Building Healthy Families in Washington
Have you ever tried to call your bank, but couldn’t get a real person on the phone to answer your question? Or gotten stuck filling out a form online and didn’t know who to call? Systems can be overwhelming even for the savviest of us. They can be even more overwhelming for families with limited resources. That’s where our Healthy Connections Team comes in – trusted experts in navigating systems and local resources. We work with families to connect them to resources they need to be healthy and safe, including health insurance.
This month, the Healthy Connections Team was given an award from Public Health – Seattle & King County for enrolling 3,657 King County residents into health insurance from November 1, 2016 – January 31, 2017. WithinReach has been assisting families in obtaining health insurance during Open Enrollment since the inception of the Affordable Care Act four years ago. This year, our team was the top community service organization for enrollment numbers in King County!
What makes the Healthy Connections Team unique is that our outreach specialists and coordinators meet people where they are at – whether it’s providing information online, enrolling people in benefits programs over the phone, or meeting them in-person where they are. We understand the best way to connect people to the services they need is to eliminate the barriers standing in their way.
Many people don’t realize that if someone is referred to a service, it doesn’t mean that they actually receive the service. Sometimes, the application process may not be in a language they understand. Or they may always reach a busy signal when trying to call. Oftentimes, people don’t understand the qualifications for benefits or exactly what the benefits are. These are all things the Healthy Connections Team can navigate to make sure Washington families receive the support they need.
The Team is located in Seattle but provides services to people across the state. All of our team members are certified King County Navigators, trained to know the various health coverage options in Washington and help with eligibility and enrollment forms. Through this work, Washington families get connected to everything they need to be healthy and safe. To learn more about what the Healthy Connection team does, check out our ParentHelp123.org website!
Estoy inscrito en Washington Apple Health ¿Qué sigue?
Dentro de un mes de inscribirse en Washington Apple Health, también recibirá una tarjeta blanca con el nombre de su plan de salud, que es la compañía de seguros por la cual recibirá su cuidado médico.
He oído a gente hablar de ProviderOne. ¿Qué es ProviderOne?
ProviderOne es el sistema computarizado que coordina sus planes de salud también conocido como “Managed Care”, que están disponibles bajo Washington Apple Health (Medicaid) . Si usted está inscrito en Apple Health, usted puede manejar su cobertura a través del Portal del Cliente ProviderOne . Los proveedores de salud también pueden utilizar el Portal del Cliente ProviderOne para comprobar y ver si está inscrito en Washington Apple Health.
Han pasado dos semanas y no he recibido mi tarjeta ProviderOne. ¿Qué debería hacer?
Si usted no ha recibido su tarjeta dos semanas después de que se haya inscrito, puede llamar a servicio al cliente por medio de línea de la Autoridad de Salud al 1-800-562-3022. La buena noticia es que todavía puede ir al médico y recoger las recetas antes de tener sus tarjetas. Usted sólo tendrá que ir a una clínica o farmacia que acepte Washington Apple Health (Medicaid) y su plan de salud. La clínica o farmacia puede buscar su Identificación de cliente ProviderOne sin la tarjeta y le preguntaran por su nombre, fecha de nacimiento y número de seguro social.
¿Cómo puedo saber a qué plan de salud me he inscrito?
Después de entregar su solicitud de Washington Apple Health usted tiene la oportunidad de elegir en cuál de los seis planes de atención administrada desea inscribirse. Si usted no sabe en qué plan desea inscribirse, no se preocupe; se le asignará un plan automáticamente durante la noche del día en que su solicitud es recibida, sin embargo, usted puede cambiar su plan si resulta que no es el que desea.
También recibirá un libro Medico de Beneficios llamado Healthy Options, con información sobre sus beneficios y planes disponibles en su área. También puede ver esta publicación como un archivo PDF.
¿Qué plan de cuidado administrado debería elegir?
Se requiere que todos los planes de cuidado administrado proporcionen un conjunto de servicios básicos, por lo que a la hora de elegir un plan de atención administrada puede ser útil tener dos cosas en cuenta:
● ¿Qué planes acepta su médico?
- Algunos médicos aceptan algunas coberturas de Washington Apple Health de cuidado administrado y otros no. Por lo tanto, es importante que llame a su médico o clínica para ver primero si aceptan Washington Apple Health, y si es así, qué planes de cuidado administrado toman.
● Beneficios Adicionales
- Además de los servicios básicos ofrecidos por todos los planes de atención médica administrada, los planes también proporcionan beneficios únicos adicionales que pueden ayudarle a tomar su decisión.
¿Cómo puedo cambiar los planes?
Hay maneras diferentes en las que usted puede cambiar los planes de cuidado administrado. Usted puede acceder a su ProviderOne Portal del Cliente, por correo o fax (1-866-668-1214) el formulario de registro incluido en el folleto de beneficios médicos Healthy Options, o llame a línea de Apple Health de Servicio al Cliente (1-800-562-3022).
¿Puedo seguir viendo a los mismos proveedores de atención médica con mi nuevo plan?
Su proveedor de atención médica sólo podrá aceptar ciertos planes de cuidado administrado, aunque generalmente aceptan Washington Apple Health (Medicaid). Llame a su médico para ayudar a determinar cuál es el plan que elegirá.
También puede llamar a su plan de atención administrada o visite su sitio web para obtener una lista de proveedores de cuidado de la salud en su área.
Basic Food Changes in 2016
Written by Maricruz Sanchez, Bilingual Outreach & Enrollment Specialist
Do I have to be working in order to qualify for Basic Food/SNAP/the Food Stamp Program?
The answer to this question has most commonly been “no,” but this is going to change starting January 1st, 2016 if you are an able bodied adult without dependents (ABAWD) living in King, Snohomish, and parts of Pierce County*. Because Washington state has seen high unemployment rates in the last few years, residents have been temporarily exempt from having to meet certain work requirements to qualify for the Basic Food (food stamps) program. The temporary suspension of this work requirement is known as the ABAWD time limit waiver. However, recent declines in the unemployment rate in the areas listed above have prompted policy changes that will reinstate work requirements; basically, ABAWDs have to be working to qualify for Basic Food starting on January 1st (although there are some exceptions).
Who counts as an ABAWD?
Generally speaking, an able-bodied adult without dependents (ABAWD) includes individuals from the age of 18 through 49 who are not responsible for the care of a child or an incapacitated household member. When the ABAWD waiver expires on January 1st, ABAWD recipients of Basic Food benefits are limited to 3 months of benefits in a 36 month period. Once that 3 month grace period is up, ABAWDs are required to meet additional work requirements in order to continue to qualify for Basic Food. The current ABAWD time limit waiver is set to expire on December 30, 2015, meaning ABAWD clients in the affected areas of King, Snohomish, and Pierce County may begin their first month of a limited 3 month food benefit in January. At the end of those three months, unless they are fulfilling the ABAWD work requirement, they will not be eligible to receive benefits again until January 1, 2018, when the current 36 month period resets.
We know this is a lot of confusing information. A major priority in preparing for this change is ensuring that all clients whose benefits could be affected have access to clear information about what to expect and how to fulfill the work requirement if necessary. To be clear, some ABAWD individuals on Basic Food can be exempt from work requirements. This includes individuals who are:
• Younger than eighteen or older than forty-nine years old;
• Determined to be physically or mentally unable to work for at least 3 months in the future;
• Caring for a person who is incapacitated;
• Living in a household with a child, even if the child is not receiving Basic Food for reasons such as alien status;
• Applying for or receiving unemployment benefits;
•Qualified students in school at least half time;
• Participating in a chemical dependency treatment and rehabilitation program; or
• Eligible for one of the annual federal-approved exemption slots under the fifteen percent exemption rule.
What if I don’t meet any of the criteria above?
This means that you’re considered a non-exempt ABAWD, and that you must participate in one of the following activities in order to meet the necessary work requirement and continue to get food benefits:
• Work at least 20 hours per week, or a minimum average of 80 hours per month (this includes work study hours);
• Complete at least 16 hours per month of unpaid volunteer work;
• Participate in a Basic Food Employment and Training (BFET) program.
If your benefits are terminated after your 3 months of food assistance without having met work requirements, you can become eligible again if you participate in one of the requirements above.
DSHS has made plans to mail postcards to ABAWD clients offering information about enrollment in BFET services, so keep an eye out. They are also working to assure that ABAWD exemptions are carefully considered for clients who may not be subject to these work requirements. Finally, they are issuing communications in hopes that affected ABAWDs will have a clear understanding of how they may go about fulfilling work requirements.
Even with all of this effort from DSHS, it is a big change and we know that many will have questions. You can call WithinReach at the Family Health Hotline at 1-800-322-2588 with any questions about this transition. You can also email DSHS for information about BFET and volunteer opportunities at email@example.com.
*In Pierce County, the cities of Tacoma and Lakewood will not be affected by this policy change; ABAWDS residing in these cities will continue to be exempt from work requirements.
Big transitions are tough–reach out for help!
Around noon I gave Aaron a call because he mentioned that he was available for contact during his lunch hour. Once we were on the phone, I quickly found out that he and his wife were new parents and newly on a single income. His wife had taken extended leave to stay at home with their baby for the first few months. I also learned that this new dad was a full time student at the local technical college. This family was undergoing a lot of big changes at once, and I could tell that they were overwhelmed. Aaron let me know that they didn’t plan on needing assistance for very long – just a little help during this new transition period. After the brief screening, it appeared that Aaron’s household was likely eligible for Basic Food, Washington’s food assistance program. He was interested in pursuing Basic Food benefits so we took a few more minutes and completed the application together over the phone.
Amidst this new, exciting time in their lives Aaron and his wife found some financial stress. Aaron mentioned that with the single income they would really have to keep an eye on their expenses. He wanted to mitigate some of the challenges that would come with supporting his family on tight budget: “I don’t want to have to choose between money for gas and money for food, you know?” Aaron made it clear that one area of expenditure he did not want to worry about was proper nutrition for his family.
It can be difficult discussing “money problems” or financial instability, let alone conveying that you may be facing food insecurity. Aaron admitted that it was tough to even acknowledge a need, but he was open to receiving information about local resources and finding out if Basic Food was an option for his family. Basic Food and programs like it exist to help people when they are vulnerable— at WithinReach, we all believe that people like Aaron should never have to worry about how to put food on the table.
Our team is extremely knowledgeable about Washington’s Basic Food program and eligibility criteria. We’re happy to walk you through the process of applying for Basic Food. We make it simple and streamlined – you can complete your application over the phone with us, and go to your local DSHS office the very next day for your interview.
To find out if you might be eligible for Basic Food, call our Family Health Hotline at 1-800-322-2588 or check out our Benefit Finder.
Open enrollment is here!
What do you need out of a Health Plan?
Health Plans are not one size fits all. If you plan on using your coverage only for preventive care, you may think that the cheapest plan is the best fit. But accidents happen—and they can lead to hefty out-of-pocket costs depending on the type of plan that you purchased. If you have existing health conditions or take prescription drugs, there are certain plans that can help keep your money right where it belongs: in your pocket. It can be helpful to think through all that you need from your health insurance before beginning the enrollment process so you end up with the best plan for you.
You may be eligible for subsidies to help you pay your premiums.
Worried about how having health insurance would impact your budget? You may be eligible for tax subsidies (also known as tax credits). Tax subsidies can help lower the cost of your monthly premium. You can apply these credits to your premium amount right away so that your monthly health insurance payment is affordable.
More plans means more competition–and that is a WIN for you and your budget!
There are a lot more plans to choose from this open enrollment period. Competition between these plans means that many plan premiums are lower that they were at last open enrollment. You should shop around even if you are already enrolled in a Health Plan. Even if you think your health plan is great, check out the other plans that are out there. Chances are, you will find a plan that is better and at a lower cost than the amount that you are already paying.
Avoid getting fined for not having health insurance.
Don’t pay a penalty for not having insurance coverage for you and your family. The fine for not having insurance in 2016 can cost you as much as $695 per uninsured person in your household or 2.5% of your yearly household income. That means that when you file your income taxes, the amount that you pay the IRS could increase fast! And if you anticipate a refund at tax time, the penalty can lower the amount that would otherwise go back into your pocket.
You may be eligible for free coverage today!
Depending on your income and other factors, you could qualify for immediate coverage. Washington Apple Health coverage is comprehensive and free, and will cover you today!
How can the WithinReach Family Health Hotline help?
Enrolling in a health plan can be confusing. Our friendly and knowledgeable staff can help you make sense of your options and apply for coverage for you and your family. Not only can we get you enrolled into affordable medical coverage over the phone, but we can also help you access other programs that can help you and your family stay healthy. Don’t hesitate to call the Family Health Hotline at 1-800-322-2588.
Calling on Mom: How do I find a doctor who takes Washington Apple Health?
If you have a doctor that you would like to continue seeing…
You will want to contact your physician’s office to see if they accept Apple Health and–if they do–if they have a preferred network. Asking these questions will guide your next steps and put you on the right track so you can continue to see your preferred physician.
If your preferred doctor DOES accept Apple Health…
That’s great! Now that you know your physician’s preferred Apple Health network, you will want to request enrollment into that network. For assistance and guidance regarding this process, you can call our Family Health Hotline at 1-800-322-2588.
When you’re ready to enroll in a specific network, you can call the Medical Assistance Customer Service Center at 1-800-562-3022 to enroll into a specific network or log into ProviderOne (make sure you use Windows Explorer as your browser) to switch your enrollment online.
If your preferred doctor DOES NOT accept Apple Health…
That’s too bad, but don’t panic! You have a few options to choose from. If you have yet to be assigned a specific network or Managed Care Health Plan, you can call our Family Health Hotline and we can find you a clinic in your area that accepts Apple Health. If you have already received your Managed Care Plan, you will have an assigned primary care provider (PCP) or clinic printed on the front of the card along with a contact number.
If you DO NOT have a preferred doctor…
You should be able to follow the same steps as if your provider does not accept Apple Health. You can contact our Family Health Hotline to find a clinic in your area who accepts the coverage or you can refer to your Managed Care Plan card to see the PCP you have been assigned to.
Keep in mind that you can always switch your Managed Care Plan if you do not like the plan that you are currently enrolled in or if you have already been in enrolled into a plan that your preferred physician does not accept. If you have any questions about your coverage and need help navigating your health insurance benefits, please call our Family Health Hotline at (800) 322-2588. We are here to help you!
For general information about your Apple Health coverage, read our other blog post, I Have Insurance Through Washington Apple Health. What Is Next?
Our resident Mom (also known as Chris Gray) is a fulltime mother to a rambunctious and curious 2 year old, and is expecting her second child in early March. During the day, she is also an Outreach and Enrollment specialist at WithinReach and a Certified Navigator. Chris has first-hand experience being enrolled in programs such as Apple Health and WIC. She also supports the Breastfeeding Coalition of Washington and is a Certified Lactation Educator.
Not Having Health Insurance Might Impact Your Family’s Finances!
Health insurance is a very broad term and could encompass a variety of health insurance plans. For the purposes of the Affordable Care Act health insurance coverage is determined by a standard called “minimum essential coverage”. If a health plan has this label, it means that it has met the federal standard of a quality health insurance plan. For many people the establishment of minimum essential coverage plans now provides a higher quality and broader scope of service from their health insurance providers than what was available prior to the Affordable Care Act. All minimum essential coverage plans must cover 10 essential health services that are outlined here. For a large number of people, the minimum essential coverage requirement has been met through their existing health plan. If not, the Affordable Care Act has created new health plan options.
Common types of minimum essential coverage:
- The vast majority ofemployer-sponsoredhealth plans
- All of theprivate health plans offered through the Washington HealthPlanFinder
- Apple Health plans offered through the Washington HealthPlanFinder
- TRICARE plans offered through the US Military
For some people, there will be no changes in their health plans or how they apply for health insurance. But for 41 million uninsured Americans , the enactment of the Affordable Care Act has opened new doors to affordable, accessible and quality health insurance coverage. In Washington State, new health insurance plans are now offered through the Washington HealthPlanFinder with government subsidies such as tax credits and cost sharing reductions to make the insurance more affordable for most individuals and families. Other programs, like Washington Apple Health, have expanded to allow more people to enroll in free and low-cost health insurance. These new options present viable opportunities for health insurance that have not existed in the past.
What happens if I did not get health insurance?
If an individual or family was not able to enroll in a health insurance plan in 2014, they could face a fee when they file their 2014 taxes. This fee acts as the enforcement piece of the Affordable Act Care and it is commonly referred to as the individual responsibility requirement. In order to make health insurance affordable and accessible to everyone, the majority of people need to participate. Fees acts as a way to hold each other accountable and keep the overall cost of health insurance low. The amount of the fee will vary by household. The basic fee schedule for not having health insurance in 2014 and 2015 is:
Are there any other options?
The fee is not designed to punish people that cannot afford health insurance or have experienced hardship. There are a number of reasons why someone may not have been able to enroll in health coverage over the past year. In response to the unique needs of individuals and families, the federal Health Insurance Marketplace offers exemptions that allow people to go insured for short periods of time or to be completely exempt from the individual responsibility requirement and therefore exempt from paying any fees associated with not having health insurance.
To find out more about the exemptions offered through the Health Insurance Marketplace and how to apply for them, call the Family Health Hotline at 1-800-322-2588 or contact us through our website: ParentHelp123.org
2015 Open Enrollment for the Washington HealthPlanFinder is happening now to February 15th. Call the Family Health Hotline to speak to a Health Insurance Navigator about your options: 1-800-322-2588.
 Kaiser Family Foundation. Key facts about the uninsured population. http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
Tags: ACA Affordable Care Act Family Health Hotline fee exemption options Health Coverage Health Fee health insurance Health insurance enrollment marketplace ParentHelp123 TRICARE uninsured Washington Apple Health Washington HealthPlanFinder Washington state
Washington Apple Health: A Health Insurance Answer for Many Parents
Balancing the Budget & Tough Choices Families Make Everyday
Olympia managed to avert a budget crisis, much to the relief of Washington citizens and many lawmakers. It took months of work, negotiations and two special sessions to come up with a final budget that our legislators could agree to. During the process, furlough notices were sent to workers whose employment depended on state funding. Single parents that relied on childcare subsidies scrambled to make arrangements under already difficult circumstances. Pregnant women, caregivers and parents wondered if they might get the aid that goes a long way in providing much needed nutrition for their families. During these last two weeks of budget negotiations the word “budget” seemed to be at the forefront of everyone’s mind. At WithinReach we worried what the looming government shutdown could mean for the most vulnerable families we work with.
We were relieved when we learned a budget passed and a government shutdown avoided. Unfortunately, these feelings of accomplishment and relief did not come to all. There are thousands of families in Washington that are not able to balance their household budgets and provide their families with basic needs. At the WithinReach Family Health Hotline, we talk to these families every day. These families make concessions and choices about what to fund and what to forgo on a daily basis. These are hard choices. Pay the rent or feed the family? They choose to find a way, and sometimes they ask for help.
The families we talk to want to know that they are doing everything in their power to keep their children on track. They want to provide enough food for their children so that they have the necessary nutrition to focus and do well in school. They want their children to receive health insurance so that they will not have to forgo medical care or be strapped with huge hospital bills. They want for their children what we believe all children deserve—access to healthy food and quality health care. The recent budget passing helped to remind us of the important role these government benefit programs serve in the lives of families throughout Washington. They truly help to lessen the financial struggles of families and help parents breathe easier knowing their children have what they need to be healthy. We are happy to answer those phone calls, and help to alleviate the tough choices that many of those families are forced to make every day.