During January, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recognizes National Poverty in America Awareness Month. There are 37.2 million Americans living in poverty, an increase of 3.3 million people since 2019. In 2020, racial and ethnic minorities continued to be disproportionately affected by poverty, with Black (19.5%) and Hispanic (17%) Americans shown to have poverty rates that were more than twice that of White Americans (8.2%).

There is a clear and established relationship between poverty, socioeconomic status, and health outcomes, with those living in poverty having an increased risk of chronic conditions, lower life expectancy, and barriers to receiving quality health care. The COVID-19 pandemic has also significantly impacted low-income families. In 2020, nearly half of lower-income families reported that they or someone in their household had lost a job or taken a pay cut as a result of the pandemic, impacting their abilities to meet basic economic needs and further disrupting access to health care. More specifically, these disparities in access to health care affected low-income families of color.

National Poverty in America Awareness Month offers an opportunity for CMS OMH to advance health equity for all Americans. CMS and other federal programs offer a variety of resources to help learn how to access health coverage, manage health care costs, and fully utilize benefits. Below is a list of resources that providers can share with their patients.

Resources

• Review the guide Using Z Codes: The Social Determinants of Health (SDOH) Data Journey to Better Outcomes, which provides step-by-step instructions for health care professionals on how to use Z codes which can enhance quality improvement activities, track factors that influence people’s health, and provide further insight into existing health inequities. Find out more data on Z codes in this data highlight.
• View the Coverage to Care (C2C) Roadmap to Better Care and a Healthier You to help others better understand their health coverage and how to use it to access primary care and preventive services.
• Review the Manage Your Health Care Costs to help patients better understand health insurance costs and terms, know specific health insurance costs, plan for health care costs, and know how to pay premiums.
• Read the C2C Prevention Resources to learn more about preventive services that are available to adults, teens, children, and infants, with many available at no cost under most health coverage.
• Review eligibility requirements for Medicaid in your state as well as the Children’s Health Insurance Program (CHIP), a federal and state program that provides health coverage to children in families with incomes too high to qualify for Medicaid but too low for private coverage.
• Visit the Programs of All-Inclusive Care for the Elderly (PACE) webpage to learn how this program helps to meet the health care needs of the elderly in their own communities.
• View the Medicare Savings Program webpage to learn how members in your community can get extra help from their state.

Help your community learn more about how the Administration for Children and Families Low-Income Home Energy Assistance Program(LIHEAP) and Temporary Assistance for Needy Families (TANF) is helping to assist households meet important expenses like heating and food.

On December 31, 2021, the Federal Communications Commission (FCC) launched the Affordable Connectivity Program (ACP). This longer-term program was created by Congress in the Infrastructure and Jobs Act, and replaces the Emergency Broadband Benefit program.  This investment in broadband affordability will help ensure households can afford the internet connections they need for work, school, health care and more.

To support your ACP outreach efforts, the FCC also launched a toolkit of materials for partners to download and customize to meet their needs. More materials will be added in the coming weeks, so continue to check the page for new additions.

The ACP provides a discount of up to $30 per month toward internet service for eligible households and up to $75 per month for households on qualifying Tribal lands. Eligible households can also receive a one-time discount of up to $100 to purchase a laptop, desktop computer, or tablet from participating providers if they contribute more than $10 and less than $50 toward the purchase price.

Enrollment in the ACP is now open for households with at least one member qualifying under any of the following criteria:

• Has an income that is at or below 200% of the federal poverty guidelines;
• Participates in certain assistance programs, such as SNAP, Medicaid, Federal Public Housing Assistance, SSI, WIC, or Lifeline;
• Participates in Tribal specific programs, such as Bureau of Indian Affairs General Assistance, Tribal TANF, or Food Distribution Program on Indian Reservations;
• Is approved to receive benefits under the free and reduced-price school lunch program or the school breakfast program, including through the USDA Community Eligibility Provision;
• Received a Federal Pell Grant during the current award year; or
• Meets the eligibility criteria for a participating provider’s existing low-income program.

As the FCC transitions to this new program, the over 9 million households fully enrolled in the Emergency Broadband Benefit Program as of December 31, 2021 will continue to receive their current monthly benefit until March 1, 2022.

More information about steps current Emergency Broadband Benefit recipients must take to continue receiving the Affordable Connectivity Program benefit after March 1, 2022 will be available in the coming weeks.

New tools are available to help consumers understand their rights

Beginning January 1, 2022, new federal protections championed by the Biden-Harris Administration will shield millions of consumers from surprise medical bills—unexpected bills from an out-of-network provider, out-of-network facility or out-of-network air ambulance provider. The protections, implemented under the No Surprises Act, ban surprise billing in private insurance for most emergency care and many instances of non-emergency care. They also require that uninsured and self-pay patients receive key information, including overviews of anticipated costs and details about their rights.

In addition to shielding millions of consumers from surprise medical bills, these protections will further President Joe Biden’s work to promote competition in health care and other sectors of the American economy.

“The No Surprises Act is the most critical consumer protection law since the Affordable Care Act,” said Health and Human Services (HHS) Secretary Xavier Becerra. “After years of bipartisan effort, we are finally providing hardworking Americans with the federal guardrails needed to shield them from surprise medical bills. We are taking patients out of the middle of the food fight between insurers and providers and ensuring they aren’t met with eye-popping, bankruptcy-inducing medical bills. This is the right thing to do, and it supports President Biden’s vision of creating a more transparent, competitive and fair health care system.”

“The No Surprises Act offers significant relief to people across the country, and reinforces our fundamental belief that no one should go bankrupt when seeking necessary care,” said Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure. “We are making it easy for consumers to know and understand their rights under the law, including what they can do if they receive a surprise medical bill. Consumers will not only benefit from these rights, but also will be empowered with the knowledge to address potential violations.”

A recent report from the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) reviewed key evidence on surprise billing and the need for the consumer protections in the No Surprises Act. The report showed that surprise billing is common among those with private insurance—nearly one in five patients who go to the emergency room, have an elective surgery, or give birth in a hospital receive surprise bills, with average costs ranging from $750 to $2,600 per episode.

For Insured Individuals, Protections from Surprise Medical Bills

For people who have health coverage through an employer, a Health Insurance Marketplace®, or an individual health plan purchased directly from an insurer, the rules that took effect January 1, 2022:

• Bans surprise bills any time you receive emergency care, and require that cost sharing for these services, like co-pays, always be based on in-network rates, even when care is received without prior authorization.
• Bans surprise bills from certain out-of-network providers if you go to an in-network hospital for a procedure. This means cost sharing for certain additional services during your visit will generally be based on in-network rates.
• Requires providers and facilities to share with patients easy-to-understand notices that explain the applicable billing protections and who to contact if they have concerns that a provider or facility has violated the new surprise billing protections.

For Uninsured Individuals, Better Advanced Knowledge of Costs

For people who do not have health insurance or pay for care on their own (also known as “self-paying”), the rules that took effect January 1, 2022 require most providers to give a “good faith estimate” of costs before providing non-emergency care.

The good faith estimate must include expected charges for the primary item or service, as well as any other items or services that would reasonably be expected. For an uninsured or self-pay consumer getting surgery, for example, the estimate would include the cost of the surgery, as well as any labs, other tests, and anesthesia that might be used during the procedure.

Uninsured or self-pay consumers who receive a final bill that exceeds the good faith estimate by $400 or more can dispute the final charges.

Where to Learn More—Help Desk and Website

Both insured and uninsured/self-pay individuals who are concerned that their rights have been violated now have access to a host of tools, including a help desk (available at 800-985-3059, 8am-8pm ET seven days a week; TTY: 800-985-3059) and webpage (CMS.gov/nosurprises), where more details on registering potential violations can be found.

Although some states have enacted laws to reduce or eliminate surprise billing, comprehensive nationwide consumer protections were not available. But now, the No Surprises Act builds a national baseline of protections with a series of final and proposed rules issued in 2021, which complement existing laws in states where they already exist and protect all consumers nationwide. For more information on these rules, visit:

• Biden-Harris Administration Announces Steps to Protect Consumers and Improve Ground Ambulance Billing Practices Through No Surprises Act Implementation
• Biden-Harris Administration Improves Transparency and Oversight of Prescription Drug and Medical Costs
• Biden-Harris Administration Advances Key Protections Against Surprise Medical Bills, Giving Peace of Mind to Millions of Consumers Plagued by High Costs
• Biden-Harris Administration Issues Proposed Rules to Promote Transparency in Air Ambulance Costs, Agent and Broker Compensation
• HHS Announces Rule to Protect Consumers from Surprise Medical Bills

In Pennsylvania, more than 357,000 consumers selected health insurance through Pennie for coverage as of January 1, 2022. While open enrollment doesn’t end until January 15, this is an increase of 37,000 over the same time period last year. More consumers than ever actively shopped for plans more affordable and suitable to their specific needs. With 8 insurers providing Marketplace coverage, consumers had more choices than the past several years. 37,643 Pennie applications were deemed potentially eligible for Medicaid and transferred to the Department of Human Services. During the open enrollment period, 17,961 applications were transferred to Pennie for enrollment as they did not qualify for Medicaid. 92% of customers qualified for Tax Credits or Cost Sharing Reductions.

Pennsylvania Governor Tom Wolf announced that Department of Health Acting Secretary Alison Beam resigned her position with the commonwealth at the end of the year. The governor also announced that Department of Health Executive Deputy Secretary Keara Klinepeter will serve as Acting Secretary.

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