HIV CARE UNDER THE AFFORDABLE CARE ACT – RYAN WHITE HOUSTON EMA Carin Martin Ryan White Grant Administration May 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 2

RW Payer of Last Resort & the ACA HRSA Policy Clarification Notice “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.”

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 4

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

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. 6

RW Client Health Insurance Coverage All RW Clients Served 3/1/14 to 2/28/15 %FPLTotal%Public%Private% Marketplace % Uninsured % ,40167%2,41229%3574%2433%5,40964% ,03632%1,00325%78820%3168%1,97149% > %98%6760%1312%2421% Total12,549100%3,42427%1,21210%5725%7,40459% 7

RW Total Population 8

RW Marketplace Population 100% - 400% FPL 9

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 10

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 Served 14% decrease in average allocation/UDC served $1,566 $1, CY 2014 allocations totaled over $2.1 million

Primary Care Cost Savings CY 2015 Primary Care and Mental Health Cost Savings to Date*:  $537, *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= Savings per Client**: » $

Contact Information Carin Martin Ryan White Grant Administration - Program Manager (713)