Affordable Care Act Enrollment Assistance for the LGBT Community: A Resource for Behavioral Health Providers LGBT Enrollment Assistance Highlights • Many lesbian, gay, bisexual or transgender (LGBT) individuals lack health insurance and would benefit from enrollment support. • Behavioral health providers need to know basic facts about LGBT health disparities and experiences with coverage and care in the LGBT population. • Providers also need to understand the fundamentals of the Affordable Care Act and aspects of the law that are particularly relevant to helping LGBT people access coverage. • There are many resources available to support LGBT individuals in enrolling in appropriate coverage. 2 Toolkit Purpose This toolkit is designed to: • Increase provider awareness of issues that particularly affect the LGBT population • Provide information on key provisions of the Affordable Care Act • Provide information specific to enrollment for LGBT communities • Offer resources to support LGBT individuals who have questions or are ready to enroll More details about the information in this slide deck can be found in the briefing paper Getting Ready to Get Covered. 3 Why Does It Matter? • Among the LGBT community members who are low- or middle- income, one in four-26 percent-lack health insurance. • Many of these uninsured LGBT individuals are eligible for financial assistance to gain coverage under the Affordable Care Act. • Insurance coverage and access to health care are especially important for LGBT individuals because the LGBT population experiences health disparities such as elevated risk of depression, suicidal ideation, and substance use and misuse. • These disparities are related to the discrimination, prejudice, and social exclusion that many LGBT people encounter throughout their life. 4 Specific Concerns for the LGBT Population • LGBT individuals encounter many barriers to employer- sponsored insurance, such as high levels of poverty and a lack of LGBT-inclusive protections from employment discrimination. • Many people in same-sex relationships have difficulty obtaining a family policy to cover their partner or spouse. • LGBT individuals may be unaware of financial assistance in obtaining insurance or new laws protecting against discrimination. 5 Affordable Care Act Basics and the LGBT Community • Financial help is available on a sliding scale through the Marketplaces for individuals with an annual income of up to roughly $47,000 per year and for a family of four making up to almost $100,000. • Marketplaces must treat legally married same-sex couples equally with regard to financial assistance and family coverage, regardless of state of residence. • Marketplaces and the plans sold through them cannot discriminate based on sexual orientation or gender identity. • Individuals cannot be charged higher premiums just because they are gay, lesbian, bisexual, or transgender, or because they have a condition such as HIV. 6 Behavioral Health Coverage Considerations • Plans cannot deny coverage because of pre-existing conditions such as depression, a substance use disorder, or a transgender-related medical history, and they cannot place annual or lifetime dollar limits on coverage. • Many plans must cover the Essential Health Benefits, which include mental and substance use disorder services and prescription drugs. • Most plans must cover preventive services at no cost, including adult depression screenings and child behavioral assessments. • All Medicaid plans cover behavioral health options such as counseling, therapy, medication management, peer support, and substance abuse treatment. 7 Enrollment and Coverage Considerations for the LGBT Community • Privacy Protections: The Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act both provide protections against improper disclosure of personal medical information, including information related to a person’s sexual orientation or transgender status. • Substance abuse treatment programs or providers must obtain patient consent before disclosing protected health information, with limited exceptions. 8 More Enrollment and Coverage Considerations for the LGBT Community • Access to Coverage: Patients may appeal if they are denied coverage for behavioral health services or for other medically necessary services that they believe are covered under their plan. • The website for consumer complaints and appeals at the Federal Office for Civil Rights can be found at https://ocrportal.hhs.gov/ocr/cp/complaint_frontpage.jsf. 9 More Enrollment and Coverage Considerations for the LGBT Community • Nondiscrimination Protections: Section 1557 of the Patient Protection and Affordable Care Act, which prohibits discrimination on the grounds of race, color, national origin, sex, age, or disability in health care, also applies to the Marketplaces. • The nondiscrimination protections of Section 1557 include gender identity and sex stereotyping. 10