As Community Catalyst’s Health Equity summer intern, I got to spend some time chatting with Linda Ellis of Georgia’s The Health Initiative about why closing the coverage gap in Georgia, and other states that have yet to expand Medicaid is pivotal for LGBT (lesbian, gay, bisexual, and transgender) elders. As she shared, there was a time when it made sense to focus on LGBT specific services and to think that “we need to specifically care for our own. However, that is not the case today for an LGBT-specific organization in a state with limited resources and support for both the LGBT community and LGBT health care expansion.”

Many LGBT elders have come of age in a culture of rejection from their families and faith communities’ faith. Given the stigma attached to LGBT identities for many elders, they are often a difficult audience to reach. But Georgia’s Voice for LGBT Health is helping overcome these barriers by developing partnerships across issue areas, helping providers and advocates become more comfortable with culturally inclusive language, and addressing risks that LGBT elders and their families face.

Read on to learn more about why LGBT organizations are continuing to engage in health care reform, why outreach and education matter to LGBT elders enrolling in new health coverage options, and how the Diverse Elders Coalition has helped spark a new relationship between The Health Initiative and Georgians for a Healthy Future to ensure LGBT elders remain a point of focus as we continue to implement Obamacare across the country. 

Jessica Liao: Why should the Affordable Care Act (ACA) matter for LGBT elders?

Linda Ellis: LGBT elders can receive low cost health insurance through the ACA marketplace. The amount each individual will save is based on personal income and family size. To find out what someone may qualify for, this chart is very helpful. Unfortunately, in states that decided not to expand Medicaid, the direct financial benefits aren’t as great as they are in states that did take on the expansion. The challenges are greater for transgender individuals, who are even more likely to be poor and uninsured than their LGBT peers, and are often denied coverage or have difficult health care experiences, due to provider inexperience and bias.

The ACA works to directly address many issues experienced by LGBT elders through both providing non-discrimination protections and eliminating denial of coverage based on pre-existing conditions. The only four questions that can impact your insurance rates under the ACA are: the county you live in, your age (and there is a limit to that impact), your family size, and whether or not you use tobacco.

Jessica: What have outreach and enrollment efforts for LGBT elders been like?

Linda: In Georgia, our organization has been tasked with promoting enrollment efforts for the LGBT community at large. We’ve created a “Just the Facts” program that educates those aged 50-64 about ACA opportunities, and those 65+ about Medicare, as well as providing information about Social Security enrollment, financial and legal protections and other senior specific services

Coalition building, developing strong partnerships with mainstream community providers, and inviting all potential partners to join us are the keys to expanding LGBT enrollment. As a result, our ACA Navigators have spent a good deal of time at events that would not necessarily be seen as “LGBT friendly,” and have helped a large number of non-LGBT individuals secure health care coverage as well. That means, though, that LGBT individuals, whether or not they openly identify as such, have seen us in their communities, and that goes a long way in creating a sense of trust.

We’ve met with many LGBT individuals for whom Medicare enrollment remains a few years off who’ve been very pleasantly surprised with the coverage options they’ve been able to secure through the ACA Marketplaces. For example, one gentleman who was over 50 years old, and experiencing some significant health concerns, was able to secure health care coverage for the first time in his adult life. With subsidies, his monthly payment was less than $50. He was seen for a complete physical within a month of his insurance going into effect and had much needed surgery shortly after that. His enrollment through the ACA literally saved his life

Jessica: What are some ways Navigators can ensure that their enrollment efforts are culturally competent for LGBT elders?

Linda: If LGBT elders have a need, they’ve learned to rely on themselves or family members they trust. They have a heightened radar for sensing support – or the lack of it. All of this is compounded for individuals of color. And because the LGBT community can be very youth focused, our elders are often extremely hesitant to identify themselves as “old” or in need of such services. If your goal is to reach LGBT elders, you’ve got to keep all of this in mind, in addition to other cultural competency strategies for LGBT communities at-large.

Also, the best thing to do is to partner with community based organizations, and in some cases, private organizations, and help make referrals to these organizations. It is very important that we establish relationships with mainstream health care providers in order to make referrals to them for an individual who is uninsured or hasn’t seen a medical provider for whatever reason. And, using community based health funds, we try to help cover the costs of care or treatment for those individuals who fall in the Medicaid coverage gap and aren’t able to get health care coverage.

Jessica: Finally, what are some important dates and deadlines for enrolling LGBT elders? What resources are available for LGBT elders to learn more about their options for Medicaid/Medicare?

Linda: This year’s Open Enrollment period begins November 15, 2014 and goes through February 15, 2015. For those enrolling by December 15, insurance coverage will go into effect on January 1, 2015. For those enrolling after December 15, coverage generally goes into effect 30 days after completing the enrollment process. Those who are eligible for Medicaid, however, can enroll at any time, as can Native Americans. Additionally, certain life events, such as employment changes, qualify individuals for enrollment outside of the normal time frame. Individuals can visit this link to see if they qualify for a special a enrollment period.