Over the past few months, in Arizona, there have been multiple changes affecting health care coverage for children in Arizona. In October, a bipartisan bill passed which increased Medicaid expansion to 138 percent of the Federal Poverty Level and many more Arizona families qualified for Arizona Health Care Cost Containment System (AHCCCS).
The Affordable Care Act created an online marketplace with the aim of enrolling all eligible individuals in the U.S. in health insurance. Patients have a choice of plans to fit their individual financial and health needs. Employers are encouraged to provide health insurance to their employees, and those employees whose employers do not provide affordable health insurance, are eligible to receive tax credit subsidies to offset costs of buying private health insurance.
However, there are still numerous gaps in health care coverage for children in Arizona. The reasons for these gaps are many. First, many employers will provide health insurance for the individual employee, but not the family of the employee. In addition, because affordable health insurance is offered to an employee, the employee is not eligible to receive tax credit subsidies to offset the cost of monthly premiums, so many families cannot afford health insurance for their children. Many of these children in other states are covered by the Children’s Health Insurance Program (CHIP), which covers children up to 200 percent of the federal poverty level.
However, on Jan. 31, 14,000 children lost their health insurance because Arizona’s CHIP program, KIDSCARE II was frozen, and new enrollment was stopped. Many of these children will automatically receive AHCSS, but there will still be a good number of children who will not, and will not have health insurance.
There are other reasons for gaps in coverage, many of which relate to immigration status. Documented immigrants who enter into the USA, must wait at least five years in a “qualified” status to be eligible for Medicaid or CHIP. Families of immigrants who have received employer provided health insurance may not be able to receive health coverage because of cost. Children of undocumented immigrants, who arrived in Arizona with their families, are not covered by health insurance because they do not qualify for AHCCCS, and their parents are not able to buy health insurance.
Homelessness, mental illness, or a lack of parental knowledge or ability to navigate the health coverage enrollment process prevent many children from having health care coverage. In addition, many families are just not aware of the crucial importance of obtaining health insurance.
Why is it important to have health insurance? It is important because it helps you get the health care you need at a low cost. People with health insurance are able to go to their primary care doctor and medical home to keep themselves healthy, and take care of health problems before they become large emergencies. There are studies that having health insurance saves the public money because there are not large costs incurred because of lengthy and extensive emergency room visits for problems that could have been helped earlier by a visit with a primary care provider.
If you, or anyone you know is in need of health care, enrollment in the program created by the Affordable Care Act started Oct. 1, 2013. The deadline for enrollment has been extended to March 31, 2014. You can enroll by going to www.Healthcare.gov. There are people who are trained and certified to help you apply for health insurance, because the application is rather lengthy. These people are called “assisters” and can be found on the Healthcare.gov website or by telephoning 1-800-318-2596.
When you enroll you will be able to choose plans in the Health Insurance Marketplace. The marketplace is where you can apply for health insurance that fits your family budget. After applying you will be able to enroll in one of several different health insurance plans. If you qualify for Medicaid (AHCCCS), your application will automatically go to that agency for enrollment.
How can you keep your child’s regular doctor? On the marketplace website, you can look up your current pediatrician to see if he or she participates in the plan you choose. If you use an assister to help you apply, be sure to tell them the name of your child’s pediatrician.
What if you don’t qualify for AHCCCS or the marketplace? Many primary care pediatricians, and community health centers will see children and allow parents to pay on a sliding fee schedule. In addition, if your child has an acute episodic problem such as an ear infection, rash, etc., you can ask the school nurse to refer them to a pediatrician who participates in the Medical Services Project. The Medical Services Project is run by the Arizona Chapter of the American Academy of Pediatrics, and helps children who are in the Notch group, whose parents can not afford health insurance but do not qualify for AHCCCS.
• Dr. Elizabeth McKenna is chair of the Access to Care Committee of the Arizona Chapter of the American Academy of Pediatrics.