National Indian Health Board AIAN Health Insurance Education
National Indian Health Board AI/AN Health Insurance Education and Enrollment During the COVID-19 Epidemic
OVERVIEW § Importance of Health Insurance § Medicaid Benefits and Protections § Health Insurance Protections § Reporting Life Changes § Special Enrollment Periods § Importance of Enrollment Data
Why Enroll into Health Insurance? § Protects your Children or your Family § Peace of Mind § Financial Protection § Access to Preventive Service § Quality of Care
Reasons for Health Insurance § Encourage yourself and your family to take better care of your health. § To take care of your mental health which is equally important as physical health. § Pays for precautionary measures to keep your health in check on a regular basis. § Have the right to be protected health-wise. § Grant yourself and your family your well-deserved health insurance coverage.
Health Insurance Covers § § § § Emergency room Outpatient care Inpatient care Chronic illness Pregnancy/Childbirth Diabetes Prescription drugs Medical devices § § § § Mental health Ambulance Surgeries Physical examination Vaccinations Mammograms Laboratory services Pediatric services
Health Insurance Enrollment Strategies Right now is the ideal time for Individuals looking to enroll members of their community in health insurance. § Newly unemployed individuals § Creative ways to reach individuals § Amplified Medicaid enrollment § Connect with your Tribal communities § Let Tribal members know you are available during this Pandemic
List of Health Insurance § Medicaid (based on income, depends on state poverty level) § CHIP (families earn too much to qualify for Medicaid) § Medicare (if you are 65 and over, have renal failure, or are eligible through disability) § Marketplace (based on your income and can also be for individuals who are not eligible for Medicaid) § Employer-sponsored health insurance § COBRA
Medicaid/CHIP Benefits and Protections §Families, children, pregnant women, elderly, people with disabilities and children with working parents §No Copays, Deductibles, Co-Insurance, Premiums, Fees §State Medicaid programs must exclude certain types of Indian trust income & Indian trust property when determining Medicaid or CHIP eligibility.
Marketplace AI/AN Protections Zero Cost Sharing plan § Members of a Federally Recognized Tribe with income between 100% and 300% FPL § No copays, No deductibles or No coinsurance when receiving care from Indian Health Care providers or when receiving Essential Health Benefits through the Qualified Health Plan § No referral from a Indian Health Care provider is needed when receiving Essential Health Benefits through the Qualified Health Plan
Marketplace AI/AN Protection Limited Cost Sharing plan § Members of a Federally Recognized Tribe with income below 100% and above 300% § No Copays, No deductibles, or No coinsurance when receiving care from Indian Health Care providers § A referral is needed from a Indian Health Care provider to avoid copays, deductibles or coinsurance when receiving Essential Health Benefits through a Qualified Health Plan
What Changes to Report for Medicaid/CHIP & Marketplace § Loss of health insurance from a recent job loss or from another person’s job loss § Adult child is 26 years old and lost coverage from parents § A recent change in household size § Change in primary household § Change in eligibility for health insurance coverage or help with paying for coverage https: //www. healthcare. gov/reporting-changes/which-changes-toreport/? utm_campaign=hcgov_ab&utm_content=english&utm_medium=email&ut m_source=govdelivery
Examples of Life Changes § Tribal member loses their job due to being laid off by their employer in the wake of the COVID-19 pandemic § Becoming a new parent § Change the size of your household § Change in income § Change in location § Loss of a family member § Marriage § Retirement
AI/AN Special Enrollment Period Medicaid/CHIP: Enrollment Anytime During the Year. Marketplace: Federally Recognized Tribal members are not restricted to enrolling during open enrollment, nor do they need qualifying events. Enroll anytime during the year. ◦ Non-AI/AN family members can also enroll in or change plans through this SEP, as long as they are on the same application with their AI/AN family members.
Importance of Enrollment Data • Health plans • Job lost • Health disparities
Impact of COVID-19 § Are American Indians and Alaska Natives disproportionally impacted by COVID-19? § July 10 chart demonstrates the answer is yes Arizona, New Mexico, Wyoming, Montana, Mississippi, South Dakota and Utah § Navajo, in New Mexico and Arizona make up over 40% of American Indian and Alaska Native cases and deaths nationally. § More uninsured means more demands on Indian Health Programs and less revenue due to closings, reduced hours, fewer staff § Where will funding come from for newly uninsured?
Job Loss=Health Insurance loss New Mexico Example
NIHB ENROLLMENT ASSISTER, YOUTH & ELDER TOOLKIT
CMS Tribal Outreach & Education
Important Contacts § CMS Native American Contact https: //www. cms. gov/files/document/cms-nativeamerican-contact. pdf § State Medicaid Tribal Liaison § Indian Health Service-health insurance questions ihspatientbenefits@ihs. gov
Final 2021 Letter to Issuers in the Federally-facilitated Marketplaces May 7, 2020 -CMS released a final letter containing benefit and payment parameters for insurers in the federal Marketplace. https: //www. cms. gov/CCIIO/Resources/Regulations-and. Guidance/Downloads/Final-2021 -Letter-to-Issuers-in-the-Federallyfacilitated-Marketplaces. pdf § Specifically for American Indian and Alaska Natives • Issuers must conform to the sample Summary of Benefits and Coverages (SBCs) for zero and limited cost sharing plans. • CMS guidance concerning Indian health care providers remains unchanged from 2018 and later years. For more information, please refer to the 2018 Letter to Issuers
Health Insurance and COVID-19 § Coverage and Benefits Related to COVID-19 Medicaid and CHIP https: //www. cms. gov/files/document/03052020 -medicaidcovid-19 -fact-sheet. pdf § Coverage and Payment Related to COVID-19 Medicare https: //www. cms. gov/files/document/03052020 -medicarecovid-19 -fact-sheet. pdf § Marketplace Coverage and COVID-19 https: //www. healthcare. gov/coronavirus/
Reporting Life Changes to the Marketplace Resource § You report changes to the Marketplace by updating your application. You can update your application online, by phone, or in person — but not by mail https: //www. healthcare. gov/reporting-changes/how-toreportchanges/? utm_campaign=hcgov_ab&utm_content=englis h&utm_medium=email&utm_source=govdelivery § CMS presentation on how to report life changes https: //marketplace. cms. gov/technical-assistanceresources/report-life-event. pdf
Special Enrollment Period Resources § https: //www. healthcare. gov/coverage-outside-openenrollment/special-enrollment-period/ (Getting health coverage outside Open Enrollment) § Special Enrollment Period Overview https: //marketplace. cms. gov/technical-assistanceresources/sep-overview-slides-7 -11 -2018. pdf § Navigating Eligibility for Special Enrollment https: //marketplace. cms. gov/technical-assistanceresources/complex-cases-data-matching. pdf
Resources: Job Loss, Salary Reduction or Furloughed §https: //www. healthcare. gov/coronavirus/ (Healthcare. gov and Marketplace coverage during the time of the COVID-19 pandemic. ) §https: //www. healthcare. gov/unemployed/ (Health coverage options if you are unemployed. ) §https: //marketplace. cms. gov/outreach-and-education/losing-job-basedcoverage. pdf (loosing job based coverage and CMS) §COBRA coverage and Marketplace https: //www. healthcare. gov/unemployed/cobra-coverage/ §COBRA continuation FAQs https: //www. cms. gov/CCIIO/Programs-and. Initiatives/Other-Insurance-Protections/cobra_qna §Complex scenario help https: //marketplace. cms. gov/technical-assistanceresources/transitioning-from-employer-coverage. pdf
Other Resources §Frequently asked questions on State Medicaid and CHIP agencies: https: //www. medicaid. gov/state-resource-center/downloads/covid-19 -faqs. pdf §Medicaid and CHIP Disaster Preparedness toolkit: https: //www. medicaid. gov/stateresource-center/downloads/mac-learning-collaboratives/medicaid-chipdisastertoolkit. pdf §More frequently asked questions for State Medicaid and CHIP agencies: https: //www. medicaid. gov/state-resource-center/downloads/covid-19 -new-faqs. pdf §Cost Sharing telehealth factsheet https: //www. oig. hhs. gov/fraud/docs/alertsandbulletins/2020/factsheet-telehealth 2020. pdf and FAQs https: //oig. hhs. gov/fraud/docs/alertsandbulletins/2020/telehealthwaiver-faq-2020. pdf §Medicare telemedicine factsheet https: //www. cms. gov/newsroom/factsheets/medicare-telemedicine-health-care-provider-fact-sheet §Telehealth and rural health from HRSA https: //www. hrsa. gov/rural-health/coronavirusfrequently-asked-questions#telehealth 27
Thank you KRISTEN BITSUIE TRIBAL HEALTH CARE REFORM OUTREACH AND EDUCATION POLICY COORDINATOR NATIONAL INDIAN HEALTH BOARD KBITSUIE@NIHB. ORG 202 -507 -4084
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