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Frequently Asked Questions: Health Care Reform and People Living With HIV

September 8, 2011

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What Will Happen to People Who Get Insurance Through Their Employer?

Beginning in 2014, employers with at least 50 full-time employees will be required to offer "comprehensive" and "affordable" health insurance or face penalties. Employer insurance must pay at least 60% of an employee's health care costs; the employee can pay the remaining portion. However, the coverage must cost less than 9.5% of an employee's household income. Employers who do not offer health insurance will be assessed an annual tax penalty of $2,000 for every full-time employee beyond the first 30 employees. If health insurance is offered, but it is not considered comprehensive or affordable, the employer must pay a $3,000 annual assessment for every employee who declines employer insurance and instead gets insurance through a state Health Benefit Exchange. Although the ACA shields companies with fewer than 50 employees from these requirements, it also encourages those with fewer than 25 workers to offer health insurance by making tax credits available for two years.

What Happens to People With Veteran's Administration Coverage?

Health coverage for eligible veterans will continue through the Veteran's Administration (VA). People will meet the insurance mandate requirement if they are covered by VA insurance.


What Will the Medicaid Expansion Look Like?

Effective January 1, 2014, individuals with income under 133% FPL will be eligible for Medicaid. Unlike current Medicaid rules, eligibility will be based on income alone; assets and disability will not be requirements. The federal government will reimburse states 100% for the initial years of expansion and will decrease reimbursement to 90% by 2020. It's expected that most uninsured people with HIV who currently get Ryan White services and ADAP medications will be eligible for Medicaid in 2014.

Will Undocumented Immigrants Be Eligible for Coverage Under Health Care Reform?

Undocumented immigrants will not be eligible for Medicaid or the Health Benefit Exchange. This means that the ACA does not create any new insurance options for undocumented immigrants, and they are not subject to the insurance mandate.

With some exceptions, legal immigrants are still subject to the five-year waiting period for Medicaid. They can purchase insurance through the Health Benefit Exchange during their waiting period.

As the ACA moves forward, one of the major challenges will be to ensure that safety-net health programs remain adequately funded so that undocumented persons and other immigrants will continue to find health care.

Are There Options for Uninsured People Between Now and 2014?

The ACA currently prohibits individual and group health plans from denying coverage to children under 19 for pre-existing conditions (for plan years beginning on or after September 23, 2010).

The prohibition does not go into effect for adults until 2014. Therefore, the federal government has developed a Pre-existing Condition Insurance Plan (PCIP) to serve adults with pre-existing conditions until 2014. Each state has a PCIP, and although the rates are similar to rates for those without pre-existing conditions, they are still unaffordable for most people with HIV. Some states provide financial assistance to people living with HIV to help them cover their PCIP costs.

Ryan White and Health Care Reform

Will Ryan White Funding Still Be Needed When Health Care Reform Is Fully Implemented?

The ACA greatly increases the number of people who can get medical care though it still has gaps in what it covers and who is covered. It's clear that there will be a critical ongoing need for Ryan White services that support health but are not completely medical in nature, such as dental care and social support programs. Ryan White funding will also be needed to ensure that health care remains accessible to and affordable for people living with HIV. This will include cost-sharing and/or premium support for people who will have private insurance through the exchange or their employers. Coverage under health care reform is not available to undocumented people so Ryan White funding will be needed to support this care. Finally, it is anticipated that the ACA will create new needs for Ryan White funding, including assisting people with HIV to find new health care coverage, supporting individuals who experience gaps in their coverage due to changes in income or other circumstances, and supporting adequate reimbursement for HIV providers.

What Will Happen to Ryan White Funded Clinics?

The Ryan White Program has created a strong system of expert HIV care. One of the major challenges of health care reform will be transitioning the current Ryan White health system to the Medicaid programs and Health Benefit Exchange plans where most uninsured people with HIV will be served after 2014.

Ryan White clinics have been funded through a grant system and will now have to develop the capacity and the skill base to negotiate and contract with, as well as bill and interact with, Medicaid programs and insurance plans. In addition, reimbursement rates will vary and may not be sufficient to maintain the quality of care necessary to best serve people with HIV. Strategies will need to be developed to ensure adequate provider reimbursement for all aspects of quality care.

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This article was provided by Project Inform. Visit Project Inform's website to find out more about their activities, publications and services.
See Also
U.S. Health Care Reform

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