hiv care under the affordable care act – ryan white houston ema carin martin ryan white grant...
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HIV CARE UNDER THE AFFORDABLE CARE ACT – RYAN
WHITE HOUSTON EMA
Carin MartinRyan White Grant AdministrationMay 2015
Ryan White Program• Federal program administered through the Health
Resources and Services Administration (HRSA)
• For individuals living with HIV/AIDS who have no health insurance (public or private), have insufficient health care coverage, or lack financial resources to get the care they need for their HIV disease
• In addition to outpatient medical care, RW also funds services that support access or retention to medical care
• The Houston EMA includes Harris, Fort Bend, Chambers, Liberty, Montgomery and Waller counties
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RW Payer of Last Resort & the ACA
• HRSA Policy Clarification Notice 13-04
“Under existing guidance, grantees and subgrantees must make every reasonable effort to ensure eligible uninsured RWHAP clients expeditiously enroll in private health insurance plans whenever possible, and inform clients about any consequences for not enrolling.
If after extensive documented efforts on the part of the grantee, the client remains unenrolled in health care coverage, the client may continue to receive services through the RWHAP.”
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RWGA Payer of Last Resort Requirements
• Annual outreach to Ryan White clients that are potentially eligible for Marketplace insurance coverage.
• Should a client fail to complete enrollment during the Health Insurance Marketplace open enrollment period he/she must provide signed documentation for their client record that outlines the following to meet “every reasonable effort” guidelines:
– The client may face a tax penalty
– The client will be required to complete application process during the next Health Insurance Marketplace open enrollment period
– The reason the client did not complete enrollment
Ryan White Adult Primary Healthcare Providers• Adult Primary Healthcare Providers
– Harris Health System – Large County Hospital System
– Houston Area Community Services – Mid-Size FQHC
– Legacy Community Health Services – Large FQHC
– St. Hope Foundation – Mid-Size FQHC
– Access Health – Rural FQHC 5
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Certified Application Counselors
• The Certified Application Counselor role is a function of case management services
• Certified Application Counselors will assist individuals enrolling in Qualified Health Plans (QHPs) in the Marketplace.
• RWGA requires passing certification exam
• Standards regarding privacy and conflicts of interest.
RW Client Health Insurance Coverage
All RW Clients Served 3/1/14 to 2/28/15
%FPL Total % Public % Private % Marketplace % Uninsured %
0-100 8,401 67% 2,412 29% 357 4% 243 3% 5,409 64%
101-400 4,036 32% 1,003 25% 788 20% 316 8% 1,971 49%
>400 112 1% 9 8% 67 60% 13 12% 24 21%
Total 12,549 100% 3,424 27% 1,212 10% 572 5% 7,404 59%7
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RW Total Population
FY 2012 FY 2013 FY 201410,000
10,500
11,000
11,500
12,000
12,500
13,000
35.0%
40.0%
45.0%
50.0%
55.0%
60.0%
65.0%
70.0%
11,103
11,695
12,54965.0% 65.4%
59.0%
Total Population % Uninsured
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RW Marketplace Population 100% - 400% FPL
FY 2012 FY 2013 FY 20140
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
30%
35%
40%
45%
50%
55%
60%
65%
3,152 3,500 4,036
58.53% 58.91%
48.84%
Marketplace Poulation Uninsured
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Ryan White Health Insurance Premium & Cost Sharing Assistance
• Provides financial assistance for the following health insurance related expenses:
– Co-Payment
– Co-Insurance
– Deductible
– Premium
• Financial Eligibility for this service category is at or below 400% FPL (100% - 400% FPL for Marketplace Assistance)
• Requires Silver Level Plan
Health Insurance Assistance
CALENDAR YEAR
62.5% increase in net UDC served by HINS
in CY 13
Total Number of Clients Served
Number in Harris County
Number Outside of Harris County
Average Allocation per Unduplicated
Client Served14% decrease in average
allocation/UDC served
2013
2014
975
1584
883
1418
92
166
$1,566
$1,352
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CY 2014 allocations totaled over $2.1 million
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Primary Care Cost Savings
• CY 2015 Primary Care and Mental Health Cost Savings to Date*:
$537,590.80
*Prior year Ryan White cost of insurance billable services for clients with and Insurance Effective Date between 1/1/15 and 4/6/15; **N=311
• Savings per Client**:
» $1728.59
Contact Informatio
n
• Carin Martin
Ryan White Grant Administration - Program Manager
(713) 439-6041