Last week, The Centers for Medicare and Medicaid Services issued the final Marketplace Stabilization rule to “help lower premiums and stabilize individual and small group markets and increase choices for Americans.” While the rule is designed to help lower premiums and increase the choices consumers will have, some of the policy changes in the rule may potentially impact consumers in a negative way. Below are the key components of the final rule:
2018 Open Enrollment Period: The final rule shortens the annual open enrollment period to November 1, 2017, until December 15, 2017. This is half the duration of open enrollment periods in the past. This shortened window to enroll will result in many consumers potentially missing the opportunity to enroll in coverage and will overwhelm the already limited capacity of organizations providing in-person enrollment assistance. During the 2016 Open Enrollment period for the New York State of Health Marketplace (November 1, 2015 – January 31, 2016), about 74% of consumers enrolled or renewed their coverage with the help of an assistor. Consumers that do not enroll during the open enrollment period will only be able to enroll if they are eligible for a Special Enrollment Period (those eligible for Medicaid, Child Health Plus or the Essential Plan can enroll at any time during the year.)
Special Enrollment Period: Individuals applying outside of open enrollment will be required to provide proof of eligibility for a special enrollment period by submitting supporting documents. This rule aims to reduce fraud and abuse by ensuring that only those who are eligible are able to enroll. Consumers are not currently required to submit proof and this additional documentation burden could result in consumers experiencing delays in their coverage.
Continuous Coverage: The final rule allows insurers to require individuals to pay back past due premiums before enrolling in a plan with the same insurer the following year. Consumers who fell behind in premium payments will have to pay the balance due or they will not be able to enroll in the same coverage, forcing consumers to choose between overcoming a financial burden or being locked out of coverage for the entire year.
Ensuring Additional Choices for Consumers: the final rule allows insurers additional flexibility with the actuarial value of plans so they can offer more plan choices with lower premium options. While at first glance it does seem beneficial to offer greater consumer choice, actuarial value flexibility will allow insurers to offer cheaper plans by removing benefits or increasing out of pocket costs. Consumers may not realize what benefits are not being offered with their plan or what out-of-pocket costs they will be responsible for.
While overall these policy changes may be aimed at increasing choices and lowering costs, a robust education and outreach component should also be included to ensure that consumers understand how these changes may impact their coverage.
State-run marketplaces, like the New York State of Health, do often have more flexibility in establishing some of these policies so it is not entirely clear at this time how this final rule will impact consumers currently enrolled or enrolling in coverage through the New York State of Health Marketplace. HWCLI will continue to follow these changes and provide further updates when additional information is provided by the state.
During the holiday season, the word ‘giving’ comes up a lot. Giving thanks, giving the perfect gift, and hopefully you are hearing a lot about giving back. The magnitude of community philanthropy and kindness that we see during the holidays is heart-warming. And just like all of you, we want to continue to give to our community: we aspire to give things like social justice and equality-access to basic necessities like health care access, safe housing and nutritional supports.
For almost 70 years, the Health & Welfare Council of Long Island has been the voice for Long Island’s working families, low income individuals, the elderly, the sick and the poor. We know that nearly 1 in 4 Long Islanders are struggling to put food on their tables, pay utilities, find affordable child care and access healthcare. Long Island families are having to choose between which basic human necessities they can afford. HWCLI and our partner health and human service agencies have been and will continue to be here– providing services, advocating and supporting. But we need your help and we need your support to make sure our collective Long Island voice is loud enough to be heard in Albany and in DC. In the non-profit sector, we rely on your giving. We rely on your generosity and support so we can continue to pursue our mission of improving the lives of Long Islanders. In the spirit of #GivingTuesday and #NYGivesDay, please donate to HWCLI’s advocacy for Long Island’s at-risk and vulnerable families.
Together, we can make a difference. On November 29, your donation of any amount will help. Click here to view our New York Gives Day profile.
We hope you all have a happy and safe holiday season.
An estimated 6.8 million young people ages 10 to 17 struggle to have enough to eat, including 2.9 million who have very low food security. Urban Institute and Feeding America spent 3 years conducting focus groups with teenagers in 10 communities in an effort to get a more complete picture about how food insecurity impacts teenagers. They found that food insecure teenagers face impossible choices- often engaging in risky behavior just to survive.
During the focus groups, teens were asked questions about their observations of teen food insecurity in their communities, how young people get food, and risky behaviors, such as stealing or dealing drugs that teens may resort to during times of desperation. Several common themes emerged from the focus groups discussions:
- Teen food insecurity is widespread. Even teens that were not experiencing food insecurity themselves were aware of other teens that were.
- Teens fear the stigma associated with food insecurity and needing assistance. They may be less likely to access resources.
- Teens with younger siblings often take on the role of parent for younger siblings, ensuring they have enough to eat first and putting themselves second. Teens are often more aware of parent’s struggles with money and food insecurity than younger children.
- Teens faced with acute food insecurity reported sometimes engaging in criminal behavior such as stealing food, dealing drugs or reselling stolen items to make money.
It’s clear from the data collected in the focus groups that teen food insecurity is a multi-faceted issue that requires adding supports in multiple areas. Many nutrition programs focus on younger children so more emphasis should be placed on engaging teens in these programs, especially school meal programs. More employment options are also needed to provide teens with a way of earning money. Teens in the focus group indicated they would be glad to work but job opportunities are limited in their communities. Teens should be empowered and engaged to create programs for their communities. As a result of a focus group in Portland, a youth empowerment group is designing programming for teens in their own community. Addressing food insecurity in teens is clearly a challenge, but it’s clear that steps must be taken to provide further supports to this vulnerable population.
For more information, read the full report, Impossible Choices, from Urban Institute and Feeding America
The Child Care Council of Nassau’s Annual Meeting is highlighting the Importance of Early Learning in the Global Economy. Taking place on September 28 at the Hofstra University Club, this meeting will be addressing the question: Nassau County is OPEN FOR BUSINESS, but who will mind the store?
This event will feature a keynote speech from Bill Millet and the presentation of the Margo O’Connor Advocate of the Year Award to Elissa Giffords, DSW, LCSW.
For more information, click here.
RSVP to Kristen Weeden by September 23rd, 2016
(516)358-9250 ext 35
1 in 5 children in the U.S are living in poverty. The American Academy of Pediatrics recently released recommendations urging doctors to ask at all well-child visits whether families are able to make ends meet. Poverty has been found to impact children’s health and development significantly, and pediatricians have a unique role in identifying poverty related stress.
An individual’s health is linked largely not only to the clinical care they receive from their physician, but to where they live, work and play. To whether or not they have stable housing or if there is enough food to eat. The AAP is hoping that a single question “Do you have difficulty making ends meet at the end of the month?” will help identify families in need so they can get access to available services in their communities.
HWCLI recognizes that physicians often times do not have the staff or resources to work with patients once they have identified poverty as an issue, which is why Community Based Organizations have and important role to play when it comes to addressing the social determinants of health. HWCLI and our partners will soon be piloting projects throughout Long Island to help support pediatricians with the infrastructure needed to integrate screening for food insecurity and poverty into their practice. These projects will create a link between the patient, their doctor, and community services available to help address their needs and ultimately improve health outcomes.
You can read the full report from AAP on poverty and child health HERE
The 2015-2016 school year marked the second year of nationwide availability of Community Eligibility, an option allowing qualifying schools to offer breakfast and lunch at no charge to all students without collecting and processing individual school meal applications. More than 18,000 schools in 3,000 school districts across the country have now adopted Community Eligibility, an increase of 4,000 schools compared to last year.
These 18,000 schools represent over just over half of eligible of all eligible schools and serve about 8.5 millions children. The popularity of Community Eligibility in the first two years of implementation speaks to the desire of schools to meet the needs of their most vulnerable students by providing a healthy breakfast and lunch, which in turn better prepares students to learn.
The chart below shows the percentage of eligible school district that have adopted Community Eligibility for the 2015-2016 school year. Hempstead School District is currently the only district on Long Island that has adopted Community Eligibility.
More information about Community Eligibility can be found in this report by Center on Budget and Policy Priorities