1 Early Intervention Program (EIP) Manages Washington States AIDS - PowerPoint PPT Presentation

1

Early Intervention Program (EIP)  Manages Washington State’s AIDS Drug Assistance Program (ADAP)  Housed at the Department of Health  EHIP is EIP’s contracted Insurance Benefits Manager  Ramsell Corporation is EIP’s contracted Pharmacy Benefits Manager 2

EIP Eligibility Requirements  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 3

EIP Funding  EIP receives federal ADAP earmark funding from Part B of the Ryan White Care Act  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 4

EIP Provides it own Medical Benefits Management Ramsell Corp EHIP Pharmacy Benefits Insurance Benefits Manager Manager 5

Ramsell Corporation  Pharmacy Benefits Manager for EIP  Adjudicates all medication claims, whether it be full pay or co-pay  A Ramsell card is issued when a client becomes eligible for EIP  Manages contracts for over 1000 pharmacies across the state 6

Early Intervention Program (EIP)  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 7

Evergreen Health Insurance Program (EHIP)  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 8

History  Originally, WA State’s ADAP program was managed by DSHS  EHIP was set up by Lifelong (formally NW AIDS Foundation) in 1991 to manage the premium assistance program  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 9

Comprehensive Coverage  WA State was one of the first ADAPs to provide premium assistance rather than just paying for HIV Medications  Philosophy is that comprehensive medical coverage removes barriers to adherence to medications  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 10

EHIP Staff • Program Manager • Three Insurance Advocates • Insurance Coordinator • Payment Supervisor • Quality Analyst 11

EHIP Can Pay For:  Approved Silver & Gold Exchange Plans on the WAHealthplanfinder.org  Medicare Part D (PDP Plans) & Medicare Part C (MAPD plans)  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 12

EHIP Cannot Pay For:  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 13

How to Enroll into EHIP  If client is new to EIP and EHIP, submit EIP application and indicate yes to premium assistance  If client is existing EIP client, submit “New Enrollment/New Payable” form to EHIP  Submit bills & all required additional paperwork to EHIP 14

Documentation Required  Qualified Health Plan (QHP)  Medicare Part C & D  Plan Selection Confirmation  Bill (submit as soon as received) page or bill  HWD  Individual Plans  Bill (submit as soon as  Bill (submit as soon as received) received)  Retirement Plan  Employer Sponsored Insurance  Bill (submit as soon as (ESI) received)  Employer Form  Summary of Benefits (SOB)  Summary of Benefits  Drug Formulary  Drug Formulary  COBRA (existing plan only)  Bill (submit as soon as received)  Summary of Benefits (SOB)  Drug Formulary 15

2018 Premium Assistance Numbers  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 16

2019 Preliminary Enrollment Numbers  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 17

Questions? 18