1 Early Intervention Program (EIP) Manages Washington States AIDS - - PowerPoint PPT Presentation
1 Early Intervention Program (EIP) Manages Washington States AIDS Drug Assistance Program (ADAP) Housed at the Department of Health EHIP is EIPs contracted Insurance Benefits Manager Ramsell Corporation is EIPs contracted
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Manages Washington State’s AIDS Drug Assistance
Housed at the Department of Health EHIP is EIP’s contracted Insurance Benefits Manager Ramsell Corporation is EIP’s contracted Pharmacy
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Have proof of HIV positive status Live in Washington State Have a gross monthly income at or below 400% of the Federal
Poverty Level (FPL)
If at or below 138% FPL and if eligible for Medicaid, clients are
required to enroll into Medicaid through the WAHealthPlanFinder
Clients eligible for Medicaid are not eligible for EIP or EHIP
Must renew eligibility every six months after being approved
for EIP
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EIP receives federal ADAP earmark funding from Part B of
ADAP-AIDS Drug Assistance Programs
Programs in all 50 states that provide approved HIV
treatment drugs to Low Income people with HIV
States administer the federal funds differently WA State was one of the first to use the funds to provide
premium assistance
Program began in 1987 to pay for AZT. Expanded in 1990
with the Ryan White Care Act
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Provides it own Medical Benefits Management
Insurance Benefits Manager
Pharmacy Benefits Manager
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Pharmacy Benefits Manager for EIP Adjudicates all medication claims, whether it be full pay
A Ramsell card is issued when a client becomes eligible
Manages contracts for over 1000 pharmacies across the
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EIP in-house medical benefits management provides:
Covers HIV related care (Dr. appointments and lab work) with
contracted providers
Covers Dental and Mental Health with contracted providers Pays towards deductible, but only for EIP covered services with a
contracted provider
Covers all HIV medications
If Uninsured, EIP covers drugs based on their formulary If Insured, EIP covers all prescription drug co-pays
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Contracted with DOH Early Intervention Program (EIP) as their
Insurance Benefits Manager
EHIP is a program of Lifelong, a non-profit that has been
serving the HIV community for over 30 years
Pays health insurance premiums for people living with HIV that
are EIP eligible
Insurance experts and a resource for EIP, HIV Case Managers,
and Clients
Clients must be enrolled in EIP to be eligible for EHIP EIP determines eligibility for both programs
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Originally, WA State’s ADAP program was managed by DSHS EHIP was set up by Lifelong (formally NW AIDS Foundation)
Management of ADAP was moved to DOH in 1993 First year of the ACA brought dramatic changes to EHIP
Over 1000 clients became eligible for Expanded Medicaid 1250 clients moved from WSHIP to an ACA plan or Apple
Health
Premium Assistance fell from $23,000,000 to under
$10,000,000
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WA State was one of the first ADAPs to provide premium
Philosophy is that comprehensive medical coverage
End AIDS Washington Goals by 2020
Reduce the rate of new HIV diagnoses by 50% Increase suppressed viral loads by 80% Reduce morality rates for PLWH by 25% Reduce HIV-related health disparities Improve quality of life for PLWH
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Approved Silver & Gold Exchange Plans on the
Medicare Part D (PDP Plans) & Medicare Part C (MAPD
Employee Sponsored Insurance Plans (ESI or Group Plans) HWD’s (Health Care for Workers with Disabilities) WSHIP plans for clients currently enrolled Individual Plans outside the Exchange
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Stand-alone dental, vision, life, etc. Medicare Part A Medicare Part B Medicare Supplement Insurance (Medigap) Medicare Advantage plans without Rx coverage Catastrophic plans* Bronze level plans* HSA’s, FSA’s & HRA’s* QHP’s & Individual plans not on EIP/EHIP’s approved list* COBRA’s*
*Exceptions can be made if already enrolled and outside Open Enrollment period;
required to change during the next Open Enrollment to an approved plan
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If client is new to EIP and EHIP, submit EIP application and
If client is existing EIP client, submit “New
Submit bills & all required additional paperwork to EHIP
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Medicare Part C & D
Bill (submit as soon as
received)
HWD
Bill (submit as soon as
received)
Retirement Plan
Bill (submit as soon as
received)
Summary of Benefits (SOB) Drug Formulary
COBRA (existing plan only)
Bill (submit as soon as
received)
Summary of Benefits (SOB) Drug Formulary
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Qualified Health Plan (QHP)
Plan Selection Confirmation
page or bill
Individual Plans
Bill (submit as soon as
received)
Employer Sponsored Insurance
(ESI)
Employer Form Summary of Benefits Drug Formulary
Total clients Served – 2,379 Total months of coverage paid for – 22,556 Total amount of premiums paid – $10,542,762.08 58% of clients enrolled in EIP receive EHIP Premium Assistance
Large number of clients enrolled in Medicare have a $0 premium
due to subsidy programs
Clients enrolled in ESI’s often do not need premium assistance or
employer does not accept EHIP payments
Between 4% and 9% of EIP enrollees remain uninsured yearly
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Qualified Health Plans-852 Individual Plans-186 (Will increase as we receive January premium confirmations) Medicare Part D Plans-284 Medicare Part C Plans-461 HWD Plans-22 ESI/Group/Retirement Plans-114 WSHIP-219 Total as of 1/7/2019: 2138
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