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HIV Care under the ACA: Addressing the Needs of HIV Providers & Health Professionals in Louisiana DEANN GRUBER, PHD LOUISIANA DHH OPH STD/HIV PROGRAM APRIL 11, 2015
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HIV Care under the ACA: Addressing the Needs of HIV
Providers & Health Professionals in Louisiana
DEANN GRUBER, PHDLOUISIANA DHH OPH STD/HIV PROGRAMAPRIL 11, 2015
Louisiana DHH OPH
STD/HIV Program
Surveillance
Program Evaluation
Prevention
Regional Ops
Services for Persons Living
with HIV
Admin/Busn
STD Testing and
Treatment
Louisiana DHH OPH
STD/HIV Program
Surveillance
Program Evaluation
Prevention
Regional Ops
Services for Persons Living
with HIV
Admin/Busn
STD Testing and
Treatment
Services for Persons Living with HIVRyan White Part B Funds
Part B Base Award is primarily contracted to Community-Based Organizations
Case Management
Medical Transportation
Mental Health/Substance Abuse Counseling
Nutritional Services
AIDS Drug Assistance Program (ADAP) funds can be used to provide medication and insurance services to eligible persons living with HIV
Louisiana Health Access Program
Louisiana Drug Assistance Program (L-DAP)
•Drug costs for uninsured clients •Drug cost shares for insured clients
Managed through
Louisiana Health Insurance Program (HIP)
Insurance premiums Medical (non-drug) cost shares
Coordinated through
Louisiana Health Access Program (LA HAP)
• Process L-DAP & HIP enrollment through single application
• Available to applicants up to 300% FPL with LA residency, HIV
diagnosis, and Medicaid ineligible
Some changes over the years
Rebranded “ADAP” to “LA HAP”
Centralized enrollment process Previously: insured clients apply through separate HIP application
Currently: Single application, staff at SHP office
Contracted with a Pharmacy Benefits Manager: Ramsell New, larger pharmacy networks
Electronic medication claims processing
Ability to enter & track client eligibility data through centralized database
Entered a new era for insurance coverage The Patient Protection and Affordable Care Act
How do clients use LA HAP benefits?Uninsured: medications only
Make sure pharmacy is in the Ramsell network for uninsured clients (lahap.org Forms and Applications Full L-DAP Pharmacy Network)
Present Ramsell Card at pharmacyLA HAP is billed electronically
How do clients use LA HAP benefits? Insured (co-pays, coinsurances, deductibles, and/or premium assistance):
Premiums: If eligible clients request premium assistance, HIP will pay premiums regularly.
Medical services: Insurance company (including Medicare) is always the first payer. Provider or client must then bill HIP for cost-shares/deductibles.
Pharmacy services: Insurance company (including Medicare) is always the first payer. Client should then use LA HAP card for cost-shares so pharmacy can bill LA HAP electronically.
1) 2)
1) 2) Bill HIP
What does HIP cover?LAHAP CAN pay for… LAHAP CANNOT pay for…
Most medicines Erectile dysfunction drugs, nutrition supplements, OTC drugs, cosmetic drugs
Doctor visits In-patient hospital stays
Tests and lab work Discount health/pharmacy plans
Premiums for a stand-alone dental plan Cost-shares for a stand-alone dental plan
Cost-shares for a stand-alone vision plan Premiums for a stand-alone vision plan
Cost-shares for a general health plan that includes vision services
Vision services not covered by the health plan
Premiums for a general health or dental plan that includes vision services Products or services that the client’s
insurance company doesn’t cover
Important LA HAP updates sent out via weekly bulletin
LA HAP application, application assistance, related forms, pharmacy network, uninsured formulary
Referrals to case management
How LA HAP works, tax info, the Marketplace, using insurance
External links: Medicaid, DHH, etc.
Updated regularly; all LA HAP topics/application troubleshooting
Benefits of Health Insurance
Comprehensive medical services vs. access to medications on LDAP formulary
Increased provider options in networksCost effective
Avg cost/client on LDAP: $964/mthAvg cost/client on HIP: $618/mth
LA HAP Clients: 5,418 EnrolledMarch 31, 2015
Medications Only: 1,671 personsHealth Insurance Assistance: 3,747 persons
ACA Federally Facilitated Marketplace: 2,137Transferred from Meds to FFM: 819 persons
Non-FFM: 1,610 persons
HIV Continuum of CareLouisiana, 2013
Persons living with HIV
In HIV care Retained in HIV care
Viral suppression (<=200)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%100%
69%
54%49%
Pe
rce
nta
ge
18,199
9,774
12,536
8,831
HIV Continuum of CareLouisiana, 2013
Persons living with HIV
In HIV care Retained in HIV care
Viral suppression (<=200)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%100%
69%
54%49%
Pe
rce
nta
ge
18,199
9,774
12,536
8,831
70% of PLWH in care were virally sup-pressed
HIV Continuum of CareUninsured Medication ClientsApril 2013-March 2014
Persons living with HIV
In HIV care Retained in HIV care
Viral suppression (<=200)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%100%
69%
54%49%
100% 98%
81%
71%
All PLWH
Uninsured Medication Clients
Pe
rce
nta
ge
18,199
9,774
12,536
8,831
70% of PLWH in care were virally suppressed
3,368 3,311
2,727
2,385
72% of Uninsured Med Clients in care were virally sup-pressed
HIV Continuum of CareInsurance Services ClientsApril 2013-March 2014
Persons living with HIV
In HIV care Retained in HIV care
Viral suppression (<=200)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%100%
69%
54%49%
100%96%
82% 81%
All PLWHInsurance Services Clients
Pe
rce
nta
ge
18,199
9,774
12,536
8,831
70% of PLWH in care were virally suppressed
2,6822,584
2,200 2,181
84% of Insurance Services Clients in care were virally sup-pressed
Summary
LA HAP’s enrollment of eligible persons living with HIV continues to increase
Continued emphasis on enrolling persons in health insurance vs medications only
Multiple benefits related to health insurance
www.lahap.org 504-568-7474
Questions/Acknowledgements
DeAnn Gruber, Director
Kira Radtke Friedrich, Services Manager
Alicia Cooke, Capacity Building Specialist
Jennifer Gomez, LDAP Coordinator
