ADAP programs & the ACA Marketplace; how can we make them work together? Strategies from the Florida experience Joey Wynn – Co Chair, FHAAN Community Relations Director, Empower U (Miami - Dade County’s newest FQHC) ADAP Advocacy Association (aaa+) 2014 ADAP Summit, April 14 th 2014 Westin Hotel, Washington D.C.

Essential Elements of a Strategy to Leverage ACA plans for ADAP Client Transitions: Create constructive dialogue with ADAP staff Create constructive dialogue with ADAP staff Get funding data & enrollment figures etc… Get funding data & enrollment figures etc… Have a goal – keep it simple Have a goal – keep it simple Have Solutions & ask to provide proposals Have Solutions & ask to provide proposals Be Realistic! (non - expansion states especially) Be Realistic! (non - expansion states especially)

Essential Elements of a Strategy to Leverage ACA plans for ADAP Client Transitions: Create a workgroup of PLWH, service providers, and opinion leaders: Create a workgroup of PLWH, service providers, and opinion leaders: –Within the statewide planning group if you have one, or start a task force: locally, then get regional participation, then statewide (include various stakeholders) –Work with the available data from the Health Department, and calculate the overall costs of providing medications, versus the average cost of the Marketplace plans in your area!

Essential Elements of a Strategy to Leverage ACA plans for ADAP Client Transitions: Develop a timeline Develop a timeline –Work backwards from dates you need to start enrollment (November 15 th 2014) –Key events for calculating operational issues; average costs per premiums, up front deductible costs, formulary management issues, contrast HIV provider networks, etc… –Link tasks to an accountable person or groups or agencies to keep things organized!

Essential Elements of a Strategy to Leverage ACA plans for ADAP Client Transitions: Working without a Crystal Ball: The variables are critical, but unknown Working without a Crystal Ball: The variables are critical, but unknown –Part B Grant Award for the upcoming year –Find the actual plans available for each area included in the transition –Some will have robust formularies, some won’t; provider coverage can change drastically –Costs for medications, premium increases etc…

Essential Elements of a Strategy to Leverage ACA plans for ADAP Client Transitions: Have solutions! Have solutions! –Identify areas where you can reduce costs, provide better efficiencies, or areas to improve productivity (PBM requirements, detailed analysis of plans beyond formularies etc…) –Identify all of the existing resources to leverage ACA Marketplace enrollers & staff –Sometimes your suggestions are working against the Bureaucracy’s goals – be willing to compromise in some areas (open plans, open formularies, simple payment processes can be unrealistic for brittle DOHs)

Essential Elements of a Strategy to Leverage ACA plans for ADAP Client Transitions: The parameters, both good and bad! –Costs per client per month for medications –Deductibles –Monthly Premiums –Co Pays –Federal Subsidy Amounts –Formulary Limitations –Network’s HIV Provider inclusion - Timing Lag –Appeals – dealing with Private Ins. Industry

Florida Overview – Cascade

Florida Overview – Trends in Care: Viral Load Suppression

ADAP Attachments

Opportunity Statement Currently the Fl. Dept. of Health can serve approx. 14,500 persons on ADAP with level funding. Currently the Fl. Dept. of Health can serve approx. 14,500 persons on ADAP with level funding. A pilot project for 500 people NOW will provide actual utilization & cost data this cycle, aiding in more accurate projections for the upcoming enrollment period (Nov 14) A pilot project for 500 people NOW will provide actual utilization & cost data this cycle, aiding in more accurate projections for the upcoming enrollment period (Nov 14) For next enrollment cycle, we proposed a unique project transitioning 5,102 clients from ADAP to the ACA Marketplace & involves other local Ryan White Grantees to help ensure program stability (See diagram) For next enrollment cycle, we proposed a unique project transitioning 5,102 clients from ADAP to the ACA Marketplace & involves other local Ryan White Grantees to help ensure program stability (See diagram) Various workgroups assist in solutions for a variety of operational & policy issues as well as refining financial projections on a regular basis Various workgroups assist in solutions for a variety of operational & policy issues as well as refining financial projections on a regular basis

Potential Effects - ADAP

Expected Savings to the program- ADAP Funding based on an average of $10,000 per client per year. Projected avg. cost of $560 per premium & $3,537 per annual deductible ADAP Federal Poverty Level Numbers FPLAprox. NumberPotential Savings to ADAP 0 – 99%8089No impact 100 – 249%5102Approx. 12 Million 250 – 400%992Approx 9.4 Million

Expected Savings to the program- ADAP Newly available slots Potential cost savings 1,500$12 Million Anticipated Benefits of Transition

Workgroup Analysis- ADAP

Expected Savings to ADAP

ADAP Attachments