Health Insurance Access for the Many and the Few

*Nefertiti Townes, Program Manager for Health Insurance Programs, Nassau-Suffolk Hospital Council*

Guest blogger, Nefertiti Townes, who oversees health insurance programs at the Nassau-Suffolk Hospital Council (NSHC) talks about her 12 years working to help Long Islanders understand their insurance plans and other programs and coverages for which they may be eligible. The pandemic made this work especially challenging.

Helping Everyone Get Covered

About 95 percent of New Yorkers have health insurance – one of the highest rates of coverage in the United States. However, even with this success, there remains a population of underinsured individuals– mainly our aged, blind and disabled folks– who for one reason or another are not enrolled in Medicaid programs for which they are eligible. Then there is the population of individuals who have insurance, whether it’s public or private, who don’t understand how their plans work– the intricacies of co-pays, deductibles and the like.

It’s my job and that of my staff to connect with these individuals and screen them for programs and coverages they perhaps did not know about or did not know how to go about applying for. When the pandemic hit in March 2020 and our office, like all others, was placed on lockdown, we were not sure how successful our outreach efforts would be. Prior to the COVID-19 pandemic, my team and I would routinely go out into the field, promoting our services at libraries, health fairs, and other community-based events. The pandemic forced us—and the rest of the world— to quickly pivot. Thanks to revised guidelines from the Department of Health and the New York State of Health Marketplace, my team and I were able to successfully transition to assisting our clients over the phone. I’m proud to say that our number of clients remained fairly steady throughout COVID-19, with no significant decline. Remarkably, we found that access was not affected. Client eligibility for Medicaid-type programs increased from 64% prior to COVID, to 72% during the pandemic. This increase in eligibility is a reflection of the unfortunate realities of COVID-19— many people became unemployed, lost spouses, lost alternative sources of income, lost employer-based insurance, or experienced other hardships.

We offer three programs to assist distinct populations.

Aged, Blind and Disabled Insurance Enrollment Program. This is a collaborative effort with the New York State Department of Health and the Suffolk County Department of Social Services. As the program’s name suggests, this initiative provides enrollment assistance to people over the age of 65 and adults and children who are blind or disabled throughout Nassau and Suffolk counties in applying for a multitude of Medicaid services, such as spenddowns, coverage of long-term care services, or a buy-in for working people with disabilities. Individuals can be over income guidelines required to qualify for Medicaid. Strategies like a Pooled Income Trust can preserve a client’s excess income to be used for daily expenses, such as rent, food, and utilities. A spenddown is another strategy that preserves a client’s excess income, as long as that income is spent in its entirety on a monthly basis, exclusively on healthcare services. A Pooled Income Trust is a legal arrangement between an approved not-for-profit entity and an individual. An individual sends their income to the trust– the trust pays bills for them. A spenddown reflects the medical expenses a person incurs that are greater than or equal to the income eligibility limits. Both of these situations eliminate excess income or resources that would make the individual otherwise ineligible for Medicaid. Many people do not realize that Medicare does not pay for long-term care services, but for those elderly with limited incomes, having Medicaid can mean the difference in having an aide assist with daily living skills or access to subsidized transportation.

Community Health Advocates (CHA). Through this program, we also assist insured individuals with understanding, utilizing, and navigating their health insurance benefits. The CHA program is overseen by the Community Service Society of New York State, which has a grant from the New York State Department of Health. The Nassau-Suffolk Hospital Council receives funding from the Community Service Society to service individuals in Nassau and Suffolk counties. The CHA program also enables my team to provide clients with help in understanding consumer rights and responsibilities under the Affordable Care Act, education about the NY State of Health online marketplace options and referrals to Navigator agencies or the Marketplace for assistance when appropriate. When many people lost their jobs during the pandemic, we were able to offer them guidance and referrals. Through the CHA program we serve an average of 55 consumers each month, and our number of CHA clients remained the same throughout the COVID-19 crisis.

Medicare Telephone Assisters (MTA). This is a grant-funded program through the New York State Department of Health (NYSDOH). The NYSDOH provides us with a list of consumers to be contacted monthly. MTA clients are enrolled in Medicaid and are seeking to enroll in Medicare. These clients are required to apply for Medicare as a condition of continued eligibility for Medicaid. Whether the consumer is eligible or ineligible, proof must be submitted to the Department of Social Services. We assist clients with this process. During the pandemic, we also helped people understand notices they received from state and local governments regarding their benefits under the Families First Coronavirus Response Act (FFRCA).

Why Assistance Is Needed

There is a tremendous body of research documenting the positive effects on health access and outcomes that come with having health insurance coverage. It’s especially important that vulnerable populations – such as the aged, blind, and disabled – have health insurance so that their health issues do not accelerate and worsen. Data from the Long Island Health Collaborative Community Health Assessment Survey shows that when asked what prevents people in their community from getting medical treatment, “No Insurance” was the number one answer among both Nassau and Suffolk County residents for four consecutive years since the survey’s 2016 inception. Although this survey reflects responses from all age groups, it underscores how vital health insurance is overall.

With all of the recent and ongoing changes in healthcare, it can be a challenge for the average consumer to navigate their options. Programs like ABD, CHA, and MTA are in place to provide much-needed guidance when it comes to lengthy applications and enrollment processes, ensuring the client has all of the documentation needed to complete their application, and ultimately get the health insurance they need.

For more information about any of the enrollment assistance programs offered by the Nassau-Suffolk Hospital Council, please call 631-435-3000 or visit coverage4healthcare.com.

Editor’s Note: In the Hudson Valley region, consumers can access insurance enrollment assistance from the following agencies: