Medicaid Expansion and the Potential Impact for People living with HIV/AIDS in Georgia Jeff Graham, Executive Director Georgia HIV Advocacy Network

Massachusetts’ Successful Reform Implementation Improves Health Outcomes and Meets NHAS Goals Source: Massachusetts and Southern New Hampshire HIV/AIDS Consumer Study Final Report, December 2011, JSI Research and Training, Inc. Note: MA Outcomes N = 1,004 Source: Cohen, Stacy M., et. al., Vital Signs: HIV Prevention Through Care and Treatment — United States, CDC MMWR, 60(47); (December 2, 2011); Note: National Outcomes HIV-infected, N = 1,178,350; HIV-diagnosed, n=941,950

Economic Status of Ryan White Consumers In 2010, Ryan White programs served 27,817 duplicated clients in Georgia 67% had household incomes equal to or below the FPL with an additional 22% between 101% and 200% of the FPL. Source: 2013 SHARP Georgia State Report, An Analysis of the Successes, Challenges, and Opportunities for Improving Healthcare Access With a Focus on People Living With HIV and AIDS. Amy Katzen, Amy Rosenberg, and Robert Greenwald

Georgia Medicaid Income Limits Today Can’t qualify 250% 200% 150% 100% 50% Includes PeachCare Family Size Annual Income 1$11,490 2$15,510 3$19,530 4$23, % Federal Poverty Level 2013

Under ACA states were required to expand Medicaid if they wanted to continue to participate in the program; 26 states joined lawsuit against this provision Now: States can decide whether or when to expand If a state decides to cover the expansion group, it may drop the coverage later No deadline for state decision All other aspects of the ACA remain in place What this means for your patients without expansion: Most people below 100% FPL will have no affordable coverage options since the law only offers tax credits on the Exchanges for those between % FPL. What Does the ACA Mean for Medicaid?

If we don’t expand this sets up a “Coverage Gap” Source: Center for American Progress

1115 Waivers: A Stop-gap Measure For many years, Section 1115 waivers have been used by states to test new coverage approaches not otherwise allowed under Medicaid program rules. To date, five states have received approval of a Section 1115 waiver to implement the Medicaid expansion (Arkansas, Iowa, Michigan, Pennsylvania and Indiana)ArkansasIowaMichiganPennsylvaniaIndiana Governor has announced plans to seek a waiver to address coverage gap concerns for at least two large hospital systems: Grady (Fulton & DeKalb) and Memorial (Savannah). Details have not been released but most all agree this is a step in the right direction. Any 1115 waiver proposal is required to be available for public comment twice, once before it is submitted to HHS by the state and once after it is submitted to HHS. Cover Georgia Coalition has created a waiver principles document to prepare for conversations like this.

The Medicaid Expansion in Georgia Coverage Forecasts: -645,000 to 900,000 new Medicaid enrollees (by 2019) Reduces low-income uninsured by 50% to 75% Source: Kaiser Commission on Medicaid and the Uninsured, Urban Institute