Policy Update:The Affordable Care Act and the     Ryan White Program   Philadelphia EMA Planning Council             Augus...
August 2012                                Policy Update   2 Today’s Topics              Affordable Care Act              ...
August 2012                                     Policy Update   3 Today’s Handouts1.       CAEAR Coalition Comments on the...
August 2012    AACO Director’s Meeting Federal Policy Update   4The HIV Health Care Environment
August 2012                      Policy Update   5Affordable    Patient Protection and              Affordable Care Act as...
August 2012                       Policy Update   6               First Supreme Court decisionWhat            on ACAHappe...
August 2012                           Policy Update   7Implications for Medicaid Expansion States Supreme Court did not  ...
August 2012                              Policy Update   8Implications for States Failing to Expand States that do not   ...
August 2012                                           Policy Update   9Uninsured                                          ...
August 2012                         Policy Update   10               Ensure that a comprehensiveReform                Ess...
August 2012            Policy Update   11 Coverage Options by 2014
August 2012                       Policy Update   12Essential      • Qualified Health Plans offeredHealth           throug...
August 2012                         Policy Update   13                Ambulatory servicesRequired                Emergen...
August 2012                         Policy Update   14EHB             Unlimited access to antiretroviral                 ...
August 2012                       Policy Update   15EHB Process     By September 28, 2012, States                 must te...
August 2012                       Policy Update   16Questions       What are the most importantRegarding        benefits ...
August 2012                        Policy Update   17               Ryan White HIV/AIDS TreatmentRyan            Extensio...
August 2012                                   Policy Update   18Status of     Program                         FY2012 FY201...
August 2012                          Policy Update   19HIV Care      • What is the future of the Ryan                White...
August 2012                         Policy Update   20               RWP providers will beRyan                increasingl...
August 2012            AACO Director’s Meeting Federal Policy Update   21CAEAR Coalition Guiding Principles forReauthoriza...
August 2012                         Policy Update   22Principle 1:    Access and accountabilityOpen            Cultural ...
August 2012                         Policy Update   23Principle 2:    Aligning and integratingEnsure           systems of...
August 2012                         Policy Update   24Principle 3:    Sufficient funding and effectiveFortify          di...
August 2012                          Policy Update   25Principle 4:    ACA transition flexibilityMaintain        Support...
August 2012                        Policy Update   26Local         • Use existing data systems (e.g.,Activities      undup...
August 2012                       Policy Update   27Act Now       • Improve provider and                organizational kno...
August 2012                             Policy Update   28General Resources• HealthCare.gov     • Trust for America’s Heal...
August 2012                            Policy Update   29HIV-Specific Resources• AIDS.gov                 • CAEAR Coalitio...
August 2012                        Policy Update   30              Thank you!               Matthew McClain              A...
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Policy Update: The Affordable Care Act and the Ryan White Program, presented by Matthew McClain

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

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  • SCOTUS accepted the States’ argument at face value without evidence of actual coercionSince its enactment the Medicaid law has included a provision that allows the Secretary of HHS to deny all or part of a non-compliant State’s federal funding. It has never been used to terminate the entirety of a Status’ funding. , as argued by Pennsylvania and 25 other States, ruling it is unduly coercive on the StatesLower courts will be hearing many coercion claims
  • Example: Expanding coverage of community-based services and supports for people with disabilities and the eldgerly
  • Example: Expanding coverage of community-based services and supports for people with disabilities and the eldgerlyExample is modified adjusted gross income provisionsHealth exchangesa are for people with incomes at or above 100% FPL or individual below 100% FPL who do not qualify for Medicaid due to their immigration status.
  • SCOTUS accepted the States’ argument at face value without evidence of actual coercionSince its enactment the Medicaid law has included a provision that allows the Secretary of HHS to deny all or part of a non-compliant State’s federal funding. It has never been used to terminate the entirety of a Status’ funding. , as argued by Pennsylvania and 25 other States, ruling it is unduly coercive on the StatesLower courts will be hearing many coercion claims
  • Policy Update: The Affordable Care Act and the Ryan White Program, presented by Matthew McClain

    1. 1. Policy Update:The Affordable Care Act and the Ryan White Program Philadelphia EMA Planning Council August 9, 2012 Presented by Matthew McClain
    2. 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. 3. August 2012 Policy Update 3 Today’s Handouts1. 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. 4. August 2012 AACO Director’s Meeting Federal Policy Update 4The HIV Health Care Environment
    5. 5. August 2012 Policy Update 5Affordable Patient Protection and Affordable Care Act as amendedCare by the Health Care andAct Education Reconciliation Act (March 2010) National Federation of Independent Business versus Sebelius (June 28, 2012)
    6. 6. August 2012 Policy Update 6  First Supreme Court decisionWhat on ACAHappened  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. 7. August 2012 Policy Update 7Implications 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. 8. August 2012 Policy Update 8Implications 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. 9. August 2012 Policy Update 9Uninsured Currently Total Newly Eligible EligibleAdults with Eligible UninsuredIncomes <138% <100% <138% <138% FPL FPL FPL FPLBelow 138% 15.0 11.4 4.3 19.4 USFPL by million million million millionMedicaid PA 520,000 398,000 92,000 613,000Eligibility NJ 307,000 245,000 42,000 349,000Status Source: The Urban Institute Health Policy Center
    10. 10. August 2012 Policy Update 10  Ensure that a comprehensiveReform Essential Health Benefits packagePriorities  Ensure access to essentialfor People services covering the gapsLiving with  Ensure smooth transition forHIV/AIDS vulnerable populationsand HIV  Prepare service organizations forAdvocates a changing healthcare landscape  Make Medicaid managed care work for people with HIV
    11. 11. August 2012 Policy Update 11 Coverage Options by 2014
    12. 12. August 2012 Policy Update 12Essential • Qualified Health Plans offeredHealth through ExchangesBenefits • State Medicaid programs forHighlights 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. 13. August 2012 Policy Update 13  Ambulatory servicesRequired  Emergency servicesEssential  HospitalizationHealth  Maternity/newborn careBenefits  Mental health and substance use disorder services  Prescription drugs  Rehabilitative services  Laboratory services  Prevention, wellness, and chronic disease management services  Pediatric services
    14. 14. August 2012 Policy Update 14EHB  Unlimited access to antiretroviral drugs and viral hepatitisPackage medicationsthat Meets  Unlimited access tothe Care HIV/infectious disease specialistsand  Case managementTreatment  Mental health and substance abuse servicesNeeds of  Preventive and wellness servicesPLWHA  Laboratory testing  Services needed to meet national standards of HIV care
    15. 15. August 2012 Policy Update 15EHB 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. 16. August 2012 Policy Update 16Questions  What are the most importantRegarding benefits for PLWHA?EHBs to  Which plans will beMeet the considered?Needs of  What benefits do those plansPLWHA currently offer?  What are the concerns?  Which plan looks best?  What needs to be added?
    17. 17. August 2012 Policy Update 17  Ryan White HIV/AIDS TreatmentRyan Extension Act of 2009 (Public LawWhite 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. 18. August 2012 Policy Update 18Status of Program FY2012 FY2013 FY2013 FY2013 (millions) Obama Need SenateHIV/AIDS RWP $ 2.392 +$ 80.0 +$ 483.0 +$ 30.0FY 2013 CDC $ 1.11 +$36.0 +$ 684.0 +$ 2.0Appropria- HOPWA $ 332.0 -$ 2.0 +$ 48.0 -$ 2.0tions
    19. 19. August 2012 Policy Update 19HIV Care • What is the future of the Ryan White Program?Advocacy • What will bridge services from theQuestions 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. 20. August 2012 Policy Update 20  RWP providers will beRyan increasingly dependent on 3rdWhite and party payment (51% now to asACA 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. 21. August 2012 AACO Director’s Meeting Federal Policy Update 21CAEAR Coalition Guiding Principles forReauthorizationOpen access to quality health careEnsure continuity of careFortify resources and increase client capacityMaintain and strengthen flexibility and adaptability
    22. 22. August 2012 Policy Update 22Principle 1:  Access and accountabilityOpen  Cultural competencyAccess to  Quality medical trainingQualityHealthCare
    23. 23. August 2012 Policy Update 23Principle 2:  Aligning and integratingEnsure systems of careContinuity  Linkage to appropriate careof Care  Reducing HIV-related health disparities
    24. 24. August 2012 Policy Update 24Principle 3:  Sufficient funding and effectiveFortify distribution of resourcesResources  Infrastructure and essentialand support servicesIncrease  Workforce development August 2012Client  Organizational and networkCapacity capacity
    25. 25. August 2012 Policy Update 25Principle 4:  ACA transition flexibilityMaintain  Support local controlandStrengthenFlexibilityandAdapta-bility
    26. 26. August 2012 Policy Update 26Local • Use existing data systems (e.g.,Activities unduplicated RWP client datato Prepare analysis of insurance status)for ACA • Maximize 3rd party billingand Ryan • Understand gaps in coverageWhite • Participate in national andReauthor- state advocacy group processesization and decisions (e.g., CAEAR Coalition and PA Health Choices Work Group)
    27. 27. August 2012 Policy Update 27Act 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. 28. August 2012 Policy Update 28General 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. 29. August 2012 Policy Update 29HIV-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. 30. August 2012 Policy Update 30 Thank you! Matthew McClain AIDSpolicy@aol.com
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