Before the Affordable Care Act (ACA), another Ryan White Care (RWC) program linked RWC clients to insurance for HIV care. The AIDS Insurance Continuation Program enabled its clients to keep their private health insurance and saved public funds. Unfortunately, that program has had a very turbulent year.

In the fall of 2014 the administrators of the AIDS Insurance Continuation Program (AICP) informed its subcontracted agencies that all their contracts would end by March 31, 2015. AICP had subcontracted with these agencies to recruit clients and to provide “health insurance” case management for its clients. As of press time, it is not clear who will provide recruitment and case management to AICP clients after March 31, 2015.

Two local agencies, Broward House, and The Wellness Center, had their contracts terminated. According to staff of the Wellness Center, other problems occurred had last year: a rushed attempt to transition AICP clients into ACA marketplace plans, a poor selection of ACA plans, and change in eligibility requirements.

While the number of AICP clients is relatively small, the AICP Program has had over ten years of experience providing funds to maintain health insurance for people with HIV. With the coming transfer of large numbers of RWC clients to the ACA marketplace plans, this experience could be invaluable.

This experience, however, was concentrated at three levels: the Department of Health in Tallahassee, Health Council of South Florida, and the direct service agencies. The Federal Ryan White Care Program and the State of Florida General Revenue jointly provide funds to the Florida Department of Health which contracts with the Health Council of South Florida to administer the program. The Health Council had subcontracted with agencies such as Broward House and the Wellness Center to provide client services

Another RWC insurance program has recently emerged - ADAP Premium Plus. Many people lack a clear idea of the relationship between these two programs. As the Florida Department of Health controls the budget for both programs, its interpretation has great clout.

Nick Van Der Linden of the Florida Department of Health explained the relationship as follows: “The ADAP Premium Plus insurance program is a component of ADAP designed to assist eligible ADAP insured clients with their out-of-pocket costs. ADAP Premium Plus clients have private or government-sponsored health insurance with prescription coverage equivalent to the ADAP formulary drugs. The AIDS Insurance Continuation Program (AICP) is a sub-component of the ADAP Premium Plus insurance program. Premiums are paid through our contracted provider, the Health Council of South Florida.”

According to the people who control the budget of both programs, the newer ADAP Premium Plus insurance program has absorbed the older AICP program. Under this definition, within ADAP programmatic difference exists between government sponsored health-insurance and private health insurance.

While this has been a turbulent year for AICP, it has probably been confusing to its clients. With an influx of RWC clients into ACA marketplace plans set to occur over the next few years, the percentage of clients with private insurance will decrease relative to those with government-sponsored insurance. More changes lie ahead.