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Friday, September 21, 2012

HIV/AIDS Coverage and Care: Before, During, and After ACA Implementation

The Affordable Care Act, passed in 2010, is expected to expand insurance coverage and care for millions of people in the U.S., including people living with HIV. The provisions of the ACA will dramatically impact access to care, specifically antiretroviral therapy (ART), which is critical for the health of people with HIV.

Traditionally, there have been numerous sources of insurance coverage for people living with HIV. Most notably are public programs, such as Medicaid and Medicare, and the Ryan White HIV/AIDS program. Currently, Medicaid is estimated to cover the largest share of people with HIV and a significant portion of people with HIV rely primarily on Ryan White, operating as the “payer of last resort” for people with HIV who are uninsured or underinsured.

Prior to the implementation of the ACA, people living with HIV were more often than not, shut out of the individual market due to the fact that insurers consider HIV an uninsurable, pre-existing, condition. Medicaid, Medicare and public programs were therefore, important pathways for people living with HIV to receive coverage. However, prior to the ACA, federal law excluded non-disabled adults without dependent children from Medicaid, presenting a catch-22 for many low-income people with HIV who could not qualify UNTILL they were disabled even though Medicaid covers medications that delay and hinder the development of HIV-related disability. Ryan White has often supplemented these other forms of coverage, providing additional services where needed.

The ACA is currently in a transition period until its full effect date of 2014. Until then, the ACA has established a temporary program in which every state allows people with pre-existing medical conditions, such as HIV, to purchase coverage through a Pre-Existing Condition Insurance Plan (PCIP). The transitional ACA plan also prohibits individual and group plans from placing lifetime limits on coverage, preventing people will expensive illnesses, like HIV, from exhausting their coverage. 

Additionally, a new state Medicaid option was developed to cover childless adults with incomes up to 138% of the federal poverty level (FPL), however, limits to coverage or continued ineligibility result in the continued use of the Ryan White program. 

The full extent of ACA’s coverage expansions will go into effect in 2014. With this full implementation, insurers will no longer be able to deny coverage to people with pre-existing conditions, and with this, the temporary Pre-Existing Condition Insurance Plan will no longer be needed. Annual limits on coverage will also be prohibited and health insurers will be required to guarantee issue and renew health insurance regardless of health status. Individuals will be able to purchase coverage through state-based “health insurance exchanges”, and people without access to employer-sponsored coverage will be eligible for subsidies to purchase coverage within the exchange.

Finally, the ACA also establishes a new Medicaid eligibility category for people with incomes up to 138% FPL, thus removing categorical eligibility requirement that have often limited people with HIV in the past.

The ACA has increased and improved access to care for people living with HIV and following its full implementation in 2014, it is expected to further expand and enhance access.

*To read Kaiser Family Foundation’s full take on the issue, please see the article
How the ACA Changes Pathways to Insurance Coverage for People with HIV

*To get access to more articles, fact sheets and blog posts on the issue, check out http://www.hivhealthreform.org/

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