1. CPACS3510 Shallowford Road NE, Atlanta, GA(770) 936-0969 / cpacs.org Health Insurance for Immigrants and Refugees: Best Practices, Challenges and the Way Forward Tuesday, April 26, 2016

2. Objectives Discuss challenges and best practices for providing ACA Services Learn about in-language and other resources available Identify recommendations for improving access to care

3. Acronyms AAPI/ API – Asian Americans and Pacific Islanders ACA – Affordable Care Act AIAN – American Indian/ Alaskan Native FFM – Federally Facilitated Marketplace FQHC – Federally Qualified Health Center LEP – Limited English Proficient OE – Open Enrollment QHP – Qualified Health Plan

5. PEOPLE NEED PEOPLE CPACS is the first, largest and oldest organization in the Southeast to focus on issues and concerns of Asian Americans, especially women, children and families with low incomes.

6. CPACS’ Mission To promote self-sufficiency and equity for immigrants, refugees, and the underprivileged through comprehensive health and social services, capacity building, and advocacy

7. CPACS GOALS Empower Immigrants and Refugees Direct Service: - 8 Dept. Programs: i.e. community health, counseling, social services, senior services, housing, legal services, education, youth programs Mobilize for Social Change Advocacy: - Community Education/Training - Civic Engagement - Media/Other Campaigns - Research/White Papers - Policy, Institutional, Legislative Adv. Build Stronger Communities Capacity Building: - Coalition Building - Shared Funding - Leadership Building/Training

8. CPACS Service locations in 4 counties: DeKalb, Gwinnett, Cobb and Fulton –FQHC - CPACS Cosmo Health Center 12 Departments 7 standard languages Over 16 languages in-house

9. AAPIs in Georgia ♦ 5 th fastest growth of AAPIs in the nation ♦ Top 10 counties with AAPI populations –Gwinnett, Fulton DeKalb, Clayton, Cobb, Chatham, Clarke, Richmond, Columbia, and Muscogee

10. Asian Americans in Atlanta, GA Asian American population is 254,307 and 5% of the city (3% statewide). Data from 2010 census at www.census.gov

11. Data from 2008-2010 census estimates at www.census.gov Asian Americans in Atlanta, GA 9 out of 10 are foreign born Asian American population is 254,307 and 5% of the city (3% statewide).

12. Data from 2008-2010 census estimates at www.census.gov Asian Americans in Atlanta, GA 9 out of 10 are foreign born Asian American population is 254,307 and 5% of the city (3% statewide). 1/2 of the Asian Americans are on a path to citizenship

13. Asian Americans in Atlanta, GA 9 out of 10 are foreign born Asian American population is 254,307 and 5% of the city (3% statewide). 1/2 of the Asian Americans are on a path to citizenship Gwinnett County has over 85,000 Asian Americans (11%). Data from 2010 census at www.census.gov

14. Asian Americans in Atlanta, GA 9 out of 10 are foreign born Asian American population is 254,307 and 5% of the city (3% statewide). 1/2 of the Asian Americans are on a path to citizenship Data from 2008-2010 census estimates at www.census.gov Gwinnett County has over 85,000 Asian Americans (11%). Asian Americans have one of the highest rate (46%) of limited English proficiency.

15. Asian Americans in Atlanta, GA 9 out of 10 are foreign born Asian American population is 254,307 and 5% of the city (3% statewide). 1/2 of the Asian Americans are on a path to citizenship Data from 2008-2010 census estimates at www.census.gov Gwinnett County has over 85,000 Asian Americans (11%). Asian Americans have one of the highest rate (46%) of limited English proficiency. Almost 1 in 3 (29%) are low-income

16. Asian Americans Advancing Justice “A Community of Contrasts,” 2014

17. CPACS ACA Program Providing services since OE1 Specialize in Immigrants and Refugees 6 Certified Application Counselors –Provide in-language ACA services Korean Spanish Vietnamese Chinese (Mandarin/Cantonese) Thai Nepali Burmese

18. CPACS ACA Program In-language enrollment and assistances –Problem solve technical barriers Year round support to the Marketplace Provide education on health insurance literacy (how to use health insurance, find providers, importance of preventative care, etc.)

19. Challenges Process is not always simple! –Identity Verification problems, verifying immigration status, confirming income is correctly reported; 1095-As and taxes Language barriers –Lack of in-language correspondence and materials, fear of being misunderstood over phone

20. Challenges Lack of knowledge on Health Insurance –Come from countries with different or no healthcare system –Complicated terminology and system to navigate Financial Understanding and Constraints –Concept of paying monthly and then paying when accessing care –Affordable according to FFM v. Affordable to Client

21. Challenges Individuals and Families who fall in Coverage Gap –Linkage to low cost self-pay options that meet healthcare needs like FQHC Misinformation on plan benefits and tax credits

22. Best Practices Understanding the difference between immigration statuses and related policies –Immigrants – Permanent Residence for more than 5 years Qualify for Medicaid and Peachcare Qualify for Medicare if worked more than 40 Quarters (10 years) –Immigrants – Residence less than 5 years or not a Green Card Holder DO NOT qualify for Medicaid, Peachcare, Medicare, and some other government benefits

23. Best Practices Understanding the difference between immigration statuses and related policies –Refugees Automatically receive Medicaid and Peachcare for 1 st 3 months in U.S. Eligible for Medicaid and Peachcare after 3 months depending on income Must work 40 quarters (10 years) to receive Medicare

24. Best Practices Be familiar with different immigration documents Permanent Resident Card or Green Card Employment Authorization Card Machine-Readable Immigrant Visa

25. Best Practices Provide in-person interpretation services –When using phone interpretation, information can be lost or mistranslated Linkage to care –Provide information on local providers for services and ensure access to services in-language –FQHCs

26. Best Practices Keep cultural competence in mind –Family Structure –Immigration Status Be mindful of mixed status families –Different healthcare systems –Don’t make assumptions!

27. Best Practices Provide enrollment print-outs Continuing health insurance literacy education –In-language –Visual examples –Provide handouts and access to other resources

28. Resources GHF’s GEAR Resource –Exit Form Coverage to Care Road Map and BookletsCoverage to Care Road Map and Booklets Action for Health Justice’s Health Insurance Enrollment Glossary Health Insurance Enrollment Glossary Consumer Report’s Health Insurance Enrollments Tools Health Insurance Enrollments Tools

29. Recommendations and Moving Forward Increase bilingual in-person assisters for multiple languages Produce more in-language and visual health literacy materials Continuing to enforce implementation of language access requirements of ACA for QHPs Increase in network adequacy to make sure more in-language and local providers are included on QHPs

30. Questions? Sarah Brechin 770-936-0969 ext.157 sarah.brechin@cpacs.org Center for Pan Asian Community Services (CPACS) 3510 Shallowford Road NE, Atlanta, GA 30341 www.cpacs.org www.facebook.com/cpacs.org