HIV Policy 2012

Planning in a time of uncertainty and change
Let’s remember how far we have come




http://youtu.be/haEPLCA_H2Y
HIV in the 21st Century
   National HIV/AIDS Strategy
   Ryan White Program
   Health Reform
   ‘Medical Model’
   Clinical Care Team
   ‘Treatment as Prevention’
   Test and Treat Strategy
   High Impact HIV Prevention
   Prevention with Positives
   Enhanced Comprehensive HIV Prevention Planning
HIV Programs in US
   Ryan White Program
   Medicaid
   Medicare
   Housing Opportunities for People With AIDS -
    HOPWA
   Centers for Disease Control and Prevention- CDC
   AIDS Drugs Assistance Program - ADAP
   Substance Abuse and Mental Health Services
    Administration - SAMHSA
   Veterans Administration - VA
Ryan White
                       Medicaid
Reauthorization
                    Expansion 2014
    2013

            Uncertainty


  Elections         Essential Health
November 2012          Benefits
http://youtu.be/vmdbllWOOzs
Affordable Care Act


Expansion of Medicaid
No discrimination by insurance
          companies                No $ limits


                   Subsidies for
  Essential                        Coordination
                  premiums and
health benefits                      of care
                   cost-sharing
Ryan White and Medicaid Expansion

       51%
     Medicaid
    (disability)
                   ~90%+ Ryan
                   White clients
                     Medicaid
                    eligible in
     Medicaid
                       2014
    Expansion
     to cover
    133% FPL
Ryan White Clients Insurance             Ryan White Clients
                Status, 2009                        Income, 2009
                      Unknown
                        1%                 <100% FPL   100-199%   200-299%   >300%



Other       None          Private                           4%
                                                       5%
Public      17%            17%
 1%
                                                13%

                                Medicare
                                 13%




           Medicaid                                                 78%
            51%
Estimated Changes to Insurance Status for Philadelphia EMA
 Ryan White Clients Following the Full Implementation of the
 ACA
9000
                                                8315
8000
                                7942
7000
               6250
6000

5000
                                                         Medicaid
4000                                                     ESI
                                                         Uninsured
3000
               2,047
                           1,535
2000
       2,071                                    1,535
1000
                               891              518
  0
        Baseline RW    2014 Average     2014 Enhanced
                        Participation    Participation
Health Reform and Ryan White
         Medicaid
                      75/25 rule??
        Expansion??
Health Reform and Ryan White Program




http://vimeo.com/46052691
National HIV AIDS Strategy

                              Reduce
                              HIV rate

                              Coordinate
                              d response

        Increase access to
           care for people                  Reduce HIV-
        living with HIV and                related health
            improve their                   inequalities
          health outcomes
Ryan White
                       Medicaid
Reauthorization
                    Expansion 2014
    2013

            Uncertainty


  Elections         Essential Health
November 2012          Benefits
resources
   HIVHealthReform.org
   Kaiser Family Foundation
       www.kff.org
   Commonwealth Fund
       www.commonwealthfund.org/
   Office of HIV Planning
       www.hivphilly.org

                             Nicole Johns
                        Office of HIV Planning
                        215-574-6760 ext. 108
                       Nicole.johns@gmail.com

HIV Policy 2012

  • 1.
    HIV Policy 2012 Planningin a time of uncertainty and change
  • 2.
    Let’s remember howfar we have come http://youtu.be/haEPLCA_H2Y
  • 3.
    HIV in the21st Century  National HIV/AIDS Strategy  Ryan White Program  Health Reform  ‘Medical Model’  Clinical Care Team  ‘Treatment as Prevention’  Test and Treat Strategy  High Impact HIV Prevention  Prevention with Positives  Enhanced Comprehensive HIV Prevention Planning
  • 4.
    HIV Programs inUS  Ryan White Program  Medicaid  Medicare  Housing Opportunities for People With AIDS - HOPWA  Centers for Disease Control and Prevention- CDC  AIDS Drugs Assistance Program - ADAP  Substance Abuse and Mental Health Services Administration - SAMHSA  Veterans Administration - VA
  • 6.
    Ryan White Medicaid Reauthorization Expansion 2014 2013 Uncertainty Elections Essential Health November 2012 Benefits
  • 7.
  • 8.
    Affordable Care Act Expansionof Medicaid No discrimination by insurance companies No $ limits Subsidies for Essential Coordination premiums and health benefits of care cost-sharing
  • 9.
    Ryan White andMedicaid Expansion 51% Medicaid (disability) ~90%+ Ryan White clients Medicaid eligible in Medicaid 2014 Expansion to cover 133% FPL
  • 10.
    Ryan White ClientsInsurance Ryan White Clients Status, 2009 Income, 2009 Unknown 1% <100% FPL 100-199% 200-299% >300% Other None Private 4% 5% Public 17% 17% 1% 13% Medicare 13% Medicaid 78% 51%
  • 11.
    Estimated Changes toInsurance Status for Philadelphia EMA Ryan White Clients Following the Full Implementation of the ACA 9000 8315 8000 7942 7000 6250 6000 5000 Medicaid 4000 ESI Uninsured 3000 2,047 1,535 2000 2,071 1,535 1000 891 518 0 Baseline RW 2014 Average 2014 Enhanced Participation Participation
  • 12.
    Health Reform andRyan White Medicaid 75/25 rule?? Expansion??
  • 13.
    Health Reform andRyan White Program http://vimeo.com/46052691
  • 14.
    National HIV AIDSStrategy Reduce HIV rate Coordinate d response Increase access to care for people Reduce HIV- living with HIV and related health improve their inequalities health outcomes
  • 15.
    Ryan White Medicaid Reauthorization Expansion 2014 2013 Uncertainty Elections Essential Health November 2012 Benefits
  • 16.
    resources  HIVHealthReform.org  Kaiser Family Foundation  www.kff.org  Commonwealth Fund  www.commonwealthfund.org/  Office of HIV Planning  www.hivphilly.org Nicole Johns Office of HIV Planning 215-574-6760 ext. 108 Nicole.johns@gmail.com

Editor's Notes

  • #12 the product of applying research done by the Kaiser Commission on Medicaid and the Uninsured to our EMA. These are estimates based on EMA data that has been noted as limited, due to duplications. OHP staff calculated the projections based on the data reported by AACO for insurance status for 2010, using the participation percentages in the Kaiser report. These participation estimates assumed that those with employer sponsored coverage would have similar participation regardless of outreach efforts (25%). However, the uninsured participation is expected to increase from 57% in the standard participation to 75% in the enhanced participation scenario. Individuals covered under other insurance types were not considered for this model. These projections result in 63% - 66% of Ryan White clients being Medicaid enrolled (this includes the individuals already enrolled in Medicaid). Between 4% - 7% of Ryan White clients will remain uninsured. However, those captured within that 4-7% uninsured may gain access to insurance through employers or through the state insurance exchanges. This Medicaid range is less than the estimate above that 75% of Ryan White clients will be Medicaid-eligible based on income alone, because the Kaiser projections are for enrollment, not just eligibility. There will be a number of individuals who do not enroll in Medicaid for any number of reasons, including lack of knowledge of eligibility, lack of the proper documentation of eligibility, and not wanting to participate.
  • #14 4:00-14:45