health care

Fight the Dismantling of the Affordable Care Act (ACA)

The week of March 4th, New Yorkers for Accessible Health Coverage, a project of CIDNY, submitted comments to the US Department of Labor expressing strong concerns with a proposed rule expanding Association Health Plans.

We believe that the proposed changes would negatively impact access to quality, affordable care for consumers, disrupt the individual and small business marketplace, and further strain the limited resources of state regulators. The loosely affiliated small businesses joined together as AHPs would be exempt from many of the consumer protections created by the Affordable Care Act (ACA). These include insurance standards such as Essential Health Benefits, premium rating rules, and risk pooling. As was seen in the past with AHPs, fraud, abuse, and plan solvency present potential concerns, especially as oversight and regulatory authority remains in question.

We are particularly concerned that Association Health Plans will use various practices to discriminate on the basis of health status. This will segment the market, making the ACA-compliant market, that the people we serve now enjoy, into a high-risk pool that will become unaffordable to them.

Learn more about the impact of Association Health Plans here.

Please Take This Survey about Your Medication

Do you take medication for a chronic or rare disease? Has your insurance company forced you to switch medication?

We have previously had success working with a coalition of health care advocates to pass legislation that regulates Step Therapy in New York in 2016. We are asking for your help to pass another patient-friendly bill. In this case, it relates to Non-Medical Switching, the practice of changing insurance coverage mid-plan year and ultimately forcing a patient to switch medication.

In order to pass legislation that prevents patient harm by regulating Non-Medical Switching, we need to first prove the extent of its impact to legislators. Our partners developed a survey that asks patients about their experience with this and how it has impacted their lives and also can protect hair loss problems.

We would like the survey results to be as representative of the patient population of New York as possible.

Here is the survey link. Please complete by the end of the day on Friday, March 9th.

ICAN Helps New Yorkers Who Need Long-Term Care

New York State’s Independent Consumer Advocacy Network (ICAN) program helps New Yorkers with disabilities with their health insurance and long-term care problems. Long-term care includes care in a nursing home or in your own home with help from an aide. Personal care aides can help with activities like getting dressed, walking, and going to the bathroom.

The way the long-term care system works can be hard to figure out, which is why ICAN is here to help.

ICAN is a group of advocates and lawyers from different organizations across New York State, including CIDNY. ICAN’s staff at CIDNY are experts in the long-term care system and handle a wide range of cases from all five boroughs of New York City. Our staff provides services ranging from simple advice to representing people at appeals, free of charge.

In 2015, New York State created both the Independent Consumer Advocacy Network (ICAN) and the new Fully Integrated Dual Advantage (FIDA) insurance plans. FIDA was intended to make it easier for people with both Medicaid and Medicare to get health care.

When people with Medicaid become eligible for Medicare, they usually have to change their Medicaid plan. Then they have to figure out how to use their separate Medicaid and Medicare insurance on their own to get health care. These “dual-eligibles” generally need more care than most people with only Medicaid. The State hoped that setting them up with a single plan that combines their Medicaid and Medicare would make it easier for them to get services.

Many people were confused by the changes.

Luckily, ICAN was created to help people navigate the new long-term care system at the same time as the new FIDA program. ICAN helps people who need long term care services with any kind of Medicaid managed care: FIDA, FIDA-IDD, MLTC, MMC, PACE, MAP, and HARP. ICAN’s services include answering people’s questions, giving advice, advocating with plans or agencies, and representing people in formal appeals.

If your managed care plan denies coverage for services you need, ICAN can help you fight to keep your services.

Here are some real examples of how CIDNY’s ICAN advocates have helped consumers:

Fran* fell and hurt herself and had to go to the hospital. After she recovered, her family wanted to bring her home, but her insurance plan refused. They said she needed more help than they were providing, but did not want to pay for more. With ICAN’s help, she was able to get the plan to pay for 24-hour help, which let her live at home.

Carolyn* was stuck on the second floor of her family home and couldn’t get out on her own. The insurance company had promised to send people to carry her wheelchair down the stairs whenever she needed to go out, but they never actually did. ICAN helped her get a stairlift so that she could go out whenever she wanted.

CIDNY’s ICAN staff understand how difficult it can be for New Yorkers with disabilities to get the help they need. If you are confused about the long-term care system or a notice you received, you can call ICAN’s toll-free telephone help line at (844) 614-8800. ICAN’s staff will answer your questions and will try to help you solve your problems. See how ICAN has helped other New Yorkers with disabilities on ICAN’s website.

(*Names changed for confidentiality.)

It’s Almost Time for Open Enrollment

Open enrollment season is coming for the NY State of Health, the Marketplace where you can sign up for health insurance offered through the Affordable Care Act or ACA (also known as Obamacare).

Open enrollment starts November 1, 2017 for new enrollments and November 16, 2017 for renewals. Open enrollment runs through January 31, 2018.

You may have read news about a much shorter open enrollment period this year and other actions that the Trump administration has taken that are expected to destabilize insurance markets. New Yorkers should know that New York State has decided to keep this extended enrollment period the same as in the past and that New York is spending the same amount on advertising as in previous years. None of the changes will affect open enrollment for 2017.

Obamacare protects people with disabilities by requiring that insurance plans cover the elderly, people with pre-existing conditions, and people with complex medical needs. Association health plans and short-term plans don’t have the same comprehensive benefits and consumer protections. These plans would appeal to healthy, less costly individuals. This will destabilize insurance markets for the rest of us by creating higher premiums and fewer choices. CIDNY will continue to advocate at the state level for protections for all New Yorkers.

During open enrollment, you can enroll in a Qualified Health Plan, which will have a premium and deductibles/copays. Most Marketplace consumers receive financial assistance to help them with premiums and some get help with co-pays. Costs have come down relative to last year, on average 5%.

Depending on your income, you may be eligible to enroll in Medicaid or Essential Plan, which have no or low out-of-pocket costs. Children under 19 can enroll in Child Health Plus. You can enroll in these programs at any time of the year.

You may receive confusing mail or online notices during open enrollment. CIDNY has navigators who can help you understand notices and enroll or renew coverage in the NY State of Health. Call the receptionist in Manhattan at 212/674-2300 or in Queens at 646/442-1520 and ask to speak with a navigator for more information. We’re here to help.