DOMESTIC VIOLENCE BEST PRACTICES & FACTS
DOMESTIC VIOLENCE AND CULTURALLY SPECIFIC FACTORS
Scenario: A monolingual Chinese-speaking young 26-year-old Chinese female recently emigrated from rural China appears in the emergency room with a broken arm and a sprained wrist. She keeps her eye contact minimal and alternately looks at the floor and then the door. Her posture is slumped and turned inward making her appear much smaller than her 5’2 frame. With the assistance of a bi-lingual hospital translator, the patient states her husband brought her in after she “fell into a door” and injured herself. When asked how she “fell into the door” she stated she wasn’t moving fast enough and her husband “helped to move faster.” She anxiously asks one question: “Can you fix me fast, my husband will get upset if this takes too long? I don’t want to upset him.”
Provider considerations: Are your staff and clinical model of care prepared to assess this patient for domestic violence in a culturally congruent and effective manner to better enhance patient engagement and treatment outcome? To do so, what are the stereotypes and cultural norms that must be acknowledged? What would the culturally effective trauma-informed care look like for this patient?
WHEN HOME IS WHERE IT HURTS…
- Domestic violence (DV) accounted for 21% of all violent victimization between 2003 to 2012.
- Intimate partner violence (IPV) accounted for 15% of violent victimization as compared to violence committed by immediate family members (4%) or other
- Of IPV, 32% were committed by well-known or casual acquaintances and 38% were committed by strangers.
- The majority of reported DV incidents were committed against female at 76% compared to incidents committed against male victims at 24%.
- 77% of DV incidents occurred at or near the victim’s home.
DOMESTIC VIOLENCE AND ACA ENROLLMENT
Victims of Domestic Violence Eligible for ACA Enrollment throughout Year
Victims of domestic violence and spousal abandonment are eligible to apply for health insurance at any point during the year as opposed to open enrollment windows. This Special Enrollment Period (SEP) is not widely known and has been in effect since 2015. Previously, the eligibility requirements and open window for this SEP were more restrictive. In 2015, the Centers for Medicare & Medicaid Services (CMS) released formal guidance that expanded the definition of who is eligible to receive this SEP to “any member of the household who is a victim of domestic abuse including unmarried and dependent victims within the household, and including spousal abandonment and their dependents”.
This decision allows unmarried partners, as well as dependent children or adults, to access this SEP if they are victims of abuse. This SEP is valid for 60 days following an eligible individual’s request in which they may apply for, and enroll in, coverage for him or herself and dependents through the Federally-facilitated Marketplace. This SEP is available to both men and women, and no documentation is needed to prove domestic violence. However, the individual must attest to domestic violence on his or her tax forms in the following year.
Domestic violence survivors should do the following if they need health insurance:
- Call the healthcare.gov call center at (800) 318-2596. This SEP is only available by calling and is not available online.
- The applicant should indicate that they are a domestic violence survivor, which will help initiate the application process.
- A SEP will be granted and the survivor will have 60 days to pick and enroll in a plan.
Applicants using this SEP may be eligible for health care subsidies. The call center can assist with the completion of the application and answer questions about subsidy eligiblity and completion of tax forms for the year in which the applicant recieved the SEP.