Policy Update:The Affordable Care Act and the Ryan White Program, presented by Matthew McClain

1. Policy Update:
The Affordable Care Act and the
Ryan White Program
Philadelphia EMA Planning Council
August 9, 2012
Presented by Matthew McClain

2. August 2012 Policy Update 2
Today’s Topics
Affordable Care Act
Medicaid expansion
Essential Health Benefits
Ryan White Program
FY 2013 Appropriations
Reauthorization
Actions and Resources

3. August 2012 Policy Update 3
Today’s Handouts
1. CAEAR Coalition Comments on the Future of the Ryan
White Program (July 31, 2012)
2. Ryan White Work Group Comments on Next Steps for the
Ryan White Program (July 31, 2012)
3. AIDS Budget and Appropriations Coalition: FY 2013
Appropriations for HIV/AIDS Programs (August 2, 2012)
4. NHeLP 50 Reasons for Medicaid Expansion (August 2,
2012)
5. Urban Institute: Considerations in Assessing State-
Specific Fiscal Effects of the ACA’s Medicaid Expansion

4. August 2012 AACO Director’s Meeting Federal Policy Update 4
The HIV Health Care Environment

5. August 2012 Policy Update 5
Affordable Patient Protection and
Affordable Care Act as amended
Care
by the Health Care and
Act Education Reconciliation Act
(March 2010)
National Federation of
Independent Business versus
Sebelius (June 28, 2012)

6. August 2012 Policy Update 6
 First Supreme Court decision
What on ACA
Happened  Individual mandate is valid
 Insurers must abandon pre-
existing condition exclusions
and lifetime caps on coverage
 Essential health benefits
upheld
 Curbs the power of Federal
government to enforce the
Medicaid expansion

7. August 2012 Policy Update 7
Implications for Medicaid Expansion States
 Supreme Court did not  Federal match will be
strike the Medicaid 100% initially then 90%
expansion nor make it (now 57%)
optional  States that expand must
 Many implementation comply with all
mandatory provisions
questions, some of
such as reasonable
which the President
promptness and due
and HHS will address process

8. August 2012 Policy Update 8
Implications for States Failing to Expand
 States that do not  States not allowed to
expand must still cover expand to <138% FPL
all individuals under and get the ACA match
133% FPL and meet  Uninsured people with
other ACA and Medicaid incomes below FPL are
Act requirements ineligible for health
 Maintain Medicaid exchange subsidies
eligibility criteria and  Must extend Medicaid
MAGI as of March 2010 coverage to low income
children aged 6-19 years

9. August 2012 Policy Update 9
Uninsured Currently
Total
Newly Eligible Eligible
Adults with Eligible
Uninsured
Incomes <138% <100% <138% <138%
FPL FPL FPL FPL
Below 138% 15.0 11.4 4.3 19.4
US
FPL by million million million million
Medicaid PA 520,000 398,000 92,000 613,000
Eligibility NJ 307,000 245,000 42,000 349,000
Status Source: The Urban Institute Health Policy Center

10. August 2012 Policy Update 10
 Ensure that a comprehensive
Reform
Essential Health Benefits package
Priorities
 Ensure access to essential
for People services covering the gaps
Living with  Ensure smooth transition for
HIV/AIDS vulnerable populations
and HIV  Prepare service organizations for
Advocates a changing healthcare landscape
 Make Medicaid managed care
work for people with HIV

11. August 2012 Policy Update 11
Coverage Options by 2014

12. August 2012 Policy Update 12
Essential • Qualified Health Plans offered
Health through Exchanges
Benefits • State Medicaid programs for
Highlights newly eligible beneficiaries
• Basic Health Plans for people
between 133%-200% FPL
• No higher premiums based on
health status or gender
• No cost sharing for preventive
services

13. August 2012 Policy Update 13
 Ambulatory services
Required
 Emergency services
Essential  Hospitalization
Health  Maternity/newborn care
Benefits  Mental health and substance use
disorder services
 Prescription drugs
 Rehabilitative services
 Laboratory services
 Prevention, wellness, and chronic
disease management services
 Pediatric services

14. August 2012 Policy Update 14
EHB  Unlimited access to antiretroviral
drugs and viral hepatitis
Package medications
that Meets  Unlimited access to
the Care HIV/infectious disease specialists
and  Case management
Treatment  Mental health and substance
abuse services
Needs of  Preventive and wellness services
PLWHA  Laboratory testing
 Services needed to meet national
standards of HIV care

15. August 2012 Policy Update 15
EHB Process  By September 28, 2012, States
must tell Federal government
which benchmark plan it
selected and what additions
are needed to meet EHB and
non-discrimination mandates
of ACA
 HHS will review the plan to
assure it meets the
requirements

16. August 2012 Policy Update 16
Questions  What are the most important
Regarding benefits for PLWHA?
EHBs to  Which plans will be
Meet the considered?
Needs of  What benefits do those plans
PLWHA currently offer?
 What are the concerns?
 Which plan looks best?
 What needs to be added?

17. August 2012 Policy Update 17
 Ryan White HIV/AIDS Treatment
Ryan Extension Act of 2009 (Public Law
White 111-87, October 30, 2009).
Program  First enacted in 1990 as the Ryan
White Comprehensive AIDS
Resources Emergency Act.
 Amended and reauthorized 4 times-
1996, 2000, 2006, and 2009
 Current law expires in 13 months
but does not sunset, permitting
appropriations and implementation
after September 30, 2013

18. August 2012 Policy Update 18
Status of Program
FY2012 FY2013 FY2013 FY2013
(millions) Obama Need Senate
HIV/AIDS
RWP $ 2.392 +$ 80.0 +$ 483.0 +$ 30.0
FY 2013
CDC $ 1.11 +$36.0 +$ 684.0 +$ 2.0
Appropria-
HOPWA $ 332.0 -$ 2.0 +$ 48.0 -$ 2.0
tions

19. August 2012 Policy Update 19
HIV Care • What is the future of the Ryan
White Program?
Advocacy
• What will bridge services from the
Questions expiration of RW in 2013 to when
coverage starts in 2014?
• Will RW need to focus on what and
who won’t be covered such as
wrap-around/support services,
undocumented persons, accessing
the new system, and quality?

20. August 2012 Policy Update 20
 RWP providers will be
Ryan
increasingly dependent on 3rd
White and party payment (51% now to as
ACA much as 80% with ACA)
 Number of entirely uninsured
RWP clients should decrease
dramatically
 Gaps to be determined will
remain: e.g. uninsured, those not
enrolled, insurance coverage
gaps, ineligibles, HIV prevention
services

21. August 2012 AACO Director’s Meeting Federal Policy Update 21
CAEAR Coalition Guiding Principles for
Reauthorization
Open access to quality health care
Ensure continuity of care
Fortify resources and increase client
capacity
Maintain and strengthen flexibility and
adaptability

22. August 2012 Policy Update 22
Principle 1:  Access and accountability
Open  Cultural competency
Access to  Quality medical training
Quality
Health
Care

23. August 2012 Policy Update 23
Principle 2:  Aligning and integrating
Ensure systems of care
Continuity  Linkage to appropriate care
of Care  Reducing HIV-related health
disparities

24. August 2012 Policy Update 24
Principle 3:  Sufficient funding and effective
Fortify distribution of resources
Resources  Infrastructure and essential
and support services
Increase  Workforce development
August 2012
Client  Organizational and network
Capacity capacity

25. August 2012 Policy Update 25
Principle 4:  ACA transition flexibility
Maintain  Support local control
and
Strengthen
Flexibility
and
Adapta-
bility

26. August 2012 Policy Update 26
Local • Use existing data systems (e.g.,
Activities unduplicated RWP client data
to Prepare analysis of insurance status)
for ACA • Maximize 3rd party billing
and Ryan • Understand gaps in coverage
White • Participate in national and
Reauthor- state advocacy group processes
ization and decisions (e.g., CAEAR
Coalition and PA Health
Choices Work Group)

27. August 2012 Policy Update 27
Act Now • Improve provider and
organizational knowledge and
skills (e.g., RWP monitoring
standards, Medicaid
participation, patient
navigation, medical case
management)
• Improve consumer knowledge
and skills (e.g., rights,
responsibilities, eligibility,
program navigation)

28. August 2012 Policy Update 28
General Resources
• HealthCare.gov • Trust for America’s Health
• WhiteHouse.gov • National Association of County
• HHS.gov and City Health Officials
• Families USA • Association of State and
• Urban Institute
Territorial Health Officials
• National Association of
• Kaiser Foundation
Community Health Centers
• National Health
• State Healthcare Access
Law Program
Research Project

29. August 2012 Policy Update 29
HIV-Specific Resources
• AIDS.gov • CAEAR Coalition
• Treatment Access • National Association of
Expansion Project State and Territorial
• Treatment Action Group AIDS Directors
• HIVhealthreform.org • AIDS United
• Federal AIDS Policy • HIV Medicine
Partnership Association
• Coalition for a National
AIDS Strategy

30. August 2012 Policy Update 30
Thank you!
Matthew McClain
AIDSpolicy@aol.com