Office of Citywide Health Insurance Access Expanding Health

Office of Citywide Health Insurance Access Expanding Health Insurance Coverage for New York City Families

Office of Citywide Health Insurance Access (OCHIA) § Mission : Increase access to health insurance § Focus: • Enrollment of all eligible for public health insurance • Expansion of health insurance options for small businesses and individual workers • Ensuring availability of domestic partner coverage § Method: • Research and analysis for clear policy level decisions • Development of tools to allow partners strong local level planning in outreach efforts Human Resources Administration ♦ Office of Citywide Health Insurance 2

Facts About the Uninsured § 1. 3 million uninsured NYC residents below age 65 • Most are low-income and working • Over 50% are employed by small businesses that do not offer health insurance coverage § Approximately 499, 000 uninsured New Yorkers are eligible for Medicaid, Child Health Plus and Family Health Plus • About 39% are children Sources: Health Insurance Coverage in New York, 2004 -2005. United Hospital Fund (2007); NYS DOH unpublished estimates of the ASEC/CPS Human Resources Administration ♦ Office of Citywide Health Insurance 3

Outreach and Enrollment to NYC’s Uninsured Health. Stat, a citywide initiative mobilizing the work of city agencies, private organizations, community and faith-based organizations and managed care plans to identify and enroll eligible residents in public health insurance programs. § Enrolled over 12, 000 individuals through Health. Stat partnerships year to date. Human Resources Administration ♦ Office of Citywide Health Insurance 4

City Agency Partners § Administration for Children’s Services (ACS) § Department of Small Business Services (DSBS) § Community Assistance Unit (CAU) § Department of Corrections (DOC) § Department of Education (Do. ED) § New York City Fire Department (FDNY) § Department of Health & Mental Hygiene (DOHMH) § Health and Hospitals Corporation (HHC) § Department of Homeless Services (DHS) § New York City Housing Authority (NYCHA) § Mayor’s Office of Immigrant Affairs (MOIA) § Department of Parks and Recreation (PARKS) § Department of City Planning (DCP) § New York City Police Department (NYPD) § Department of Youth and Community Development (DYCD) § Department of Probation (DOP) § Taxi and Limousine Commission (TLC) Human Resources Administration ♦ Office of Citywide Health Insurance 5

Public Health Insurance Programs Available in New York City Human Resources Administration ♦ Office of Citywide Health Insurance 6

Public Health Insurance Programs § Programs for children • Child Health Plus A (also known as children’s Medicaid) • Child Health Plus B § Programs for adults • Medicaid • Family Health Plus Human Resources Administration ♦ Office of Citywide Health Insurance 7

Facilitated Enrollment Organizations § Authorized by NYS Department of Health to enroll New Yorkers in public health insurance programs in non-traditional settings • Home • Office • Other community settings § Assist client throughout the enrollment process § Offer resources in various languages Human Resources Administration ♦ Office of Citywide Health Insurance 8

Facilitated Enrollers Health Plans § Affinity Health Plan § Ameri. Choice of New York, Inc. § Amerigroup Community Care § Center. Care Health Plan § Community Choice Health Plan § Fidelis Care New York § Group Health Incorp. (GHI) § Healthfirst, PHSP § Health Plus § Health Insurance Plan of New York § Metro. Plus Health Plan § Neighborhood Health Providers § New York Presbyterian Community Health Plan § United Healthcare § Well. Care of New York, Inc. Human Resources Administration ♦ Office of Citywide Health Insurance 9

Facilitated Enrollers Community Based Organizations § Alianza Dominicana, Inc. § Metropolitan New York Council of Jewish Poverty § Brooklyn Perinatal Network, Inc. § Morris Heights Health Center § Generations+/Northern § Ridgewood Bushwick Manhattan Health Network Senior Citizens Council § Hispanic Federation § Safe Space § Jewish Community § Structured Employment Center Economic Development Corp (DBA) SEEDCO § Joseph P. Addabbo Family Health Center § The Children's Aid Society § Medical and Health Research Association of § Yeled V’Yalda NYC, Inc. Resources Administration ♦ Office of Citywide Health Insurance §Human Make the Road New York 10

Facilitated Enrollers DOHMH § Manhattan Washington Heights Health Center 600 West 168 th Street, 2 nd floor Chelsea Health Center 303 Ninth Avenue, 1 st floor § Queens Corona Health Center 34 -33 Junction Blvd. , Basement § Brooklyn Homecrest Health Center 1601 Avenue S. Brownsville Health Center 259 Bristol Street, 2 nd floor Crown Heights Health Center 1218 Prospect Avenue, Basement § Bronx Tremont Health Center 1826 Arthur Avenue Hillside Health Center 164 -19 Hillside Avenue, 1 st floor Human Resources Administration ♦ Office of Citywide Health Insurance 11

Managed Care or Fee-forservice § Public health insurance coverage is available through managed care or fee for service § Managed care allows for the coordination of treatment and care through a primary care physician § In NYC, joining a health plan is mandatory for most people (exemptions and exceptions) § Families can pick a plan as part of the application process or are auto-assigned a health plan Human Resources Administration ♦ Office of Citywide Health Insurance 12

Overview of Adult Health Insurance Human Resources Administration ♦ Office of Citywide Health Insurance 13

Adult Health Insurance Programs Medicaid Family Health Plus § Free Health Insurance § No age limit § Benefits provided through managed care or fee for service § Medicaid may provide up to 90 days of retroactive coverage for unpaid medical bills § Free Health Insurance § Adults 19 to 64 years of age who are uninsured with incomes that are too high for Medicaid § Benefits provided only through managed-care organizations § No retroactive coverage Human Resources Administration ♦ Office of Citywide Health Insurance 14

Adult Health Insurance Eligibility § To be eligible for Medicaid or Family Health Plus, requires proof of: • Income • Residency • Appropriate immigration status (not required for pregnant women) • Resources • Age (FHP only: 19 – 64 years old) • No other health insurance (FHP only) Human Resources Administration ♦ Office of Citywide Health Insurance 15

Adult Medicaid/Family Health Plus § Must be a New York State resident. • A resident is someone who intends to make NY his/her home (no minimum time requirements) § Short-term visa holders (tourist, work, school) are not eligible, unless they have filed to stay here on a permanent basis Human Resources Administration ♦ Office of Citywide Health Insurance 16

Adult Medicaid/Family Health Plus/CHP A Immigration Eligibility § People belonging to most immigration categories can receive Medicaid or Family Health Plus including: • • • Naturalized Citizen Legal Permanent Resident (green card holder) Refugee Asylee PRUCOLS Human Resources Administration ♦ Office of Citywide Health Insurance 17

What is PRUCOL? Permanently Residing Under Color Of Law § Immigrants who are eligible because they are in the U. S. with the knowledge and permission or acquiescence of USCIS. § Includes immigrants who are waiting for their interview with USCIS to become Lawful Permanent Residents. Who is not PRUCOL? These individuals are not eligible: § Short term visa holders (for example, students and tourists - unless they have filed to stay on a permanent basis) § Undocumented immigrants Human Resources Administration ♦ Office of Citywide Health Insurance 18

Family Health Plus is Available for Working Individuals Income Levels This chart is only a guide. Individuals should see an enrollment counselor for eligibility screening. Yearly Income Monthly Income Weekly Income Resource Level Single Adult $10, 404 $867 $216 $13, 050 Couples with No Children $14, 004 $1, 167 $291 $19, 200 19 -20 year olds living with their parents $15, 600 $1, 300 $325 $13, 050 2* $21, 000 $1, 750 $437 $19, 200 3* $26, 400 $2, 200 $550 $19, 800 4* $31, 800 $2, 650 $662 $19, 950 5* $37, 200 $3, 100 $775 $20, 100 $5, 400 $450 $112 $2, 550 Family Size For each additional person add: * A pregnant woman, people with disabilities, high medical expenses and some others may be eligible at higher income levels. These people should be referred to HRA for a Chart effective January 2008; subject to annual income updates. comprehensive eligibility determination. * Parent living with at least one child under 21 NOTE: Human Resources Administration ♦ Office of Citywide Health Insurance 19

Adult Health Insurance Benefits Some of the benefits include: § Regular checkups; § Hospital inpatient and outpatient services; § Emergency room care; § Prescription drugs; § Specialist care; § Smoking cessation agents; § Medical supplies and equipment. Human Resources Administration ♦ Office of Citywide Health Insurance 20

Overview of Children Health Insurance Human Resources Administration ♦ Office of Citywide Health Insurance 21

Children Health Insurance Programs CHP A CHP B § Free Health Insurance § Children under 19 years old § Benefits provided through managed care or fee for service § CHP A may provide up to 90 days of retroactive coverage for unpaid medical bills § Free or low cost § Children under 19 years old NOT Medicaid eligible § Benefits provided only through managed-care organizations § No retroactive coverage Human Resources Administration ♦ Office of Citywide Health Insurance 22

Children Health Insurance Programs Benefits Some of the benefits include: • • • Regular checkups Immunizations Hospital care Emergency room care Prescription drugs Dental care Eyeglasses Specialty care Medical equipment Human Resources Administration ♦ Office of Citywide Health Insurance 23

Child Health Insurance Eligibility § Eligibility for CHP A and CHP B, requires proof of: • • • Income Residency Appropriate immigration status (CHP A ONLY) Age (CHP B only – Under 19 years old) No other health insurance (CHP B ONLY) Human Resources Administration ♦ Office of Citywide Health Insurance 24

Child Health Plus B is Available for Children of Working Individuals Income Levels This chart is only a guide. Individuals should see an enrollment counselor for eligibility screening. Children Under 19 NOT Medicaid Eligible Each Additional Person, Add: Monthly Income For Family Size* Premium Categories 1 2 3 4 5 $1, 368 $1, 866 $2, 346 $2, 826 $3, 306 $480 $9 Per Child Per Month (Maximum of $27 per family) $1, 924 $2, 590 $3, 256 $3, 922 $4, 588 $666 $15 Per Child Per Month (Maximum of $45 per family) $2, 167 $2, 917 $3, 667 $4, 417 $5, 167 $750 Full Premium Per Child Per Month** Over $2, 167 Over $2, 917 Over $3, 667 Over $4, 417 Over $5, 167 $750 Free Insurance * Pregnant women count as two individuals. ** Full premium amounts vary by health plan; Current premium levers average $125 per child per month Human Resources Administration ♦ Office of Citywide Health Insurance NOTE: Effective January 2008; subject to annual income updates. 25

Application Process Once an application is completed and submitted: § HRA has 30 days to process applications for children and 45 days for adults; 90 days for a disability review § CHP B processing time can range from 2 – 6 weeks depending on when application is submitted. • For example, applications received by the 20 th of the month the child will be covered starting the first day of. Administration the following applications Human Resources ♦ Officemonth. of Citywide. For Health Insurance th 26

How to Maintain Coverage § Individuals enrolled in public health insurance must renew every year or risk losing coverage § Since 2003, all programs use a mail-in renewal process. • Medicaid, Family Health Plus and Child Health • • Plus A enrollees receive mail-in renewal packet from HRA. Child Health Plus B enrollees receive mail-in renewal packet from their health plan Mailings sent about 3 months prior to card expiration date. These forms must be completed, signed and returned by mail • Consumers can call 1 -888 -692 -6111 for questions about enrollment and ♦renewal Human Resources Administration Office of Citywide Health Insurance 27

Where to Enroll in Public Health Insurance Programs Families can apply for all public health insurance programs at: § Human Resources Administration – New Yorkers can enroll at the City’s Community Medicaid Offices § Facilitated Enrollers – Health Plans, Department of Health and Mental Hygiene and Community-Based Organizations can help to complete and submit applications for all programs Human Resources Administration ♦ Office of Citywide Health Insurance 28

Where to Enroll in Public Health Insurance Programs § As of February 1, 2008, families will be able to take advantage of presumptive eligibility at a number of Child Health Clinics throughout the City § Screeners will be onsite to enroll children into the Child Health Plus programs Human Resources Administration ♦ Office of Citywide Health Insurance 29

What If Individuals Are Not Eligible For Public Health Insurance Programs? § HHC Options www. nyc. gov/hhc - financial screening system available at New York City Health and Hospitals Corporation facilities § CHCANYS/Community Health Centers www. chcanys. org - Offer primary care and supportive services on a sliding fee scale § Health Insurance Options For Small Businesses, Sole Proprietors and Working Individuals www. nyc. gov/healthstat Human Resources Administration ♦ Office of Citywide Health Insurance 30

What If Individuals Are Not Eligible For Public Health Insurance Programs? OCHIA’s Website - www. nyc. gov/healthstat Provides information on: § Free health services provided by DOHMH § Free or reduced price prescription drugs § Vision Services § Dental Care Human Resources Administration ♦ Office of Citywide Health Insurance 31

For More Information Contact: Jeannine D. Mendez 212 -331 -4205 mendezj@hra. nyc. gov www. nyc. gov/healthstat Human Resources Administration ♦ Office of Citywide Health Insurance 32

Thank You Human Resources Administration ♦ Office of Citywide Health Insurance 33