Charles StephensAIDS UnitedSouthern Regional Organizer Tuesday, October 16, 2012

Planning for Successful Medicaid Expansion Advocacy

in South Carolina

Agenda

• Why is Medicaid expansion important for people living with HIV?

• Essential Health Benefits

• What’s happening now?

• Messaging • Mapping Out Next

Steps

Expanded Medicaid eligibility in 2014 will result in greater access to care for people living with HIV.

Why Medicaid Expansion is Critical

Estimates of Insurance Coverage Among Patients with HIV (N=19,235), 2010*

Why Medicaid Expansion is Critical

• Offers the greatest promise to ending the United States HIV/AIDS epidemic.

• Wider and more reliable access to HIV treatment and care through Medicaid expansion

• Will reduce health disparities and new infections.

By expanding health coverage to tens of thousands of HIV

positive individuals who are uninsured or under insured,

the ACA can have an important impact on treatment as

prevention. Focus on Medicaid expansion and on Essential

Health Benefits will be important.

REMEMBER!!!!

Also, remember…

Medicaid expansion will help more HIV-positive Americans receive a diagnosis and will help ensure linkage to care, access to drugs, and help in effectively managing adherence to maintain their own health and that of their partners.

Essential Health Benefits

• Essential health benefits must include coverage of services and items in all 10 statutory categories.

• The health law lists 10 broad categories of essential benefits, including preventive care, emergency services, maternity care, hospital and doctors’ services, and prescription drugs.  

Essential Health Benefits

• Prescription drugs

• Mental health and substance use disorder services

• Hospitalization

• Maternity and newborn care

• Emergency services

• Ambulatory patients services

• Rehabilitative and habilitative services

• Laboratory services

• Preventive and wellness services and chronic disease management

• Pediatric services, including oral and vision care

Essential Health Benefits

States have latitude within those categories.

The minimum benefits available to consumers in California will be different from those for people in New York, for example.

South Carolina

• Over 15,000 South Carolinians are living with HIV/AIDS,

• 43% of those who know their status are not in treatment.

• Expanding Medicaid would significantly alleviate the state’s HIV epidemic.

• If South Carolina does not expand Medicaid, hospitals will face severe deficits and be forced to close or pass costs onto consumers of private health insurance, inflating premiums.

• Federal dollars will pay for 90-100% of the cost of covering newly eligibles across the nation, making South Carolina one of the biggest potential beneficiaries of the funds associated with the expansion (nearly 20% of South Carolinians are uninsured).

• Increased federal funding contributes to the economy – creating jobs and spurring consumer spending.

Also…• Moreover, if South Carolina does

not expand Medicaid, South Carolinians will ultimately subsidize the cost of coverage in states that do, via federal taxation.

• Net Savings – South Carolina’s spending on newly eligibles will be offset by the savings realized in reduced spending on uncompensated care.

• In the first five years of expanding Medicaid, South Carolina would realize net savings of $678 million.

• The Department of Insurance is accepting comments regarding the selection of a South Carolina essential health benefits (EHB) benchmark plan for health insurance coverage under the federal Affordable Care Act by September 25 according to South Carolina Healthcare Voices and the South Carolina Department of Insurance Site.

• There was a September 25th hearing that was rescheduled but did not include a date.

• As of October 10th , according to http://www.statereforum.org/state-progress-on-essential-health-benefits a working group on Essential Health Care Benefits was formed but no benchmark plan was recommended.

What’s happening now in SC…

What’s happening now, cont…

To facilitate an effective state-level implementation, the South Carolina Institute of Medicine and Public Health and  South Carolina Healthcare Voices, is convening stakeholders from the non-profit sector and state agencies to explore the various state-specific elements of the legislation and examine possible approaches to implementation. 

What’s happening now, cont…

This initiative will include the creation of open, non-discriminatory, educational workgroups to help the state prepare for and implement health reform.  By bringing diverse stakeholders around the table we will develop a plan that is best for the state

What’s happening now, cont…

This effort, with honorary co-chairs Doug Bryant, a former Commissioner of the SC Department of Health and Environmental Control, and Robby Kerr, a former Director of the SC Department of Health and Human Services, will focus on building linkages with key state agencies to provide a neutral forum for collaborative decision-making and expand the collective public capacity to address the implementation of this legislation.

In short, the goal of this initiative is to create a public-private collaborative so that South Carolina can most successfully implement health care reform and take advantage of the funding opportunities that are available to our state. 

Advocacy next steps

• How do you identify which coalitions to be apart of?

• Which coalitions should you join?

• How do you identify stakeholders, champions, and grasstops?

• Where are decisions being made, and how do you get a seat at those tables?

Advocacy next steps, cont…

- Setting up meetings with elected representatives

- Sign-on Letters- Meet with agency

directors - Voter

mobilization!!!!!

Messaging, pt 1

You are meeting with a South Carolina State Legislator about ACA expansion. You have 10 minutes to make your case. Take 5 minutes to develop three speaking points. Use materials if you need.

Break off in small groups, and take the next 15 minutes practicing your talking points.

Messaging, pt 2

What talking points can we use to take to elected officials and key decision makers?

Messaging, pt 3

Lets create a plan!!!!!!

What needs to happen in the next 90 days?

-sign-on letters -meetings with

representatives- State lobby days

Examples of talking points • Before health care reform…– health insurance companies could legally

discriminate against me– I had to be disabled by AIDS before I could get

the care that would prevent me from progressing to AIDS

•

Educate Yourself• Get the facts on health care reform and what it means for

people living with HIV• Take advantage of available resources

– HIV Health Reform www.HIVHealthReform.org – Families USA www.FamiliesUSA.org – Community Catalyst www.CommunityCatalyst.org– Treatment Access Expansion Project www.TAEP-USA.org– AIDS United www.AIDSUnited.org – White House www.whitehouse.gov/healthreform

• Factsheets/Talking points• Webinars• Policy Updates