Ryan White & Health Care Reform
Future Paths for Integration, Expansion, and
Innovation
Harvard Law School Health Law and Policy Clinic &
Treatment Access Expansion Project
In collaboration with:
AIDS Foundation of Chicago, National AIDS Strategy Coalition, HIV Prevention
Justice Alliance, HIV Medicine Association, Project Inform, Ryan White Medical
Providers Coalition
This webinar is sponsored by the Treatment
Access Expansion Project (taepusa.org), AIDS
Foundation of Chicago, HIV Prevention Justice
Alliance, and the Coalition for a National AIDS
Strategy (nationalaidsstrategy.org).
One of many groups supporting the Coalition’s
efforts, Bristol-Myers Squibb has generously
sponsored this teleconference, with no review
or editorial discretion as to topics or content
discussed.
Presentation Outline
• Introduction (and moderating)
Robert Greenwald, Harvard Law School & TAEP
• Part 1: The Changing Landscape
Amy Killelea, Harvard Law School & TAEP
• Part 2: Opportunities for Sustaining/Expanding
HIV Care under Health Care Reform
Andrea Weddle, HIVMA & Amy Killelea
• Part 3: Next Steps and Advocacy Efforts
Anne Donnelly, Project Inform
• Part 4: Resources
Part 1
The Changing Landscape
The Future of Ryan White Funded HIV
Care under Health Care Reform
Ryan White Funding is Not Enough to
Meet Increased Need
Number of People Living with AIDS in the US
vs. Ryan White Funding (adjusted for inflation)
What Does Health Care Reform Mean
for HIV/AIDS Care and Treatment?
Medicaid Expansion
 Starting in 2014, no longer have to be disabled to
be eligible for Medicaid
 Most low-income, uninsured people will now be
automatically eligible for Medicaid (133% FPL =
~ $14K for an individual and $29K for family of four)
 Includes a new Essential Health Benefits Package
What Does Health Care Reform Mean
for HIV/AIDS Care and Treatment?
Increased Access to Private Insurance
 Pre-existing Condition Insurance Program
 State-based exchanges (starting in 2014)
•
Subsidies for those with income up to 400% FPL
 Elimination of many harmful and discriminatory
insurance practices
•
E.g., No higher premiums based on health
 Individual and employer mandates
What Does Health Care Reform Mean
for HIV/AIDS Care and Treatment?
New Investments in Care and Prevention
 Community health center expansion
• $11 billion over five years
 Prevention and Public Health Fund
•
$750 million in FY 2011
 Health care workforce investments
What Does Health Care Reform Mean
for Ryan White Clients?
2008
2014
Ryan White
Program
Medicaid
 30% were uninsured
 68% had incomes at
or below 100% FPL
 22% had incomes
between 101% and
200% FPL
 34% were insured
through Medicaid
 12% had private
insurance
 Expands to most
people up to 133% FPL
 Eliminates disability
requirement
Health Care Reform
Private
Insurance
 Subsidies to purchase
insurance for people
with income up to
400% FPL
 Elimination of preexisting condition
exclusions
What Does Health Care Reform Mean
for Ryan White Providers?
Starting in 2014, the Role for Ryan White Will Change
Because Most People Will Have Insurance Coverage
 Greatest challenges
• Medicaid’s provider reimbursement rates
• New reimbursement systems
 Greatest opportunities
• Relief to an increasingly underfunded Ryan White Program
• New investments in community-based care
• Potential for new reimbursement systems and funding
streams for Ryan White providers (RWPs)
Part 2
Opportunities for
Sustaining/Expanding HIV
Care under Health Care
Reform
1.) Making the Medicaid Expansion
Work for People with HIV and AIDS
Implementation Opportunities
Essential Health Benefits
 Floor of benefits available to newly-eligible beneficiaries
 Must be comprehensive enough to meet the needs of
people with HIV and AIDS and other chronic conditions
• Comprehensive prescription drug benefit
• Mental health, substance abuse, and support services
• Prevention
Demonstration Projects
 Center for Medicare and Medicaid Innovation (CMMI)
coordinated and integrated care projects
• Medicaid Health Home program
• HRSA/CMS evaluation of RW model of care
Outreach
 RWPs will continue to be first line of information for newlyeligible Medicaid beneficiaries
Opportunities Beyond Health Care Reform
for Building a Robust HIV Care System
 Health Homes
•
Medical home certification for RWPs
 Provider Reimbursement (fee for service and
managed care)
• Advocate for enhanced rates for HIV providers
• Ensure payment for coordination of care
 Medicaid Defense
• Protect optional benefits and provider payment levels
• Limit exceptions to “maintenance of effort” requirements
Ongoing Ryan White Advocacy
•
To provide essential wrap-around care, treatment and
support services
2.) Making Private Insurance Reforms
Work for People with HIV and AIDS
Designing Insurance Exchanges that Meet
the Care and Treatment Needs of People
with HIV and AIDS
 Essential Health Benefits Package
•
•
Among others, ensuring comprehensive prescription drug
benefit, mental health and substance abuse services
Maximizing access to support and prevention services
 Integration of RWPs into provider networks
 Patient navigation
 Maximize potential of 3rd-party billing and
reimbursement
3.) Integrating HIV/AIDS Care and
Treatment into the Health Center
Program
Leverage New Investments
Health Care Reform Allocates $11 Billion to Community
Health Centers
Enhanced
Training and
Technical
Assistance
New Access
Point Grants
$11 Billion
Expansion of
Services
Construction
and Renovation
Overlapping Populations of FQHCs and
Ryan White Funded Clinics
Overlapping Missions of FQHCs and
Ryan White Funded Clinics
Health Center Program Mission
Health centers are community-based and patientdirected organizations that serve populations with
limited access to health care regardless of ability
to pay.
Ryan White Program Mission
The Ryan White Program supports cities, states,
and local community-based organizations that
provide HIV-related services to those who do not
have sufficient health care coverage or financial
resources for coping with HIV disease. Ryan White
fills gaps in care not covered by other sources.
The Basics
What is an FQHC?
 A community health center that meets federal requirements and
receives significant grant funding and other federal benefits
•
Serves federally designated medically underserved population or located in
federally designated medically underserved area
•
•
•
Serves all residents of service area regardless of ability to pay
Provides full continuum of primary and preventive care services
Governed by an independent community-based board of directors, a certain
percentage of which must be health center consumers
 Funding to become a new FQHC grantee only available when New
Access Point grant funding announcements are released by HRSA
What is an FQHC Look Alike?
 A community health center that satisfies FQHC requirements and
receives many, but not all, FQHC benefits, but has not been awarded
a grant
•
Look Alikes are in a good position to apply for grant funding (and full
FQHC status) when new grants are announced by HRSA
Becoming or Collaborating with
an FQHC
Who can Apply?
 A private non-profit or public agency that serves a
federally designated medically underserved area or
population
How Can I Collaborate with an Existing FQHC?
 Referral arrangement
 Established/contractual arrangements
• Co-location arrangement
• Purchase of services agreement
 Sub-recipient arrangement
Benefits and Challenges
Benefits of becoming/collaborating with an FQHC include:
 FQHC specific grant funding
 Enhanced Medicaid and Medicare reimbursement for services
 Opportunity for RWPs to continue to provide wrap-around services
 Opportunity for RWPs to ensure smooth transitions
 Opportunity to fill gaps in HIV medical provider expertise and experience
Challenges of becoming/collaborating with an FQHC:
 Changing mission and expanding services beyond HIV and AIDS
 Requires bridges between Ryan White and Health Center Programs
 Restructuring governing board
 Costly and labor-intensive application process
 In collaboration agreement, difficult for FQHC benefits (e.g., cost-based
reimbursement) to go to collaborating partners
4.) Other Opportunities for Integrating
HIV/AIDS Care, Treatment, and
Providers into Broader Health Care
Systems
Other Opportunities
 Ensure that HIV/AIDS providers benefit from
National Health Service Corps investments
 Build on federal investment in developing HIV
centers of excellence
 Seek demonstrations, pilot projects, and grants
• E.g., new payment mechanisms for coordinated care
• E.g., medical home demonstration projects
• E.g., Community Transformation Grants
Part 3
Next Steps and Advocacy
Efforts
What You Can Do
 Educate yourself about health care reform and what it means
for the HIV/AIDS community
 Defend health care reform!
•
•
E.g., Medicaid Expansion, Prevention and Public Health Fund
Join the HIV Health Care Access Working Group
 Maximize effective state implementation of health care reform
•
•
E.g., Sound implementation of Medicaid expansion and private
insurance exchanges
Connect with other health advocates working on the state level
 Start conversations on collaboration/ integration with FQHCs
•
With Your board – Your community – Neighboring FQHCs
 Ensure you are accessing all existing resources
 Stay tuned
•
•
Follow up T/A and webinars
Guidance from HRSA
What Questions Should the HIV/AIDS
Community Consider Going Forward?
 Is my organization (or where I get my care) poised to
maximize funding streams/opportunities?
 What populations are currently served and what does it
mean to expand to others?
 What services are currently provided and is there the
capacity to expand?
 What models of care are already in place and do these
models fit into health care reform models?
 What FQHCs exist in the area and what is the relationship
with them?
• What HIV services do they provide (e.g., HIV testing)
Part 4
Available Resources
What Resources Are Available?
 HRSA Resources, www.hrsa.gov
o Planning grants
o T/A
 NACHC Resources, www.nachc.org
o Trainings and T/A, including FQHC 101
o Guidance documents
 Primary Care Organizations
 Treatment Access Expansion Project,
www.taepusa.org
 HIV Medicine Association, www.hivma.org
What Resources Are Available?
Health Care Reform Resources
 Kaiser Family Foundation, www.kff.org
 FamiliesUSA, www.familiesusa.org
 Healthcare.gov, www.healthcare.gov
What Resources Are Available?
AIDS Advocacy Resources
Coalition for NHAS,
www.nationalaidsstrategy.org
HIV Prevention Justice Alliance,
www.preventionjustice.org
Dose of Change – AIDS Advocacy Skills
Building, www.doseofchange.org