CHIPRA MENTOR ORIENTATION CHIPRA TEEN LEADER PROJECT

Post-It Notes What do you hope to get out of this project? What do you hope teens would get out of it?

Presenters Dr. Kim Uyeda, MD, MPH Director Student Medical Services, Community Partnerships & Medi-Cal Programs Jeanne Aguinaldo Student Engagement Program Director The L.A. Trust for Children’s Health Nina Lee Nguyen, M.P.H Project Coordinator

Mentor Orientation Agenda 1. Overview of LAUSD’s CHIPRA Project 2. Health Insurance 101 (Covered CA & Medi-Cal) 3. LAUSD’s CHAMP Break 4. Teen Leader Project 5. Recruit, Train, Support 6. Wrap Up

Overview of CHIPRA in LAUSD

What is CHIPRA? The Children’s Health Insurance Program (CHIP) was signed into law in 1997 The program provides health coverage to eligible children through Medicaid The program is administered by states, and funded jointly by state and federal government. The U.S. Census Bureau showed that in 2008, 7.3 million children did not have health insurance coverage that year. Overview of LAUSD’s CHIPRA Project

What is CHIPRA? CHIPRA stands for Children’s Health Insurance Program Reauthorization Act Signed by President Obama on February 4, 2009 The Act support states in developing efficient and effective strategies to identify, enroll, and retain health coverage for uninsured children who are eligible for Medicaid or the Children’s Health Insurance Program (CHIP), but not enrolled. Overview of LAUSD’s CHIPRA Project

Who is Involved? Overview of CHIPRA in LAUSD LAUSD Parent Community Services Branch Outreach The L.A. Trust Teen Leader Project CHAMP and Healthy Start enrollment Overview of CHIPRA in LAUSD

History of the Teen Leader Project LAUSD has a history of successfully using youth engagement to positively impact community health through outreach and education efforts. Blood pressure screenings and education in Latino community Changing attitudes and behavior through the Students for Nutrition and eXercise (SNaX) program Covered CA Outreach & Education Teen Leader Project Overview of CHIPRA in LAUSD

The L.A. Trust for Children’s Health TEEN LEADER PROJECT subcontracted to The Los Angeles Trust for Children’s Health The L.A. Trust is a non-profit organization working to improve the health of children of LAUSD. Our mission is to increase student health and readiness to learn through access, advocacy and programs. Overview of CHIPRA in LAUSD

Goal of CHIPRA Teen Leader Project Through trained mentors and teen leaders, fourteen thousand four hundred (14,400) relatives, adult family friends or neighbors will receive educational information about: The importance of health insurance to stay healthy The requirements in U.S. to have health coverage The basics of Medi-Cal and how to facilitate access enrollment and assistance through CHAMP Overview of CHIPRA in LAUSD

Each Teacher or Certificated Staff The Role of Teachers Train the Trainer Model 15-20 Teen Leaders Each Teacher or Certificated Staff Up to 500 Students 3000 1000 2000 25 12 Trusted Adults The impact of outreach and awareness! Overview of CHIPRA in LAUSD

CHIPRA is also known as ___________________. Check Your Knowledge! CHIPRA is also known as ___________________.

Health Insurance 101

https://www.youtube.com/watch?v=-58VD3z7ZiQ Health Insurance 101

What is Health Insurance? “A contract that requires health insurer to pay some or all of your health care costs in exchange for a premium.” Healthcare.gov, U.S. Centers for Medicare & Medicaid Services Health Insurance 101

How does health insurance work? Members pay a monthly (or semi-annual or annual) premium to the insurance company People can have “employer-based” health insurance through their jobs. Employer will pay a portion of premium, and you pay a portion out of your paycheck The policy spells out what services the insurance company will cover and how much of the bill you have to pay out of pocket. Health Insurance 101

How much does insurance cost? Depending on what type of plan and coverage that you have, prices for co-pays, deductibles, and other out-of-pocket expenses can vary. Co-pay: This is a way of sharing medical costs. You pay a flat fee every time you receive a services. (e.g. $20 for every visit to doctor) Deductible: The amount you must pay each year to cover your medical expenses before insurance starts paying. Health Insurance 101

What are the types of plans? Health Maintenance Organization (HMO) PREFERRED PROVIDER ORGANIZATION (PPO) No deductible but there is copayment (correction: may be a low deductible) Limited to seeking care from within the plan’s network of doctors You can choose a primary-care physician, but you will need a referral from your primary-care physician to visit a specialist Generally more affordable due to limitations Deductible vary with the premium Doctors, hospitals and providers are part of the PPO network, you can see doctors outside the network and receive partial coverage A physician in the network requires co-payment A physician outside network requires a coinsurance (you pay part of the bill) Understanding how the system works Health Insurance 101

What are the types of plans? HEALTH SAVINGS ACCOUNTS (HSA) Savings accounts that allow you to save money to pay for current and future medical expenses on tax-free basis In order to be eligible, you must be covered by high- deductible health plan Good option for individuals who want to protect themselves from high health care costs. Health Insurance 101

Why America Needed the Affordable Care Act (ACA) 50 million Americans had no health insurance. 129 million Americans with pre-existing conditions could be turned away or taken advantage of, and often were. Premiums were doubling every ten (10) years while corporate profits soared. Health Insurance 101

Affordable Care Act The Affordable Care Act (ACA) is also known as ObamaCare. It is a Federal law passed in 2010, that changes how some people get health care in the US Under ACA, insurance companies can’t deny anyone care because they’re sick now or have been sick in the past (pre- existing conditions) Covers children on parents’ health insurance policy until they turn 26 years old The ACA creates health benefits exchanges. In California, it is called Covered California. Health Insurance 101

Affordable Care Act ACA Accomplishments Free preventive care; free annual check-ups Standard forms in easily understandable language Easy-to-use, online marketplace Established 10 essential health benefits and minimum levels of coverage Expanded Medi-Cal eligibility from 133% to 138% federal poverty level (FPL) Health Insurance 101

Affordable Care Act 10 ESSENTIAL HEALTH BENEFITS (EHB): Outpatient (Ambulatory) Services Emergency Services Hospitalization Maternity and Newborn Care Mental Health and Substance Use Disorder Services, including Behavioral Health Prescription Drugs Therapy (Physical and Occupational Therapy) Laboratory Services Preventive and Wellness Services & Chronic Disease Management Children’s Pediatric Services, including Oral and Vision Care Health Insurance 101

Covered California Covered CA is the health insurance marketplace where you can compare and choose health plans It can help people find out if they qualify for financial help to make insurance more affordable. People can also find out if they’re eligible for low or no cost coverage through Medi-Cal. Legal residents of CA who do not have health insurance from their employee or a government program can get coverage through Covered CA. Health Insurance 101

Choose from silver, bronze, gold and platinum health plans from 11 health insurance companies Health Insurance 101

Covered California Health Insurance 101

SIX (7) LA COUNTY’S APPROVED HEALTH PLANS Covered California SIX (7) LA COUNTY’S APPROVED HEALTH PLANS Anthem Blue Cross of California Blue Shield of California Health Net Kaiser Permanente L.A. Care Health Plan Molina Healthcare Oscar Health Plan Health Insurance 101

WHAT IF I AM ALREADY INSURED? Covered California WHAT IF I AM ALREADY INSURED? Employer-provided: If your employer provides insurance, then you are probably okay. They are required by law to give you a letter stating the insurance provided by them meets Minimum Essential Coverage standards. Medi-Cal Covered: Medi-Cal meets the Minimum Essential Coverage standards. You are covered! Covered but It’s Expensive: If your employee share of the monthly premiums exceeds 9.5% of your household income, then you are able to opt out of employer-provided insurance and enroll into a Covered CA plan. Your employer is required to give you a voucher of equivalent value to use in the exchange. Health Insurance 101

Covered California: Open Enrollment OCTOBER 1 Covered CA Renewal Period Begins NOVEMBER 1 Covered CA Open Enrollment Begins JANUARY 1 Health Benefits Begin on this Date! JANUARY 31 Open Enrollment Period Closes YEAR-ROUND Qualifying Life Changing Events = Special Enrollments Medi-Cal Enrollments *If the ACA continues to be a law by the end of the year. If everything stays the same Health Insurance 101

Covered California QUALIFYING LIFE EVENT Exceptions exist for those who have qualifying life events. The law provides for individuals to enroll outside of open enrollment periods if they experience changes in their lives such as moving to a new state, changes to income, and changes to family status (including marriage, divorce, and the birth of a child). Health Insurance 101

Medi-Cal Medi-Cal is the State of California’s Medicaid health insurance program. Medi-Cal and the Children’s Health Insurance Program (CHIP) offer free or low cost health coverage for eligible children and other family members. Health Insurance 101

Medi-Cal Health4AllKids In 2015, Senate passed two bills (SB)75 and (SB)4, which changed Medi-Cal for children: All income-eligible children (families earn <266% FPL) who are less than age 19 can enroll in full-scope Medi- Cal Children with restricted-scope Medi-Cal will transfer to full-scope Medi-Cal without having to reapply Children with Kaiser Permanente Child Health Program and Healthy Kids must apply for Medi-Cal Health Insurance 101

Medi-Cal Health4AllKids Medi-Cal does not share immigration information. Children should apply for Medi-Cal now, even if they have other coverage or have family members with coverage. Some families may have to pay a small premium for Medi-Cal. Most families will need to select a health plan. Health Insurance 101

Medi-Cal Health4AllKids Medi-Cal Does Not Share Immigration Information Children are no longer restricted based on immigration status. All children in California should qualify for Full Scope Medi-Cal, If they meet the income eligibility requirements. Restricted Scope (“emergency” Medi-Cal): primarily undocumented adult immigrants. Full Scope services not available under restricted-scope: dental, vision, ongoing primary, preventive, prescription, specialty care, mental health, & substance abuse. Health Insurance 101

Medi-Cal Health4AllKids Children should apply for Medi-Cal Now Children in restricted scope should have been automatically moved to full scope on May 2016 Children should apply for Medi-Cal NOW even if they have other coverage such as: Transitioning from Kaiser Child Health Program Transitioning from local Healthy Kids County health program (e.g. My Health LA) Many of these programs do not track whether their kids have restricted scope Medi-Cal Health Insurance 101

Medi-Cal Health4AllKids Some Families May Have to Pay a Small Premium Medi-Cal is free for kids with family income below 266% FPL ($2,794/month income for a family of 4) Above that, Medi-Cal monthly premiums are $13/month/child ($39/month maximum per family) No Medi-Cal co-pays* – treatment & medication without charge Health Insurance 101

Check Your Knowledge! California’s health benefits exchange is called ____________. True or False? All income-eligible children can enroll in full-scope Medi-Cal regardless on immigration status. True or False? Children who are currently enrolled in Kaiser Permanente Child Health Program or Healthy Kids, will automatically be enrolled/transferred into Medi-Cal.

CHAMP Children’s Health Access and Medi-Cal Program

Children’s Health Access and Medi-Cal Program (CHAMP) CHAMP is part of the of Student Health and Human Services Division at Los Angeles Unified School District CHAMP supports student academic achievement and promotes wellness by enrolling children and youth into health insurance programs. CHAMP provides information to parents and district staff on free or low-cost health insurance options. LAUSD’s CHAMP

CHAMP Services Covered CA (all ages) CHAMP provides application assistance for the following programs: Covered CA (all ages) Medi-Cal (restricted/full-scope) (all ages) CHAMP refers eligible clients to: My Health L.A. (19 & up) WIC, CHDP, CalWORKS and Other county/state/ federally funded programs LAUSD’s CHAMP

CHAMP Services Over the phone enrollment assistance In-Person assistance by appointment, with a HCA at one of the following Hub locations: SEPA Center (Plasencia EL) 1379 Angelina St. Los Angeles 90026 Zelzah Clinic, 6505 Zelzah Ave. Reseda. 91355 Referral to any of 100 schools where Healthy Start staff offer enrollment assistance Helping locate a certified application counselor in your area. LAUSD’s CHAMP

Check Your Knowledge! What is the name of the unit in LAUSD’s Student Health and Human Services Division that can assist families in enrolling in health insurance programs?

Repeal & Replace? Health care advocates are advising people to continue applying for health insurance, either through Covered CA and Medi-Cal CHAMP will continue to assist families with health insurance enrollment, information will not be shared with immigration authorities. Any replacement to the ACA will not occur overnight Covered CA and Medi-Cal 101

Teen Leader Project

Teen Leader Project Step 1: Recruit 15-20 active students to participate Step 2: Find a space and time to train the students with Teen Leader Training, CHAMP Video, and Resources Step 3:Ensuring personal safety Step 4: Provide on-going support and guidance Step 5: Ensure accountability for Contact Log Step 6: Collect Contact Log, Contact Sheet by April Step 7: Evaluate Teen Leader Project Teen Leader Project

Recruit, Train, Support

Recruiting Teen Leaders Who do I recruit? 10th - 12th graders in good academic standing For Spring 2017, recruit minimum of 15-20 students Follow school policy on parent permission for participation Check into school’s service learning requirements Emphasize on the service-learning component Recruit, Train, Support

Recruiting Teen Leaders Spread the word with flyers, announcements, info meeting, etc. Customize the Flyer with Your Name and Room Number Recruit, Train, Support

Training Teen Leaders Secure a location for the training Schedule two-hour training (one-time after school or separate in 2-3 sessions) Teen Leaders are providing outreach and education. They are NOT Certified Enrollers Personalize your training with anecdote to make the experience more meaningful for your leaders. Recruit, Train, Support

Risk Your Pennies Game Recruit, Train, Support

Support and Guidance Ensuring personal safety Teen Leaders should only provide outreach and education to trusted adults (e.g. relative, neighbor, family friend) Teen Leaders should not be outreaching to strangers, going door-to-door, or out in public spaces Providing on-going support and guidance Have weekly check-ins Make yourself available for questions Recruit, Train, Support

Support and Guidance Ensuring accountability for Contact Log Teen Leaders need to make 12 contacts At check-in meetings, get updates on Contact Log, ask Teen Leaders about their experience, review Questions Recruit, Train, Support

L.A. Trust Staff Support End of March, Staff will email and contact everyone to check the progress of the project at your school Staff will be available to provide support for your trainings (photo opportunities) Staff will respond quickly to emails or phone calls

Debrief Meeting Required de-briefing for Teacher Advisors Monday, April 24th, between 5-7 p.m. Or Monday, May 1st, between 5-7 p.m. Location: Beaudry building TBA Required documentation for stipend payment Submit calendars, contact logs, meeting sign-in sheets, student evaluations, and extra materials

Check Your Knowledge! What grade levels can Teen Leaders come from? Teen Leaders should only outreach and educate ____________adults. How many contacts are students asked to reach? When is the next Debrief meeting?

Best Practices from Previous Cohorts “I found it helpful to have the seniors present to older peers” “I encouraged students to use Thanksgiving break to talk to adults” “Used an existing Government class period 6 and took from there” “Announcements didn’t work, personal recruitment did” “Students were assigned a reflection paper, got positive feedback” Recruit, Train, Support

Teen Leader Project Successes Some evaluation responses from past CHIPRA Teen Leaders: “In the future I would like to go into public health, and an important component of health is that people have covered services.” “I liked being able to educate people about something that could really benefit them.” “I do want to continue because I want to help others and it helped me a lot with social skills.”

Teen Leader Project http://thelatrust.org/chipra-teen-leader-project/

Post-election Resources LAUSD Student Health and Human Services Extended Support Sites at 8 locations throughout the district Open weekdays from 8:00 a.m. to 4:30 p.m. Hotline number: (866)-742-2273 For more resources on immigration, mental health, DACA policies, refer to: http://achieve.lausd.net/Page/11959

Review Materials Teen Leader Toolkit Inside Each Teen Leader Folder 1 packet of Training slides 1 Leader-Education and Outreach Guide 1 Medi-Cal Factsheet 1 Teen Leader Survey 12 Sheets of Contact Logs 12 CHAMP Flyers and Card (ENG/SPAN) per Leader Swag: The L.A. Trust Pencils

The L.A. Trust Teen Project contact: Jeanne Aguinaldo jeanne@thelatrust.org Nina Nguyen nina@thelatrust.org