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.
2015 Legislative Session Summary
Last Friday the legislature finally adjourned the 2015 legislative session. At WithinReach, we believe that healthy, resilient families make strong communities and we have been working hard in Olympia throughout the session to break down barriers that prevent Washington families from getting the support they need to be healthy. Even though it was a very long legislative session (the longest in Washington State history), we ultimately emerged with some incredible successes for Washington families!
Universal Developmental Screening for All Children (SB 5317) – The Bright Futures guidelines issued by the American Academy of Pediatrics recommends universal screening of children for autism and developmental conditions. The full range of screenings is currently required to be covered for kids on private insurance, but kids on Washington Apple Health did not have this guarantee. Senate Bill 5317 sought to bring equity to this issue by requiring full coverage of these screening for kids on Apple Health. We are happy to share that the bill passed the legislature, has been signed by Governor Inslee, and received full funding in the final 2015-17 operating budget ($1.422mil total). Children on Apple Health will receive coverage for developmental and autism screenings starting on January 1, 2016.
Apple Health for Kids Hotline Funding & Maintaining a Robust Navigator Program – Buying insurance can be difficult and both the Apple Health for Kids Hotline and the Navigator Program under the Health Benefit Exchange are vital tools that provide the assistance families often need when applying for health care coverage. We are happy to share that both programs received ongoing funding in the final 2015-17 operating budget and therefore will be able to continue to provide much needed support to individuals and families in Washington.
Vaccine Coverage for the Children’s Health Program – In order to make progress toward achieving Washington’s immunization goal rate of 80%, we need to ensure universal access to vaccines. We are happy to share that the funding needed to provide full vaccine coverage for kids on the Washington Apple Health – Children’s Health Program was included in the final 2015-17 operating budget ($2.343mil total).
Thank you to everyone who used your voice to support these critical issues! We could not have done it without you.
Connect With Us: Sign up for our e-news list to join a network of people committed to connecting families with health and food resources! Choose action alerts on – Immunization, Breastfeeding, Child Development, Health Care Access, and/ or Food Access.
Tags: Apple health for Kids Children’s Health Program Communities critical issues families health insurance legislative session supporting families Universal Developmental Screening Vaccine Coverage Washington Legislature
Goodbye and good luck to our AmeriCorps team!
Our amazing AmeriCorps team will be finishing their service at WithinReach next week. Their work as Outreach and Enrollment Specialists over the past 10 months helped families and individuals all over Washington access necessary nutrition and health resources. We are going to miss this team, but they are off do to more meaningful work in Washington and beyond! Check out where they’re headed, and what their time at WithinReach meant to them:
Jessica Vu: I’ll be doing another year of service as a VISTA member with Harvest Against Hunger and the South King County Food Coalition. We will be working to develop a farm that will grow produce for 12 food banks in South King County. In my year at WithinReach, I learned the value of engaging your community!
Kasey Johnson: I am applying to medical programs to become a family physician that serves a rural community here in Washington state. I am also planning to continue working with one of our community partners, the Edmonds Mobile Clinic. My year at WithinReach taught me so much; it’s been very exciting to be a part of broad change regarding health insurance and to see how public benefits are distributed and accessed by our community members experiencing poverty. This knowledge will be carried with me as I continue to serve my community and work toward change for its most vulnerable members: the poor and uninsured.
Chris Garrido-Philp: It has been a pleasure to get to know communities in King and Snohomish County through WithinReach. I have learned that the diverse people who access assistance through our state’s programs come from all walks of life. I plan to continue my learning of direct service work and overcoming barriers in the healthcare system through the University of Washington Master of Social Work program this fall.
Amber Bellazaire: In September, I will begin a Master in Public Health program at the University of Michigan. I look forward to implementing the knowledge gained through our community-based fieldwork as service members at WithinReach in my future studies.
Jodie Pelusi: I hope to use the communication skills/methods I learned in this position to better serve communities in the future while working in the PeaceCorps. I will be in Cameroon starting in the fall for 2 years as a Maternal and Child Health Specialist. I am interested in further developing resourceful methods to work with community members in creating their own solutions to the health disparities they face. This year has given me the courage to take initiative in my future goals.
Emma Lieuwen: I will be staying on at WithinReach and will continue to do outreach over the summer. I have learned there is a great need in Washington for food and health resources and there is plenty of work left to be done.
We are proud to be part of the journey for these future leaders! If you’re inspired to serve, check out the application to be part of the next wave of AmeriCorps members at WithinReach.
AmeriCorps Week: Language is a source of empowerment!
There was one particular client story I walked away with from this experience that enhanced my perspective of language barriers. This client helped me see the other side of this complex barrier by showing me how much language is a source of empowerment.
Mariana** is a middle-aged Latin American woman who approached me toward the end of the event accompanied by a volunteer interpreter. She sat down and prefaced the conversation by saying that she wanted to try to communicate with me independently, but she also wanted the interpreter present in case there was any confusion. Mariana told me that she had recently become self-employed and was having difficulty navigating the exchange to choose a health plan for herself. The interaction was more drawn out than my usual interactions to confirm understanding on both ends; there were occasional tangents in Spanish until Mariana remembered that I didn’t understand. Since it was the end of the day, we weren’t able to complete the interaction with the purchase of her health plan so we exchanged information in order to complete it over the phone at another time.
In the following weeks we exchanged multiple phone calls so I could complete her application, explain the terminology surrounding insurance, guide her through the process of going to Staples so she could fax me her income verification, and finally purchase a plan.
In the months of my service I’ve had a wide range of final remarks from clients after finishing an interaction with them: “Finally,” or “glad that’s over,” as if the service was something I had withheld from them that I had finally granted. However, most of the final remarks are those of gratitude: “Thank you for making this easy for me,” and “thank you for being so kind.”
On my last phone call with Mariana she said, “Noelle, before you go I want to tell you something…” She thanked me first for assisting her with her application, but then went on to thank me for taking the time to understand her. She said that she had always been nervous about speaking English in public for fear of not being understood or taken seriously. She said she truly felt that our interactions had occurred in such a way where she understood what I was telling her and that I understood what she was trying to say.
Before my work with Mariana, I had seen my AmeriCorps service as a way to tear down the general systemic barriers that prevent people from accessing the resources they need. Now, I view my interactions with clients as opportunities to build bridges to resources despite these barriers. The value in our work comes from providing assistance that is personal and empathetic to the difficulties of navigating complicated systems.
**Client name has been changed to protect privacy.
All It Takes Is One Accident!
Edited by: Kari Geiger, WithinReach AmeriCorps Program Lead
The current deadline for enrollment is February 15th 2015! Create an account or log in to your account on www.wahealthplanfinder.org today to update your application and explore your options. For tips and tricks, check out some articles we wrote over the past year:
- What to consider when buying a Qualified Health Plan
- How to Apply For Health Insurance If Your Income Is Unpredictable
- Self employed? We Have Answers to Your Health Insurance Questions
- I bought health insurance through the Washington Healthplanfinder. What’s next?
Remember: The deadline to enroll is FEBRUARY 15th, 2015, so log on today or call us for help through our Family Health Hotline for assistance at: 1-800-322-2588!
Tags: Accident Family Health Hotline finances health insurance Health Plan Healthcare insurance coverage Open Enrollment out of pocket WA HealthPlanFinder Washington Health Benefit Exchange Washington state
Being Prepared Over Feeling Invincible: Why Medical Insurance Is Important While You Are Young
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
WA Healthplanfinder Gets a Makeover: 6 things you need to know!
WithinReach Bridge to Basics Outreach team, AmeriCorps
The sign in button is now located in the upper right corner. Additionally, there is now a designated section on the homepage to directly access Apple Health Renewals and Enrollment in the middle of the page.
“Is any member on this application a child 26 or older seeking adult disabled dependent coverage?”
Answer “yes” to this question if one of your dependents is an adult child with a disability; meaning, they cannot work due to their disability and are financially dependent on you. How this question is answered won’t affect your eligibility for Apple Health.
If someone is covered by Medicare, they are likely ineligible for Qualified Health Plans and Apple Health.
After submitting your application, you will be taken to the Eligibility Status screen. This page provides the following information for each member of your household:
- Eligibility status (Approved, Ineligible, Conditional, etc)
- The program name (for example, Washington Apple Health)
- Coverage dates
- Next steps
Change #4: Pending Coverage and Document Upload
If you, or someone on your application, has a “pending coverage” eligibility status, you may be required to submit documents for additional verification. You can click the “upload documents” button to upload files. If you are prompted to submit documents, do so as soon as possible to avoid losing coverage.
If you need to report a change on your application, you can now see how the change affects your eligibility. This is an improvement from how change reporting used to go, which required you to select and purchase a plan if you tried to make a change.
This year, there will be more Qualified Health Plans to choose from. Be sure to shop around, consider your needs, and explore your options to make sure you’re getting the best plan for your needs and budget.
Self employed? We Have Answers to Your Health Insurance Questions
Health Insurance Enrollment: Which Dates Matter?
Yes. You may qualify for coverage that is of no cost to you, or coverage that will require you to pay a premium. The Affordable Care Act requires most U.S. citizens and legal permanent residents* to have health insurance coverage for at least 9 months of the year. Therefore, it would be best to enroll by the March 23 deadline so as to get coverage by April 1st and avoid paying a penalty on your 2014 taxes.
I have insurance through my employer at this time, but there is a chance that I will be laid off in the next few months. Will I be able to enroll in insurance after March 23rd without receiving a penalty?
Yes. Certain qualifying events like the loss of a job enable you to enroll without a penalty. For a list of other qualifying events, please refer to this list from the Federal government. Also, if you qualify for free coverage through Washington Apple Health (aka Expanded Medicaid), you need not worry since Washington Apple Health enrollment remains open, year-round.
*The Affordable Care Act mandates that Americans have health insurance, beginning in 2014. Those without insurance may be required to pay a penalty on their 2014 taxes. Some may be exempt from this mandate and will not have to pay a penalty if they do not have health insurance. For more information on these exemption eligibility requirements, please refer to this infographic from The Kaiser Family Foundation.
Finding Help in Washington State
Through Medicaid expansion, a large group of adults who would not have qualified for Medicaid in the past are now eligible for free health coverage. In our work on the Family Health Hotline phone lines, and outreach at community food banks, libraries and job training centers we meet people like Pamela each day.
Pamela recently relocated from Arizona to Belfair, WA in hopes of finding a job. After being laid off a year ago and losing her health insurance, Pamela struggled to find a job in Arizona. Living without health insurance for the last year has put mental strain on Pamela. She says, “I’ve worked my whole life and have never asked for help from anyone. I lost my job due to a merger and I can’t find a new one. I’m in my 60’s and I was taking medication for arthritis and hormone replacement when I lost my health insurance.”
Unable to see a doctor to get her prescriptions, Pamela could not take her medications, which caused her to often worry, ‘What if I get sick?, What if I get in an accident?’ The constant worry kept Pamela anxious and stressed most of the time. The move to Washington was a new start and she was excited for the natural beauty of Washington, and the potential of finding work.
Being new to Washington, and confused about the Affordable Care Act, Pamela did not know where to turn for help. She said, “I was so confused by ObamaCare. I was scared that I would not be able to afford health insurance and would be penalized. I tried to watch TV and stay informed but everything I heard was different. I could not get a hold of what was going on.”
A friend referred Pamela to WithinReach and within five days, we had helped her enroll in both Food Stamps and Washington Apple Health Insurance. For anyone who is unsure about signing up for health insurance, Pamela would tell them, “I had my doubts but the state of Washington has been more than gracious and helpful to me. I’m so impressed with how nice everyone is and how empathetic everyone is. It seems like people with children get most of the help but us older folks need help too. I am so grateful I found it.”
If you or someone you know is looking for help applying for health insurance or just wants more information about their options, they can call our Family Health Hotline at 1-800-322-2388 or visit ParentHelp123.
Mohamed Ali: A True Champion of Change
I am a refugee from Somalia, who swore to devote his personal and professional life to bettering the health and lives of Americans in 2004. I am someone who invested his entire education in health sciences and public health on two continents. I studied tropical medicine and researched solutions for curative tools for devastating pathogens in prestigious research laboratories. I never stopped following my dreams, and I changed my career path to population health, recognizing the unmet needs faced by many of my fellow Somalis in America and elsewhere.
Somalis in the United States confront many challenges accessing healthcare as well as in understanding and receiving health services and information. Health issues can be daunting, and few organizations are well equipped to handle the customs and language of my community. As a result, my people sometimes suffer. I decided to advocate and fill the gap in refugee health services, and I wanted to do something to ensure my community had access to information that would protect them. When a major storm headed for King County in 2012, I knew from experience that many immigrant communities may not be prepared. People had died from carbon monoxide poisoning in past storms when they tried to heat their homes with grills and other unsafe sources. This time, I worked with partners at King County and a local mosque to send a phone message to Somalis with information about storm preparedness and hotline number. We also set up a warming shelter and rented vehicles to bring meals to families. This time, nobody died.
Fortunately, good work sometimes gets rewarded, and mine was noticed by the White House! In September, I was was recognized as a Champion of Change at the White House. On September 24th, the same day I was honored as a Champion of Change, there was something else taking place in the capitol: Ted Cruz made his historic stand on the chamber floor, speaking for 21 hours about the need to defund the Affordable Care Act (ACA) in exchange for avoiding a government shutdown. He made his point, but as an immigrant who advocates for healthy equity and social justice for all Americans, I could not sit and let it go unaddressed. I got a pen and paper and expressed my opinion on the new law. It read “ YES ACA.”
It might not seem like much, but it was a monumental statement for me, the 2013 Champion of Change who was recognized for protecting his community from a potentially deadly winter storm.
I stood up with my sign in front of the Capitol Hill where Senator Ted Cruz made his speech. I choose to say ‘YES!’ to the Affordable Care Act, I choose to represent Americans who could not be there, and I spoke for millions of Americans who are voiceless and uninsured. I did it because health insurance companies should not be allowed to take advantage of us anymore and turn away million Americans with pre-existing conditions. I support the marketplace for all insurance providers to compete on behalf of consumers, hopefully leveling out uncontrollable premiums. I spoke for those tens of millions who are underinsured, the many who had coverage but were afraid of losing it, and the 50 million Americans who had no insurance at all. We are not asking government handouts here, but a fair system.
I believe all American families deserve to be healthy. That’s a big statement, I know. Let me explain how we think about it at WithinReach. To us, a healthy family knows they can see a doctor before there’s a crisis, not only when they are in crisis. They don’t have to decide between paying for groceries or paying the bills. They have a community that can support them and as a result they, in turn, can support others. Being healthy in these ways positions families for success in all ways. Unfortunately, there are thousands of families across Washington state who want to be healthy and could be healthy, but currently are not. Health must be seen as a central element of a thriving society and not something that causes constant anxiety and fear for our families. Let’s work together to make health a reality for all families.