Pennsylvania: AIDS Organizations in for Sea Change

A White House Office of National AIDS Policy (ONAP) public forum held recently at the University of Pennsylvania addressed the Affordable Care Act, especially ACA's effect on care for under- and uninsured HIV/AIDS patients, now delivered through the Ryan White Care Act. In 2014, ACA will allow many of these patients to be insured under Medicare or Medicaid.

Through ACA, new funding will be available to Federally Qualified Health Centers. These provide a continuum of care not specific to one population or disease, regardless of a patient's ability to pay. Both Mazzoni Center and Action AIDS recently won grants to begin applying for FQHC status.

"My fear is for the smaller organizations that have relied mostly on Ryan White dollars," said Nurit Shein, Mazzoni's executive director. "What is going to happen to them?"

Organizations have to do some strategic thinking about how to protect the best services, said Kevin Burns, executive director of Action AIDS. "So we need to talk about partnerships and mergers in a civilized way that will serve our clients best."

One response is the "health home" structure. Under ACA, states can create networks that offer integrated services for Medicaid recipients.

Instead of competing for the same money, AIDS organizations "need to move toward being collaborative partners," said Dr. T.J. Ghose, the panel moderator from the university's School of Social Policy and Practice. "Basically, the need of the hour is to start the conversation in our community with Community Health Centers and [FQHCs] to get into these networks and create teams that can utilize ACA funding for HIV care." The federal government also needs to ensure that being imprisoned does not result in automatic Medicaid and Medicare delisting, the current practice, Ghose said.

"We need to show the federal government the value of the Ryan White model and be really proactive in providing information through the systems that are now soliciting public comment," said Shein.

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