ACA Implementation and the Border Focus on HIV, as well as STD,
TB, Addiction & Family Planning Concerns
Alphabet Soup: ACA, HIV, SUD, TB, and HCV on the BorderJune 20,
2014
Tom Donohoe, MBAAssociate Professor of Family MedicineDirector,
UCLA Pacific AIDS Education and Training CenterAssociate Director,
UCLA Center for Health Promotion and Disease Prevention
David Geffen School of Medicine at UCLA
#
I have already seen you present on the ACA(in-person, webinar,
etc)
TrueFalseI dont remember#
Yesb. Noc. Im not sure
Talking PointsAnswer: No. How many ACA-related trainings have
you already attended (last 12 months)?
01-23-45 or more#
Declaration of DisclosureI do not have any financial
arrangements or affiliations with commercial sponsors which have
direct interest in the subject matter#
Read during opening.Educational Objectives 1State the importance
of understanding ACA implementation for California and Arizona and
how it will impact border communities & people living with HIV,
TB, HCV, and SUD
Identify key dates for ACA roll-out and strategize to
effectively implement the ACA locally#
At the end of this training participants will be able to(read
objectives)Educational Objectives 2Explain how the ACA will extend
new insurance benefits and patients rights and
responsibilitiesImprove HIV patients engagement (linkage &
retention) in high-quality HIV care as systems changeObtain further
information and referral resources for ACA implementation in the
border region as more patients become enrolled#
(read objectives)Which best describes WHERE you work?
ClinicCommunity-based organizationHealth
departmentUniversityHospitalOther#
Which best describes WHAT you do?
Clinician (MD, PA, NP, nurse, dentist, etc)Case managerHealth
education (peer educator, promotora)Medical AssistantOther#
What type of clinician?
MDNPPANurseDentistOther#
The Border#
So lets start our with some definitions.
What do we mean when we say the US/Mexico Border region?
There is a commonly accepted definition for the border region
and its the same one the federal agency that funds our
collaborative (the Health Services and Resources Administration or
HRSA) uses.
So what do YOU think the US/Mexico Border region is?The
HRSA/Federal definition of the U.S. border region is how many miles
from Mexico?
5 miles 12 miles 62 miles 75 miles 100 miles#
The Border
#
The border between the United States and Mexico stretches
approximately 2,000 miles (3,220 kilometers) from the southern
border of Texas to California.
The La Paz Agreement of 1983 defines the United States-Mexico
border region as the area extending 100 kilometers (or 62 miles) on
either side of the border. The border region includes 4 U.S. and 6
Mexican states in total: Texas, New Mexico, Arizona and California
in the U.S.; and Baja California, Sonora, Chihuahua, Coahuila,
Nuevo Leon and Tamaulipas in Mexico. Additionally, there are
approximately 25 Native AmericanNations located within the Border
Region, creating a tri-national region (e.g., scroll across
Arizona, Mexico, Tohono OOdham Tribal Nation).
The US border region includes the US communities that lie within
62 miles from the border with Mexico. (Scroll along the US side
with the Adobe cursor.) This US border region has some of the
poorest economic and health outcomes in the United States, some of
which we will highlight in the next slide.U.S. Border Region
ChallengesHealth Professional Shortage Area (HPSA)Higher incidence
of infections diseases compared with the U.S. averageIf made a
state, the border region would rank:1st in number of uninsured
children2nd in death rates due to hepatitis3rd in deaths related to
diabetesLast in access to health careLast in per capita income
Source: US/Mexico Border Health Commission#
The border region has increased health disparities, compared
with the rest of the US. First it is designated a Health
Professional Shortage Area (HPSA.) Most of the U.S.-Mexico border
region is rural. Of the U.S. border counties, 73% are Medically
Underserved Areas (MUAs) and (63%) are Health Professional Shortage
Areas (HPSAs.) HPSAs are designated by HRSA as having shortages of
primary medical care, dental or mental health providers. The Border
Region has Higher incidence of infections diseases compared with
the U.S. average.
If it were a separate US state, the border region would rank:1st
in number of uninsured children2nd in death rates due to
hepatitis3rd in deaths related to diabetesLast in access to health
careLast in per capita income
Now Im going to turn it over to Kiesha who is going to talk
about a theme for todays webinar: The need to test, link and keep
people in high quality HIV care on the border.
Where the Poor and Uninsured Americans Live
#
HIV Treatment CascadeGardner, E., et al. (2010). The spectrum of
engagement in HIV care and its relevance to test-and-treat
strategies for prevention of HIV infection. Clin Infect Dis.
52(6):793-800.#
A central goal of the Affordable Care Act is to significantly
reduce the number of uninsured by providing a continuum of
affordable coverage options through Medicaid and new health
insurance exchanges. Strengthening health care also means reducing
the growth of health care costs and promoting high-value effective
care. This means getting people into care and keeping them in
care.
One way we in the HIV world can go about this is to refer back
to our HIV treatment cascade road map. Many of you are probably
already familiar with Gardners article on the spectrum of
engagement in HIV care. Clinical Trial HIV/Prevention Trials
Network 052 (known as HPTN 052) demonstrated that if a person was
virally suppressed to undetectable levels of HIV in the
bloodstream, they are 96% less able to transmit the disease to
their partner. That news means clearly treatment is prevention. So
getting to zero or no new infections are part of the plan.If our
ultimate goal is to increase the number of HIV positive individuals
who are adherent with undetectable viral loads, we need to ensure
that they get tested and know their HIV status, they get connected
to---and stay in---high quality HIV care. Later we will illustrate
through case discussions the conenctions between the treatment
cascade and ACA implementation on the border.Affordable Care Act
(ACA)#
So how does the Affordable Care Act help address these health
disparities on the border? Although todays webinar is going to
focus on people living with HIV on the border, lets first look at
the impact of the affordable care act on US health disparities in
general. Passage and implementation of the Patient Protection and
Affordable Care Act is one of the biggest changes in US healthcare
in 2 generations.Health Reform from the BeginningMedicare &
Medicaid establishedAffordable Care Act (ACA) signed into
lawSupreme Court upholds ACA#
So how did we get here? The last change this large in the US
healthcare system occurred when Medicare and Medicaid were
established. Medicare is a national social insurance program,
administered by the U.S. federal government since 1965, that
guarantees access to health insurance for Americans aged 65 and
older and younger people with disabilities. Medicaid is the United
States health program for families and individuals with low income
and resources. It is a means-tested program that is jointly funded
by the state and federal governments, and is managed by the
states.[1] People served by Medicaid are U.S. citizens or legal
permanent residents, including low-income adults, their children,
and people with certain disabilities. Poverty alone does not
necessarily qualify someone for Medicaid.
The Patient Protection and Affordable Care Act was signed into
law in 2010 and was upheld by the Supreme Court in 2011, with the
provision that states would not lose their exisiting Medicaid
funding if they chose not to expand Medicaid.
Where We Are Now & Where We Are
GoingOutreach/EducationAssistors/Navigators
MarketplacesSign-up starting October 1, 2013
Health Insurance (Marketplaces & Medicaid expansion)
coverage begins January 1, 2014ACA fully implemented#
REMEMBER: Access to the health insurance market places begins
October 1, 2013 when the market places open. Soon you will hear
from a lot of outreach and education programs---from CBOs to the
media-- describing the marketplaces in your state and pushing
people who will need to get health insurance to learn more about
the marketplaces. People who can use the marketplaces to sign up
for Medicaid or to purchase insurance will be referred to Assisters
and Navigators who will actually start enrolling people October
1.
This is when people can begin signing up for health insurance
that begins January 1, 2014.
When the Patient Protection and Affordable Care Act is fully
implemented in 2019, we will have millions of people with new
health insurance coverage. We will still have millions without
coverage, which we will describe more fully at the end of the
webinar.I feel the ACA will make my job more secure
TrueFalseIm not sure/Dont know#
Yesb. Noc. Im not sure
Talking PointsAnswer: No.
What About HepC and ACA?Rachel McLean, MPHBrian Risley, Danny
Jenkins..*MediCal expansion? Co-pays, Payment assistance, budget
busters, reinfection rates, Costs costs costs costs sustainable?
Undocumented?*Affordable Care Act (ACA) & HIV
ServicesElimination of pre-existing condition exclusionsExpansion
of Medicaid to non-disabled adults with incomes of up to 133% of
FPLSubsidies to purchase insurance through exchanges for people
with income up to 400% FPLMore PLWH are eligible for
Medicaid/Marketplace exchanges
#
How does the Affordable Care Act improve access to coverage and
protect people living with HIV/AIDS now? There are a few key
provisions in the ACA that directly benefit people living with
HIV/AIDS.
READ SLIDE
Health Reform will bring health insurance coverage to 32 million
people over the next few years. Yet, there will still be about 23
million people in the country without health insurance. They will
be outside the health care system. Some people will choose not to
buy insurance and will have to pay a fee. And about 7 million will
be undocumented immigrants.
Ryan White Funds: Payer of Last ResortRyan White Program funds
may not be used for any item or service for which payment has been
made or can reasonably be expected to be made by another payment
source.
#
For those people living with HIV who still remain uninsured and
have no other payer options for their care, remember Ryan White
will remain the payer of last resort. Income status of individuals
who receiveRyan White-funded services
FPL = Federal Poverty Level#
When we look at the income status of individuals who receive
Ryan White services you can see that the majority make less than
100% of the federal poverty level. Remember is states that are
expanding Medicaid, people earning less than 133% of the federal
poverty level will qualify for Medicaid if they dont already have
it. People making more than this amount and less than 400% of the
federal poverty level, about 10-20% of Ryan White patients, will be
required to purchase health insurance of or pay a penalty. However,
they are very likely to qualify for additional assistance from
their state or local AIDS program and/or ADAP (AIDS Drug Assistance
Program.)
As people living with HIV move from Ryan White as payer of last
resort to Medicaid or private insurance to pay for their medical
needs, the ACA defines what essential health benefits they will
receive.
So what is 100% FPL for a single person?What is 100% of the 2013
FPL for a single person
$5,025/year$7,110/year$11,490/year$13,170/yearI have no
idea#
2013 Federal Poverty Level
CoverageforAll.org 138% FPL=$15,856The federal poverty level, or
FPL, is the set minimum amount of gross income that an individual
or family needs for food, transportation, shelter and other
necessities. In the U.S. this level is determined by the Department
of Health and Human Services (HHS). FPL varies according to family
size, is adjusted for inflation and is reported annually.
Medicaid Expansion
JAMA. 2013;309(12):1219. doi:10.1001/jama.2013.2481#
Medicaid has been the countrys health coverage program for
low-income individuals and families since 1965. It is jointly
administered and funded by the federal government and the states.
The federal government sets basic guidelines, and the states have
broad authority to modify their Medicaid programs as they see fit,
as long as they meet the federal guidelines.
Beginning in 2014, the Affordable Care Act (ACA) provides for
the expansion of Medicaid eligibility to adults with incomes up to
138% FPL ($15,586 for an individual), which would make millions of
currently uninsured adults newly eligible for the program. The 2011
Supreme Court ruling maintains the Medicaid expansion, but limits
the Secretarys authority to enforce it. This means that states
decide whether or not to adopt Medicaid expansion.
For most states that do not implement the ACA Medicaid
expansion, there will be large gaps in coverage for low-income
individuals because individuals with incomes below poverty are not
able to access subsidies to purchase coverage in in the new health
insurance exchanges. Individuals with incomes below 100% FPL
($11,490 annually in 2013) generally cannot receive subsidies to
purchase coverage in the newly established health insurance
exchanges and will not gain any new affordable coverage options and
continue to face the consequences of being uninsured. This could
leave individuals with higher incomes access to health coverage
options while leaving those with lower incomes few or no options
for affordable coverage. Which border state has said it will NOT
expand Medicaid as part of ACA implementation?
Arizona California New Mexico Texas#
Ryan White Core Services vs. Essential Health Benefits (EHB)Ryan
White Core ServicesAmbulatory & outpatient careAIDS
pharmaceutical assistanceMental health servicesSubstance abuse
outpatient careHome health careMedical nutrition therapyHospice
servicesHome and community-based health servicesMedical case
management, including treatment adherence servicesOral health care
(not standard)
ACA Essential Health Benefits*Ambulatory patient
servicesEmergency servicesHospitalizationMaternity & newborn
careMental health & substance use disorder services, including
behavioral health treatmentPrescription drugsRehabilitative &
habilitative services & devicesLaboratory servicesPreventive
and wellness services & chronic disease managementPediatric
services, including oral & vision care
#
Under Ryan White, a person has access to Ryan White Core
Services, which include (read red list) and others. Under the ACA,
qualified health plans include the following Essential Health
Benefits as part of coverage. It will be important for the Ryan
White case managers, benefits counselors and others to understand
the choices a transitioning patient may face, and understand what
assistance may be offered to them to help them remain in
high-quality HIV care. Health Insurance (Marketplace) Exchanges
Kaiser Family Foundation. State Decisions for Creating Health
Insurance Marketplaces.
http://www.kff.org/health-reform/state-indicator/state-decisions-for-creating-health-insurance-exchanges-and-expanding-medicaid/
#
The ACA creates health insurance marketplaces or exchanges in
every state. These are online portals where people can shop for
private insurance---with the potential for immediate tax credits or
subsidies--or sign up for Medicaid. All states will have
marketplaces, regardless of whether or not they expand
Medicaid.
The Kaiser Family Foundation website has a helpful infographic
mapping state decisions for creating their type of health insurance
marketplaces.
California and New Mexico will both host state-based
marketplaces. Both Arizona and Texas will host
federally-facilitated marketplaces. State-Based Marketplace
Exchanges:California & New Mexico
#
In California the body managing the state-based marketplace is
called Covered California and in New Mexico it is called the New
Mexico Health Insurance Alliance.
Federally Facilitated Marketplace Exchanges: Arizona &
Texas
#
For updated information on federally-facilitated market places,
like those in Arizona and Texas, you can visit healthcare.gov.ACA
Implementation on the Border#
Now we will talk a little about each of the four border states
and their progress towards ACA roll-out in Jan 2014. For each state
we have developed a case study to highlight some of the key issues
individuals living with HIV on the border may face beginning in
October 2013, when the marketplaces open, for coverage that begins
January 1, 2014..
The four cases we present are composites based on real-life
situations that could occur to people living with HIV on the border
as the Affordable Care Act is implemented. They do not depict any
individuals and any similarities are purely coincidental. We wish
to thank our expert reviewers in each state for their help in
reviewing these demonstration cases.
ACA Implementation on the BorderExpanding health insurance
coverage in every stateIncreasing access to MedicaidEstablishing
Health Insurance MarketplacesCovering preventive services with no
deductible or co-pay#
Overall, implementation of the Affordable Care Act will mean
more people will have health insurance coverage in all 4 US border
states (California, Arizona, New Mexico and Texas) starting January
1st, 2014. Much of this increased coverage will take place because
of planned expansions of Medicaid in 3 of the 4 states (Texas
currently is not planning an expansion of Medicaid)
Beginning Oct. 1, 2013, individuals in every state will be able
to shop for health insurance and compare plans through the
Marketplace. More people will be able to afford coverage because of
tax credits and costs sharing to purchase insurance through these
Health Insurance Marketplaces for those who make less than 400% of
the federal poverty level.
Remember the Affordable Care Act also includes key provisions
for expansion of preventive services and eliminates deductibles and
co-pays for preventive services.
ACA Implementation in ArizonaExpanded MeidicadImplemented
federally-run health insurance marketplace
#
Lets begin with Arizona. Since January the governor of Arizona,
Jan Brewer, has stated her support to expand Medicaid and bring
healthcare to an additional 350,000 Arizonans. The state senate has
voted to approve Medicaid expansion. The state legislature,
however, has not yet voted to make Medicaid expansion the law.
Arizona has also decided not to run its own state health insurance
marketplace. 947,880 or 18% of Arizonas non-elderly residents are
uninsured, of whom 866,366 (91%) may qualify for either tax credits
to purchase coverage in the Marketplace or for Medicaid if Arizona
participates in Medicaid expansion.
For the purposes of todays case discussion we will assume
Arizona moves forward with the intended Medicaid expansion.
Case Study: Arizona
Pedro is a 28 year old resident of Nogales, Arizona making
($12,065 or 105% FPL) who commutes to Tucson for HIV care at a Ryan
White clinic. He has been in the U.S. legally for 7 years. He also
receives HIV dental care and case management services through the
Ryan White program in Tucson. He wants to stay at his HIV
clinic.
#
Pedro is a 28 year old resident of Nogales, Arizona making
($12,065 or 105% of the federal poverty level) who commutes to
Tucson for HIV care at a Ryan White clinic. He has been in the U.S.
legally for 7 years. He also receives HIV dental care and case
management services through the Ryan White program in Tucson. He
wants to stay at his HIV clinic.
Under the ACA, will Pedro be required to purchase health
insurance?
YesNoIm not sure.#
a,. Yesb. Noc. Im not sure
Talking PointsAnswer: No. Pedro earns less than 138% of the
Federal Poverty Level under the ACA. Assuming Medicaid expansion,
Pedro will now qualify for Medicaid. Medicaid will now be his payer
and he will no longer need Ryan White to be his payer of last
resort. If, however, Pedro made more than 138% of federal poverty
level or $15,856 he would go the federally run Marketplace to
purchase insurance on his own and would receive a government
subsidy to help cover the cost.
Will Pedro be able to continue to receive HIV dental care
through the Ryan White program?
YesNoI dont know.#
a. Yesb. Noc. I dont know
Talking PointsAnswer: Yes. Pedro will still qualify for Ryan
White funded HIV wrap-around services not covered by Medicaid, like
adult dental care.
Remember, the highest priority for Pedros health and public
health is that he remain in high quality HIV care.
ACA Implementation in CaliforniaIncreasing access to
MedicaidTransition to Medicaid expansion: Low Income Health
Programs (LIHPs)Implementing state-run health insurance
marketplace
#
California began expansion of Medicaid in 2011 through a federal
Medicaid Waiver program called the Low-Income Health Program or
LIHP. Through the LIHPswhich varied from county to county, people
who were previously uninsured and were low income (or those who
would now qualify for Medicaid expansion under the Affordable Care
Act) were enrolled into transitional programs called LIHPs. For
citizens and legal immigrants who have been here for more than 5
years but who make too much to qualify for Medicaid expansion,
California will be running its own marketplace called Covered
California. The same federal cost sharing and tax credits will
apply in Covered California as in the federally run market places.
Additionally, California is currently considering health coverage
options for legal immigrants here less than 5 years.
We will now look at a case about Juan a person living with HIV,
and how the affordable care act could impact him.
There are 13 QHPS in the state of California and 19 rating
regions.39Border Rating Regions/PlansSan Diego Imperial HealthNet
(HMO)/$269Kaiser Perm (HMO)Anthem (EPO)Blue Shield (PPO)Kaiser
Permanente (HMO)Anthem (PPO)Molina Healthcare (HMO)SHARP Health
Plan (HMO co-pay)Blue Shield (PPO)SHARP Health Plan (HMO
co-insurance)Anthem (HMO)/$336
#
ACA, FPL, HIV, and OAHIPP Medicaid Expansion (MediCal) 138% of
Federal Poverty Level (FPL) 100% 138% Immediate (or deferred)
Premium Tax Credits 400% 500%
100 % 138% Subsidies 250% $15,856 (Individual)$32,500 (Household
of 4)$11,490 (Individual)$23,550 (4)$45,960 (Individual)$94,200
(4)$11,490 (Individual)$23,550 (4)$28,725 (Individual)$58,875 (4)
Silver PlanHIV-------OAHIPP400% FPL)HealthNet (HMO):
$26940SilverWith Tax Credit (200% FPL)HealthNet (HMO): $81 (plus
subsidies)40SilverWith Tax Credit (150% FPL)HealthNet (HMO): $18
(plus subsidies)
#
Case Study: AntonioSilver (eligible for Federal Subsidy)
Premium: $41/month(of a $231/month premium--per Covered CA
calculator)
Copays: Primary Care Visit: $15 Generic Drugs: $5Lab Test
$15X-Ray: $20Deductible: $500Out of pocket maximum: $2250
#
If for example, Antonio learns his options and benefits to
remain at his clinic and he choses the silver plan (double check
these figures---show what these are for Platinum?) he would only
have to pay $75/month premium and these other
co-pays/deductibles.
But remember this does NOT include other assistance, like
OAHIPP, so many of these expenses will be taken care of, including
the remainder of his premium.
And remember he now has health insurance for his other medical
needs or emergencies.
Case Study: CaliforniaJuan is a single construction worker with
no children living with HIV. He lives in Imperial county and earns
$15,512/year (135% FPL). He does not have health insurance and goes
regularly to a Ryan White clinic for his HIV care. He has bonded
with his HIV treatment team who he says saved my life. Juan has
been in the United States legally for 5 years.
#
Juan is a single construction worker with no children living
with HIV. He lives in San Diego and earns $15,512/year (135% of the
federal poverty level). He goes regularly to a Ryan White clinic
for his HIV care. He has bonded with his HIV treatment team who he
says saved my life. Juan has been in the United States legally for
5 years.
He wants to remain at his HIV clinic.
Will Juan need to go to the Marketplace to purchase health
insurance?
No, he will go to the Market Place and enroll in Medicaid
(Medi-Cal)Yes, and he will could get his entire premium paid by
OAHIPPYes, he will need to purchase health insurance in the Market
Place, but he will get no subsidyI have no idea#
No, he will go to the Market Place and enroll in Medicaid
(Medi-Cal)Yes, he will need to go to the Market Place and purchase
health insurance, but he will get subsidiesYes, he will need to
purchase health insurance in the Market Place, but he will get no
subsidyI have no idea
Talking PointsThe correct answer is A.Juan will be able to
enroll in Medicaid (called Medi-Cal in California) as California is
expanding Medicaid for all those who earn less than 138% of the
Federal Poverty Level ($15,856). He will now have Medi-Cal as his
insurance and will likely be enrolled into a Medi-Cal Managed Care
Plan. As he loves his HIV clinic and is doing well, he can remain
there as long as they have a contract with, or participate as a
member of the provider network of, the Medi-Cal Managed Care Plan
in which he enrolls. However, just because Juan is eligible for
Medi-Cal doesnt mean that transition process will be easy or that
he wont require support and assistance in attaining (and
maintaining) his benefits. Remember the highest priority for Juans
health---and public health---is that he remain in high-quality HIV
care.
Juan is in an auto accident and receives care in the emergency
room. Does he have health insurance?
YesNoI dont know.#
Later in 2014 Juan is in a severe car accident and is admitted
to the Emergency Room. Does he have health insurance to cover his
expenses?
YesNoI dont know
Talking PointsThe correct answer is yes. Medi-Cal is health
insurance that includes ER benefits.
Case Study: MariaMaria is a single 51 year old house/hotel
cleaner living in Calexico who estimates she will make $21,027 in
2014 (183% FPL), but has no health insurance. She says she could
never afford the rates for someone my age. She has not seen a
doctor for years, but sometimes goes across the border for
antibiotics, dental care, and back pain medicine. She wants health
insurance as she has chronic back problems and owns a small house
worth $200,000. She is afraid an ER trip could bankrupt her or
cause her to lose the house.
#
48Mary is a single 62 year old hotel manager born and living in
Las Cruces, New Mexico making $21,027 per year (183% FPL), but has
no health insurance. She says she could never afford the rates for
someone my age. She has not seen a doctor for years, but sometimes
goes across the border for antibiotics and dental care. She would
especially like health insurance now as she recently inherited a
small ranch worth $250,000. She believes she is in good health and
feels great. However, she does not know that she is living with HIV
and hepatitis C. She would not report any risks for either if
asked.
Maria (cont)Maria is a little worried that she is taking too
much back pain medicine as she has to take more and more to get
relief from pain and sometimes stress as she heard these pills
could be addictive. Otherwise, she believes she is in good health
and feels great.
However, she does not know that she is living with HIV and
hepatitis C. She would not report any risks for either if
asked.
#
49Mary is a single 62 year old hotel manager born and living in
Las Cruces, New Mexico making $21,027 per year (183% FPL), but has
no health insurance. She says she could never afford the rates for
someone my age. She has not seen a doctor for years, but sometimes
goes across the border for antibiotics and dental care. She would
especially like health insurance now as she recently inherited a
small ranch worth $250,000. She believes she is in good health and
feels great. However, she does not know that she is living with HIV
and hepatitis C. She would not report any risks for either if
asked.
Under the Affordable Care Act, Maria will be required to
purchase health insurance or face a tax penalty.
a. Trueb. Falsec. Im not sure#
I think Maria will sign up for health insurance (NOT pay the
penalty)
a. Trueb. Falsec. Im not sure#
Maria signs up & chooses a qualified health plan primary
care provider. Do you think she will be tested for HIV as part of
her routine care with her provider in 2014?
a. Yesb. Noc. Im not sure#
Were YOU offered an HIV test the last time YOU saw your primary
care provider?
a. YesI rememberb. Noc. Nowe already knew my HIV statusd. Im not
sure I dont remember#
Do you think Maria will be tested for HCV as part of her routine
care with her provider in 2014?
a. Yesb. Noc. Im not sure#
Remaining UninsuredMillions of individuals will remain uninsured
after January 1, 2014, including:Individuals subject to the mandate
who do not enroll Individuals who are eligible for Medicaid, but do
not enrollIndividuals who are not lawfully present#
Despite the broad sweeping impact of the Affordable Care, many
people will still remain uninsured. Often this group is referred to
as the residually uninsured.
The UC Berkeley Center for Labor Research and Education and the
UCLA Center for Health Policy Research estimate that in California
alone 3-4 million people will still remain uninsured in 2019. About
of these are predicted to be individuals who are eligible for
Medicaid expansion or subsidies to purchase health insurance in the
marketplace, but who face barriers that prevent them from becoming
insured. Predicted barriers to enrollment included lack of
awareness about the programs, challenges in the enrollment process,
or inability to afford subsidized coverage.
Additionally, an estimated 72 percent of these remaining
uninsured in Californian will be exempt from paying tax penalties
under the minimum coverage requirements of the ACA due to income,
lack of an affordable offer of coverage (8% of income or less) or
immigration status.
We know we have covered a lot of information so far in this
webinar and we want to encourage you to continue to seek ACA
implementation information on your own.Resources
[email protected]#
The next few slides will review what types of information are
available right now, with a focus on information relevant for HIV
providers, especially Ryan White providers.
#
Chart11106400HIV InfectedHIV Infected874056HIV DiagnosedHIV
Diagnosed655542Linked to CareLinked to Care437028Retained in
CareRetained in Care349622Need ARTNeed ART262217On ARTOn
ART209773Viral SuppressedViral Suppressed
Number of Individuals
Sheet1State of EngagementNumber of IndividualsHIV
Infected1,106,400HIV Diagnosed874,056Linked to Care655,542Retained
in Care437,028Need ART349,622On ART262,217Viral Suppressed209,773To
resize chart data range, drag lower right corner of range.
Chart10.70.210.060.03
HIV/AIDS Bureau. 2009 RDR. Household Income Data.Column1
Sheet1Column1100% FPL70%101-200% FPL21%201-300% FPL6%>300%
FPL3%To resize chart data range, drag lower right corner of
range.