ACA Protects People with Chronic Conditions Against Discrimination in their Health Coverage

CID-NYGuest blog by Heidi Siegfried, Project Director at New Yorkers for Accessible Health Coverage (NYFAHC) and Health Policy Director, Center for Independence of the Disabled. A few days ago, Health Affairs published an article that highlighted how the non-discrimination provisions of the Affordable Care Act (ACA), Section 1557, can protect consumers against benefit designs that discriminate against people with chronic conditions or significant health needs.

New York has long prohibited denial of coverage or premium variation based on health status and the ACA now prohibits charging higher premiums or denying coverage for people with pre-existing conditions. Still, network and formulary designs can have the effect of discriminating against people with serious illnesses and disabilities.

People often overlook the fact that Section 1557 prohibits discrimination based on disability status as well as race, color, national origin, sex, and age.  HCFANY and NYFAHC submitted comments to the U.S. Department of Health and Human Services (HHS) on the proposed rules for Section 1557 in November 2015. In these comments, we asked HHS to specifically define discriminatory benefit design in the regulations implementing Section 1557 and to include all beneficiaries with chronic conditions or serious illnesses.  Although HHS did not provide a definition, they do consider benefit design discrimination on a case-by-case basis and will review complaints of disability-based discrimination. HHS also provides examples of potentially discriminatory benefit designs such as placing all HIV drugs on the highest tier.

The Health Affairs article points out that the Americans with Disabilities Act was amended to define disability as an impairment of major bodily functions such as immune system, normal cell growth, digestive, bladder, neurological, respiratory, and endocrine systems which would reach many people with chronic conditions.  Therefore, when consumers encounter discriminatory formularies, coverage limitations, or plans that exclude certain specialists, they can use Section 1557 to enforce their rights to non-discriminatory benefit design by filing complaints with the Office of Civil Rights at HHS or by challenging the plans in court.

Guest Post: Kari Siddiqui, Policy Analyst, Schuyler Center for Analysis and Advocacy

Everyone cheered when the Affordable Care Act (ACA) included a provision allowing young adults to stay on their parents’ health insurance until they turned 26.  An equally important and lesser-known provision extends health insurance coverage to young adults formerly in foster care, who are unlikely to have the option of receiving health coverage through family. The ACA extends Medicaid access to these youth, with no income restrictions, until they turn 26.

The Medicaid to 26 provision went into effect in January 2014 and offers health insurance coverage to the more than 20,000 youth who age out of foster care across the country each year. In New York State alone 1,283 youth aged out of foster care in 2012. These young adults particularly need health coverage as they transition from foster care into their independent adult lives.

The Schuyler Center for Analysis and Advocacy, a member of the HCFANY steering committee, is working to ensure that young adults can take advantage of this benefit. With input from our State partners, the New York State Department of Health and the Office of Children and Family Services, Schuyler Center developed materials to help youth understand and access this benefit. Young adults with ties to foster care – those still in care and those who have aged out – are helping us to shape the message, target outreach, and design materials. Their input helps us understand how to reach youth where they are and communicate effectively.

Drawing on this input, Schuyler Center developed outreach and education materials, including a brochure with an application checklist, newsletter articles, videos (like the one above featuring Shanice), a youth-targeted Everything You Need to Know guide to the Medicaid to 26 benefit, as well as a toolkit for providers. Please join us in these outreach efforts, and use the materials we’ve created to reach youth and providers in New York State and in your communities across the country. Follow Schuyler Center on Twitter at @SchuylerCenter using the hashtag #Medicaidto26 and find all materials on our website: www.scaany.org/scaa-resources/medicaid-to-26

 

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“The Affordable Care Act gave me a chance and ended my six year nightmare of living without health insurance. It was way more simple and affordable than people think.”

Karen E., Ulster County

The Affordable Care Act is working in New York, according to HCFANY’s new publication, The ACA is Working: New Yorkers Tell Their Stories.

The new publication shares stories from New Yorkers like Karen, a single mother from Ulster County, who was finally able to get affordable health coverage for her family after being uninsured for six years, thanks to federal subsidies. Ben, from Broome county got covered thanks to the ACA’s Medicaid Expansion and enrolled in the same plan as his son. And Engracia got help from a local Navigator to enroll in a plan that saves her $4,500 a year.

The ACA is Working: New Yorkers Tell Their Stories features twelve consumer stories and quotes from New Yorkers in all regions of the State who enrolled in private Qualified Health Plans, Medicaid, Child Health Plus, and small business plans, all through the NY State of Health Marketplace during the first Open Enrollment period. Many got help to enroll from Navigators, who offer free, unbiased, in-person enrollment help. The stories are paired with key statistics and facts about how the ACA is working for New York – and most importantly, New Yorkers.

View HCFANY’s full press release here.

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Outreach Worker Engracia Jamieson and Volunteer Jan Kenyon at Great Day in Harlem  (above) and   RWV-NY Community Organizer Liza Lederer (right) at Brooklyn Pride

This coming Labor Day Weekend marks the unofficial end of summer, and it’s been a busy one for health coverage advocates and volunteers! Here’s an update from the field from the Get Covered NY Campaign, a grassroots effort to raise awareness about the new insurance options available through NY State of Health, and help NYC residents get covered. Get Covered NY is a project of Health Care For All New York, Greater NYC for Change, and Raising Women’s Voices – NY.

Guest Post by Aliza Lederer-Plaskett, Community Organizer for Raising Women’s Voices-NY

Raising Women’s Voices and our partners in the Get Covered NY initiative are wrapping up a busy summer of outreach to uninsured New Yorkers. We have tabled and leafleted at a wide variety of events in low-income communities in Upper Manhattan, Brooklyn and the Bronx, as well as Westchester and Rockland counties.

We’ve been to the Hunts Point Summer Fish Festival in the Bronx. We’ve reached out to LGBT people by tabling at Pride Festivals in Harlem, Brooklyn, the Bronx, Rockland County and lower Manhattan. We’ve been to book fairs, Harlem Week and back-to-school events where we can reach families with children who may be eligible for Child Health Plus. In Westchester and Rockland Counties, we have done outreach at cultural festivals and presentations on the Affordable Care Act and NY State of Health for members and staff of local nonprofit organizations.

Our dedicated and trained Get Covered New York volunteers have been taking clipboards and handouts around the events, interacting with attendees and taking down the names of people who would like to be contacted by a Navigator to begin the application process. Through this hands-on approach, we have collected more than 900 names of uninsured and underinsured individuals throughout July and August.

As we speak with uninsured people in the field and collect their information, we have noted who has experienced a major life change – which may qualify them for a special open enrollment period. We also flag people who we think might qualify for Medicaid, for which there is year-round enrollment. We then forward their contact information directly to a Navigator at the Community Service Society.  Other uninsured individuals are entered into the Get Covered NY database, to be called by volunteers at phone banks that will start up again as the November 15 start of the next open enrollment period draws closer.

We have begun to pack our September and October schedule chock full of community events to ensure that we can reach as many people as possible prior to the start of the new enrollment period.  Got an event you’d like to see us at?  Interested in becoming a volunteer? Please contact Liza Lederer at liza@raisingwomensvoices.net and we’ll get you set up to help get New York covered!