On June 25th, the U.S. Supreme Court announced its ruling in the King v. Burwell case. The 6-3 Court ruling means that subsidies will continue to be available for the hundreds of thousands of Ohioans who have purchased coverage through the Health Insurance Marketplace.
This ruling is a victory for working Ohioans. Our state is one of 34 that the Court decision affects because we operate on a federal exchange. A majority of the Health Center patients in Ohio are low-income and rely on the subsidies to maintain their coverage and options to care.
“Today’s Supreme Court ruling affirms what Community Health Centers across Ohio see firsthand every day – access to quality health care AND coverage ensure good health. It is a victory for Ohioans that rely on the subsidies to maintain their coverage and options to care.”
“Ohio’s Community Health Centers provide free in-person enrollment assistance and education to individuals and families seeking health coverage – many for the first time. This ruling ensures that individuals who previously delayed seeking care can keep their coverage and continue to receive high-quality health care.”
“Ohio’s Community Health Center Certified Application Counselors (CAC) can answer consumer questions about all types of health care coverage, eligibility and enrollment periods. Open Enrollment for the Marketplace begins November 1, 2015, however some may qualify for a Special Enrollment period due to life events like marriage, a permanent move or a change in job status. In addition, Ohioans may be eligible for Medicaid, which enrolls year-round."
Ohio Planning for National Health Center Week Webinar
National Health Center Week will be here before you know it and it is never too early to plan. To help you plan and provide the most up-to-date information, OACHC hosted a webinar this week. In addition to having Elizabeth Kwasnik from National Association of Community Health Centers present the national overview, OACHC gave an Ohio perspective to help you organize your outreach plans, engage your community, create awareness, and celebrate the impact Health Centers have in Ohio. The Ohio speakers included OACHC's Teresa Rios-Bishop, Lisa Porter of CAA of Columbiana County and Rebecca Shaw of Lorain County Health & Dentistry.
Not only did this webinar cover events during NHCW15, OACHC's Teresa Rios-Bishop talked about OACHC Ohio Health Center Hero Award as well. The Health Center Hero Award is a great way to recognize outstanding individuals working at your Community Health Center. All nominees will be recognized with a certificate to display for their hard work, special web communications and media releases. Visit www.ohiochc.org/hero to nominate your Health Center Hero.
Sponsorships for State and Federal Legislators at Your Event
Another great NHCW feature to look out for is OACHC's sponsorship program. NHCW events eligible for sponsorship must include participation of a state or federal legislator. There is a limit of one sponsorship per Health Center organization per year.
Don't forget to take pictures or even make a video during your NHCW15 events! Last year Lorain County Health & Dentistry of Ohio won the video contest! Let's try to do it again! Go Ohio! Learn more about the Picture and Video Contest
ICD-10 is coming up and will be here before we know it! OACHC along with multiple other organizations want to make sure you can get the information you need. Here is a compilation of ICD-10 resources and events you can sign up for to get ICD-10 ready!
OACHC
OACHC's upcoming ICD-10 Training: Roadmap to Change
The Columbus Division of Water has issued a nitrate advisory June 8th and the advisory remains in affect (view the advisory here). If you live, are traveling to the affect area you should know about this advisory.
The Columbus Medical Association advises us to "be aware of nitrate toxicity as a potential cause of methemoglobinemia, especially in young infants". Learn More
The Columbus Division on Water is warning people not to give tap water to infants below 6 months of age. This includes using it for anything the infant may consume (formula, juice, baby cereal..)
A first instinct may be to boil the water. However, boiling the water actually increases the nitrate level. The Columbus Division of Water specifically warns, DO NOT BOIL THE TAP WATER.
According to the Columbus Division of Water, Healthy adults and older children can consume higher levels of nitrate because they have fully developed digestive systems.
Remember, Pregnant adults even if healthy should not consume the tap water while the advisory is going on. ODH is providing bottled water to infants and pregnant women who cannot obtain bottled water on their own and are in the area impacted by the high nitrate levels in Ohio. Learn more here
Even if you are not in the affected area it is always good to know what to do if it ever happens in your area. Here are someFAQs on Nitrates in Water .
Restoration of Medicaid Coverage for Pregnant Women in State Budget Needed
Access to Prenatal Care is Absolutely Necessary
The state budget bill also known as House Bill 64, includes a provision that will reduce Medicaid eligibility for pregnant women from 200% of FPL to 138% FPL. While we understand the strategy to move these women from Medicaid to the Marketplace, because of limitations set in place by the federal government, we do not believe now is the appropriate time for such a transition and advocate for restoration of the 200% eligibility limit.
Ohio uses the federal exchange for Marketplace enrollment. There is a single open enrollment period that spans three months, once a year. While there are opportunities to gain coverage outside those three months (Special Enrollment Periods or SEP), becoming pregnant does not trigger an SEP or access to Marketplace coverage. Therefore under HB 64, if a women between 139 and 200% FPL is either unable to gain Marketplace coverage or chooses to pay the federal mandate penalty instead of enrolling and then becomes pregnant, she cannot access health care coverage until the next Open Enrollment period. In this instance, both women and their unborn children are at risk. With Ohio’s abysmal infant mortality rates, maintaining eligibility as it is today at 200% FPL ensures Ohio women do not fall in this coverage gap and provides a path to access the prenatal care they need.
Premature Births - By the Numbers
The cost of maintaining the current coverage for pregnant women in Medicaid at up to 200% FPL is estimated at $15M for the upcoming biennium. HB 64 proposes to reduce eligibility to 138% FPL, a change which can ultimately lead to less access to prenatal care, and in turn, worse birth outcomes and increased infant mortality rates. Specifically:
• According to Nationwide Children’s Hospital, NICU stays average $66,000 in Franklin County and can cost in excess of $2M. • The U.S. Agency for Healthcare Research and Quality accounts that medical costs for the average very-low-birthweight infant are $79,000, compared with $1,000 for a normal newborn. • National data has shown that the average cost in the short term of an extreme premature birth to be well over $100,000, and between $40,000 and $100,000 for early premature birth. Other data has shown that children born before 32 weeks have costs over $280k on average. • Hospital Length of Stay: The March of Dimes reports that premature and low birth weight infants spend an average of 15 days in the hospital, compared to just 2 days for healthy, full-term infants.
Further, if Ohio scales back Medicaid coverage for pregnant women between 139 – 200% FPL it is important to note that once the child is born to a mom who falls in that coverage gap, Medicaid in all likelihood will cover the child’s immediate and long-term health care costs – whether good or bad. So even if we don’t pay for the health insurance coverage of Mom-to-be, we will cover the child once born and his or her birth outcomes.
Early entry into care is associated with better birth outcomes which we all want, and health insurance coverage is an important and essential tool in getting women into care as soon as possible. Improved birth outcomes translate into substantial cost savings, because the costs associated with preterm births are estimated to be 10 times greater than those for full-term births.
We have a cause and effect scenario. According to the ODM’s 2014 Report on Pregnant Women, Infants and Children, the average total cost during pregnancy of a woman enrolled in Medicaid in 2013 was $8,458. And the average cost of caring for premature or a low birth-weight baby for its first year of life is about $49,000. Simply put, if more women go without prenatal care, the more likely Medicaid will have to cover infants at a higher cost.
IN SHORT: The return on investment is clear. Maintaining Medicaid coverage for pregnant women to 200% FPL is cost-effective, provides a pathway forward for full-term pregnancies and positive birth outcomes, and will keep Ohio on track to improve our infant mortality rate.
