The South Florida AIDS Network (SFAN) functions as the networking/advisory body for the Ryan White Care (RWC), Part B grant in Broward County. Its monthly meetings are open to the public.
The November SFAN meeting focused on the upcoming transition of clients from Ryan White Care (RWC) programs to the Affordable Care Act (ACA) marketplaces. Joshua Rodriguez of Broward Department of Health reported that ADAP will select about 800 clients to transition from RWC programs to ACA marketplace programs. Rodriquez stated that clients could decline this opportunity. This opportunity allows those selected clients to move from an HIV health care system (RWC) to a full health care system (ACA marketplace plans). This transition has the backing of the Federal Government.
On November 10, Florida ADAP issued an ADAP Program Update. In that update, the Health Resources and Service Administration (HRSA) stated its requirement that all grantees “vigorously pursue enrolling clients in the Marketplace and inform clients of the consequences of not enrolling.” That update also reported that the ADAP program will select for transition those clients with incomes between 100 percent and 249 percent of the Federal Poverty Level.
ADAP will notify by letter those RWC clients selected for this transition to a new program ADAP Premium Plus. Unselected clients will remain in traditional ADAP. As of press time, no one could provide the date for this notification. ADAP Premium Plus will pay ACA insurance premiums, deductibles, copays, and other insurance related costs for those clients who decide to transition. The ACA marketplace program will provide its standard subsidy, based on income and household size.
People will have to report their income and household size in order to calculate the ACA subsidy correctly. The IRS will determine if someone’s income reports match their employer’s reports. They will adjust that person’s tax refund to resolve any differences. Someone whose income varies throughout the year may find this both important and difficult. Those individuals will have to monitor and report any changes. This issue concerns local insurance broker, Cliff Eserman, President of Incompas Financial Insurance, Inc. He feels that easily made errors of omission could cause someone with a small refund to accumulate a tax debt.
Broward County residents will have about 100 health plans from which to choose. The Florida ADAP program and the AIDS Institute will be selecting a subset of plans that meet criteria for HIV care and cost-effectiveness. ADAP will only pay for plans in this subset. People on ADAP should not select plans before knowing which plans ADAP has approved.
Some agencies will provide assistance to people in selecting a health care plan. Lisa Agate, Program Manager, Broward Regional Health Planning Council, reported that each ADAP client selected for this transition will be assigned to an ACA assistance agency for help. Agate said people should wait until the first week in December to select a plan.
The lack of certainty, amid the seriousness of the issues, frustrated many at the meeting. One person compared it to a train running at 100 mph with the track still being laid down, just 50 feet ahead of the engine.
Next SFAN Meeting: Friday, December 5 at 10:00 a.m., at the Holy Cross Healthplex, 1000 NE 56th Street, Ft. Lauderdale, FL 33334. Newcomers are encouraged to attend.
For more information on this transition, please visit http://bit.ly/1zwB2Zv
ADAP Premium Plus and threats to patient choice of pharmacies
An issue within ADAP Premium Plus could threaten freedom of pharmacy choice. ADAP has identified CVS Pharmacy as its pharmacy benefits manager. Nick Van Der Linden said that “ADAP clients are encouraged to use the program's contracted pharmacy benefits manager, currently CVS Health.”
This differs from a Florida Department of Health web document (http://bit.ly/1zwB2Zv, slide 21) that said that use of CVS was “required.” While this could be a simple case of an “encouragement” slipping into a “requirement,” it does not bode well for patient choice of pharmacies. Last spring state-wide hearings were held about freedom of pharmacy choice within Ryan White Care, but at press time remain unresolved.
Attention all people on ACA plans
Open enrollment for the ACA marketplace plans began on November 15 of this year. As all 2014 ACA plans will cease to provide coverage as of January 1, 2015, people currently on ACA marketplace plans have to select a new plan by December 15, 2014 to ensure continuous coverage.
People on the ACA with varied income levels or household size throughout the year have to report those changes to the Marketplace to ensure correct calculation of the ACA subsidies. If your reported income does not match your employer’s reported income, it will be resolved in your tax refund.