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An Online Resource Library on Gender-Based Violence.

How can my program help domestic violence survivors access affordable health coverage?

Monday, January 05, 2015

by Shaina Goodman of the National Resource Center on Domestic Violence

For many victims of domestic violence, access to health care is a critical component of their healing and recovery. The health consequences of domestic violence are serious, and can include chronic pain, arthritis, asthma, gastrointestinal problems, heart disease, and more (Kendall-Tackett et al, 2003; Breiding, Black, & Ryan, 2008). Women with a history of intimate partner violence also utilize health care services more often and have higher health care costs than women without such a history (Ulrich et al, 2003).

Despite a recent significant drop in the number of uninsured, 32 million Americans still lack health insurance. This is troubling because insurance coverage not only improves health outcomes, but can help strengthen both social well-being and economic security. Helping people in need gain access to health coverage can sometimes be the difference between life and death. A recent study following one state’s health care reform efforts in the last decade shows that near universal health coverage leads to a drop in mortality rates.

For these reasons, advocates can play an important role in helping domestic violence survivors understand their options for affordable health coverage. The Patient Protection and Affordable Care Act (ACA) (sometimes referred to as Obamacare) provides avenues for those that were previously uninsured or underinsured to get the coverage they need – but there is still some confusion and anxiety about what the law means and how to access the options that might be available. We hope this guidance provides clarity for advocates and for the survivors with whom you work.

Enrolling in Health Coverage

The ACA provides new options for consumers (eligible individuals and their dependents) to enroll in health coverage. The Health Insurance Marketplaces facilitate the purchase of health insurance by providing a set of health care plans for consumers. Some states have set up their own Marketplaces, but many states opted to have the federal government manage their Marketplace. In either case, those seeking to obtain coverage can begin the process by going to From there, consumers can compare available plans, find more information about coverage, and enroll in health insurance.

Advocates should ask survivors accessing services if they are aware of the enrollment period deadlines. For 2015 coverage, the Open Enrollment period ends February 15, 2015.

Partnering with In-Person Assisters: In-person assisters are people and organizations that have received special training to help consumers navigate the insurance options available to them and enroll in coverage. This a great opportunity for partnership – domestic violence organizations can make referrals to these assisters, work with them on supplemental trainings, and otherwise collaborate to ensure increased support for domestic violence victims. Enroll America’s Connector can help you find assisters in your area.

Helping Survivors Afford Coverage

The ACA provides new options for consumers to receive financial help to enroll in coverage. Consumers across the country may be eligible for federal premium tax credits to help reduce the cost of insurance premiums and for cost-sharing reductions to limit out-of-pocket costs.

The Kaiser Family Foundation’s Explaining Health Care Reform: Questions about Health Insurance Subsidies has more information on eligibility for the ACA premium tax credit and the amount of credit that may be available. This tax credit calculator will also help consumers estimate the cost of their premiums and the subsidies that may be available.

Importantly, there is a special rule for domestic violence victims with regard to getting these tax credits. In general, if someone is married, s/he must file taxes jointly with her/his spouse in order to get the tax credit. However, the IRS has issued regulations making an exception to this rule for domestic violence survivors. In other words, domestic violence victims, whether married or not, can file their taxes separately and could still be eligible to receive a tax credit to help pay for their premiums.

Currently, the IRS has released draft instructions for accessing the premium tax credit, including as a domestic violence victim filing separately.

The National Women’s Law Center We’ve Got You Covered Toolkit provides important information for women and their families about available health coverage options. Additional NWLC resources include healthcare enrollment talking points for advocates and a checklist of items for women to consider as they move through the enrollment process.

What If a Survivor Doesn’t Want Coverage?

Under the ACA, people must have health coverage or pay a fine (also known as a “shared responsibility payment”) on their federal income tax return. The fine for the 2015 coverage year is $325 per adult or 2% of household income (above the federal tax filing threshold), whichever is higher. However, there are several exceptions to this coverage requirement. For example, if a person’s income is below the federal tax filing threshold, s/he is not required to have coverage and is automatically exempt from the shared responsibility payment.

Second, there are a number of hardship exemptions that may be available. One of these exemptions is having “recently experienced domestic violence.” The hardship exemption application is available online but must be submitted via mail. It is straightforward and easy to complete; importantly, it does not require documentation of domestic violence victimization, just a short statement as to why the person is seeking an exemption from the coverage requirement.

Other Things to Know about Domestic Violence and the ACA

Under the ACA, health insurance plans are prohibited from denying health coverage to women based on a range of factors, including being a survivor of domestic or sexual violence.

The ACA also helps ensure that people with private coverage can receive certain preventative health care services without cost sharing. Screening and brief counseling for domestic violence are included among these preventive health services. For information about identification and screening by healthcare providers, public health intervention approaches, training for providers, and more, visit the National Health Resource Center’s Health Cares about IPV website and the VAWnet Domestic Violence and Health Care Special Collection.

To learn more about the tax credits under the ACA and other tax issues relevant to enhancing survivors’ economic stability, join the National Resource Center on Domestic Violence and the National Women’s Law Center for a free national webinar on Monday, January 26th: Tax Season: What Advocates Need to Know to Help DV Survivors.

In what ways does your agency help survivors meet their health care needs?