HIV Care under the ACA: Addressing the Needs of HIV Providers & Health Professionals in Louisiana D E A NN G RUBER, P H D L OUISIANA DHH OPH STD/HIV P ROGRAM A PRIL 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 HIV  Ryan 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 pharmacy  LA 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 visitsIn-patient hospital stays Tests and lab workDiscount health/pharmacy plans Premiums for a stand-alone dental planCost-shares for a stand-alone dental plan Cost-shares for a stand-alone vision planPremiums 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 networks  Cost effective  Avg cost/client on LDAP: $964/mth  Avg cost/client on HIP: $618/mth

LA HAP Clients: 5,418 Enrolled March 31, 2015  Medications Only : 1,671 persons  Health Insurance Assistance: 3,747 persons  ACA Federally Facilitated Marketplace: 2,137  Transferred from Meds to FFM: 819 persons  Non-FFM: 1,610 persons

HIV Continuum of Care Louisiana, 2013

HIV Continuum of Care Uninsured Medication Clients April 2013-March 2014

HIV Continuum of Care Insurance Services Clients April 2013-March 2014

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 

Questions/Acknowledgements DeAnn Gruber, Director Kira Radtke Friedrich, Services Manager Alicia Cooke, Capacity Building Specialist Jennifer Gomez, LDAP Coordinator