DRAFT Presentation Outline Part One: Overview/Introduction- - - PowerPoint PPT Presentation

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)

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Part 2 Current Access to Care and Public Health Crisis

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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

• bligations
• 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

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Medicaid = a Disability Program for People Living with HIV and AIDS

~ 74% of people living with HIV/AIDS

• n Medicaid are

eligible because of disability

Spending per Medicaid User with and without HIV by Type of Service (2007)

Source: Jen Kates, Kaiser Family Foundation, Medicaid and HIV: A National Analysis (October 2011)

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We Cannot Fight an Epidemic with a Discretionary Program Alone

Source: Andrea Weddle, HIV Medicine Association, HIV Medical Provider Experiences: Results of a Survey of Ryan White Part C Programs, Institute of Medicine Committee on HIV Screening and Access to Care, September 29, 2010

Ryan White Part C Caseloads Compared to Funding Levels: 2001 to 2009

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Status Quo = Public Health and Access to Care Crisis

The Current Crisis

29% of PWHIV uninsured Thousands

• n ADAP

waitlists Demand for Ryan White care and services > funding 42-59% of low-income PWHIV not in regular care Disparities in health access, health

• utcomes

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We Are Not Alone!

Number of Uninsured Americans

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).

10 20 30 40 50 60 2001 2005 2009

41.2 Million 46.6 Million 50.9 Million

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Part 3 The Affordable Care Act (ACA) and a Changing HIV/AIDS Care Landscape

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• 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

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• 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

• 2. Supports Enhanced & Coordinated Care

Through Medicaid Health Home Program

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• 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

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• 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)
• 4. Reforms Private Insurance and

Reduces Discriminatory Insurance Practices

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• 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

Promotes Access to Private Insurance through State-Based Exchanges

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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

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HIV/AIDS Care and Treatment, 2014

Individuals with income up to 133% FPL Eligible for Medicaid based on income alone (Ryan White Program still needed to fill in gaps not covered by Medicaid) Individuals between 133% and 400% FPL Eligible for premium tax credits and cost-sharing subsidies to purchase private insurance (Ryan White Program still needed to fill gaps not covered by private insurance) Individuals with unmet care and treatment needs Ryan White Program still a safety net for: insured people with unmet need and gaps in services legal immigrants not eligible for Medicaid, and undocumented immigrants

The ACA and HIV/AIDS Care: Looking Ahead to 2014

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Part 4 Advocacy Priorities for ACA Implementation

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ACA Essential Health Benefits

• Ambulatory services
• Emergency services
• Hospitalization
• Maternity/newborn care
• Mental health and substance use

disorder services

• Prescription drugs
• Rehabilitative and habilitative

services

• Laboratory services
• Preventive and wellness services and

chronic disease management

• Pediatric services

Federal Guidance/Regulations State Implementation Decisions

• 1. Ensuring a Comprehensive Essential

Health Benefits Package

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• 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 – Mental health services – Peer support services – Insurance assistance

• Medicaid will NOT be available for:

– Undocumented immigrants – Legal immigrants within the 5 year ban

Ryan White HIV/AIDS Program

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• Work with all relevant agencies, including Medicaid,

departments of insurance, and state health departments – Data requests – Coordinated plans/strategy – Public hearings

• 3. Be at the Table

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