By Emily Eckert
Program Associate, Health Reform Implementation, AMCHP
The passage of the Affordable Care Act (ACA) created several pathways to achieve its core triple aim goal of reducing the number of uninsured Americans by providing access to affordable, high-quality health insurance. One of these pathways was the creation of the Health Insurance Marketplace. The Health Insurance Marketplace offers affordable coverage options for MCH populations who may not be eligible for or have access to other public or private insurance programs.
The United States has seen a decline in the uninsured rate with the implementation of the ACA and the roll-out of the Health Insurance Marketplace. Since the ACA coverage provisions took effect in October 2013, upwards of 16.4 million uninsured people have gained health insurance coverage. These high enrollment numbers, combined with the millions of newly-eligible individuals living in states with expanded Medicaid programs, have dropped the American uninsured rate below 10 percent for the first time in more than 50 years.
MCH populations are reaping significant benefits from this reform, with a more than 5.5 percentage point decline in the number of women ages 18-64 living without insurance. Additionally, the ACA includes a number of provisions to expand access to care for women and children, including access to preventive services with no cost sharing, greater coverage of maternity-related care, and increased pediatric benefits for all children.
Starting Nov. 1, 2015, the Marketplace will be back in business for the third season of open enrollment. The third open enrollment period will last for three months, ending Jan. 31, 2016.
To be eligible for Marketplace coverage, individuals must meet eligibility requirements. To learn more about eligibility, visit the guide to eligibility page on Healthcare.gov. If an individual does not meet the eligibility requirements to enroll in a qualified health plan (QHP), there are other options available, for example, Medicaid and the Children's Health Insurance Program (CHIP). It is important to remember that individuals and families can apply for these programs year-round. For more information on eligibility for these programs for MCH populations, be sure to check out the AMCHP comprehensive Coverage Chart for MCH populations. In addition, federally qualified health centers (FQHC) across the country offer primary care and other specialty services to individuals with or without insurance. For a full list of FQHCs, visit the HRSA Find a Health Center page.
To help individuals and families navigate the various health insurance options, the Centers for Medicare and Medicaid Services (CMS) funds navigator programs throughout the country. For a complete list of in-person assisters in your state, visit the CMS website.
As MCH leaders, it is important that you prepare your staff for the upcoming open enrollment period. This includes equipping your outreach materials with information on enrollment opportunities and eligibility criteria; coordinating with navigator agencies and other groups in your state that provide in-person enrollment assistance; and ensuring that all front-line staff serving MCH populations (including WIC agencies, Title X family planning clinics, local health departments, home visiting programs, etc.) have the information they need to inform, refer and help individuals understand their options.
Selected AMCHP Resources for Further Information
The Affordable Care Act: A Working Guide for MCH Professionals