How will healthcare reform change health insurance for people living with HIV/AIDS?
By Kevin Moore, Psy.D. on 11/16/12
Even though current Ryan White services fund a complete spectrum of medical services from medical and dental care to receiving HIV medications, it is always a good idea to get health insurance. One never knows when she or he might need to go to the emergency room. Besides, the current way that Ryan White services are certified in the Commonwealth of Pennsylvania and other States, Ryan White recipients are required to apply for benefits such as Medicaid, if they are eligible. Given this state of things, what will change?
First of all, about 50% of people who are currently eligible for Medicaid are not receiving this entitled benefit, primarily because they have not applied but also because of bureaucratic difficulties. This percentage should go down. While a high percentage of people living with HIV/AIDS are receiving the Medicaid coverage, also called Medical Assistance or MA, they are sometimes kicked off of their coverage because the state declares that they have failed to keep current documentation or have exceeded the income limits or other eligibility criteria. One of the aims of the Medicaid expansion is to reduce the sometimes adversarial nature of public benefits. This change will be a tricky one as it will depend on each states’ Medicaid administration to conform to a yet to be determined standard. Pennsylvania’s Department of Public Welfare has dropped hundreds of thousands of enrollees for new technicalities since the Corbett Administration, though many of these were able to regain coverage with additional documentation. Healthcare reform should reduce the amount of gaps of Medicaid coverage by current recipients.
Second of all, for states that accept Medicaid expansion from the federal government, people up to 133% of the Federal Poverty Level (FPL) will be eligible to receive Medicaid. This will be a significant benefit to a group sometimes called “the working poor.” For states, such as Pennsylvania, who have indicated they will not accept the Medicaid expansion, this 100-to-133% FPL group are in danger of not being eligible for Medicaid but still being mandated to have health insurance. It is extremely unclear how this will play out, and this may be the single most fractious, partisan, hot-button issue of healthcare reform implementation. This should be a primary target of advocacy for people living with HIV/AIDS as they could end up in the worst case scenario of having neither Medicaid nor the current Ryan White care system and face a penalty for not having health insurance.
Third, for people above 133% and up to 400% FPL, state health care exchanges will be established so they can have both access to new groups of insurance pools and assistance in deciding which plan is right for them. Depending of level of income, there are maximum percentages of the cost of insurance that can be charged. To be clear, a working class American in 2014 will be able to individually purchase health insurance whose coverage far exceeds what the individual must contribute. Curious how this might work out for you or your loved ones? Try this easy to use subsidy calculator: http://healthreform.kff.org/en/SubsidyCalculator.aspx. Some states, like Pennsylvania, will not choose to set up healthcare exchanges themselves and thus an arm of the federal government, the Department of Health and Human Services, will set it up for that state. In either case, each health exchange will have to decide how they will cover people living with HIV/AIDS. As they cost on average about five times as much per year as the average Medicaid recipient, it will require massive advocacy on a state level to ensure that people living with HIV/AIDS are well cared for in the state exchanges.
Finally, people above 400% of the FPL will not receive subsidies for their insurance, but they will enjoy other benefits of healthcare reform such as not being rejected for insurance because of a pre-existing condition such as HIV/AIDS, no lifetime caps on insurance spending, and other protections previously unavailable. Whatever your income, healthcare reform will directly benefit you in multiple ways.