Table of Contents - Introduction - Health Issues - Family Issues         Financial Security - Immigration - Violence Against Women         Discrimination & Employment Issues - Basic Needs - Appendix

Health Care Plans and Programs Programs for Specific Needs Reproductive Issues Issues of Interest to Women Living Wills aaaaaWomen are the primary decision-makers and consumers of health care. In addition to their own gender-related needs, many are caring for children, aging parents, or ill spouses and relatives. Particularly because of their many different roles such as wife, mother, and caregiver, women need to understand how to navigate the health care system.

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Most women and men rely on a healthcare plan, usually provided by an employer, to pay at least part of the medical bills that they and their family members incur. Since unexpected doctor and hospital bills can be extremely costly, relying on personal savings to pay all of these costs may jeopardize both your physical and financial health. If you lack adequate group coverage and can afford to pay the premium, you can also buy individual coverage.      Other Americans rely primarily on government-sponsored insurance and benefit programs. For example, people over 65 who have been paying into the Social Security and Medicare programs over the years are eligible for Medicare. Persons under 65 with limited incomes may qualify for Medicaid and other government health benefit programs. Some people may qualify for both Medicare and Medicaid at the same time.      One person in six in New Jersey has no coverage at all because his or her employer offers no health coverage. Most of these people are too young for Medicare and earn too little to afford individual coverage but too much to receive Medicaid. New laws will close some but not all of these gaps. The various types of group and individual coverage, government health programs, and government reforms are described below. What to Do      In planning to provide for your health and that of your family, begin with proper food, sleep and exercise. Record your family’s health history: heart disease, strokes, cancer, diabetes, childhood diseases, vaccinations, allergies, medications, etc. Record baseline blood pressures and cholesterol levels. Learn what care your health coverage provides, which doctors and hospitals your plan uses, and how to get bills paid. Private Insurance: Traditional and HMO          Health coverage has changed significantly in the past decade. Ten years ago, most people chose their own family doctor, directly consulted a specialist of their own choice and filled out insurance forms to request payment from the insurer. After excluding any co-payments or deductibles payable by the participant, the insurance company paid whatever the plan’s conditions and rate structure provided.      Some health insurance plans still operate under this "fee-for-service" format. But the cost of such plans can be high, and this has caused both employer and government plans to rely increasingly on "managed care" plans, including those run by Health Maintenance Organizations (HMOs). An HMO ordinarily requires its members to use only certain hospitals and doctors. The member must select a "primary care physician" from a list provided by the HMO. This doctor then serves as both the participant’s health service coordinator and the HMO’s financial "gatekeeper" whose approval is needed, for example, before the HMO will pay any specialist’s fees. Even when that permission is granted, the specialist must be selected from an approved list. Except in emergencies, HMOs will not usually pay for outside services that could be provided within the system. Other managed care plans, unlike HMOs, sometimes list approved providers but also pay part of costs outside the plan’s network. See the 1999 NJ HMO Performance Report.      Some managed care programs do not offer full coverage. Some offer no cholesterol monitoring for heart disease (the leading cause of death in women and men), no programs to quit smoking, and no coverage for teenage depression, eating disorders or substance abuse. The Law      Until recently, those who were not covered by a group plan often were unable to buy individual health care coverage. State laws now allow you to buy any of five types of individual policies from a number of insurance companies, at a uniform cost, regardless of your health status, age, gender, profession, claims history or location within the state.      A small business with two to 49 employees may also now buy a group policy in which an employee’s health status is not a cost or eligibility factor. Employees who work at least 25 hours per week are eligible. Some small employer plans that preexisted standard plans are not required to conform to the newer standards.      Some large employers do not buy insurance but insure themselves. They, too, are exempt from the standard plan requirements. Some laws require the insurance company or the employer to notify you if you are not being given the usual coverage.      Under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA), if your employer has 20 or more employees and you would lose your health insurance at work for various reasons (like loss of your job, a cutback to part-time hours or a divorce that would end spousal coverage) you may have the right to pay to continue that same coverage yourself for up to 18 months at 102 percent of cost (this coverage is extended to 29 or 36 months under certain circumstances). Your employer must give you notice of these rights. Under recent state laws, the right of others to continue individual coverage is also guaranteed. You may have to wait for up to one year for coverage of a preexisting condition if you allowed your prior coverage to lapse. Likewise, in the small employer group coverage market, there is a waiting period of up to six months for coverage of a preexisting condition if the employer has only two to five members in its group. This restriction may not be imposed on other small employer groups (six to 49 members).       If you go on unpaid leave for up to 12 weeks under the federal government’s Family and Medical Leave Act (FMLA), applicable if you work for an employer of 50 or more employees, your employer must continue any health coverage during your leave. What to Do      Check out your coverage options. If you have a choice of group plans, check with each to determine whether it covers the particular types of care that you will need. Resources      For information about individual plans or for a free buyer’s guide call: New Jersey Department of Banking and Insurance (609)984-0445 For information about small employer plans, call: (800)263-5912 For information about the Health Access Program, call: New Jersey Department of Health and Senior Services (800)367-6543 Medicare The Law      Medicare serves 1) persons who would be eligible for Social Security based on their contributions over the years and who are either 65 or older, and 2) persons of any age with permanent kidney failure or with certain disabilities. Since eligibility is based on qualifying contributions paid by the recipient or a family provider or on other monthly premiums, Medicare has no income restrictions.      Unlike Medicaid (discussed below), Medicare does not pay the long-term costs of nursing home care, though it does provide coverage for certain limited in-patient care. Medicare does not pay for most prescription drugs, for routine check-ups, custodial care assistance with daily living activities such as bathing or eating, private nurses or most routine care related to obtaining a hearing aid, dentures, eyeglasses, or charges for a private hospital room. Coverage is also subject to various exclusions and co-pays. About 70 percent of Medicare recipients have purchased supplemental "Medigap" insurance to pay for bills that Medicare does not cover. Medicare has two parts: Part A (hospital) and Part B (medical).      Part A is available to contributors having enough Social Security work credits. It may begin at age 65, even if you have not yet retired and do not yet receive Social Security payments. It is also available to many persons with disabilities and persons needing kidney dialysis or transplants who are eligible for Social Security insurance or benefits. Part A pays up to 90 days of hospital stay for each illness. There are also 60 lifetime reserve days that can be used after the 90 days, subject to a deductible. After the 90 days, Medicare also pays up to 100 days in a nursing facility that has rehabilitation care following certain illnesses. It can also pay for certain home nursing, therapy, supplies and services, whether you are hospitalized or not. Hospital coverage includes a semi-private room, meals, services relating to operating and recovery rooms, intensive and coronary care, drugs, lab tests, X-Rays, and certain other medical devices and services.      Part B medical insurance is for people over 65 who pay a monthly insurance premium, regardless of Social Security work credits. You will be enrolled in Part B automatically when you enroll in Part A unless you work past age 65, apply as a disabled person who does not meet Part A’s disability standards, or live in a foreign country or United States possession at the time you apply. Medicaid pays Part A Medicare coverage for certain low-income people who qualify.      Part B pays for doctors and for drugs in treatments that cannot be self-administered. It includes some hospital outpatient and home care, ambulance transportation, lab tests, special oral surgery, annual mammographies, X-Rays and various other services and equipment. Doctors often agree to limit their costs to Part B coverage limits; they may not charge more than 15 percent above those limits. What to Do      Apply for Medicare about three months before you turn 65 to allow time for processing. Apply at that time even if you do not plan to receive Social Security checks until later. It is often cheapest to buy Medigap coverage while you are still in your late fifties and still working. Appeal a decision if it seems wrong. Medicare denies some coverage that it does not consider medically necessary. Appeal through Social Security within 60 days. If you are still dissatisfied, appeal further through the federal courts (get a lawyer). Resources Social Security (800)827-1000 For problems relating to claims or payments, call your Regional Administrative Carrier For other Medicare and Medigap insurance advice, call: Counseling on Health Insurance for Medicare Enrollees (CHIME) through the Division on Aging (800)792-8820 Medicaid The Law      Medicaid, unlike Medicare, is needs-based; it is limited to persons with poverty level income and few other assets (the federal poverty level is presently $16,400 for a family of four); over 65, blind or disabled receiving Social Security’s Supplemental Security Income (SSI); over 65, blind or those disabled who are below the federal poverty level with less than $4,000 in individual (or $6,000 joint) assets; who are infants up to age one or pregnant women with incomes below 185 percent of the federal poverty level (no asset limits); who are children up to age 18 in families below 133 percent of the federal poverty level (no asset limits); receiving home and community service under such programs as the AIDS Community Care Alternative Program (ACCAP).      Where asset limits apply to Medicaid eligibility requirements, certain assets are exempt. These include your home and household effects, life insurance under $1,500 per person, and a car used for health treatment, modified for the disabled, or needed for essential activities (or a $4,500 household exclusion for cars).      Medicaid pays for physician, inpatient and outpatient hospital care, prenatal care, clinical services, prescriptions, dental care, optometrist, eyeglasses, mammograms, family planning services and contraceptives, laboratory and X-Ray services, nurse/midwife services and prosthetic devices. Most Medicaid services are now provided through managed care providers, though some mental health and substance abuse services do not yet use managed care.      Managed care is now optional for special needs populations, but plans are underway to move these groups into managed care also. There are also limited slots in Medicaid "waiver" programs for disabled children and adults who require an institutional level of care to enable them to remain at home.      Medicaid is the "provider of last resort." Persons who qualify for other coverage, such as Medicare, must use that first. What to Do      To discuss Medicaid eligibility, call the Beneficiary and Provider Services Section, New Jersey Division of Medical Assistance and Health Services. Recipients of SSI through Social Security (see chapter on Basic Needs) are signed up for Medicaid automatically. As with other insurance, be certain that your coverage has begun before canceling any prior coverage. If Medicaid declares you ineligible, you can request a hearing within 20 days after notification. When you wish to challenge a decision from your Medicaid HMO, you also have the option, but only if you choose, of first using the HMO’s own appeals procedure in addition to Medicaid appeals. If your Medicaid coverage is being terminated, you may keep the coverage pending an appeal if you file your appeal within ten days of notification. If you disagree with the administrative finding, you may also take a further appeal to the Division of Medical Assistance and Health Services that must reach a decision within 45 days. Further appeals may be made through the court system. Resources To apply for Medicaid call: Division of Medical Assistance and Health Services, (609)588-2600 You may also apply through your County Welfare Agency NJ Care Program      The NJ Care program supplements Medicaid for elderly and disabled persons with income too high for SSI but nonetheless at or below the federal poverty level for the preceding year. Non-exempt resources cannot exceed $4000 ($6000 for a couple). Supplementing Medicaid’s doctor and hospital care, it provides other mental health services, prescriptions, X-Rays, eyeglasses, and hearing aids for persons with limited income and resources who are over 65, pregnant, blind, or disabled on Social Security. The Medically Needy Program      This extends Medicaid to cover nursing home and other services for those whose income is too high to qualify for SSI but who face medical expenses that exceed their income and resources. It serves senior citizens who are 65 and over and persons with disabilities whose need for a nursing home exceeds their income. It also covers certain pregnant women, dependent children to age 21, and elderly, blind or disabled people who meet various other needs-based criteria. Restrictions on Medicaid Funding      The New Jersey Supreme Court has upheld state regulations requiring that, before Medicaid funds are used, IRA retirement proceeds of the spouse remaining in the community be used to fund the other spouse’s long term care unless total assets (minus exclusions) are no more than $76,400. In deferring to the legislature, the Court acknowledged that these criteria might sometimes lead to near-term impoverishment of the spouse remaining in the community.      In 1996, Congress restricted the use of Medicaid, Food Stamps, SSI and other public assistance by legal aliens. New Jersey has since restored Medicaid coverage for legal aliens who resided in the United States prior to August 22, 1996. Except for certain exemptions, those who began such residence after that date are ineligible for Medicaid for five years. (Even then, most will remain excluded because their sponsor’s income will be imputed to them, making them ineligible for Medicaid). Charity (Hospital Assistance) Care      After modifying a long-standing program, New Jersey claims to be the first state to have established a comprehensive program designed to subsidize hospitals that provide free charity care for people who cannot pay. More stable funding was recently provided for this program (and for the Health Access and KidCare programs) through an increase in the tax on cigarettes. The Law      A hospital in the state may not deny admission or quality services to a New Jersey resident based on inability to pay. Charity care is available to persons with income at or below 200 percent of the federal poverty level; persons with income between 200 percent and 300 percent qualify for reduced costs. What to Do      You must apply within a year after leaving the hospital. Ask the hospital’s financial office to provide you with a form. You will need to provide acceptable identification. Resource If a hospital denies charity care to which you think you are entitled, appeal within 30 days to: New Jersey Department of Health and Senior Services (609)275-8714

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Children NJ FamilyCare (formerly NJ KidCare)    NJ KidCare is now NJ FamilyCare--health care for uninsured children, parents, couples, and single adults. NJ FamilyCare is not a welfare program - it's low-cost health coverage through a variety of recognized Health Maintenance Organizations (HMOs). For many people, there are no monthly premiums or co-payments. For families with higher incomes, however, a small co-payment and monthly premium may be required.  NJ FamilyCare covers just about every healthcare need, including doctor visits, eyeglasses, hospitalizations, lab tests, x-rays, prescriptions, regular checkups, mental health, and dental, for most children and some adults. Childless individuals and couples with incomes up to 50% of the federal poverty level will be eligible for medical benefits similar to the Medicaid program. Childless individuals and couples with incomes between 50% and 100% of the federal poverty level will be eligible for a typical managed care benefit widely used in the New Jersey private sector. The Law      NJ FamilyCare will provide free or low-cost health insurance to uninsured parents with incomes up to 200% of the federal poverty level (currently $34,100 for a family of four). FamilyCare will also provide free health insurance to uninsured childless adults with incomes up to 100% of the federal poverty level (currently $8,350 for a single adult).     Families with incomes between 150% and 200% of the federal poverty level will be required to contribute a $25 monthly premium per adult. What to Do      You must register for this program to receive its benefits. If you are eligible, sign up for this program at one of numerous municipal, county and state government locations throughout the state. You may also call the NJ FamilyCare Hotline to receive an application by mail. Resource For information about the program or how to find a place near you where you can sign up your children and family, call: NJ FamilyCare Hotline (800)701-0710 Catastrophic Illness in Children Relief Fund      This is a state-funded program to help pay uninsured and unfunded medical expenses when New Jersey children under 19 suffer a major illness. Changes in the percentages were made in 1999 resulting in increased aid for families. Resource Catastrophic Illness in Children Relief Fund, Hotline (800)335-3863 Special Child Health Services provides early intervention for infants and toddlers with disabilities. Call: New Jersey Department of Health and Senior Services, (609)777-7734 Elder Care      In addition to Medicare and Medicaid, there are many other health care services available for older citizens – sometimes with no income qualifications. The New Jersey Division of Senior Affairs assists older adults in locating available and appropriate resources. By calling their toll-free number, you can learn about various federal, state, and local programs and be connected to an appropriate agency in your community. The following programs for older people merit particular attention. Resource Division of Senior Affairs’ Information and Assistance Service, (800)792-8820 New Jersey Performance Report for Nursing Homes Respite Care      The New Jersey Statewide Respite Care Program is designed to assist older citizens, at or below the federal poverty level, who have no more than $40,000 in resources, to avoid nursing home placement and to relieve caregivers of the stress of older citizen care. It provides companions, home health aides and homemakers (hourly or overnight), and medical or social day care. Resource Statewide Respite Care Program, (609)588-2902 Adult Day Care      The New Jersey Adult Day Services Association also provides, on less than a 24 hour basis, regularly scheduled nursing care, transportation, therapy, social activity, personal care, meals, rehabilitation and counseling for the functionally impaired. Alzheimer Care      Persons diagnosed by a physician as suffering from Alzheimer’s Disease and who meet income eligibility criteria may also qualify for informal caregiver supervision through the Alzheimer Adult Day Care Program. The COPSA program run by the University of Medicine and Dentistry of New Jersey also provides comprehensive services for victims of Alzheimer’s and related conditions. Resources Alzheimer Adult Day Care Program, (609)588-3274 Alzheimer’s Services (diagnostic, support counseling information and referral services), (800)424-2494 Dental Care      The New Jersey Dental Association sponsors the "Senior Dent" program through which persons 65 or over, at or below the poverty level with no dental insurance or Medicaid eligibility, can receive a 15 percent discount on dental care through participating dentists. Resource You can apply by calling the Senior Services NJ EASE (800)792-8820 Pharmaceutical Assistance and Hearing Aid Assistance for the Aged and Disabled (PAAD and HAAAD) -      New Jersey low-income residents who qualify for SSI and are over 65 or disabled get prescriptions and diabetic items for a $5 co-pay fee and $100 toward the cost of a hearing aid. The eligibility standard will rise annually based on Social Security’s cost adjustments. Income limits for 2001 are $19,238 for single persons and $23,589 for married couples. PAAD was recently extended to pay for syringes and needles for victims of multiple sclerosis. Resources Contact New Jersey Department of Health and Senior Services for information, (800)792-9745 Many other programs are available to older citizens for such health services as free flu shots and blood pressure screening Nationwide Clearinghouse for Older Citizen Programs, (800)677-1116 HIV INFECTION and AIDS      New Jersey has the highest percentage of AIDS-infected women in the country. One-third of all children born to them have been infected and more than 10,000 New Jersey children have already been left motherless because of AIDs. The Law      Persons affected with AIDS who are receiving various government entitlements, such as Supplemental Social Security Income, are automatically eligible for Medicaid benefits. Certain persons with disabilities who also have AIDS qualify for Medicaid even if they have income or assets that somewhat exceed normal Medicaid limits. County transportation is often available for use by disabled AIDS victims for medical, educational, employment and even recreational purposes.      As noted earlier, Medicaid also provides funding for the Aids Community Care Alternative Program (ACCAP), which assists needy AIDS victims diagnosed with an HIV infection. While it does not provide nursing home coverage, customary under Medicaid, it provides medical day care, private nursing, drug abuse treatment, personal care assistance, 24-hour hospice care for persons diagnosed as having less than six months to live and intensive supervision of children in foster homes.      The New Jersey AIDS Drug Distribution Program also provides New Jersey residents with pharmaceutical prescriptions to treat any HIV infected person whose income is below $30,000 (add $10,000 each for other dependents, up to a maximum of $70,000). A doctor’s certified HIV positive diagnosis is needed to enroll.      No one may test you for HIV antibodies without your informed consent. All HIV cases are reported to the Department of Health. Your name, address and other information is reported with confidentiality.      The New Jersey Law Against Discrimination protects persons infected with HIV and AIDS against discrimination in housing, employment and public accommodations (e.g., schools and colleges; public hospitals and clinics). HIV and AIDS may not be factors in insurance decisions, absent a sound, actuarial reason.      New Jersey now requires semen banks to test all donors for AIDs. What to Do      To receive AIDS counseling or testing for AIDs or HIV virus, go to one of many counseling centers throughout the state. Resources For information about counseling centers, call: New Jersey AIDS Hotline, (800)624-2377 If you believe you have been discriminated against because of AIDs, contact a plaintiff’s employment lawyer. You may also call: New Jersey Division on Civil Rights, (609)292-4605 New Jersey Women and Aids Network, (732)846-4462 Mental Health      In the past, most health insurance plans provided little coverage for mental health problems such as the treatment of depression, trauma, adolescent problems, eating disorders and anxiety disorders. Under the federal Mental Health Parity Act of 1996, a health insurance plan for an employer with more than 50 employees must now provide the same financial level of coverage for mental health benefits as for medical and surgical purposes. This law does not apply, however, if this would cause the particular plan’s costs to rise more than one percent. New Jersey law now requires hospital, medical, and health service corporations, commercial individual and group health insurers, and HMOs to provide health benefits coverage for biologically-based mental illness under the same terms and condition as provided for any other sickness. Medicaid, Medicare and NJ Care offer limited mental health services. The NJ KidCare program includes comprehensive mental health coverage.      Even with the new parity requirements, few private health care plans cover a broad range of mental health. For example, many still do not provide for eating disorders, drug and alcohol abuse or depression among teenagers. Medicare reimbursements for outpatient care have been lowered as a result of the Balanced Budget Act of 1997. Outpatient programs in Hamilton, Toms River, Toms River South, and Paramus which specialized in mental health and substance-abuse treatment, close in September 2000.      New Jersey residents who have no treatment options other than by entering a mental health facility may be entitled to treatment at one of the state’s public hospital facilities. Such facilities will admit a qualified patient if she poses a danger to either herself or others. The commitment may be either voluntary or involuntary. The danger to self or others may arise from inability to care for herself, suicide attempts or threats of serious injury to others.      In an involuntary commitment, a person cannot be held more than 72 hours without a court order. A court may order a person held, pending a hearing, for up to 28 days. If the court then finds no basis for commitment, the patient must be discharged within 48 hours. Resource The New Jersey Psychiatric Association, (800)345-0143. This association provides additional information about mental health options. There are also many support group meetings held throughout the state to address specific emotional problems, disorders, addictions, bereavements, and other situations. For more information about self help programs, call: (800)367-6274 Substance Abuse      Substance abuse arises from use of tobacco, alcohol or chemicals, such as drugs. Directly or indirectly, substance abuse accounts for a shocking percentage of the health care problems of America. It directly accounts for about 20 percent of all hospital time paid by Medicare and far more than one quarter of all the hospital care costs that Medicare provides. Tobacco is a factor in 80 percent of the cost, but alcohol and drugs are also significant factors in Medicare cases. Substance abuse is also an important secondary factor in such medical problems as neoplasms, circulatory disorders, cardiovascular problems, respiratory problems and injuries. Patients with substance abuse problems take twice as long to recuperate from medical conditions such as pneumonia and burns.      Medicaid’s substance abuse statistics are even more dramatic. In 1991, the last year in which statistics are available, 3.9 million of Medicaid’s hospital days were attributed to substance abuse: a cost of $3 billion. Substance abuse in pregnant women alone accounts for 32 percent of all Medicaid hospital days. It often causes low birth weight, premature delivery, mental retardation, congenital malformations, or cardiovascular and respiratory conditions in the child.      Because of the costs, many health insurance policies do not cover the treatment of substance abuse without a special rider. The Mental Health Parity Act also excludes substance abuse protections. Resources Ala-Call-Alcoholism Help (800)322-5525 Narcotics Anonymous/Family Help (800)922-0401

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Birth Control The Law      The New Jersey Constitution forbids government to restrict the private use of contraceptives. Persons of either sex may purchase prescription or non-prescription contraceptives without regard to marital status, age, or parenthood. Health insurance plans vary considerably in the contraceptive services they will cover. Most cover surgical methods (a hysterectomy, etc.) but do not pay for intrauterine devices, implants, or pills. What to Do      You may buy birth control pills, IUDs and diaphragms from a drug store with a doctor’s prescription. Condoms, foam, sponge and other common contraceptives need no prescription. Free access to contraceptives, at any fertile age, for low income recipients is discussed later in this chapter’s discussion of Adolescent Sexuality. Sterilization The Law      New Jersey law considers a person to have the right to be sterilized voluntarily. Medicaid recipients may only use Medicaid funds to do so if they are 1) at least 21 years old, 2) have signed a written consent at least 30 days before the operation, and 3) have been informed of alternative birth control methods and the nature and risks of the procedure. Because sterilization may have significant effects on your life, consider the decision carefully. Even though you have the legal right to make the decision alone, it is best to first talk about this decision with persons you trust. Abortion      In recent years the United States Supreme Court has partially upheld its decision in Roe v. Wade by affirming "the right of the woman to choose to have an abortion before viability." The Court now permits states to restrict abortions "if the law contains exceptions for pregnancies which endanger a woman’s life or health." In 1998 the New Jersey Legislature enacted a law, over the governor’s veto, to ban late-term D&X (partial birth) abortions. That law has been challenged in court and the statute will not be enforced pending appeal. The Law      New Jersey law allows any woman – married or single, including a minor – to have an abortion through a licensed physician, though certain restrictions begin after the 12th week of pregnancy. Those restrictions require that abortions after the 12th week take place in a licensed clinic or hospital. After the 20th week, New Jersey only permits an abortion to protect the woman’s life or health.      On August 15, 2000 the New Jersey Supreme Court ruled unconstitutional a year-old law requiring those under 18 to inform their parents before having an abortion.      Restrictions limit the use of federal Medicaid funds for certain "elective" abortions. New Jersey’s limited Medicaid funds are usually insufficient to pay the full cost of an abortion. What to Do      Remember that time is crucial. You should get a pregnancy test as soon as you suspect that you may be pregnant. First trimester abortions are safer, cheaper, and can be performed at a more convenient location. Before making your choice, as with all significant life decisions, consider talking with someone you trust: perhaps a relative, clergy or councilor.       A mother’s ability to place her child for adoption or foster care are other choices discussed in the chapter on Family Issues. Resources Your regular doctor Your local Planned Parenthood or Women’s Clinic, listed in your phone book Adolescent Sexual Health      Statistics about teenage sexuality show that, while there has been a significant drop in teenage pregnancies throughout the country since 1992, the United States has the highest proportion of teen-age out-of-wedlock births among major industrial countries (37 percent). All but a small percentage of these pregnancies were unplanned.      Young, sexually active teenagers often have multiple sex partners, putting them at high risk of contracting sexually transmitted diseases (STDs). Teenage girls between 15 and 19 are the principal victims of gonorrhea. About one person in four with the HIV virus contracted it as a teenager. Syphilis, chlamydia and human papilloma virus are also prevalent among teenagers. Some of these diseases result in infertility, chronic pelvic pain, ectopic pregnancies, cervical cancer and death.      Besides the health risks, teenagers and society also face other kinds of serious issues relating to adolescent sexuality. The Law aaaaa Based on this serious health risk, New Jersey and federal laws provide minors with confidential access to sexual counseling, birth control, family planning services, and diagnosis and treatment of sexually transmitted diseases — all without parental notice or consent. The federal government’s Title X program provides family planning clinics with funding for contraceptives, pregnancy tests, screening for sexually transmitted diseases, and pelvic exams for economically needy persons. Persons with incomes between 100 percent and 250 percent of the federal poverty level are provided with discounted fees based on their ability to pay. When a minor requests confidential services without parental involvement, any payment obligation is based solely on the minor’s income (e.g., part-time employment and allowance). When one parent knows about this use of family planning services but the other does not, the parental income will be excluded if the minor’s confidentiality might otherwise be breached. Resources • For information about confidential birth control information, counseling, and supplies, call your local Planned Parenthood office, listed in your phone book • Family planning centers throughout the state offer a variety of medical and counseling services covering the entire spectrum of reproductive issues. For more information call: New Jersey Department of Health and Senior Services, Family Planning Program (609)292-8104 • Family Planning Association, (609)393-8423 • Family Health Line, (800)328-3838 • New Jersey Family Planning League, (973)622-2425 • Teen Pregnancy Prevention Hotline (800)THE-KIDS

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Mammograms aaaaa New Jersey women have the highest rate of breast cancer of any state. Mammograms are also discussed above under Medicaid and Medicare. Insurance companies that offer group or individual health plans must provide women participants between the ages of 35 and 40 with at least one baseline mammogram; those between 40 and 50 with mammograms every two years (more often if a doctor requests); and an annual mammogram for women over 50. aaaaa The risk of breast cancer increases with age. An annual exam is recommended for women over 40 – more frequent than these mandatory health coverage requirements provide. Insurance companies must offer individual and group purchasers, at their option, a plan that includes annual mammograms for all women over 40. The permitted cost to be charged for mandatory coverage items is set forth in the applicable statute. Insurers also must offer, at prescribed costs to any group or individual that wants it, a policy that provides an annual medical consultation on breast self-examination procedures. Mastectomies aaaaa Plans must provide a 48-hour hospital stay for a "simple" mastectomy and 72 hours for a modified radical mastectomy, unless the woman and her doctor prefer a shorter stay. Individual and group health plans must cover the cost of post-mastectomy reconstructive surgery on one or both breasts as well as the cost of outpatient chemotherapy to treat breast cancer. Resource • New Jersey Breast Cancer Coalition (732)247-0071 Pap Smears aaaaa Group plans that cover more than 49 persons must provide all women over age 20 with pap smear tests every two years. Insurers must also offer similar provisions for sale to other individual and group health plans at prescribed costs. Prenatal Care aaaaa Your chances of giving birth to a healthy baby are greatly increased when you receive prenatal care early in your pregnancy. This includes monitoring and also advice about exercise, rest, healthy diet and avoidance of harmful substances (alcohol, drugs and tobacco). Poverty and lack of knowledge have caused some low-income mothers to have babies with low birth weights. This sharply increases the danger of infant mortality or prolonged health problems. aaaaa The United States ranks 23rd among developed countries in overall infant mortality. In the U.S. and in New Jersey, a black infant is more than two times as likely as a white infant to die before his or her first birthday. Even when factors such as income, education, maternal age and marital status are similar, black women deliver babies who die, before age one, twice as frequently as white women. (More information available at NJ's Department of Human Services' Black Infants - Better Survival Web site) aaaaa Women may seek prenatal care in a private physician’s office, hospital, clinic, health center, or Planned Parenthood Center. In New Jersey, Medicaid provides prenatal care for women with incomes up to 185 percent of the poverty level. A Medicaid service provider may presume that a pregnant woman is eligible for prenatal care while proof of eligibility is being gathered. The state has graded HMOs on the services they offer and has urged some to improve coverage for prenatal and child care and checkups for new mothers. aaaaa New Jersey’s Child Health Insurance Program (CHIP) also assures care for pregnant women with special needs. Those who have HIV or AIDS and have sufficient financial need will receive AZT, a drug that not only treats the infection but seems to increase the chances of having a healthy baby. Resources • NJ FamilyCare Hotline (800)701-0710 • Information on prenatal care service (609)292-5616 • Information about centers which treat infants with common diseases or conditions (609)984-1343 • Information about a specific disease/condition (609)292-1582 Hospital Maternity Stays aaaaa HMOs and other healthcare plans that insure hospital stays for childbirth may no longer limit the stay to less than 48 hours for a normal delivery or to less than 96 hours for a cesarean delivery. This ends "drive-through delivery" requirements of some HMOs and enables the mother to recuperate while also bonding with her new infant in the first, critical hours. Breast Feeding aaaaa The U. S. Surgeon General has noted that breast feeding provides many substantial health benefits in babies. The New Jersey legislature recently passed a law requiring all places of public accommodations to permit women to breast feed in public. Public places that try to prevent women from doing so are subject to fines, which increase with repeated violations.

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aaaaaThe New Jersey Supreme Court has, through a series of cases beginning in the 1970s, established one of the most liberal "right to die" policies in the nation and has dramatically expanded the circumstances in which life sustaining medical treatment may be withdrawn for patients who are profoundly or incurably ill. aaaaa New Jersey law prohibits assisted suicides and other forms of active euthanasia, but the New Jersey Supreme Court has determined that a competent adult has a broad constitutional right to forego or withdraw the use of life-sustaining medical treatments and devices when they are profoundly or incurably ill. A New Jersey statute appears to protect this right though new state agency rules are expected as this guide goes to press. aaaaa Because an individual often becomes incapacitated during a terminal illness, the law permits you to document your treatment preference in advance. This is called a "living will." You can also name someone to make decisions for you if you are unable to do so. This is called a "durable power of attorney." This document becomes effective when 1) it is given to your doctor or health care institution, and 2) your doctor, with a second physician’s verification, determines that you no longer have the capacity to make the decision yourself. A pregnant woman can also declare that she wishes to forgo life support. aaaaa The law is comprehensive. It describes specific medical procedures involved, the circumstances that trigger the need for a decision, and which persons may and may not serve as witnesses to the writing or become the individual’s designee. It also defines the roles of the attending physician, the healthcare institution and others; explains how the individual may revoke or modify the writing or otherwise dispute a finding of incompetence; and describes how any questions about your intent should be interpreted under the particular circumstances that have arisen. What to Do • Remember that a living will is a legal instrument. While you have the right to draw it up yourself, perhaps by using one of the pre-printed forms that are available, it is best to consult an attorney. • Put one copy of the writing with your important papers. Do not keep it in a safe deposit box: no one may be able to open it at the time it is needed. • Give copies to your lawyer, doctor, designee and others who may be asked to come forward to explain your intent. • Since a named designee is permitted to decline to serve and will need to understand your wishes in detail, you should always discuss the instrument with her or him in advance. Resource • The New Jersey Department of Health monitors how doctors, healthcare institutions and others handle these issues (800)367-6543

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