Thursday, December 5, 2013

Affordable Care Act still a maze for HIV-positive people in Ga.

After the disastrous rollout of the Affordable Care Act, the Obama administration has met their Nov. 30 deadline to fix the “vast majority” of issues that have plagued the site since its Oct. 1 introduction. And with that, area organizations are ramping up efforts to inform those in the LBGT community, and specifically those living with HIV, about the benefits of the Affordable Care Act and how to obtain them.

More than anything, officials at several organizations want people to know about the new rules concerning preexisting conditions. Previously, those with HIV or other serious health issues were often turned down or charged exorbitant rates when applying for health insurance. In perhaps the most significant aspect of the Affordable Care Act, insurance companies may no longer deny coverage for preexisting conditions.
It's probably the biggest single thing that will benefit those living with HIV and AIDS in Georgia,” said Georgia Equality Executive Director Jeff Graham. “This completely opens up the market for people living with HIV.” Georgia Equality and The Health Initiative plan a Healthcare Town Hall on Dec. 11 for people, especially LGBTQ people and those with HIV/AIDS to learn more about their options through the ACA.

Graham also cites the new marketplace's lower cost options in general, specifically for those who have insurance benefits through COBRA. A search of the federal website will allow them to find a plan at a lower cost without sacrificing benefits, he said.

On Dec. 2, the 25th anniversary of World AIDS Day, President Barack Obama praised the ACA for providing coverage to all who need healthcare regardless of any preexisting conditions.

“And thanks to the Affordable Care Act, millions of insured Americans will be able to get tested free of charge. Americans who were uninsured will now be able to have access to affordable health care coverage, and beginning in January, no American will be again denied health insurance because of their HIV status,” Obama said.

Ga. groups analyzing plans best for local HIV clients
Dr. Gwen Davies, clinical director at Positive Impact, cites the success of the similar health insurance initiative that's been in place in Massachusetts since 2006. “What you want is for people with HIV to have access to care, access to medication, and that's exactly what they've seen happen in Massachusetts,” she said.

The website issues have delayed access to organizations looking to analyze plans for consumers. “The issue is being able to tell people what plans are available,” Davies said. “Some of them have better coverage for medications than others, as far as those living with HIV.”

The Health Initiative, in collaboration with The Rush Center and Georgia Equality, had hoped to have the analysis of the various health care options available for the community by early to mid-November. But due to Healthcare.gov's technical glitches, a final analysis is expected in early December.

There are five different insurance companies offering 68 different kinds of plans,” said Graham. “We'll be analyzing the plans and looking at the formularies to see what kind of medication is covered.”

Armed with that information, they will best be able to help those living with HIV decide on the plan that's right for them.

To aid in the effort, The Health Initiative hired a navigator that will supply free support for consumers as they check eligibility requirements, choose plans and complete enrollment forms. However, people are advised to wait until the data analysis is done before contacting The Health Initiative for assistance and to set up an appointment. Navigators are also available through the federal healthcare site as well.

Positive Impact will be offering more patient education for those living with HIV now that the website is running more smoothly. Two staff members are also being trained as navigators. And, the organization will soon be able to offer their services to those with private insurance and Medicare. Previously, Positive Impact only accepted Medicaid.

Our goal is twofold. One, it's to make sure people we are already seeing can continue their care and keep their provider,” Davies said. “And two, we want to make sure that people are able to access it at any level of income.”

Complicating matters, however, was Gov. Nathan Deal's refusal of federal funds to expand Medicaid in Georgia for lower income individuals.

That's a huge problem,” said Davies. “An enormous number of our clients, maybe 70 percent of them, would have been covered by that Medicaid expansion.”

Graham calls it “probably the greatest challenge that people living with HIV statewide will face” adding that the majority of those living with HIV have incomes low enough to qualify for the expanded Medicaid offer.

The Ryan White Program offers help to those with HIV who don't have the financial means for sufficient care, but Davies fears those funds could be at risk.

We never know how much money will be in the Ryan White system year-to-year,” she said. “This year and next, it's not such a problem for people with HIV, but it likely will be reduced after that because the assumption under the Affordable Care Act was that people with low incomes would be covered under the Medicaid expansion.”

So if they need specialty care outside of the Ryan White funds, they will basically be indigent.”

The issue is expected to be used against Deal in next year's gubernatorial election, in which the final result could have a major impact on healthcare options for lower income individuals, especially those living with HIV, for years to come.

MORE INFO 
Atlanta Healthcare Town Hall
sponsored by The Health Initiative and Georgia Equality
Wed., Dec. 11, 6:30-8 p.m.
Phillip Rush Center
1530 DeKalb Ave., Atlanta, GA 30307
www.thehealthinitiative

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