Several health-related study committees met during the summer and fall months, and most of them are wrapping up their work. The Consumer and Provider Protection Act Study Committee held its final open meeting in November with a focus on network adequacy and provider directories. Claire McAndrew from Families USA, a national consumer health advocacy organization, and Georgians for a Healthy Future’s Health Policy Analyst Meredith Gonsahn delivered testimony on the importance of setting network adequacy standards and ensuring provider directory accuracy and usability. Look out for a final report from the committee later in December!

Georgians for a Healthy Future hit the road again recently, this time to Savannah! Along with the Georgia Budget & Policy Institute and the Chatham County Safety Net Planning Council, we hosted Coverage and Access to Care: A Local Focus on Savannah.  The event provided the opportunity to have a roundtable discussion about the health and health care needs of people in Georgia’s coastal region. We were joined by representatives from local hospitals, insurers, non-profit organizations, enrollment assisters, and interested Savannah residents for the gathering.

Guided by the chart book, the group had a dynamic discussion about how we could make Georgia’s Medicaid program work better for those who are already enrolled, as well as the benefits of expanding it to cover Georgians in the coverage gap. It was clear the attendees were eager to talk about improving coverage and access to care by closing Georgia’s coverage gap.

Our conversation also touched on the open enrollment period and the needs of consumers enrolling through the health insurance Marketplace (aka healthcare.gov). GHF highlighted our new toolkit and Health Insurance User’s Manual as tools to help Savannah-area consumers get enrolled, stay enrolled, and effectively use their coverage.

This roundtable event gave us the opportunity to learn from the Savannah stakeholders, meet new partners, and identify areas where we can work together to improve Georgia’s health care system.  We look forward to returning to Savannah soon to build on this visit.

Dear Friends,

It’s an exciting time in health advocacy. The nation’s uninsured rate has plummeted over the past two years as Americans who were left out of our health system for too long have finally been invited in. Here in Georgia, half a million people gained coverage through the health insurance marketplace last year and we are working hard to raise awareness during this current open enrollment period.

But the pathway to coverage remains blocked for our lowest-income citizens here in Georgia because our state policymakers have not yet taken action to expand Medicaid. Approximately 300,000 Georgians are stuck in a coverage gap: they don’t qualify for Medicaid today and can’t access tax credits to buy private health insurance because their income is too low. Many of these Georgians are working in jobs that don’t come with health insurance. They are restaurant workers, child care workers, and even some veterans. They are our friends and neighbors, and we all suffer when they are left out.

Georgians for a Healthy Future is committed to making sure the voices of these Georgians are heard as public policy decisions are made that impact their lives. In the coming year, we plan to redouble our efforts to close the coverage gap in Georgia. This means we’ll be criss-crossing the state to talk to people who fall into the gap and to connect with community leaders, launching a digital advocacy campaign to mobilize the voices in support of closing this gap, and continuing to make the case directly to policymakers.

We need your help to do this. We need your partnership, your stories, and your voice. And on November 12^th, Georgia Gives Day, we hope you will help support our campaign to close the coverage gap by choosing to give to Georgians for a Healthy Future.

You can donate here.

Your partner in advocacy,

Cindy Zeldin

Executive Director

Georgians for a Healthy Future

Georgians for a Healthy Future is excited to release our new enrollment toolkit! The toolkit is a comprehensive compilation of fact sheets, neatly organized, that are designed to walk consumers through each step of the enrollment process – from how to get health insurance (enrollment) to how to use health insurance once they have it (post enrollment). You can download it here.

Need more information like this? You’re in luck! GHF has created the GEAR Network for people just like you. GEAR is the new central hub of resources for Georgia’s enrollment assisters and community partners that are working with people to educate them on their health and health coverage options. We’ll send out weekly emails full of local resources and the information you need to know through OE3 and beyond. For more information on GEAR, check out this presentation.

Who, what, when, where and why

By Pranay Rana

Pranay is GHF’s Consumer Education and Enrollment Specialist. A certified application counselor, he assists consumers with enrollment into health insurance through the Marketplace. Pranay can also help you once you have enrolled with questions about how your coverage works. To set up a meeting with Pranay you can email him or give him a call at 404-567-5016 x4. 

Open Enrollment 2016 (OE3) is less than 10 days away! Open enrollment is an annual period when individuals and families can choose from a variety of coverage options in the marketplace, apply for tax credits, and purchase a health plan that best meets their needs. Consumers can get 24/7 over-the-phone enrollment assistance via the Health Insurance Marketplace at 1-800-318-2596 or can find local in-person assistance at localhelp.healthcare.gov.  Individuals and families with incomes between 100% and 400% of the 2015 federal poverty level (FPL) may be eligible to receive financial assistance to help pay for their monthly premiums (see the chart below for what FPL means in real dollars). Consumers with lower incomes  (between 100% and 250% of the FPL) may be eligible for additional help with out-of-pocket costs if they choose a “silver bars” plan.  In 2015, 9 out of 10 Georgians who enrolled into marketplace plans were able to access tax credits. Consumers who do not qualify for subsidies may still be able to purchase plans through the marketplace at a full price.

So, when does my coverage start?

 Subsidies and Reconciliation Requirements

The marketplace will discontinue subsidies for those consumers who did not fulfill their tax filing requirements for 2014 in order to reconcile their income and subsidies at the end of the year. Consumers are advised to fulfill their tax filing requirements every year and call the marketplace or local assisters for help if subsidies are being dropped without any legitimate reasons. Consumers who do not qualify for subsidies because their income is too low are also advised to obtain an Exemption Certificate Number (ECN)  to avoid tax penalties.

What do I need to do to renew my existing plan?

You may simply call the marketplace for 2016 application renewal if you need to change plans for 2016 or update your information. If you are happy with your existing plan and have no updates to make then you do not need to do anything. The marketplace will simply auto-renew your application for 2016.

What if I need help?

• You can call GHF’s enrollment assister at 404-331-9981 or email prana@healthyfuturega.org
• You can call the marketplace 24/7 at 1-800-318-2596
• You can also find local help at healthcare.gov.

Federal Poverty Level Table, 2015

We  know that closing Georgia’s coverage gap would help adults who are uninsured. But how does it affect families and children in our state? GHF and Georgetown University Health Policy Institute’s Center for Children and Families have teamed up to bring you new research to answer that question. Key findings include:

• Nearly three-in-ten Georgians potentially eligible for coverage should Georgia choose to close the coverage gap are parents with dependent children residing in their home.

• Of those parents that could benefit from expanded Medicaid eligibility, nearly two-thirds (57 percent) are employed. Nearly half of all uninsured parents (46 percent) work in restaurants, retail, or professional service occupations.

Children enrolled in Medicaid are more likely to receive well-child care and are significantly less likely to have unmet or delayed needs for medical care, dental care, and prescription drug use due to cost.

The Taxotere Lawsuit served as a perfect example to prepare everyone involved, read the full report here.

Georgians for a Healthy Future and the Georgia Budget and Policy Institute are proud to release our joint publication: Understanding Medicaid in Georgia and the Opportunity to Improve It. Inside you will find infographics, new data, and compelling charts that simplify the complex issue of Medicaid in Georgia. 

Part one explains who gets Medicaid in Georgia, how Medicaid protects Georgians during economic downturns, how Medicaid controls costs in the state, and more.

Part two outlines Georgia’s opportunity to close the coverage gap.  Here you’ll find out what Georgia’s health insurance coverage gap is, how we can use Medicaid to close it, and who stands to benefit detailed by job sector, demographics, and veteran status.

Part three details economic and social benefits of closing the coverage gap. Why is closing the coverage gap a good deal for Georgia and the state’s economy? What are the savings other states realize by closing the gap? How does coverage affect a person’s financial and physical health? 

Download the chart book here.

Do you or does your organization work directly with consumers to help get them covered? Do people in your community come to you with questions about how to make sense of their health insurance? If so, GEAR is for you! Please join us for a webinar to introduce the new Georgia Enrollment Assistance Resource Network — GEAR! GEAR is the new central hub of resources for Georgia’s enrollment assisters and stakeholders who work to educate people on their health and health coverage options. GEAR is full of handouts, interactive consumer tools, important updates, and other materials that will help enrollment assisters and community organizations better educate Georgians on health insurance enrollment, health insurance literacy, and more.

Want to learn more about GEAR and how you and/or your organization can benefit?  Join us on October 19th for a webinar where we will demonstrate how to access GEAR and review some of the materials that can be found there. We will also get your feedback about other resources you would like to see included on GEAR in the future. GEAR is built to help more Georgians connect to health coverage and we want it to work for you!

You can register for the October 19th GEAR webinar here.

We (Consumer Education Specialist, Whitney Griggs, and Community Outreach Manager, Laura Colbert) made the drive to Augusta this week to check in with health care stakeholders and consumers in the northeast Georgia city.  We were warmly welcomed by community partners and are excited to return for next week’s community forum Coverage and Access to Care: A Local Focus on Augusta.

Our primary purpose for the trip was to attend the Greater Augusta Health Network’s (GAHN) fall forum.  The forum covered a variety of topics, including how the local District 13 Department of Public Health provides much needed direct patient services to people in its service areas, GAHN’s on-going health care utilization data collection efforts, and the Affordable Care Act’s effect on small employers (51 to 99 employees).

The forum closed with a discussion panel of indigent care providers, including Medical Associates Plus, St. Vincent de Paul health clinic, and Christ Community Health Services. These providers described their determined efforts to provide care for Augustans who cannot afford health insurance or pay for their health care. Mentioned by all three panelists was the need to close Georgia’s coverage gap. Every day each clinic serves people who need health care coverage, like veterans who can’t get are at the VA. The clinics are able to do this work only because of generous donations and profits from a few insured patients. While these charity care clinics are doing amazing work, they say that they cannot provide all the care that is needed for Augustans in the coverage gap.  Each of the panelists made the case that closing the coverage gap would be great for their patients and clients, and for their clinics.

Christ Community Health Services generously hosted us in the afternoon, so we could talk to their patients about why closing the coverage gap is important to them. One of the patients they talked to was Tracy. Tracy has chronic pain in her back, and is managing anxiety and depression brought on by her back pain. Her pain makes it impossible for her to sit at a computer to do her graphic design work, which means she has no income and no health care coverage. Tracy is stuck in the coverage gap, I told her that There are several good CBD companies to choose from when shopping online and that’s something that may help her. Her mother, Maria, pays what she can for Tracy’s care and drives her to and from appointments.  Tracy told us that she isn’t asking for a hand-out, she “just wants the public benefits that I paid into when I was working.”

It was clear from our visit that closing the coverage gap is an important issue to health care stakeholders and consumers in Augusta.  To learn more about the coverage gap in Augusta and in Georgia, join us for a community forum next Thursday, September 24^th.

RSVP here.

You’re invited to a panel discussion about the state of health care in Augusta and across Georgia. Local stakeholders and community leaders will discuss the current state of health insurance coverage and access to care, present regional and state data on Medicaid and the uninsured, and discuss opportunities to work together to improve coverage and access to care through direct collaboration and through policy change. We will place a special focus on Georgia’s coverage gap and lessons learned from other states that have reduced their uninsured rates by expanding Medicaid or through alternative approaches, such as a waiver.     The event will take place at the Augusta Richmond County Public Library on Thursday, Sept. 24th, 9 to 11 am. Coffee and a light breakfast will be served. This event is free, but we ask that you please register so we can get an accurate head count.

Panelists include:

Dr. Jacqueline Fincher, MD, MACP

Board of Regents | American College of Physicians | Managing Partner,  McDuffie Medical Associates

A representative from Christ Community Health Services

Tim Sweeney, Deputy Director of Policy Georgia Budget and Policy Institute

Dr. Bill Custer, Director of Center for Health Services Research

Click here to register for the event.