Saint Peter’s helps uninsured get health care insurance
Program offers medical coverage to children, families
By Erick Rommel
Head Staff Writer
NEW BRUNSWICK — There are nine million uninsured children in the United States. More than five percent of those children, approximately 500,000, live in New Jersey. In an effort to reduce that number, Saint Peter’s University Hospital hosted a July 14 event to help families apply for health insurance through the NJ FamilyCare program.
NJ FamilyCare offers full health coverage through a variety of HMOs; Saint Peter’s University Hospital participates in five of the program’s HMOs.
“This is not a welfare based program,” said Shanda Williams, health benefits consultant for NJ FamilyCare. “It mirrors commercial insurance.”
Coverage includes most health care needs, including doctor visits, eyeglasses, hospitalization, lab tests, regular checkups and prescriptions. In most cases, dental coverage is also provided.
Most qualifying families receive NJ FamilyCare without monthly premiums or co-payments; some are required to pay a small amount. “Family care in the past looked at lower incomes,” said Teri Provenzano, supervisor of charity care for Saint Peter’s University Hospital. “I think the state had to realistically look at working families that weren’t offered insurance through work and come up with a better plan.”
Eligibility rules
Eligibility for NJ FamilyCare is based on family size and monthly income. A family of two without insurance can have a maximum family income of $3,850 per month before taxes and still qualify. The income limit for a family of six is $7,817 per month. These limits are increased for larger families. Families that earn close to the maximum income may only qualify for coverage of children less than 19 years old.
Undocumented residents often rely on NJ FamilyCare to provide medical coverage for their children born in the United States. Ana, who lives in New Brunswick, applied for her 4-year-old son, Julian, who was born at Saint Peter’s University Hospital. Her husband recently started a new job. He earns less than $400 per month and is not eligible for benefits until he has been employed for a year.
Speaking through a translator, Ana said Julian having insurance will give her peace of mind. “Right now, if Julian gets sick, I can’t take him to the doctor because I can’t afford it,” she said. “That worries me.”
Because Ana, her husband, and their 9-year-old son, Ernesto, do not participate in Social Security, they are not eligible for NJ FamilyCare. If needed, they can receive assistance through Saint Peter’s University Hospital’s charity care program.
Ana said she is grateful that Julian will have health insurance. “Health care today is very expensive,” Ana said. “This is a great program because it makes it possible for people to have health care.”
Covering basic needs
Mary Williams also applied for NJ FamilyCare. The 46-year old New Brunswick resident has been without medical insurance for two years. She currently works seasonally for the South Brunswick Board of Education earning less than $8,000 a year. Her children, a 13-year-old and 6-year old twins, all with asthma, already have NJ FamilyCare. “I like that the doctor accepts it,” she said. “I can call him any time of night. He makes house calls.”
If she receives approval for NJ FamilyCare, Williams already knows what her priority will be. She needs to see a dermatologist to treat eczema, which painfully splits the skin on her hands. Without insurance, she is forced to rely on over-the-counter treatments which do not work as well as prescription medicine.
Williams’ sister, Elaine, 49, also applied for NJ FamilyCare. She hopes the program will cover her prescription costs. She currently pays $375 per month, more than half her monthly income. “I have two [prescriptions] in my pocket today that I can’t afford to have filled,” she said.
Elaine described the lack of insurance as a circle. If she does not take her medicine, she gets sick. When she gets sick, she goes to the doctor, who says something needs to be done because the medicine is not working. After Elaine says she cannot afford to take the medicine, she receives a one-month voucher for a free prescription. She takes the medicine for a month and gets better. After that, she stops taking the medicine, gets sick again, and the circle repeats.
Providing assistance
While health care is costly, Elaine thinks a solution can be found. “If a person needs a doctor or medicine, it should be worked out,” she said. “If you can afford to pay you should. If not, the rest of society should help.”
Programs such as NJ FamilyCare are meant to provide that assistance. During the event at Saint Peter’s University Hospital, approximately 15 families applied for coverage. Shanda Williams assisted many of those applying with completing their applications. She believes the biggest obstacle in reducing the number of uninsured children and families is the lack of awareness about programs such as NJ FamilyCare. Every time she assists with an application, one thought repeats itself. “I don’t understand why they didn’t apply sooner, or why we’re not reaching these people,” she said.
Those interested in NJ FamilyCare can apply at Saint Peter’s University Hospital or call (800) 701-0710. Multilingual operators are available. For more information, visit www.njfamilycare.org/
*The attached/referenced article was originally published in The Catholic Spirit, the official newspaper of the Diocese of Metuchen, and is protected under U.S. and international copyright law