Taetia Phillips-Dorsett October 19, th Annual CERC Health Disparities Institute

 The percentage of people in the U.S. without health insurance decreased to 15.7% in 2011 from 16.3% in 2010, the U.S. Census Bureau reports.  million people were insured last year, up from million in  Young adults ages 19 to 25 who gained coverage accounted for 40% of the decline in uninsured last year, according to Census Bureau statistics. The Patient Protection and Affordable Care Act extended dependent coverage to adults up to age 26 in September * % uninsured U.S. * % uninsured U.S.V.I *Source: Modern HealthCare alert

Uninsured 32, % Medicare 14, % Medicaid 8, % State Employees, Retirees, and Dependants 31, % Other Private 27, % Health Coverage of USVI Residents *Source: 2009 BER Insurance Survey (SHADAC Study)

Potentially Eligible for Employer Coverage Potentially Eligible for Public Program Coverage Not Eligible for Employer or Public Coverage 9.9%22.3%67.9%

 Medicare- 16,082 as of Jan 2012  Medicaid- 9,085 as of FY2011  Medicare/Medicaid Dual Eligibles-780 as of Jan 2012

GROUPNUMBER CURRENTLY COVERED (from 1/2010 MAP Report) Children4,760 Pregnant Women**430 Non-Disabled Adults1,280 Elderly930 Disabled2,530 TOTAL COVERED8,480 *Medicaid Rolls fluctuate annually between 8,500-10,000

**Eligibility Criteria: $ 5,500 for the head of household plus $ 1,000 for every other person in the family AND Your savings is no more than: $1,500 for the head of household $ 100 for each extra family member Medically Needy vs. Categorically Needy Even if you make more than the limit of $5,500, if you have high medical bills, you can still get Medicaid. If you subtract your medical bills from your income and it brings your income below the limit, Medicaid will pay the rest of your medical bills. You have to bring your receipts to the office as proof. For example: $6,500 is your yearly income $1,000 in receipts for medical costs can be brought to the MAP office when you apply. This is termed your “spend-down” then MAP pays the rest.

 Expands Access to Care  Ends Insurance Abuse  Makes Health Care More Affordable

 Proposed $300 million in additional federal funding presents an opportunity to reduce our uninsured population from 28% over the reform period.  Proposed up to $30 million in additional funding to establish a Health Insurance Exchange  Provide coverage for childless adults up to 133% FPL beginning in 2014

 Provide coverage extension to pregnant women and children up to 100% of the poverty level. (USVI Executive Branch Policy Decision)  Only 67% of mothers receive prenatal care during first trimester, as compared to 83% nationally.  In the VI 14% of babies are born preterm; the national average is 12%.  Importance of Text for Baby and Healthy Pregnancy, Healthy Babies Initiatives.

SERVICES OFFERED PROVIDER AVAILABILITY /ACCESS

Insured-15,174 GVI CIGNA plan members (8,301 active & 6,873 retirees) *41% members classified as having a chronic condition *32.5% identified for active Disease Management Programs *10,686 identified as having one or more gaps in care -Public Coverage Programs (Medicare/Medicaid) *Are most health services provided on- or off-island? *Are all covered services on par with Mainland Medicaid programs? *Impact of a high local match rate (45%) and a capped federal Medicaid allotment (~$14 million)

Underinsured -Private Employer Sponsored Beneficiaries/ Individuals *What entity is tracking health experience for these groups? *Where can they seek additional coverage for services not covered by their policies? Uninsured -Documented Residents vs. Undocumented Residents *What is the true impact of both populations on territory uncompensated health care rates? *Are all populations aware of where primary/specialty care services are offered in the USVI? Sliding fee scales?