1. HIV CARE UNDER THE AFFORDABLE CARE ACT: ADAP’S IN THE NEW ERA Richard Aleshire, MSW Program Manager, HIV Client Services Office of Infectious Disease Washington State Department of Health June 4, 2015

2. WHAT IS THE WORK OF HIV CLIENT SERVICES?  Vision: End HIV by preventing new infections in Washington State  Mission: The mission of HIV Client Services is to suppress viral load by ensuring access to quality services for people living with HIV in Washington State.

3. WHAT SERVICES ARE PROVIDED BY HIV CLIENT SERVICES? Community-based programs (funding to 15 agencies)  Medical Case Management (primarily – 85% of granted funds go to this category)  Medical Transportation  Food Bank and Home-delivered Meals  Medical Nutrition Therapy  Substance Abuse – Outpatient treatment Centrally-operated program from DOH (statewide):  Washington’s AIDS Drug Assistance Program (ADAP) known in Washington as the Early Intervention Program (EIP)  PrEP DAP (Pre-Exposure Prophylaxis Drug Assistance Program)

4. WHAT IS AN ADAP?  1987 – The US Congress appropriated funds to the AZT Program to assist States pay for the only approved antiretroviral (ARV) at the time  1990 – Incorporated this funding into the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, now known as the Ryan White Program  1996 – Congress began separately earmarking funds that went to the States under Part B of the Ryan White Program  The Washington State Legislature also provided general funds state to pay for HIV meds in the late 80’s

5. WHAT DOES ADAP (EIP) PAY FOR?  Insurance-based program – we, through the Evergreen Health Insurance Program – EHIP), purchase insurance for individuals  We then wrap-around the clients’ insurances  We pay for:  Insurance premiums  Co-pays for medications on our formulary (over 250 – including all ARV’s, mental health meds and HepC meds)  Co-pays for medical visits, lab work related to a client’s HIV  Dental services  For clients without insurance we pay full cost for their medications, medical visits, lab work, dental  As the recipient of federal funds we ensure that we are “payer of last resort” and that we “vigorously pursue” clients getting onto insurance

6. HOW IS ONE ELIGIBLE FOR EIP?  Live in Washington State  Documentation of HIV+ Status  Make less than 400% of the Federal Poverty Level (FPL) or about $47,080 per year for a single individual or $97,000 for a family of four  Ensure the client has no other access to coverage (“payer of last resort”)  Apply for insurance as eligible during open enrollment  Apply for Medicaid if apparently eligible and below 138% of the FPL

7. HOW HAS EIP CHANGED SINCE ACA?  Over 1,200 clients became eligible for expanded Medicaid  Over 600 clients were able to be offered lower cost insurance through our State’s health benefit exchange (wahealthplanfinder.org) (paid by EIP/EHIP)  Lowered costs to DOH allowing us to increase eligibility from 300 to 400% of the FPL and to be consistent with requirement allowing tax credits  Changed our income calculation to be consistent with Medicaid and Health Benefit Exchange’s use of MAGI (modified adjusted gross income)  Allowed us to offer PrEP DAP

8. WHAT IS PREP?  PrEP means Pre-Exposure Prophylaxis  PrEP is the use of anti-HIV medication that keeps HIV negative people from becoming infected (Truvada)  PrEP was approved by the FDA in July, 2012 for use to reduce the risk of HIV infection and has been shown to be safe and effective  PrEP is highly effective against HIV when taken every day  PrEP can interfere with HIV’s ability to copy itself in the body after a person has been exposed  PrEP can prevent HIV from establishing an infection and making a person sick  CDC recommends PrEP be considered for people who are HIV-negative and at substantial risk for HIV infection

9. WHAT IS PREP DAP?  PrEP DAP (Pre-Exposure Prophylaxis Drug Assistance Program) provides coverage for medication (Truvada) that can decrease an HIV-negative person’s risk of becoming positive  PrEP DAP launched in April 2014 with a low eligibility criteria  Washington State resident  Documentation of current HIV-negative status  No income restriction  PrEP DAP built on infrastructure of ADAP  Funded with non-federal dollars due to restrictions from our federal funding sources at HRSA and CDC

10. WHERE ARE WE NOW WITH PREP DAP? Gender: Female (3%) Male (96%) Other gender (<1%) Transgender (FtM) (<1%) Insurance Status: Uninsured (13%) Insured (87%) Ethnicity: Non-Hispanic/Latino(a) (72%) Hispanic/Latino(a) (15%) No Answer (13%) Race: Alaskan Native/American Indian (<1%) Native Hawaiian/Pacific Islander (<1%) Other (2%) Black/African American (3%) Asian (4%) Multi Race (6%) No Answer (7%) White/Caucasian (77%) 369 Applications Received 318 Active PrEP DAP Clients 36 Denied 15 Incomplete Apps

11. What is END AIDS Washington? Governor Jay Inslee announced a commitment to End AIDS in Washington. The governor issued a proclamation on World AIDS Day 2014 (12-1-2014) that appoints an HIV Planning Steering Group (HPSG) to develop a statewide plan for reducing the rate of new HIV diagnoses by 50 percent by 2020. Why else are we doing this???

12. QUESTIONS?