Resources for the Uninsured. Prepared for WCEDA By Katherine R. Gaulke, PhD, MHA (262)

Transcription

1 Resources for the Uninsured Prepared for WCEDA By Katherine R. Gaulke, PhD, MHA (262)

2 Katherine R. Gaulke, PhD, MHA Doctorate in Public Service Leadership from Capella University. Graduate of University of Florida with a Master of Health Administration and Saint Leo University with a Bachelors in Business Administration (Accounting). Founder & Executive Director (volunteer) - Wisconsin Association of Free & Charitable Clinics, Inc. (WAFCC) Member of the American College of Health Care Executives (ACHE) Previous careers include: Payment Resolution Manager, Financial Analyst and Accountant for HCA Patient Account Services Dr. Katherine R. Gaulke Medical Office Property Manager for Cogdell katherinegaulke@hotmail.com Spencer Erdman, Inc Dr. Gaulke is NOT an insurance agent. Insurance specific questions should be directed to a broker/agent. Presentation is for information purposes only. There is no promise or guarantee of coverage or affordable coverage. You assume all health & coverage risks/payments and should conduct your own research.

3 WISCONSIN Badgercare (Medicaid) & Marketplace (Healthcare.gov) Coverage Comparison U.S.-born & Naturalized Citizens Lawfully Present Immigrants Medicaid Expands to adults without dependents with incomes up to 100% of FPL. Persons 101%-133% of FPL losing Medicaid and moving to Marketplace (eligible for hardship waiver) Many remain subject to a fiveyear wait before they may enroll or are excluded from eligibility. Exchange Coverage Individuals without affordable employer coverage can buy coverage through the Marketplaces. Tax credits available to individuals with incomes between 100%-400% of poverty who are not eligible for Medicaid. May purchase exchange coverage and receive tax credits on the same basis as citizens. Persons with incomes below 100% of poverty who are ineligible for Medicaid based on immigration status may purchase exchange coverage and receive tax credits. Undocumented Immigrants Remain ineligible for Medicaid. Prohibited from purchasing exchange coverage and receiving tax credits.

4 How to Find an Insurance Agent Questions to Ask What insurance companies do you have a contract with? What Marketplace insurance companies in my county are you contracted with? How many Marketplace plans have your written? Have you assisted with Marketplace appeals and waivers? Will you help with BadgerCare applications? Can you help with Medicare? What Medicare companies are you contracted with? How to Lookup Your Agent Go to the Wisconsin Office of the Commissioner of Insurance Website o Click on Agent/Agency o Click on Agent/Agency Look Up Or Call (800) Monday - Friday 7:45am - 4:30pm

5 NAVIGATORS A navigator can be an individual or an entity that supervises or employs an individual who performs any activities and duties related to the navigator program on behalf of the federal exchange and who receives funding to perform such functions on behalf of the federal exchange. Complete current list found at Walworth County s is Kathie Duschene RACINE KENOSHA COMMUNITY ACTION AGENCY, INC N. WISCONSIN ST. RACINE WI

6 Who are the uninsured post-aca? PERSONS WHO: o Find employer family coverage unaffordable. o Cannot enroll in Medicaid. o Are exempt from Insurance Mandate & Shared Responsibility Payment. o Dropped their expensive COBRA insurance after the open enrollment period, not realizing this does NOT trigger a special enrollment. o File taxes separately from their spouse, rendering them ineligible for subsidies in the Marketplace. o Are 65 or older and find Medicare Part B and Advantage premiums unaffordable; but are not eligible for any subsidies. o Are waiting for their insurance to kick-in. o Are caught in the differences of income determination between the Marketplace (annual) and Medicaid (monthly) income figuring o Are undocumented residents and can not purchase insurance in the United States (i.e., no Social Security number or legal document number). o Are unable to quit, or choose to smoke, and are penalized up to 50% higher premiums, thus making insurance unaffordable. o Missed Open or SEP Enrollment period o (no waiver for this). o Do not have dental or vision insurance. o Those that are CONFUSED or DON T KNOW Source: WAFCC, 2015 #TheNeedContinues Handout According to RWJ only 25% have been to an FCC #TheNeedContinues

7 Free & Charitable Clinic Defined Free and Charitable Clinics (FCCs) are safety-net health care organizations that utilize a volunteer/staff model to provide a range of medical, dental, pharmacy, vision and/or behavioral health services to the uninsured, underserved, economically and socially disadvantaged, and vulnerable populations. Such clinics are 501(c)(3) tax-exempt organizations, or operate as a program component or affiliate of a 501(c)(3) organization. Entities that otherwise meet the above definition, but charge a nominal/sliding fee to patients, may still be considered FCCs provided essential services are delivered regardless of the patient's ability to pay. Free or charitable clinics often restrict eligibility for their services to individuals who are uninsured, underinsured and/or have limited or no access to primary, specialty, or prescription health care.

8 FREE CLINICS NEARBY Walworth County Open Arms Free Clinic 797 E. Geneva St., Elkhorn (262) Jefferson County Community Dental Clinic 520 Handeyside Ln, Fort Atkinson (920) Rock River Free Clinic 1541 Annex Rd, Jefferson (920) Watertwon Area Cares Clinic 415 S. 8 th St., Watertown (920) Rock County HealthNet of Rock County 23 W. Milwaukee St, Janesville (608) Waukesha County Community Outreach Health Clinic W180N8085 Town Hall Rd, Menomonee Falls (262) Eagle s Wing Free Clinic 225 Eagles Lake Ave, Mukwonago (262) Lake Area Free Clinic 856 B. Armour Rd., Oconomowoc (262) St. Joseph s Medical Clinic 826 N. East Ave., Waukesha (262)

9 FQHCs Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors.

10 FQHCs NEARBY FQHCs o Community Health Systems 74 Eclipse Center, Beloit (608) Kellogg Avenue, Janesville (608) o Sixteenth Street Waukesha Community Health Center 309 E. North Street, Waukesha Main phone: (262) Behavioral Health phone: (English) (Spanish)

11 Retail Clinics A retail clinic is a category of walk-in clinic located in retail stores, supermarkets and pharmacies that treat uncomplicated minor illnesses and provide preventative health care services. They are sometimes called "retail-based clinics," "convenient care clinics," or "nurse-in-a-box." Minor injuries, minor illnesses, screening & monitoring, skin conditions, vaccines, wellness & physicals, labs & tests $20-$235 (published price list)

12 RETAIL CLINICS NEARBY Retail Clinics o Aurora Quick Care Brookfield Mall - 95 N Moorland Rd, Brookfield (262) Walmart Wolf Run, Mukwonago, WI Note that Aurora Quick Cares are willing to schedule days at employers o Walgreens 3925 W Elm St, McHenry, IL (815) E Sunset Dr, Waukesha (262) o Minute Clinic/CVS Pharmacy W Sunset Drive, Waukesha (866)

13 Questions/Discussion