ryan white program overview hiv care under the affordable care act: addressing the needs of hiv...

RYAN WHITE PROGRAM OVERVIEW

HIV Care Under the Affordable Care Act: Addressing the Needs of HIV Providers & Health Professionals in Georgia

Wednesday, May 20, 2015Loudermilk Conference Center

Atlanta, GA 30303

OUTLINE1. General Ryan White Program Overview2. Fulton County Ryan White Program

What do we fund? How many people do we serve? Who do we serve?

3. Ryan White and ACA HRSA Requirements Funding for Health Insurance Program

4. Future of Ryan White in ACA Era

RYAN WHITE PROGRAMThe Ryan White HIV/AIDS Program, which began in 1990, provides HIV-related services in the United States for those who do not have sufficient health care coverage or financial resources for coping with HIV disease. The program fills gaps in care not met by other payers. The majority of Ryan White funds support primary medical care and essential support services.

http://www.hab.hrsa.gov/abouthab/aboutprogram.html



RYAN WHITE PROGRAM• The Ryan White legislation created a number of

programs, called Parts, to meet needs for different communities and populations affected by HIV/AIDS.o PART A: provides emergency assistance to Eligible

Metropolitan Areas and Transitional Grant Areas that are most severely affected by the HIV/AIDS epidemic.

o PART B: provides grants to all 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and 5 U.S. Pacific Territories or Associated Jurisdictions.




• PART C: provides comprehensive primary health care in an outpatient setting for people living with HIV disease.

• PART D: provides family-centered care involving outpatient or ambulatory care for women, infants, children, and youth with HIV/AIDS.

• PART F: provides funds for a variety of programs:o THE SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE PROGRAM grants fund

innovative models of care and supports the development of effective delivery systems for HIV care.

o THE AIDS EDUCATION AND TRAINING CENTERS PROGRAM supports a network of 11 regional centers and several National centers that conduct targeted, multidisciplinary education and training programs for health care providers treating people living with HIV/AIDS.

o THE DENTAL PROGRAMS provide additional funding for oral health care for people with HIV.

o THE MINORITY AIDS INITIATIVE provides funding to evaluate and address the disproportionate impact of HIV/AIDS on African Americans and other minorities.




FULTON COUNTY RYAN WHITE PROGRAM• Fulton County has administered the Ryan White Part

A Program on behalf of the 20-county Eligible Metropolitan Area (EMA) since the legislation began.

• Funded since 1991 the 1st year in which funds were awarded.

• One of original 16 EMAs. Now there are 24 EMAs and 32 TGAs.

WHAT DO WE FUND?

PRIORITY CATEGORY FY14 FY15

Outpatient Ambulatory Medical Care 9,463,022$ 11,026,777$ ADAP 1,500,000$ Oral Health 1,900,435$ 1,898,715$ Health Insurance Premium & Cost Sharing 1,027,000$ 1,027,000$ Mental Health 1,316,299$ 1,216,299$ Medical Nutrition Therapy 148,210$ 148,210$ Medical Case Management 1,511,096$ 1,411,096$ Substance Abuse - outpatient 1,124,491$ 1,024,491$ Case Management Non-medical 384,012$ 384,012$ Child Care 26,068$ 26,068$ Emergency Financial Assistance: Medications 1,062,654$ 1,277,324$ Emergency Financial Assistance: Utility Assistance 21,567$ Food Bank/ Home-Delivered Meals 916,636$ 916,636$ Housing 12,540$ 10,400$ Legal 88,445$ 88,445$ Linguistics 66,392$ 66,392$ Medical Transportation 89,200$ 100,000$ Psychosocial Support 205,827$ 205,827$

HOW MANY PEOPLE DO WE SERVE?

CLIENTS SERVED BY PRIORITY CATEGORY (FY14), CY14 CAREWare Ryan White Data

Report

PRIORITY CATEGORYCLIENTS SERVED

% OF ALL CLIENTS (13,157)

Outpatient Ambulatory Medical Care 11,350 86.3%Oral Health 3,162 24.0%Mental Health 2,484 18.9%Medical Nutrition Therapy 1,108 8.4%Medical Case Management 7,036 53.5%Substance Abuse - outpatient 984 7.5%Case Management Non-medical 8,722 66%Child Care 128 1%Emergency Financial Assistance 775 6%Food Bank/ Home-Delivered Meals 1,186 9%Housing 3 0%Legal 113 1%Linguistics 313 2%Medical Transportation 2,532 19%Psychosocial Support 2,419 18%

WHO DO WE SERVE?

GENDER

• 75% of all clients, and 75% of all OAMC clients were male

• 24% of all clients, and 24% of all OAMC clients were female

• 1% of all clients, and 1% of all OAMC clients were Transgender

CY14 CAREWare Ryan White Data Report

RACE/ETHNICITY (ALL CLIENTS)

• Race (regardless of ethnicity) of clients served:o Blacks 79.5% (n=10,460)o Whites 17.7% (n=2,333) o All Other Races 2.3% (n=303)o Unknown 0.5% (n=61)

• Clients of Hispanic Ethnicity served:o Black Hispanics 0.40% (n=52) o White Hispanics 4.39% (n=577)o All other races with Hispanic Ethnicity 0.56% (n=74)o Unknown Race 5% (n=38)


AGE (ALL CLIENTS)

• 45% were age 25-44• 44% were age 45-64• 8% were under 25• 3% were 65+


HIV/AIDS STATUS (ALL CLIENTS)

• 48.5% (n=6,378) HIV +, not AIDS• 4.4% (n=582) HIV +, AIDS status unknown• 44.9% (n=5,904) CDC-defined AIDS• 1.1% (n=149) HIV indeterminate (< age 2) • 0.8% (n=102) HIV –• 0.3% (n=42) Unknown (affected clients only)


ANTIRETROVIRAL STATUS (11,350 OAMC CLIENTS)

• 23% (n=2,620) None• 70% (n=7,891) HAART• 7% (n=839) Mono or Dual


OAMC VISITS (11,350 OAMC CLIENTS)

• 9% (n=1,053) 1 Visit • 11% (n=1,305) 2 Visits • 30% (n=3,356) 3-4 Visits• 50% (n=5,636) 5 or More


HOUSEHOLD INCOME (ALL CLIENTS)

• 61% (n=7,973) ≤ Federal Poverty Level (FPL)– Thus, 61% of clients are ineligible for coverage

under ACA• 25% (n=3,282) 101-200% FPL• 7% (n=913) 201-300% FPL• 3% were >300% FPL


RYAN WHITE AND ACA

HRSA REQUIREMENT

• RW is the payer of last resort and grantees must “vigorously pursue” client eligibility for public and private insuranceo Grantees may not dis-enroll clients from services

for failure to enroll in public or private insurance coverage

AGENCIES MUST VIGOROUSLY PURSUE 3RD PARTY COVERAGE INCLUDING ACA

• RW grantees and sub-grantees must “vigorously pursue” any excess premium tax credit a client receives from the IRS upon submission of the client’s tax return

• HRSA is considering allowing RW grantees to cover client tax liabilities associated with an overpayment of the premium tax credit

LOCAL REQUIREMENT

• Agencies Describe Policies and Practices in Funding Application

• Contractual Requirement• Checked During Site Visits• 61% of our Part A clients are ineligible for coverage

under ACA due to income ≤ 100% FPL

PART A EFFORTS TO SUPPORT HEALTH INSURANCE PROGRAM

• FY14 $1,027,000o State Program Did Not Roll-out as Plannedo Funded Local Agencieso Patient Access Network Foundationo Virtually no funds expended

• FY15 $1,027,000o State Program is Beginning – Funds not Neededo Funds May be Reallocated

GEORGIA DEPARTMENT OF PUBLIC HEALTH HIV FUNDING FOR CARE AND TREATMENT

Division of Health Protection, Infectious Disease and Immunization Section, HIV Office, Georgia Department of Public Health

FEDERAL 67,728,076$ STATE 16,594,194$

Part B Base 12,473,753$ 23% ADAP 11,587,504$ 70%ADAP 32,093,981$ 59% Health Districts 3,146,885$ 19%ADAP Supplemental 9,486,948$ 17% Grady 1,267,119$ 8%MAI 557,798$ 1% Administration 592,686$ 4%Emerging Communities 161,543$ 0% 16,594,194$ 100%

54,774,023$ 100%TOTAL: 84,322,270$

Health Insurance Program 5,267,181$ 51%Medications 4,995,107$ 49%

10,262,288$ 100%

Medications 2,691,765$ 100%

FY 2015-16 Ryan White Part B/ADAP Grant

FY 2015-16 ADAP Shortfall Relief Grant

FY2014-15 Ryan White Part B Supplemental Grant

FY 2014-15 HIV/AIDS Funding

As we continue to move forward with universal health coverage there are three questions that will determine impact of ACA on Ryan White Programs

1. Extent of insurance expansion? 2. Scope of benefits through insurance expansion? 3. Ryan White Program ability to provide vital

enabling services and fill ongoing gaps?

RYAN WHITE AND ACA IN THE FUTURE

RYAN WHITE AND ACA IN THE FUTURE

• To make health care reform work we also need a Ryan White Program that is able to:o Provide vital enabling services to get people in

care and keep them in careo Provide insurance assistance to support newly

insured clientso Cover services and populations left out of reform

Intersections of Ryan White and the Affordable Care Act (ACA), Amy Killelea, JD, NASTAD, U.S. Conference on AIDS, October 1, 2012 http://www.hivhealthreform.org/wp-content/uploads/2012/12/Health-Reform-and-RW-USCA-9-27-12-ppt.pdf

http://www.hivhealthreform.org/wp-content/uploads/2012/12/Health-Reform-and-RW-USCA-9-27-12-ppt.pdf

http://www.hivhealthreform.org/wp-content/uploads/2012/12/Health-Reform-and-RW-USCA-9-27-12-ppt.pdf

MASSACHUSETTS EXAMPLEChanged how Ryan White funding was used in state, with greater share of resources shifting from paying for care to paying for:• Insurance continuation• Co-payments• Support services to help engage people with

HIV in care and support adherence

EXCERPT FROM HRSA FY 2014 CONGRESSIONAL JUSTIFICATION FOR RYAN WHITE FUNDING

“It is anticipated, however, that, on average, coverage will not be adequate for the care and treatment of people living with HIV/AIDS (PLWH) due to plan limitations on the scope of coverage…

Other Ryan White services that may not be covered include oral health care, medical case management, treatment adherence counseling, psychosocial support services, outreach and a host of other support services that in many cases are critical to identifying, linking and maintaining people living with HIV and AIDS in care.”

Updating the Ryan White HIV/AIDS Program for a New Era: Presentation and Dialogue with UCHAPS, June 10, 2013, Jeffrey S. Crowley, Distinguished Scholar/Program Director, National HIV/AIDS Initiative, O’Neill Institute for National and Global Health Law, Georgetown Law

CONTACT INFORMATION

Jeff Cheek, DirectorFulton County Ryan White Program

Office of the County Manager137 Peachtree Street, SW

Atlanta, GA 30303

404/612.0789

[email protected]

mailto:[email protected]

ryan white program overview hiv care under the affordable care act: addressing the needs of hiv...

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