions in the Marketplace – Nelson Amendmento States can ban abortion
outrighto No “subsidy” funds can be
used for abortion except for Hyde permitted
• Medicaid Restrictions Remain -
Hyde Amendmento Rape, Incest or Life
Endangerment
Seeking Access: Low-Income Women Access to Health Care 17
Pregnant Women:Maternity Care
• Full-Scope Medicaid Coverageo Meets state income threshold
• Pregnancy-Related Coverageo Exceeds threshold, but below
133% of the FPL
• Medicaid Expansiono Not if pregnant at time of application
• Children’s Health Insurance Plano State Option, State Discretion on
upper-income threshold
• Health Insurance Marketplaceso Qualified Health Plans must
include maternity coverage
Name of presentation goes in footer 18
ACA & Women with Disabilities• Pre-existing condition exclusions prohibited
• Medicaid Community First Choice Optionso State option to cover HCBS for people up to
150% FPL or requiring institutional care
• Medicaid Removal of Barrierso State option to provide HCBS to people up
to 3X the SSI rate who are in waiver programs (currently only up to 150% FPL)
Seeking Access: Low-Income Women Access to Health Care 19
Women of Color: Medicaid
Seeking Access: Low-Income Women Access to Health Care 20
Women of Color: MarketplaceMarketplace 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)
Name of presentation goes in footer 21
ACA Non-Discrimination: Sec. 1557• 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
Name of presentation goes in footer 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
Washington DC Office
Los Angeles Office North Carolina Office
1444 I Street NW, Suite 1105Washington, DC 20005ph: (202) 289-7661fx: (202) [email protected]
3701 Wilshire Blvd, Suite #750Los Angeles, CA 90010ph: (310) 204-6010fx: (213) [email protected]
101 East Weaver Street, Suite G-7Carrboro, NC 27510ph: (919) 968-6308fx: (919) [email protected]
www.healthlaw.org
THANK YOU