DRAFT Presentation Outline • Part One: Overview/Introduction- Importance of HCR to the NHAS (ONAP) • Part Two: Current Access to Care and Public Health Crisis (HLS/TAEP) • Part Three: The Affordable Care Act (ACA) and a Changing HIV/AIDS Care Landscape (HLS/TAEP) • Part Four: Advocacy Priorities for ACA Implementation (HLS/TAEP) • Part Five: Educating Your Community and Protecting HCR (AFC/AU) DRAFT
Part 2 Current Access to Care and Public Health Crisis DRAFT
Context for Reform: The Current System is Not Working… A Patchwork System with Many Gaps and Holes Even people with insurance have a hard time meeting cost sharing obligations Safety net programs (Medicaid and Medicare) have strict eligibility requirements Lack of access to insurance is a huge problem for millions of Americans, particularly in the South DRAFT
Medicaid = a Disability Program for People Living with HIV and AIDS Spending per Medicaid User with and without HIV by Type of Service (2007) ~ 74% of people living with HIV/AIDS on Medicaid are eligible because of disability DRAFT Source: Jen Kates, Kaiser Family Foundation, Medicaid and HIV: A National Analysis (October 2011 )
We Cannot Fight an Epidemic with a Discretionary Program Alone Ryan White Part C Caseloads Compared to Funding Levels: 2001 to 2009 Source: Andrea Weddle, HIV Medicine Association, HIV Medical Provider Experiences: Results of a Survey of Ryan DRAFT White Part C Programs, Institute of Medicine Committee on HIV Screening and Access to Care, September 29, 2010
Status Quo = Public Health and Access to Care Crisis Demand for Ryan White care and 42-59% of services > Thousands low-income funding on ADAP PWHIV not in waitlists regular care Disparities in The 29% of health access, Current PWHIV health uninsured Crisis outcomes DRAFT
We Are Not Alone! Number of Uninsured Americans 60 50.9 Million 46.6 Million 41.2 Million 50 40 30 20 10 0 2001 2005 2009 Sources: Center on Budget Policies and Priorities, The Number of Uninsured Americans is at an All-Time High (2006), Kaiser Family Foundation, The Uninsured: A Primer (2010). DRAFT
Part 3 The Affordable Care Act (ACA) and a Changing HIV/AIDS Care Landscape DRAFT
1. Expands and Improves Medicaid • Expands Eligibility – Starting in 2014, disability requirement is eliminated for most people with income up to 133% FPL (~$14K for an individual/~$29K for family of four) • Improves Services – Medicaid expansion includes Essential Health Benefits (EHB) for the newly-eligible • Improves Reimbursement – Enhances reimbursement for primary care providers in 2013-14 • Streamlines Application and Enrollment DRAFT
2. Supports Enhanced & Coordinated Care Through Medicaid Health Home Program • Gives states the option to provide cost-effective, coordinated and enhanced care and services to people living with chronic medical conditions* • States are eligible for planning grants and increased federal support – 90% FMAP for first two years of the program * Successful advocacy led to inclusion of people living with HIV/AIDS DRAFT
3. Health Care Reform Increases Access to Medicare Prescription Drugs • 50% discount on all brand-name prescription drugs • AIDS Drug Assistance Program (ADAP) contributions now count toward copayment obligations • Part D “donut hole” phased -out by 2020 DRAFT
4. Reforms Private Insurance and Reduces Discriminatory Insurance Practices • Cannot be denied insurance because of HIV (or other chronic condition) (2014) • Health plans cannot drop people from coverage when they get sick (in effect) • No lifetime limits on coverage (in effect) • No annual limits on coverage (2014) DRAFT
Promotes Access to Private Insurance through State-Based Exchanges • Starting in 2014, creation of consumer-friendly exchanges to purchase private insurance • Federal subsidies for people with income up to 400% FPL (~$44K for an individual/~$89K for family of four) • Plans cannot charge higher premiums based on gender or health status • Plans must include Essential Health Benefits • Plans have to contract with “community providers,” including Ryan White Programs DRAFT
Health Care Reform Invests in Prevention, Access to Care, and Health Workforce Investments in Prevention and Public Health Fund Investments in Community Health Centers Investments in Health Workforce DRAFT
The ACA and HIV/AIDS Care: Looking Ahead to 2014 HIV/AIDS Care and Treatment, 2014 Individuals with income up to Eligible for Medicaid based on income alone (Ryan 133% FPL White Program still needed to fill in gaps not covered by Medicaid) Individuals between 133% and Eligible for premium tax credits and cost-sharing 400% FPL subsidies to purchase private insurance (Ryan White Program still needed to fill gaps not covered by private insurance) Individuals with unmet care and Ryan White Program still a safety net for: insured treatment needs people with unmet need and gaps in services legal immigrants not eligible for Medicaid, and undocumented immigrants DRAFT
Part 4 Advocacy Priorities for ACA Implementation DRAFT
1. Ensuring a Comprehensive Essential Health Benefits Package Federal ACA Essential Health Benefits Guidance/Regulations • Ambulatory services • Emergency services • Hospitalization • Maternity/newborn care • Mental health and substance use disorder services • Prescription drugs • Rehabilitative and habilitative State Implementation services Decisions • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services DRAFT
2. Ensuring Access to Essential Services: Covering the Gaps • Essential services needed by people living with HIV/AIDS NOT fully covered by Medicaid: – Dental services – Nonmedical case management – Nutrition services – Transportation Ryan White HIV/AIDS Program – Mental health services – Peer support services – Insurance assistance • Medicaid will NOT be available for: – Undocumented immigrants – Legal immigrants within the 5 year ban DRAFT
3. Be at the Table • Work with all relevant agencies, including Medicaid, departments of insurance, and state health departments – Data requests – Coordinated plans/strategy – Public hearings DRAFT
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