ACCESS The Patient Protection and Affordable Care Act (ACA) will allow better choices, better value, and better health for consumers. More than 32 million Americans will gain health coverage. Almost 80% of Mississippians are receiving benefits from the ACA. Young adults are able to remain on their parents’ health insurance as a result of the law. Children cannot be denied health care coverage due to pre-existing conditions. This will also be true for adults in 2014. In Mississippi, 20% of individuals and families do not have insurance. With the remaining benefits of the ACA set to go into effect at the beginning of 2014, these Mississippians will be eligible for insurance coverage. This handbook, ACCESS, is designed to increase the awareness of this law that will guarantee millions of Americans better health care and greater access to care. Coverage expansion in the law includes the establishment of the health insurance Marketplace. The Marketplace will allow you to shop for private health insurance plans for you and your family. It is our goal to provide you with information about the new options and opportunities that will be available through the Affordable Care Act.
About MHAP The Mississippi Health Advocacy Program (MHAP) is a nonprofit, nonpartisan public interest advocacy organization that strives to be a strong, effective voice for improved health care for all throughout the state of Mississippi, especially those whose health is threatened by poverty, racism, malnutrition and violence. MHAP will work with communities to identify health needs and formulate strategies for change and will research, analyze, propose and promote policies that will enhance the health status of every person, regardless of financial status. In an effort to increase public awareness of the impact of the Affordable Care Act on the state, MHAP initiated the project entitled Mississippi Road to Reform. As consumer advocates, MHAP has great concerns with the consistent lack of transparency and public input in the implementation of health reform in Mississippi. The project, MS Road to Reform, seeks to provide a mechanism for community engagement that allows the public, business community members and policy makers to have meaningful involvement as the state moves forward with implementation of the Affordable Care Act.
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CONTENTS ACCESS is a father being able to afford his son’s asthma medication. ACCESS is a mother receiving regular checkups and preventive care. ACCESS is a daughter not being denied coverage due to a preexisting condition. ACCESS is thousands of Mississippians finally having affordable health insurance options. ACCESS is your handbook to understand your new health care law.
Table of Contents Introduction to the Affordable Care Act 4 Stories: Stacey Aldridge 6 Making Insurance Affordable 8 Covering Mississippi 9 How to Shop the Marketplace 12 Navigating the System 13 Jackson’s Community Health Center 15 The Human Factor: Dr. Aaron Shirley 16 Timeline of ACA Implementation 18 What’s Covered? 20 5 Things You May Not Know about the ACA 22 FAQs 24 Infographic: Healthy Community, Healthy Economy 26 CoverMS.org 27 ACCESS is a special publication of the Mississippi Health Advocacy Program. Cover photo by Roy Adkins. Publication design by Creative Distillery.
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INTRODUCTION TO THE ACA The campaign for universal access to health care has stretched for nearly a century in the United States. The passage of the Affordable Care Act is a fulfillment of the hard work of many to ensure health care is accessible to everyone. For thousands of Mississippians, the expansion of health insurance under the ACA will prove well worth the wait. The ACA will not correct every wrong. Mississippi is well known for being first in so many of the worst health indicators. But access to health care is an important first step in improving these outcomes and improving the lives of Mississippians. The ACA seeks to expand health coverage by building on the existing public-private system for providing health insurance and filling in the gaps in the current system. It expands eligibility for the Medicaid program, the current safety net health insurance program for the poor. It creates new exchanges, or marketplaces, where people can purchase coverage and, depending on their income, receive premium subsidies to help them afford the coverage. It includes new penalties for employers that don’t offer coverage to their employees and provides tax credits to small employers that do to bolster the availability of employer-sponsored coverage. Supporting these enhanced coverage mechanisms are a new requirement that individuals, with some exceptions, have health insurance (referred to as the individual mandate) and new rules for insurers requiring them to provide coverage to everyone regardless of health status and limiting the variations in premiums they charge people.
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Together, these strategies are designed to increase significantly the number of people with health insurance.
Coverage Expansion Under the ACA Medicaid is a state managed insurance program that covers low income families, children, the elderly and people with disabilities. In return for federal funding, a state’s Medicaid program must meet minimum standards of coverage and benefits. The states are reimbursed for medical expenditures based on the per capita income of residents in a state. For instance, Mississippi receives the highest level of reimbursement 74.73% due to the state’s poverty level. That means that for every $1 Mississippi allocates for Medicaid expenditures it will receive $3 back from the federal government. Historically, eligibility for Medicaid was generally limited to low-income children, pregnant women, parents of dependent children, the elderly, and people with disabilities. However, the ACA would allow Mississippi, and other states, to expand its Medicaid program to cover all adults up to 138% of federal poverty level.
by Jarvis Dortch
That’s the equivalent of a household income of $32,500 for a family of four. That means commercial fishermen, casino workers, barbers and thousands of other Mississippians who work everyday but aren’t offered insurance on the job and aren’t paid enough to afford a health plan will finally have access to health insurance. Expansion is voluntary for the State but there are nearly 300,000 Mississippians who will be left without health insurance if Mississippi chooses not to expand.
Who’s offering coverage? Private insurance companies are offering coverage through the Health Insurance Marketplace. Depending on which county you live in, you’ll have different options to choose from.
For the first three years of the expansion, the federal government would pay 100% of the share of the costs for these adults in 2014, 2015, and 2016. The federal share in 2017 will be 95% and 94% in 2018. By 2020, that federal share will lessen to 90% where it would remain.
Mississippi Health Insurance Marketplace The other important coverage component of the ACA is the establishment of the Health Insurance Marketplace. These insurance marketplaces will be web based, similar to Travelocity and Expedia, and allow consumers to purchase affordable health insurance and easily compare health plans. Mississippians not offered employer-based coverage and ineligible for Medicaid may purchase insurance plans through the Marketplace. Additionally, individuals with incomes between 100% and 400% of the federal poverty level may qualify for premium subsidies or tax credits that could help with out of pocket health care costs. It is estimated that approximately 275,000 Mississippians will purchase private health care coverage through the health insurance marketplace. Of those eligible, 229,000 Mississippians will be eligible for premium subsidies funded by the federal government.
Counties with coverage offered by Magnolia Counties with coverage offered by Humana Counties with coverage offered by both Magnolia and Humana 5
STORIES LEARN HOW STACEY ALDRIDGE’S STORY REPRESENTS SO MANY UNINSURED WORKING MISSISSIPPIANS, AND HOW SHE’LL BE AFFECTED BY THE MAREKTPLACE.
STORY: Monet Glover and Jacquelyn Agho PHOTOGRAPHY: Roy Adkins
Suppose you had to live every day without any health insurance coverage and feared the possibility of an accident happening. For Stacey Aldridge, a coordinator at the nonprofit organization National Alliance of Mental Illness Mississippi (NAMI MS), this is a daily reality. “I have not had any kind of health insurance since 2008. In December 2008 I was working 40 hours a week and I was also a full time adult student. Family issues arose and it became impossible for me to continue both, so I chose to quit my job and live off student loans to finish my bachelor’s degree in social work.” Stacey has long had an interest in public policy and advocacy for mental health issues and believes she made the right decision to quit her office supply job and go back to school to complete her degree in social work. She began working with NAMI as an
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STORIES intern while at Belhaven College. That internship turned into a contract job which led to a coordinator position. Stacey says, “I believe in the work that NAMI MS does and I am able to see first-hand the difference we make in the lives of individuals living with mental illness in Mississippi.” Though the work at NAMI is fulfilling, because it is a very small 501(c)3 nonprofit totally reliant on grant funding, they are unable to hire employees full time and provide them with health insurance.
When Mississippians enter the Marketplace they can expect to research and compare health insurance options as well as receive assistance with premium payments. The Marketplace will provide coverage for those that fall between 100% and 400% of the Federal poverty level. Just like Stacey, there are many people that work hard to provide for themselves and their families, yet cannot afford health insurance coverage. Stacey explains, “If it’s $150-200 a month that’s something that I could swing and get rid of all the luxuries like going out to dinner with friends, but if it’s $300 or $400 a month then that’s just not feasible.”
“I’m almost 33 years old and it has started to scare me that I do not have any type of health insurance coverage at all.” This has resulted in Stacey relying on ambulatory clinics such as MEA Medical Clinics and Stacey’s annual income is $20,000 “I’m almost 33 years old even Internet health care and it has started to scare (174% of the federal poverty level). websites such as WebMD for With the implementation of the self-diagnosis. “If I ever have me that I do not have any health insurance marketplace, health insurance again and Mississippians just like Stacey will type of health insurance can have tests done, I would be able to purchase private health coverage at all.” love to confirm if my guess care coverage at an affordable rate. was correct,” says Stacey. According to the Kaiser Family Foundation premium The health insurance marketplace (Marketplace) subsidy calculator, she may be eligible for a premium opening in October 1st is a welcome sight for subsidy of $2,549 to assist her in purchasing a plan Mississippians like Stacey. For the first time, offered in the marketplace. Her monthly payment uninsured, underinsured and underemployed people would be approximately $85 or 5.11% of her income. will be able to access quality, affordable health Health care security is one of the most important insurance options. No longer will Mississippians necessities to ensuring a healthy, productive be forced to choose between doing what they are population. The Marketplace is an opportunity for passionate about and doing what they have to for Mississippians to pursue any idea for their own health benefits. business, job or career without fear of not being able As Stacey says, “I would not personally benefit to afford health care. from Medicaid expansion, because I make too much Stacey sums it up best, “It should not have to be a money (just barely), but I do not make enough trade-off for me – to work in nonprofit and mental money to be able to afford coverage without a health or to have health insurance. When opponents healthcare exchange. I have a significant amount of of ‘Obamacare’ think of who it will benefit, I don’t student loan debt that must be paid back. While I think that they picture someone like me, but the do not for a second regret finishing my degree and truth is that many people in their 20s and 30s are finding a job that is fulfilling, I am beginning to think underemployed, uninsured, and desperately need that it may not be possible to do the type of work I what the ACA provides.” want to do and stay in Mississippi.” 7
FACTS
Making Insurance Affordable How do premium subsidies work? People purchasing coverage on their own will be eligible for government subsidies (through a tax credit) towards their health insurance premiums based on income. Subsidies will be provided to people with family incomes between 100% and 400% of the federal poverty level. The federal poverty level varies by family size. In 2013, it is $11,490 for a single adult and $23,550 for a family of 4. The poverty level is estimated for 2014 based on Congressional Budget Office projections of inflation. The most that these families buying subsidized coverage in an exchange will pay towards a health insurance premium will range from 2.0% of income at 100% of poverty to 9.5% of income at 400% of poverty, with amounts at specific income levels specified in a table in the law. Subsidies are tied to a benchmark level of coverage based on actuarial value. And, subsidies will only be available to those purchasing coverage through the exchanges, which includes people who do not have access to alternative insurance (such as Medicaid and affordable employer coverage). When an exchange determines that a person is eligible for a tax credit based on expected income, and that person enrolls in coverage, subsidies will be paid directly to insurers to lower the cost of premiums (and in some cases cost sharing).
What is the amount of the tax credit provided to people? The amount of the tax credit that a person can receive is based on the premium for the second lowest cost silver plan in the exchange and area where the person is eligible to purchase coverage. A silver plan is a plan that provides the essential benefits and has an actuarial value of 70%. (In PPACA, a 70% actuarial value means that on average the plan pays 70% of the cost of covered benefits for a standard population of enrollees.) The amount of the tax credit varies with income such that the premium a person would have to pay for the second lowest cost silver plan would not exceed a specified percentage of their income (adjusted for family size), as follows:
Income Level Premium as a Percent of Income • Up to 133% FPL* 2% of income • 133-150% FPL 3 – 4% of income • 150-200% FPL 4 – 6.3% of income • 200-250% FPL 6.3 – 8.05% of income • 250-300% FPL 8.05 – 9.5% of income • 300-400% FPL 9.5% of income For example, a family of four, two adults and two children, living in Rankin County with a household income of $35,325 (150% of FPL) will receive a tax credit of $9,271 to assist in purchasing a silver plan offered in the marketplace. The most the Rankin County family would have to contribute to cost of insurance for the family would be $117 a month or 4% of their income. *FPL: Federal Poverty Line
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COVERING MISSISSIPPI
by Jacquelyn Agho
Health exchange. Travelocity for health insurance. Or maybe even One, Mississippi. Whatever moniker you’ve heard it referred to, it’s finally here. This year, the most significant piece of the Affordable Care Act (ACA) comes online. The new Mississippi Health Insurance Marketplace, commonly known as the Marketplace, is open for business. For the first time in decades, Mississippians will have access to quality, affordable health insurance.
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eginning October 1st Mississippians and their families can apply to the Mississippi Health Insurance Marketplace with coverage to begin on January 1, 2014. In the Marketplace, you can compare and buy a health insurance plan that fits you and your family’s needs. You can use the Marketplace if you are uninsured or don’t have access to reasonably priced coverage through your job. But first, there are a few things you’ll need to know about how to apply and what you’ll find when you get there.
How to Access The Mississippi Health Insurance Marketplace can be accessed in one of three ways. For those that feel more comfortable with Web-based applications, you can go to healthcare.gov. Once there, you will enter your household income along with your family size and answer a few other questions and you will be able to see and choose what plan works best for you and your budget. Secondly, you can call the Marketplace’s 24-hour hotline at 1-800-318-2596. A counselor can take you through the application process and help you enroll. Lastly, there are many forms of in-person assistance to help you select a plan and enroll. The Marketplace is required to have different types of in person counselors. The first type of in person assister
is known as a Navigator. Navigators will help you prepare electronic or paper applications to establish eligibility and enroll in coverage through the Marketplace. They will also help you determine if you qualify for an insurance affordability program such as a premium tax credit, cost sharing reductions, Medicaid and/or Children’s Health Insurance Program. Navigators are also responsible for providing outreach and education to consumers to raise awareness about the Marketplace and will refer you to a consumer assistance program if necessary. Mississippi has two Navigators for the state – Oak Hill Missionary Baptist Church and the University of Mississippi Medical Center. Oak Hill Missionary Baptist Church, located in Hernando, MS is serving over 50 counties in the Mississippi Delta and beyond, through churches and other community based organizations. They will do outreach throughout the state to ensure the message is spread about open enrollment and assist Mississippians with getting insured. University of Mississippi Medical Center, located in Jackson, MS is one of the largest public hospitals in the state. They will serve uninsured patients from all over the state that receive treatment in their hospital with getting enrolled in the Marketplace. They will also use their telehealth clinics to identify uninsured patients that will be eligible for the Marketplace and get them enrolled.
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COVERING MISSISSIPPI, CONTINUED Certified application counselors (CAC) will also be available as a resource to Mississippians seeking assistance. CACs will perform many of the same functions as Navigators, but will be housed in more accessible locations. They will be in hospitals, community health centers and community based nonprofit organizations. The list of certified application counselors is a developing one and will be located on healthcare.gov as more organizations are added. The ACA recognized that this new avenue for health benefits could be a confusing experience for some, so it allowed for the use of traditional sources of insurance information. Many Mississippians feel more comfortable with their insurance agents and brokers. Through the Marketplace, they will also be able to assist with selection of health plans and enrollment.
What to Expect Now that you know how to access the Marketplace, here’s what to expect when you get there. The Marketplace is designed to be a seamless, streamlined portal that will determine you and your family’s eligibility for a number of sources of coverage. You will be evaluated not only for private insurance, but for any public health care program like Medicaid/ Children’s Health Insurance Program that you or a family member may be eligible for as well. Right now, there are two insurance carriers in the Mississippi Health Insurance Marketplace and they are Magnolia Health Plan that will serve 46 counties and Humana that will serve 40 counties. During the application process, there will be an opportunity for you to receive premium tax credits. The cost of insurance, for many working Mississippians is still unattainable which is why these tax credits have been built into the Marketplace. If it is determined that you are eligible for a private insurance plan, you will then be evaluated for this tax credit based on your household income and family size. The tax credit is allowed for uninsured Mississippians 10
between 100% ($11,490 for an individual and $23,550 for a family of four) and 400% ($45,960 for an individual and $94,200 for a family of four) of the Federal poverty level. This tax credit will be paid directly to the insurance carrier you select and you will be responsible for the remainder of the premium. There are also cost sharing subsidies that will allow you to reduce your out-of-pocket costs, while getting more comprehensive health coverage. These are available for uninsured Mississippians at 100% to 250% ($28,725 for a family of one and $58,875 for a family of four) of the Federal poverty level.
What will be Covered The health insurance plans that will be available in the Marketplace, for the first time ever, will have to provide some essential services before they can even sell in the Marketplace. This means that you will be able to actually get comprehensive, quality plans that will be affordable for you and your family. Every plan offered in the Marketplace has to include services in at least ten (10) categories which include: • Ambulatory patient services; • Emergency services; • Hospitalization; • Maternity and newborn care; • Mental health and substance use disorder services; • Behavioral health treatment; • Prescription drugs; • Rehabilitative and habilitative services and devices; • Laboratory services; • Preventive and wellness services and chronic disease management; • Pediatric services, including oral and vision care.
Your Choices Within the Marketplace you can choose which level of plan would work best for you. There are four levels of plans, each based on the percentage of cost they cover and their cost to the consumer. The four levels are bronze, silver, gold and platinum. Bronze is the most inexpensive plan for consumers and it covers 60% of the medical costs, however it have higher out of pocket costs than other plans offered in the Marketplace. Silver covers 70% of medical costs, and is most comparable to employer based insurance plans. Gold covers 80% of medical costs and Platinum covers 90% of medical costs. As you might imagine, these top tier plans cover more costs, but the premiums are greater for the purchaser of these plans. There are also catastrophic plans offered for individuals under 30 and those with very low incomes. By applying through the
Marketplace, you will be able to do “apples to apples” comparisons to decide on the best plan for your needs. Good health is the cornerstone of any productive citizenry. This is why the Mississippi Health Insurance Marketplace is so important. This provides a strong first step in removing Mississippi from the top rankings of all the nation’s worst health lists. It provides both societal and personal financial security from bankruptcy just because of a medical accident or illness. It also allows Mississippians the freedom to pursue any career goal they desire free from the worry of what they will do in the event they get ill. Most importantly, this new Marketplace opens the doors of opportunity for hard working Mississippians to make sound health care decisions for themselves and their families with some measure of safety and stability. So mark your calendars, it’s time to get enrolled.
Meet the Smiths To make this a little more real life, let’s take the Smith family from Brandon, MS for example. Mr. Smith is a mechanic that makes $32,000 a year and Mrs. Smith is a stay at home Mom who does tax preparation just during tax season that brings in another $3,500 for the year. They have two children and the whole family is uninsured. Based on their total household income of $35,500 and their family size of four they could shop on the Marketplace. When Mr. Smith applied through the Marketplace, he realized his family would be eligible to receive an $11,144 tax credit to assist them with their premiums. They would pay no more than 4% of their income, which would be $119 per month. This plan would be the silver plan which covers 70% of their medical costs. So for less than the cost of many smartphone cell plans, the Smiths can have coverage for their entire family.
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HOW TO SHOP The Mississippi Health Insurance Marketplace is a website where you can compare and buy the health insurance plan that’s right for you. The Marketplace opens October 1, 2013, with health insurance coverage starting January 1, 2014.
Visit healthcare.gov
Create an account Give your name, address and other basic information to get started.
Can I use the Marketplace? Anyone can use the Marketplace to see their insurance options. The Mississippi Health Insurance Marketplace is designed to help individuals and families get affordable health coverage.
Fill out the application Share more about you and your family, such as household size, income, and other information to see your plan options.
How to apply You can buy insurance through the Mississippi Health Insurance Marketplace October 1, 2013 through March 31, 2014. The process will be simplified – you only need to fill out one application to get coverage and financial help.
Compare
You can apply online, by phone, or in person.
Help using the Marketplace
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If you have questions, need help selecting a health plan, or completing your application you can: • Call the toll-free call center, open 24 hours a day, seven days a week. Call 1-800-318-2596 (TTY 1-855-889-4325). • Talk to someone online. You can have a live online chat at www.healthcare.gov. Spanish-speaking individuals can use www.cuidadodesalud.gov. • Talk to someone in person. Navigators and Certified Application Counselors are trained people who can answer questions and help you fill out your application in person. Find help near you at www.coverms.org 12
Review health insurance plans side-by-side and see if you qualify for lower premiums.
Get covered
A B Pick the plan that best meets your needs.
GET HELP
Navigating the System Navigators
Consumer Assistance Programs
Under the ACA, Mississippi and other states with federally based marketplaces will have at least two Navigator programs. Navigators are nonprofit entities that will assist individuals and families in choosing health plans offered in the marketplace. Each navigator is funded, trained, and certified by the United States Department of Health and Human Services.
Consumer Assistance programs (CAP) serve consumers, at different income levels with varying health coverage, including private insurance, Medicare, Medicaid, and other public program.
University of Mississippi Medical Center Jackson, MS 1-866-274-7832 www.ummchealth.com/HealthPlan Oak Hill Missionary Baptist Church Ministries, Incorporated 3440 Wheeler Road, Hernando, MS 38632 Ph: (662) 429-8747 / Toll Free: (855) 699-2300 Fax: (662) 429-8726 / Alt: (662) 429-8779 info@getcoveredms.org
Get Covered Mississippi Oak Hill Missionary Baptist Church is one of two organizations receiving federal funds to assist Mississippians in enrolling in the Health Insurance Marketplace. Oak Hill will provide services across Mississippi under the campaign “Get Covered Mississippi.” The Get Covered Campaign is a collaborative nonpartisan effort focused on raising public awareness and engaging consumers about the new health insurance options available under the ACA. Oak Hill’s campaign is led by their Pastor Dr. Michael Minor and his passionate staff. Along with paid staff, a team of volunteers will connect you, the Mississippi consumer, to the right resources and information so you can choose a health insurance plan that’s right for you, your family, and your budget.
Mississippi’s federally designated CAP is Health Help Mississippi. Health Help can assist you and your family if you have been denied benefits or have trouble accessing insurance coverage. Health Help is your representative when you have a problem with your health insurance plan. Health Help Mississippi 800 North President Street Jackson, MS 39202 Phone: 601.354.3470 Fax: 601.354.3471 Consumer Help Line 1-877-314-3843
Health Help Mississippi- HATTIESBURG 710 S 28th Ave. Ste C Hattiesburg, MS 39402 Phone: 601.264.8686 Fax: 601.264.5604
Health Help Mississippi- STARKVILLE 1014 North Jackson Street Ste. A Starkville, MS 39759 Phone: 662.615.6060 Fax: 662.615.6112
Health Help Mississippi- HERNANDO 2560 Highway 51 South-On the Square Hernando, MS 38632 Phone: 662.298.0136 Fax: 662.298.0138
Health Help Mississippi- GREENVILLE 239 Main Street Greenville, MS 38701 Phone: 662-335-3197 Fax: 662-335-3199
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“Yes, we have questions... lots of questions.” • What happens if we don’t buy health insurance? • What about our kids’ coverage? • Do we qualify? At Humana, if it’s important to you, it’s important to us. You may be uncertain about the changes in Healthcare and what they mean to you and your family.
We are listening
Let us help you understand the choices so you can decide what the right plan is for you.
Ask us anything. We are here to help!
We’re going beyond insurance to become your partner in health. Give us a call or go to Humana.com/HealthcareForYou
1-800-713-5244 (TTY: 711)
7 a.m. to 11 p.m. EST, seven days a week
Insured by Humana Insurance Company, Humana Health Plan, Inc., Humana Health Insurance Company of Florida, Inc., or Humana Health Benefit Plan of Louisiana, Inc. Or offered by Humana Medical Plan Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan of Texas, Inc., Humana Health Plan, Inc., Humana Medical Plan of Michigan, Inc., Humana Health Plan of Ohio, Inc., or Humana Medical Plan of Utah, Inc. Our health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. For costs and complete details of the coverage, call or write your Humana insurance agent or broker. GCHHQBREN
STORIES
Jackson’s Community Health Center The new health insurance marketplace will turn thousands of Mississippians from uninsured to insured. Even with these changes, Jackson-Hinds Comprehensive Health Center will remain a focal point in serving the health and social needs of many in Metro Jackson. The new insurance marketplaces have recently brightened the spotlight on issues of access to care.
Dr. Jasmine Chapman
Increasing access to quality health care has always been a part of Jackson-Hinds’ mission. Jackson-Hinds CEO Dr. Jasmine Chapman knows first hand how important it is for families to receive quality health services. “I was inspired to work in health care because of the impact community health centers had in my community during my childhood. Community health care centers gave (my family) access to quality health care,” said Chapman Founded in 1970, Jackson-Hinds is the largest community health center in Mississippi. It was developed because of the lack of accessible health care services for the residents of poor minority communities in Jackson, Mississippi and surrounding areas. But providing direct services to the ill and injured does not provide the full picture of the center’s work. Jackson-Hinds places an emphasis on education and the preventive aspect of medicine. “Preventive medicine coupled with education on health care allows poor minority communities to rebuild,” said Chapman. “(Jackson-Hinds) also plans to extend its coverage to offer mental health services,” continued Chapman. “This expansion will include having onsite ministers, psychologists, and psychiatrists.” Growth is nothing new for Jackson-Hinds. Since its inception, it has grown from a “one-bus-and-Sunday
by Joi Owens
school-classroom” operation to become a multi-site, multi-disciplinary provider of health services in Hinds, Warren, and Copiah counties. Jackson- Hinds is one of only two federally qualified health center (FQHC) in the state operating a clinic for the homeless and the only FQHC operating a HUD housing complex for lowincome elderly and disabled residents.
Under the ACA, Jackson-Hinds will also expand on its existing role of educating the community by providing enrollment assistance to Central Mississippi consumers looking to purchase a health plan in the marketplace. Eugene Drake, Head Certified Application Specialist at Jackson- Hinds, sees the center’s role in the marketplace as making sure people are aware of enrollment dates, new laws, and how to register. Drake states that, “Our plan of action includes being visible in the community, hosting community outreach and organizational meetings. We also plan to provide information to local churches and schools. Our division is fully accessible by email, office, or online. Our primary goal is to educate and inform the younger crowd on the law.” Drake believes that it is vital to focus on education aspect of the new health care laws. As a recent Jackson State University graduate Christopher Cox, a Certified Application Counselor, with Jackson- Hinds Comprehensive Health Care Center knows well about the daunting task of securing health care insurance. Cox says that, “My role as a Certified Application Counselor in this process is to act as a liaison between the market place and the consumer. He seeks to translate information into a easy to understand language to the consumer.” For more information on the Health Insurance Marketplace, contact a Certified Application Counselor at outreach@jackson-hinds.com or 601-362-5321. 15
STORIES
The Human Factor
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ith the implementation of the Affordable Care Act, Dr. Aaron Shirley, an advocate for the improvement in healthcare in underprivileged and underserved communities, believes that politics and misconceptions have muddled honest discussion and explanation of the Affordable Care Act, Medicaid expansion and their benefits for many Mississippians. Shirley started his medical career in Vicksburg, Mississippi following a tumultuous path through segregated schooling in the South. He attended Meharry Medical College in Nashville, Tenn. in 1959 through a scholarship from the Southern Regional Education Plan, a board of Southern governors who attempted to maintain the segregation of their states’ medical schools, by providing stipends for AfricanAmericans to attend medical school out of state. As stipulated in the scholarship, recipients were required to return to their homes to practice for 5 years in “needy” areas before being allowed to leave and pursue medical careers elsewhere. Upon his return to Mississippi, Shirley took part in “Freedom Summer” and provided care for freedom riders injured during their trek through Mississippi. After becoming actively involved in the civil rights movement, Shirley decided to abandon plans of leaving Mississippi to remain in the state to practice medicine. During this time, Shirley and other African-American physicians were denied admitting privileges at area hospitals, nor could African-American physicians practice in certain hospitals in the State. Despite these denials, Shirley’s resolve to pursue admittance and residency to these institutions was strengthened. In 1965, Shirley was the first African-American in the state to be admitted to the University of Mississippi for residency in pediatrics.
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by Kristian Weatherspoon
“It was during my training that I realized that health care in Mississippi, especially poor children…in a society that on paper and on Sunday morning said it cared, but I realized the way we provided care to poor people just wasn’t adequate, so I dedicated the remainder of my career to trying to correct some of that.” Shirley’s determination to improve the plight of the poor and underserved has birthed much advancement in the area of health care in the Metro Jackson area. With his guidance, in 1970, the Jackson Hinds Comprehensive Health Center became one of the State’s largest primary care providers for underinsured and underserved populations. One of Shirley’s hallmark accomplishments is seen in the partnering of the University of Mississippi Medical Center, Tougaloo College and Jackson State University which under Shirley’s leadership, led to the development of the Jackson Medical Mall in 1997. The Medical Mall brought health services and specialized care to a previously blighted property in northwest Jackson to serve a community with less than adequate access to essential health services. Shirley’s jovial disposition in the discussion of the controversial topic of Medicaid expansion and the Affordable Care Act, tempered with real life experience is a break from the political speak that many have seen as taking over the debate about healthcare in Mississippi. “The politicians have done a good job painting Medicaid expansion Black,” he says. With the Affordable Care Act providing viable options for Mississippians with no insurance and offering providers options to provide care to the uninsured, Shirley says his mission with the Jackson Medical Mall is to help Mississippi citizens and politicians alike understand that the impacts of healthcare reform or
Meet Neil Harvey by Monet Glover
the lack there of are far reaching, far beyond barriers of race or ethnicity. As far as the benefits are concerned, Shirley says the ACA is the best answer to the worst problem, access. “You have people with insurance money but not enough doctors, hospitals and all, then you have people with a type of insurance, where you have doctors that don’t accept it, then you have those who have no insurance and not enough financial resources to purchase the care that they need, ” explains Shirley. He also points out the dangers that providers operating in smaller hospitals face with the possible elimination of Disproportionate Share Hospital (DSH) payments. Especially in rural areas, this elimination could put some hospitals and providers in danger of closure as they lose funding to treat uninsured patients. For Shirley, it all comes down to what he calls, “the human factor.” “The relief of complications or illness that adequate coverage would mean,” says Shirley. This relief is why he says the ACA and Medicaid expansion are perhaps the most pressing and important factors in the economy of Mississippi. With his decades of fighting and his significant gains in healthcare, Shirley says he still believes that the expansion of Medicaid in Mississippi is inevitable and something that the State must do. Until such time, he is committed to celebrating the victories while continuing the discourse on the need for adequate access to care. The Jackson Medical Mall is acting as a direct agent for outreach and enrollment in the insurance exchange, they have sponsored listening sessions concerning the ACA and will continue educating Mississippians on health reform. Shirley says that his work in this field is far from done, “Personally I will be looking for every opportunity to try and convince people that they should think twice before allowing folks to cause them to oppose policies that could benefit them.”
There’s one place you can go to get the latest on politics, sports, and health care—the local community barbershop. Neil Harvey, a barber of 13 years, enjoys serving his community by engaging with his clients through the barbershop. “I love barbering but with that it is a self-employed field. With it being self-employed, you don’t have health care coverage provided,” as Harvey reflects on his field of choice. This has been a major concern for Harvey over the years. In 2005, Harvey experienced consistent pain causing continued discomfort and anguish. Without insurance, he delayed going to see a doctor to find out the cause of this horrible stomach pain. As the pain worsened, Harvey knew he needed to seek medical treatment. Harvey states, “Finally I went to the emergency room.” It was there Harvey discovered he was very ill and needed immediate care. Since he had delayed seeking treatment earlier, his condition had worsened. In addition to the chronic pain he had already suffered, he had to have his appendix removed. Normally this is a simple procedure with a very short stay in the hospital. “However, since I waited because I didn’t have insurance, an infection had spread throughout my body. That resulted in me staying in the hospital for 30 days.” During his extended stay, Harvey underwent numerous surgeries totaling over $175,000. Starting next year, the Affordable Care Act sets maximum limits on how much consumers like Harvey can be required to pay out-of-pocket annually for their medical care. Under the law, the maximum amount a consumer with single coverage will pay out-of-pocket in 2014 will generally be $6,350 while a family could pay up to $12,700. Those totals include copayments and deductibles, but not premiums, and they apply only to plans that are not grandfathered under the law. Not having health insurance, especially when it is critically needed, can be detrimental financially. Due to the lack of insurance many barbers either take on other jobs that offer employer sponsored health care insurance or receive coverage through a spouse’s health plan. “Most people just go without having coverage. I live my life without health care coverage because it is so expensive,” states Harvey. Like many Mississippians, Harvey will be able to purchase health insurance through the health insurance marketplace. Mississippians will be able to compare various health plans side by side and choose the plan that is best. You may even qualify for a tax credit or subsidy that could help offset any out of pocket health care costs making health care coverage affordable for you and your family.
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ACA IMPLEMENTATION TIMELINE
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FACTS
What’s Covered? On October 1, the Mississippi Health Insurance Marketplace opened and now provides uninsured Mississippians, or those who buy their own coverage, a whole new way to shop for health plans. The number one concern for Mississippi families and individuals is whether the plans offered in the Marketplace are affordable.
Costs At-a-Glance Monthly Premium Average in Jackson, MS for a 27-Year-Old with an Income of $25,000
Second Lowest Silver Plan After Tax Credit $145
Lowest Bronze Plan After Tax Credit $8
Monthly Premium Average Across Mississippi for a 27-Year-Old with an Income of $25,000
Second Lowest Silver Plan After Tax Credit $145
Lowest Bronze Plan After Tax Credit $75
Monthly Premium Average Across Mississippi for a Family of Four with an Income of $50,000
Second Lowest Silver Plan After Tax Credit $282
Lowest Bronze Plan After Tax Credit $28
An analysis of plans offered in Mississippi’s Marketplace found that not only are premiums affordable but well below original government estimates. The findings show that a 27-year-old living in Jackson may pay out of pocket only $8 a month for a bronze-level premium that covers all preventive services, most primary care visits, and limits out of pocket costs that may result from an accident or severe illness. The statewide bronze-level premium average for the same age group is $75 a month. That means for the first time many young Mississippians will be able to afford a quality health plan for less than the costs of their smartphone bill. It’s important for consumers to know, what they pay out of pocket may be considerably less than what they see as the sticker-price for premiums. Over 80% of Mississippians eligible to shop in the marketplace will also receive tax credits that will lower their monthly premiums. Insurance plans in the Mississippi Health Insurance Marketplace fall into four categories based on how the costs of care are shared between you and the insurance company. The four categories are Bronze, Silver, Gold, and Platinum. The category you choose affects: • How much your premium is and what portion of the bill you’ll pay for covered benefits like doctor visits or prescription medications.
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• Your total out-of-pocket costs (the total amount you’ll spend for the year if you need a lot of care). Each health plan may have different costs, even if they are in the same category. In general, the more you are willing or able to pay each time for health care service or a prescription, the lower your premium will be. The Marketplace also offers “catastrophic” plans to people under 30 years old and some people without other reasonably priced coverage options. This health plan protects you from very high medical costs only if you need a lot of care, like after a serious car accident. A catastrophic plan has a lower premium but generally requires that you pay all of your health care costs up to a certain amount – usually several thousand dollars. This health plan only pays for essential health benefits after you meet the deductible. However, all health plans in the Marketplace will cover the same set of essential health benefits. Essential health benefits are 10 groups of health services that must be covered by new health plans for individuals and small businesses. These categories are: • Ambulatory patient services, like visits to the doctor’s office. • Emergency services. • Hospitalizations, where you are required to receive care in a hospital and usually stay overnight. • Care for pregnant women, new moms, and babies. • Mental health and substance abuse services. • Prescription medicines.
• Preventive care and chronic disease management to avoid and control long-lasting or chronic conditions. Services may include: • Cancer screenings and check-ups. • Programs to help you quit smoking. • Care for long-term illnesses, like diabetes. • Health care services for kids, including eye exams and dental care for kids.
Requirements For Individuals And Families In January 2014 most Americans will be required to have health insurance or pay a penalty – unless you meet certain conditions. For people without health insurance, the Mississippi Health Insurance Marketplace is a website where you can compare and buy health plans. If you are currently insured or receive health care through one or a combination of the following sources, you meet the requirement to have health insurance: • A health insurance plan offered by your employer. This includes COBRA and retiree coverage. • Insurance bought on your own. • Medicare. • Mississippi’s Medicaid program or Children’s Health Insurance Program (CHIP). • TRICARE. This is insurance for active duty military members, retirees, and their families.
• Rehabilitative and habilitative services and devices. These include physical therapy, occupational therapy, speech therapy, and walkers. • Laboratory services, like blood tests. 21
FACTS YOU MAY NOT KNOW ABOUT HEALTH CARE REFORM Increases Medicaid payments to primary care physicians
Simplifying the Medicaid eligibility process
Mississippi’s Medicaid program has provided the security of health insurance to thousands of the state’s children, elderly, and disabled. Beginning in 2014, the Affordable Care Act will allow Mississippi to expand its Medicaid program to over 270,000 working Mississippi adults, who are now uninsured or underinsured.
In 2014 Mississippi will move to a more efficient system of determining Medicaid & CHIP eligibility. Under the Affordable Care Act, complex eligibility rules will be replaced by simple income-based rules and systems for processing applications for most Medicaid applicants.
To address the increased demand for doctors, the ACA will increase Medicaid payments made to primary care physicians for primary care services during the years 2013 and 2014 to Medicare payment rates. The additional cost will be covered entirely by the federal government.
Most importantly, Mississippi parents will no longer face a maze of eligibility offices to recertify their children for Medicaid or CHIP as face-to-face inperson interviews will no longer be allowed. Annual renewals of eligibility would be modernized, and outdated, obsolete policies and procedures will be eliminated.
This means that as more Mississippians are able to see a primary care physician, Mississippi’s Medicaid program will reimburse these doctors at the much higher rate.
This streamlined process will apply to the current Medicaid population as well as adult Mississippians who gain coverage under expanded Medicaid.
Overall, expanding Medicaid in Mississippi could create thousands of new jobs in the health care industry, a healthier more productive workforce, and millions of dollars in savings for the State as a result of lower uncompensated care costs.
These eligibility improvements to Medicaid/CHIP will result in: • Mississippi offering Medicaid applications by phone, in person, online, and by mail. • The elimination of face-to-face recertification • Replacing the existing income disregards with an automatic 5% income disregard. • Mississippi providing a single application for health coverage via Medicaid, CHIP, and Premium Tax credits to be used on the state’s health insurance exchange.
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FACTS Conservative Governors have committed to implementing the ACA and expanding Medicaid in their states. Michigan Governor Rick Snyder:
Ohio Governor John Kasich:
North Dakota Governor Jack Dalrymple:
Arizona Governor Jan Brewer:
“We’re all here to support expanding Medicaid. This makes sense, for the physical and fiscal health of Michigan.”
“We are going to extend Medicaid for the working poor and for those who are jobless trying to find work. It makes great sense for the state of Ohio because it will allow us to provide greater care with our own dollars.”
“We try to leave the politics out in the hallway when we make these decisions. In the end, it comes down to are you going to allow your people to have additional Medicaid money that comes at no cost to us, or aren’t you? We’re thinking, yes, we should.”
“With this move, we will secure a federal revenue stream to cover the costs of the uninsured who already show up in our doctor’s offices and emergency rooms.”
Working families make up most of the uninsured in Mississippi.
The uninsured in Mississippi is not bound to race.
49% White
43% Black
At least one full time worker
Part time workers
Non workers
Nearly 60% of the uninsured in Mississippi are a part of working families. That means that most of the uninsured live in households with full and parttime workers. It is not the case that everyone with a job has access to affordable health insurance. Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau’s March 2010 and 2011 Current Population Survey (CPS: Annual Social and Economic Supplements).
8%
Hispanic/ Other
Access to health insurance is not an issue of race. Nearly half of Mississippi’s uninsured are white with blacks making up 43% of the uninsured population. Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau’s March 2010 and 2011 Current Population Survey (CPS: Annual Social and Economic Supplements).
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FAQs Here’s a handy list of frequently asked questions about the new options that’ll be available for health coverage. Will the Affordable Care Act require nearly all Americans to have health insurance starting in 2014 or else pay a fine?
Will the Affordable Care Act give states the option of expanding their existing Medicaid program to cover more low-income, uninsured adults?
Yes. Starting in 2014, most U.S. citizens and legal residents will be required to obtain health coverage, or pay a penalty. Some exemptions will be granted. The fee, in 2014, is 1% of your annual income or $95 per person, whichever is higher. In 2014 the payment for uninsured children is $47.50 per child. The most a family would have to pay in 2014 is $285. The fee increases every year. In 2016, it is 2.5% of income or $695 per person, whichever is higher.
Yes. As enacted, the ACA calls for the expansion of state Medicaid programs beginning in 2014 to cover nearly all individuals under age 65 with incomes up to 138% of the federal poverty level ($15,856 for an individual or $26,951 for a family of three in 2013). However, while the Supreme Court upheld the ACA, it limited the federal government’s ability to enforce the Medicaid expansion to low-income adults, effectively making the Medicaid expansion a state choice. Mississippi has elected to not expand the Medicaid program.
How do I get an exemption from the fee for not having health coverage? You may qualify for an exemption if: • You’re uninsured for less than 3 months of the year • The lowest-priced coverage available to you would cost more than 9.5% of your household income • You don’t have to file a tax return because your income is too low • You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider • You’re a member of a recognized health care sharing ministry • You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare • You’re incarcerated, and not awaiting the disposition of charges against you • You’re not lawfully present in the U.S. 24
Will the Affordable Care Act create health insurance marketplaces where Mississippians who don’t get coverage through their employers can shop for insurance and compare prices and benefits? Yes. Starting October 1, Mississippians will have a new way to access health insurance coverage. Mississippi’s Health Insurance Marketplace will be an online-based marketplace consumers can shop for private, quality health insurance plans. Will the Affordable Care Act allow undocumented immigrants to receive financial help from the government to buy health insurance? No. Under the ACA, undocumented immigrants will remain ineligible for Medicaid and will be ineligible for the premium tax credits. They also will be prohibited from purchasing coverage through a Marketplace, even at full cost.
FAQs Will the Affordable Care Act provide financial help to low- and moderate-income Mississippians who don’t get insurance through their jobs to help them purchase coverage? Yes, tax credits will be available to Mississippians who purchase coverage in the new health insurance Marketplace and who have income up to 400% of the federal poverty level ($45,960 for an individual or $94,200 for a family of four in 2013). Over 229,000 Mississippians will have the opportunity to receive tax credits to assist in the purchase of health plans offered in the new Health Insurance Marketplace. Am I eligible for a “catastrophic” health plan? People under 30 and some people with limited incomes may purchase a “catastrophic” health plan. Generally this plan requires you to pay all of your medical costs up to a certain amount, usually several thousand dollars. The premiums of catastrophic plans are usually lower than that of a comprehensive plan. These types of plans are meant to protect you from very high medical costs. Can I keep my own doctor? Most health insurance plans offered in the Marketplace have networks of hospitals, doctors, specialists, pharmacies, and other health care providers. Networks include health care providers that the plan contracts with to take care of the plan’s members. Depending on the type of policy you buy, care may be covered only when you get it from a network provider. When comparing plans in the Marketplace, you will see a link to a list of providers in each plan’s network. If staying with your current doctors is important to you, check to see if they are included before choosing a plan.
the Marketplace. You’re not considered an employer even if you hire independent contractors to do some work. What if I have a pre-existing health condition? Starting in 2014, being sick won’t keep you from getting health coverage. An insurance company can’t turn you down or charge you more because of your condition. Once you have insurance, the plan can’t refuse to cover treatment for preexisting conditions. Coverage for your pre-existing conditions begins immediately. This is true even if you have been turned down or refused coverage due to a pre-existing condition in the past. Will the Affordable Care Act cut benefits for people in the traditional Medicare program? No, the law does not cut benefits for people in the traditional Medicare program. In fact, it improves certain benefits, such as coverage of preventive services, and closes the Medicare drug coverage gap known as the “doughnut hole.”
What if I’m self-employed? If you run an income-generating business with no employees, then you’re considered self-employed (not an employer) and can get coverage through 25
HEALTHY COMMUNITY, HEALTHY ECONOMY IT HELPS WORKIN
THE IMPACT OF MEDICAID EXPANSION
FAMILIES
300,000 working uninsured and underinsured Mississippians will gain access to health insurance.
2014
2017
FEDERAL
FEDERAL
For the first three years of Medicaid expansion, the federal government covers 100% of the states’ medical claims cost. After that, the federal match never drops below 90%.
“AN OUNCE OF PREVENTION” IS BETTER THAN A “POUND OF CURE.”
The Mississippi Hospital Association currently reports $525 million per year in uncompensated emergency room care costs.
It builds a
HEALTHIER, MORE PRODUCTIVE WORKFORCE.
ne
pansion ill generate mor e than y the year o sross ac M
In 2009, insured Mississippi families paid an extra $800 to cover the uninsured.
"No matter where one stands
Expansion will result in billions of dollars in federal health care investments in our state. This is necessary to replace current federal funding that hospitals useto treat uninsured patients, which will bereduced substantially by 2020.
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itself, the evidence is clear: Mississippi will greatly benefit by accepting federal dollars to extend Medicaid, and Mississippians will be harmed if it does not." - The Mississippi Chapter of the American College of Physicians, in a letter to Governor Phil Bryant
,
.
PARTNERS
Groups from across Mississippi are convening as the Cover Mississippi Coalition because they share the vision of reducing the number of uninsured in Mississippi. Members work to build awareness, facilitate enrollment and increase health insurance literacy. The Coalition is organized around a steering committee, working groups, and community partners. Coalition members will share learning and best practices, maximize resources, identify challenges and opportunities, and build an inclusive plan to insure Mississippians. Consumer advocates, providers, clergy, and other stakeholders have recognized the need for a statewide campaign to successfully assist Mississippians in understanding and purchasing health plans in the new Marketplace. In response to these challenges, Cover Mississippi has formed as a new coalition aimed at educating and enrolling Mississippians in the new health insurance Marketplace.
Organizing members of Cover Mississippi include AARP Mississippi
Mississippi Economic Policy Center
American Association of University Women
Mississippi Health Advocacy Program
American Cancer Society
Mississippi Human Services Coalition
Children's Defense Fund Southern Regional Office Health Help Mississippi Humana
Mississippi Immigrants Rights Alliance Mississippi Primary Health Care Association
Jackson-Hinds Comprehensive Health Center
Mississippi State Conference NAACP
Mississippi Center for Justice
Planned Parenthood Southeast
Oak Hill Baptist Church
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COVER
Mississippi coverMS.org
Mississippi consumer health advocates, providers, and other stakeholders have recently recognized the immediate need to collaborate to educate and enroll Mississippians in the new health insurance Marketplace. Beginning Oct. 1, Mississippi has an historic opportunity to offer affordable health coverage to more than 275,000 Mississippians through the Mississippi Health Insurance Marketplace. Representatives of these organizations understand and agree on the need for a statewide campaign to educate Mississippians about their new health insurance options. As a result, this coalition will coordinate resources under the brand “Cover Mississippi� in an effort to reduce the number of uninsured in Mississippi.
Visit www.CoverMS.org to learn more!