The document discusses advocacy efforts for Medicaid expansion in South Carolina, including messaging around the importance of expanded access to care and treatment for people living with HIV, ongoing discussions in the state around essential health benefits and benchmark plans, and next steps advocates can take like meeting with stakeholders, elected officials, and participating in coalitions and sign-on letters.

1. Planning for
Successful Medicaid
Expansion Advocacy
in South Carolina
Charles Stephens
AIDS United
Southern Regional Organizer
Tuesday, October 16, 2012

2. Agenda
• Why is Medicaid
expansion important for
people living with HIV?
• Essential Health
Benefits
• What’s happening now?
• Messaging
• Mapping Out Next
Steps

3. Why Medicaid Expansion is Critical
Expanded Medicaid
eligibility in 2014 will
result in greater access
to care for people
living with HIV.

4. Estimates of Insurance Coverage
Among Patients with HIV (N=19,235), 2010*

5. Why Medicaid Expansion is
Critical
• Offers the greatest
promise to ending the
United States HIV/AIDS
epidemic.
• Wider and more reliable
access to HIV treatment
and care through
Medicaid expansion
• Will reduce health
disparities and new
infections.

6. REMEMBER!!!!
By expanding health coverage to
tens of thousands of HIV
positive individuals who are
uninsured or under insured, the
ACA can have an important
impact on treatment as
prevention. Focus on Medicaid
expansion and on Essential Health
Benefits will be important.

7. Also, remember…
Medicaid expansion will help
more HIV-positive Americans
receive a diagnosis and will help
ensure linkage to care, access
to drugs, and help in effectively
managing adherence to
maintain their own health and
that of their partners.

8. Essential Health Benefits
• Essential health benefits
must include coverage of
services and items in all
10 statutory categories.
• The health law lists 10
broad categories of
essential benefits,
including preventive care,
emergency services,
maternity care, hospital
and doctors’ services, and
prescription drugs.

9. Essential Health Benefits
• Prescription drugs
• Mental health and substance use disorder
services
• Hospitalization
• Maternity and newborn care
• Emergency services
• Ambulatory patients services
• Rehabilitative and habilitative services
• Laboratory services
• Preventive and wellness services and
chronic disease management
• Pediatric services, including oral and
vision care

10. Essential Health Benefits
 States have latitude
within those
categories.
 The minimum
benefits available to
consumers in
California will be
different from those
for people in New
York, for example.

11. South Carolina
• Over 15,000 South Carolinians are living with
HIV/AIDS,
• 43% of those who know their status are not in
treatment.
• Expanding Medicaid would significantly
alleviate the state’s HIV epidemic.
• If South Carolina does not expand Medicaid,
hospitals will face severe deficits and be forced to
close or pass costs onto consumers of private
health insurance, inflating premiums.
• Federal dollars will pay for 90-100% of the cost of
covering newly eligibles across the nation,
making South Carolina one of the biggest
potential beneficiaries of the funds associated
with the expansion (nearly 20% of South
Carolinians are uninsured).
• Increased federal funding contributes to the
economy – creating jobs and spurring consumer
spending.

12. Also…
• Moreover, if South Carolina does not
expand Medicaid, South Carolinians
will ultimately subsidize the cost of
coverage in states that do, via federal
taxation.
• Net Savings – South Carolina’s
spending on newly eligibles will be
offset by the savings realized in
reduced spending on uncompensated
care.
• In the first five years of expanding
Medicaid, South Carolina would
realize net savings of $678 million.

13. What’s happening now in SC…
• The Department of Insurance is accepting comments regarding the
selection of a South Carolina essential health benefits (EHB)
benchmark plan for health insurance coverage under the federal
Affordable Care Act by September 25 according to South Carolina
Healthcare Voices and the South Carolina Department of Insurance
Site.
• There was a September 25th hearing that was rescheduled but did
not include a date.
• As of October 10th , according to
http://www.statereforum.org/state-progress-on-essential-
health-benefits a working group on Essential Health Care
Benefits was formed but no benchmark plan was recommended.

14. What’s happening now, cont…
To facilitate an effective state-
level implementation, the South
Carolina Institute of Medicine
and Public Health and South
Carolina Healthcare Voices, is
convening stakeholders from the
non-profit sector and state
agencies to explore the various
state-specific elements of the
legislation and examine possible
approaches to implementation.

15. What’s happening now, cont…
This initiative will include
the creation of open, non-
discriminatory, educational
workgroups to help the state
prepare for and implement
health reform. By bringing
diverse stakeholders around
the table we will develop a
plan that is best for the state

16. What’s happening now, cont…
This effort, with honorary co-
chairs Doug Bryant, a former
Commissioner of the SC
Department of Health and
Environmental Control, and
Robby Kerr, a former Director of
the SC Department of Health
and Human Services, will focus
on building linkages with key
state agencies to provide a
neutral forum for collaborative
decision-making and expand the
collective public capacity to
address the implementation of
this legislation.

17. In short, the goal of this
initiative is to create a
public-private
collaborative so that South
Carolina can most
successfully implement
health care reform and take
advantage of the funding
opportunities that are
available to our state.

18. Advocacy next steps
• How do you identify
which coalitions to be
apart of?
• Which coalitions should
you join?
• How do you identify
stakeholders,
champions, and
grasstops?
• Where are decisions
being made, and how do
you get a seat at those
tables?

19. Advocacy next steps, cont…
- Setting up meetings
with elected
representatives
- Sign-on Letters
- Meet with agency
directors
- Voter
mobilization!!!!!

20. Messaging, pt 1
You are meeting with a
South Carolina State
Legislator about
ACA expansion. You
have 10 minutes to
make your case.
Take 5 minutes to
develop three
speaking points. Use
materials if you
need.

21. Messaging, pt 2
Break off in small groups, and take the
next 15 minutes practicing your
talking points.

22. Messaging, pt 3
What talking points can
we use to take to elected
officials and key decision
makers?

23. Lets create a plan!!!!!!
What needs to
happen in the
next 90 days?
-sign-on letters
-meetings with
representatives
- State lobby days

24. Examples of talking points
• Before health care reform…
– health insurance companies could legally
discriminate against me
– I had to be disabled by AIDS before I could get the
care that would prevent me from progressing to
AIDS
•

25. Educate Yourself
• Get the facts on health care reform and what it means for
people living with HIV
• Take advantage of available resources
– HIV Health Reform www.HIVHealthReform.org
– Families USA www.FamiliesUSA.org
– Community Catalyst www.CommunityCatalyst.org
– Treatment Access Expansion Project www.TAEP-USA.org
– AIDS United www.AIDSUnited.org
– White House www.whitehouse.gov/healthreform
• Factsheets/Talking points
• Webinars
• Policy Updates