Friday, December 20, 2013

HIV/AIDS Care and Treatment and Health Care Reform, Assumption 3

By Bob Bongiovanni

So far, we have covered two assumptions (assumption 1, and assumption 2) about people living with HIV or AIDS (PLWH/A) that are being shaken by the Affordable Care Act (ACA). Now we move to the last assumption that I will focus on, and the one that Ryan White providers and clients might find the hardest to challenge:

The Ryan White system will continue to operate “as-is” after health care reform is implemented.

First, there is a rumor that the Ryan White law ended back on September 30, 2013 and is now “winding down.”  The truth is that the current version of the Ryan White CARE Act was written with funding provision through September 30, but that doesn't mean it has ended.  It wasn't written to “sunset” out of existence, but rather to remain on the books and fundable by Congress from year to year.  Right now there is a national debate about reauthorizing or re-writing this law, but it is not in any danger of ending anytime soon.

The Kaiser Family Foundation recently released their ideas on how the Act could be improved, covering everything from using the “care cascade” approach, to building out the networks of care and integrating PLWH/A more into the mainstream health care system.

I have been asked many times what I think is going to happened to Ryan White funding, and so I am going to go out on a limb and tell you what I think is the most likely scenario.  Of course, I might be totally wrong, but here it is anyway.  First, I think the current Act will be extended for 1 – 2 years with relatively “flat” funding overall. States that do not expand Medicaid will receive enhanced Aids Drug Assistance Program awards, while states that do expand Medicaid (like Colorado) will be required to re-prioritize services that link clients to care, retain them in care, and achieve viral suppression.  There will be less Ryan White funding for clinical care and other services billable to 3rd party payers.

We could choose to be afraid of those changes, and to cling to our assumptions as long as possible.  But would that really serve the best interests of PLWH/A?  Instead, let’s find our courage and move ahead.  Each provider that serves clients with Ryan White funding must decide on their role in enrolling their clients in ACA coverage. Direct services providers should either build their capacity to bill Medicaid and other third party payers for services, or affiliate with someone who will do that billing for them, or become part of a “medical home.”

PLWH/A have displayed an amazing amount of courage and persistence, living through years of challenge and disappointment, insisting on coming in from the margins and demanding that society respect their dignity and humanity.  We who have been dedicated to serve them now need to step up our own courage, persistence, and insistence on what is right.  They deserve nothing less.

Thank you for reading.

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