medicaid expansion and the potential impact for people living with hiv/aids in georgia jeff graham,...

Medicaid Expansion and the Potential Impact for People living with HIV/AIDS

in Georgia

Jeff Graham, Executive Directorjeff@georgiaequality.org

Georgia HIV Advocacy

Network

Massachusetts’ Successful Reform Implementation Improves Health Outcomes and

Meets NHAS Goals

Source: Massachusetts and Southern New Hampshire HIV/AIDS Consumer Study Final Report, December 2011, JSI Research and Training, Inc. Note: MA Outcomes N = 1,004 Source: Cohen, Stacy M., et. al., Vital Signs: HIV Prevention Through Care and Treatment — United States, CDC MMWR, 60(47);1618-1623 (December 2, 2011); Note: National Outcomes HIV-infected, N = 1,178,350; HIV-diagnosed, n=941,950

Economic Status of Ryan White Consumers

• In 2010, Ryan White programs served 27,817 duplicated clients in Georgia

• 67% had household incomes equal to or below the FPL with an additional

• 22% between 101% and 200% of the FPL.

Source: 2013 SHARP Georgia State Report, An Analysis of the Successes, Challenges, and Opportunities for Improving Healthcare Access With a Focus on People Living With HIV and AIDS. Amy Katzen, Amy Rosenberg, and Robert Greenwald

Georgia Medicaid Income Limits Today

235%

200% 200%224%

50%

29%

75%

Fe

de

ral P

ov

ert

y L

ev

el

Can’t qualify

250%

200%

150%

100%

50%

Includes PeachCare

Family Size

Annual Income

1 $11,490

2 $15,510

3 $19,530

4 $23,550

100% Federal Poverty Level

2013

• Under ACA states were required to expand Medicaid if they wanted to continue to participate in the program; 26 states joined lawsuit against this provision

• Now: States can decide whether or when to expand• If a state decides to cover the expansion group, it

may drop the coverage later• No deadline for state decision• All other aspects of the ACA remain in place

What this means for your patients without expansion:Most people below 100% FPL will have no affordable coverage

options since the law only offers tax credits on the Exchanges for those between 100-400% FPL.

What Does the ACA Mean for Medicaid?

If we don’t expand this

sets up a “Coverage

Gap”

Source: Center for American Progress

1115 Waivers: A Stop-gap Measure

•For many years, Section 1115 waivers have been used by states to test new coverage approaches not otherwise allowed under Medicaid program rules.

•To date, five states have received approval of a Section 1115 waiver to implement the Medicaid expansion (Arkansas, Iowa, Michigan, Pennsylvania and Indiana)

•Governor has announced plans to seek a waiver to address coverage gap concerns for at least two large hospital systems: Grady (Fulton & DeKalb) and Memorial (Savannah).

•Details have not been released but most all agree this is a step in the right direction.

•Any 1115 waiver proposal is required to be available for public comment twice, once before it is submitted to HHS by the state and once after it is submitted to HHS.

•Cover Georgia Coalition has created a waiver principles document to prepare for conversations like this.

WWW.COVERGA.ORG

The Medicaid Expansion in Georgia• Coverage Forecasts:

- 645,000 to 900,000 new Medicaid enrollees (by 2019)

• Reduces low-income uninsured by 50% to 75%

Source: Kaiser Commission on Medicaid and the Uninsured, Urban Institute