1. Office of Citywide Health Insurance Access
Expanding Health Insurance Coverage for New York City Families

2. Office of Citywide Health Insurance Access (OCHIA)
Mission : Increase access to health insurance
Focus:
Enrollment of all eligible for public health insurance
Expansion of health insurance options for small businesses and individual workers
Ensuring availability of domestic partner coverage
Method:
Research and analysis for clear policy level decisions
Development of tools to allow partners strong local level planning in outreach efforts

3. Facts About the Uninsured
1.3 million uninsured NYC residents below
age 65
Most are low-income and working
Over 50% are employed by small businesses that do not offer health insurance coverage
Approximately 499,000 uninsured New Yorkers are eligible for Medicaid, Child Health Plus and Family Health Plus
About 39% are children
Our office is the process of completing an analysis of Public Health Insurance Participation that will give a current figure of the number of uninsured but eligible for public health insurance in New York City and where they are located in the communities across the City
Sources: Health Insurance Coverage in New York, United Hospital Fund (2007); NYS DOH unpublished estimates of the ASEC/CPS

4. Outreach and Enrollment to NYC’s Uninsured
HealthStat, a citywide initiative mobilizing the work of city agencies, private organizations, community and faith--based organizations and managed care plans to identify and enroll eligible residents in public health insurance programs.
Enrolled over 12,000 individuals through HealthStat partnerships year to date.

5. City Agency Partners Administration for Children’s Services (ACS)
Department of Small Business Services (DSBS)
Community Assistance Unit (CAU)
Department of Corrections (DOC)
Department of Education (DoED)
New York City Fire Department (FDNY)
Department of Health & Mental Hygiene (DOHMH)
Health and Hospitals Corporation (HHC)
Department of Homeless Services (DHS)
New York City Housing Authority (NYCHA)
Mayor’s Office of Immigrant Affairs (MOIA)
Department of Parks and Recreation (PARKS)
Department of City Planning (DCP)
New York City Police Department (NYPD)
Department of Youth and Community Development (DYCD)
Department of Probation (DOP)
Taxi and Limousine Commission (TLC)

6. Public Health Insurance Programs Available in New York City

7. Public Health Insurance Programs
Programs for children
Child Health Plus A (also known as children’s Medicaid)
Child Health Plus B
Programs for adults
Medicaid
Family Health Plus

8. Facilitated Enrollment Organizations
Authorized by NYS Department of Health to enroll New Yorkers in public health insurance programs in non-traditional settings
Home
Office
Other community settings
Assist client throughout the enrollment process
Offer resources in various languages

9. Facilitated Enrollers Health Plans
Affinity Health Plan
AmeriChoice of New York, Inc.
Amerigroup Community Care
CenterCare Health Plan
Community Choice Health Plan
Fidelis Care New York
Group Health Incorp. (GHI)
Healthfirst, PHSP
Health Plus
Health Insurance Plan of New York
MetroPlus Health Plan
Neighborhood Health Providers
New York Presbyterian Community Health Plan
United Healthcare
WellCare of New York, Inc.

10. Facilitated Enrollers Community Based Organizations
Alianza Dominicana, Inc.
Brooklyn Perinatal Network, Inc.
Generations+/Northern Manhattan Health Network
Hispanic Federation
Jewish Community Center
Joseph P. Addabbo Family Health Center
Medical and Health Research Association of NYC, Inc.
Make the Road New York
Metropolitan New York Council of Jewish Poverty
Morris Heights Health Center
Ridgewood Bushwick Senior Citizens Council
Safe Space
Structured Employment Economic Development Corp (DBA) SEEDCO
The Children's Aid Society
Yeled V’Yalda

11. Facilitated Enrollers DOHMH
Brooklyn
Homecrest Health Center
1601 Avenue S.
Brownsville Health Center
259 Bristol Street, 2nd floor
Crown Heights Health Center
1218 Prospect Avenue, Basement
Bronx
Tremont Health Center
1826 Arthur Avenue
Manhattan
Washington Heights Health Center
600 West 168th Street, 2nd floor
Chelsea Health Center
303 Ninth Avenue, 1st floor
Queens
Corona Health Center
34-33 Junction Blvd., Basement
Hillside Health Center
Hillside Avenue, 1st floor

12. Managed Care or Fee-for-service
Public health insurance coverage is available through managed care or fee for service
Managed care allows for the coordination of treatment and care through a primary care physician
In NYC, joining a health plan is mandatory for most people (exemptions and exceptions)
Families can pick a plan as part of the application process or are auto-assigned a health plan

13. Overview of Adult Health Insurance

14. Adult Health Insurance Programs
Medicaid
Free Health Insurance
No age limit
Benefits provided through managed care or fee for service
Medicaid may provide up to 90 days of retroactive coverage for unpaid medical bills
Family Health Plus
Free Health Insurance
Adults 19 to 64 years of age who are uninsured with incomes that are too high for Medicaid
Benefits provided only through managed-care organizations
No retroactive coverage

15. Adult Health Insurance Eligibility
To be eligible for Medicaid or Family Health Plus, requires proof of:
Income
Residency
Appropriate immigration status (not required for pregnant women)
Resources
Age (FHP only: 19 – 64 years old)
No other health insurance (FHP only)

16. Adult Medicaid/Family Health Plus
Must be a New York State resident.
A resident is someone who intends to make NY his/her home (no minimum time requirements)
Short-term visa holders (tourist, work, school) are not eligible, unless they have filed to stay here on a permanent basis

17. Adult Medicaid/Family Health Plus/CHP A Immigration Eligibility
People belonging to most immigration categories can receive Medicaid or Family Health Plus including:
Naturalized Citizen
Legal Permanent Resident (green card holder)
Refugee
Asylee
PRUCOLS

18. What is PRUCOL? These individuals are not eligible:
Permanently Residing Under Color Of Law
Immigrants who are eligible because they are in the U.S. with the knowledge and permission or acquiescence of USCIS.
Includes immigrants who are waiting for their interview with USCIS to become Lawful Permanent Residents.
Who is not PRUCOL?
These individuals are not eligible:
Short term visa holders (for example, students and tourists - unless they have filed to stay on a permanent basis)
Undocumented immigrants
USCIS – United States Citizenship and Immigration Services

19. Family Health Plus is Available for Working Individuals
Income Levels This chart is only a guide. Individuals should see an enrollment counselor for eligibility screening.
Family Size
Yearly Income
Monthly Income
Weekly Income
Resource
Level
Single Adult
$10,404
$867
$216
$13,050
Couples with No Children
$14,004
$1,167
$291
$19,200
19-20 year olds living with their parents
$15,600
$1,300
$325 2*
$21,000
$1,750
$437 3*
$26,400
$2,200
$550
$19,800 4*
$31,800
$2,650
$662
$19,950 5*
$37,200
$3,100
$775
$20,100
For each additional person add:
$5,400
$450
$112
$2,550
* Parent living with at least one child under 21
NOTE: Chart effective January 2008; subject to annual income updates.
* A pregnant woman, people with disabilities, high medical expenses and some others may be eligible at higher income levels. These people should be referred to HRA for a comprehensive eligibility determination.

20. Adult Health Insurance Benefits
Some of the benefits include:
Regular checkups;
Hospital inpatient and outpatient services;
Emergency room care;
Prescription drugs;
Specialist care;
Smoking cessation agents;
Medical supplies and equipment.

21. Overview of Children Health Insurance

22. Children Health Insurance Programs
CHP A
Free Health Insurance
Children under 19 years old
Benefits provided through managed care or fee for service
CHP A may provide up to 90 days of retroactive coverage for unpaid medical bills
CHP B
Free or low cost
Children under 19 years old NOT Medicaid eligible
Benefits provided only through managed-care organizations
No retroactive coverage

23. Children Health Insurance Programs Benefits
Some of the benefits include:
Regular checkups
Immunizations
Hospital care
Emergency room care
Prescription drugs
Dental care
Eyeglasses
Specialty care
Medical equipment
Medicaid – Retroactive coverage – 3 months prior to initial application

24. Child Health Insurance Eligibility
Eligibility for CHP A and CHP B, requires proof of:
Income
Residency
Appropriate immigration status (CHP A ONLY)
Age (CHP B only – Under 19 years old)
No other health insurance (CHP B ONLY)

25. Child Health Plus B is Available for Children of Working Individuals
Income Levels This chart is only a guide. Individuals should see an enrollment counselor for eligibility screening.
Children Under 19 NOT Medicaid Eligible
Premium Categories
Monthly Income For Family Size*
Each Additional Person, Add: 1 2 3 4 5
Free Insurance
$1,368
$1,866
$2,346
$2,826
$3,306
$480
$9 Per Child Per Month (Maximum of $27 per family)
$1,924
$2,590
$3,256
$3,922
$4,588
$666
$15 Per Child Per Month (Maximum of $45 per family)
$2,167
$2,917
$3,667
$4,417
$5,167
$750
Full Premium Per Child Per Month**
Over $2,167
Over $2,917
Over $3,667
Over $4,417
Over $5,167
* Pregnant women count as two individuals.
** Full premium amounts vary by health plan; Current premium levers average $125 per child per month
NOTE: Effective January 2008; subject to annual income updates.

26. Application Process Once an application is completed and submitted:
HRA has 30 days to process applications for children and 45 days for adults; 90 days for a disability review
CHP B processing time can range from 2 – 6 weeks depending on when application is submitted.
For example, applications received by the 20th of the month the child will be covered starting the first day of the following month. For applications submitted after the 20th, coverage will begin 6 weeks later.

27. How to Maintain Coverage
Individuals enrolled in public health insurance must renew every year or risk losing coverage
Since 2003, all programs use a mail-in renewal process.
Medicaid, Family Health Plus and Child Health Plus A enrollees receive mail-in renewal packet from HRA.
Child Health Plus B enrollees receive mail-in renewal packet from their health plan
Mailings sent about 3 months prior to card expiration date. These forms must be completed, signed and returned by mail
Consumers can call for questions about enrollment and renewal

28. Where to Enroll in Public Health Insurance Programs
Families can apply for all public health insurance programs at:
Human Resources Administration – New Yorkers can enroll at the City’s Community Medicaid Offices
Facilitated Enrollers – Health Plans, Department of Health and Mental Hygiene and Community-Based Organizations can help to complete and submit applications for all programs

29. Where to Enroll in Public Health Insurance Programs
As of February 1, 2008, families will be able to take advantage of presumptive eligibility at a number of Child Health Clinics throughout the City
Screeners will be onsite to enroll children into the Child Health Plus programs

30. What If Individuals Are Not Eligible For Public Health Insurance Programs?
HHC Options - financial screening system available at New York City Health and Hospitals Corporation facilities
CHCANYS/Community Health Centers - Offer primary care and supportive services on a sliding fee scale
Health Insurance Options For Small Businesses, Sole Proprietors and Working Individuals

31. What If Individuals Are Not Eligible For Public Health Insurance Programs?
OCHIA’s Website -
Provides information on:
Free health services provided by DOHMH
Free or reduced price prescription drugs
Vision Services
Dental Care

32. For More Information Contact: Jeannine D
For More Information Contact: Jeannine D. Mendez

33. Thank You