American Health Care Act Knowledge Roundup

American Health Care Act knowledge roundup (1)

By, Rebecca Levin

On Monday, house Republicans revealed their alternative to the Affordable Care Act (ACA). The American Health Care Act (AHCA) involves multiple reversals to ACA policies and will affect many Americans. Here are some useful resources we’ve identified to help digest what exactly these changes are and how they will affect people living with HIV:

  • This New York Times article lays out, point by point, the changes from the ACA to the AHCA.
  • POZ Magazine’s analysis looks at the present and future effects of the AHCA on people with HIV.
  • Vox’s article is easy to understand and covers how the plan will affect patients with chronic illnesses, like HIV.
  • The Kaiser Family Foundation’s Interactive Map compares the tax credits under the Affordable Care Act to the tax credits under the American Health Care Act.
  • The Center on Budget and Policy Priorities’ article takes an in-depth look at how the Medicaid per capita cap would affect coverage.
  • The Western Center on Law and Poverty’s two pager discusses how the AHCA will cause changes to Medi-Cal coverage and shift major financial burden to California.

The Termination of A.J. Boggs and What It Means for You

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By, Rebecca Levin

The California Department of Public Heath (CDPH) has terminated its contract with A.J. Boggs for AIDS Drugs Assistance Program (ADAP) administration.

Effective March 6, 2017, CDPH will directly provide all ADAP eligibility and enrollment services. CDPH is in the process of developing a new enrollment portal, call center, and data processing center for program administration.

The termination of the A.J. Boggs’ contract does not require any action from ADAP clients, but it will cause important changes to enrollment workers’ processes in the following weeks. Clients and providers should keep in mind the following information:

If You Are a Client:

  • The benefits you are receiving, the enrollment worker you work with, and the pharmacy you use will not be impacted by this change.

If You Are an Enrollment Worker:

  • Through 5pm March 3, 2017, continue submitting documentation to A.J. Boggs and calling the A.J. Boggs support team (Ph: 844-550-3944, Fax: 844-666-1411)
  • Beginning Monday, March 6th
    • Call 844-421-7050 for questions regarding eligibility or ADAP enrollment.
    • Fax documents related to Medical Out-of-Pocket Claims to Pool Administrators Inc. at 860-560-8225.
    • For questions regarding medication access at the pharmacy, call Magellan 24 hours a day, 7 days a week at 800-424-5906.
  • If you previously sent information to A.J. Boggs and have not heard back, please fax the information to CDPH at 844-421-8008.
  • Beginning the week of March 13th, the Office of AIDS will start providing enrollment workers training and access to the new enrollment portal.
  • OA-HIPP documentation should be submitted directly to the appropriate OA-HIPP Analyst or faxed to OA-HIPP at (916) 440-5490.

Open Enrollment Ends Today—Don’t Wait!

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By, Rebecca Levin

The first month of 2017 is almost gone, and with it, the open enrollment window for health insurance. The time to enroll is now. Be sure to enroll in a health insurance plan through Medi-Cal benefits by January 31 to access benefits in 2017.

If you attempt to enroll by January 31st and do not complete your application, you have until February 4th to complete your Open Enrollment application to receive benefits.

Keep in mind that Covered California might not be your only option. Medi-Cal offers year round enrollment and can pay for treatment and medication. You might qualify for Medi-Cal benefits if you:

  • Have an annual income that is below 138% the poverty level ($16,395 for a single adult)
  • Are 65 or older
  • Are blind or disabled
  • Are under 21 (or are a parent, caretaker relative, of a child under 21) or
  • Are pregnant

PRC’s Equal Access to Healthcare Program is here to help HIV+ San Francisco residents who have problems accessing healthcare. Give us a call at 415-777-0333 for help and more information.

OFFICE OF AIDS NOW PAYS FIRST MONTH’S HEALTH INSURANCE PREMIUM PAYMENT

By Chuan Teng, Esq.

Managing Legal Director

CA Office of AIDS’s Health Insurance Premium Payment program (OA-HIPP) now pays the first month’s premium (“binder payment”) for eligible health insurance plans (Management Memo 2016-18). Individuals must enroll in OA-HIPP within 48 hours of enrolling in a health insurance plan to access the binder payment benefit via OA-HIPP.

Individuals who miss the 48 hour deadline for binder payment may be eligible for limited special funding through AIDS Emergency Fund. See below.

HEALTH INSURANCE PLANS ELIGIBLE FOR OA-HIPP BINDER PAYMENT

The following health insurance plans sold through Covered CA are eligible for OA-HIPP binder payment.

  • Blue Shield
  • Kaiser
  • Anthem Blue Cross (non-Covered CA plans also eligible)
  • Health Net

HOW TO ENROLL (FOR NEW OA-HIPP ENROLLMENT)

New clients must enroll in OA-HIPP with a certified ADAP/OA-HIPP enrollment worker within 48 hours of enrolling in an eligible health insurance plan to access binder payment.

NEW CLIENTS: Immediately after health insurance plan enrollment, submit to an enrollment worker a Covered California Enrollment History or Current Enrollment summary page which includes the following information:

      • Premium amount
      • Health plan name and medal tier
      • Advanced Premium Tax Credit taken
      • Health plan billing address (if available)

(*A screenshot or screen-print(s) from the Covered California account is permissible.)

ENROLLMENT WORKERS: Submit enrollment documentation through the A.J. Boggs portal by creating an Update Form using the People Picker tool and inform your ADAP Advisor of a new pending OA-HIPP application within 48 hours of the client’s health insurance enrollment.


[1] Existing OA-HIPP clients must update their health insurance information in the A.J. Boggs portal as soon as possible to ensure ongoing premium payments.

    • STEP 1: Create an Update Form by using the People Picker tool to upload the enrollment documentation in the “most recent Covered California medical plan billing statement[2] field under the “Insurance Assistance” tab in the A.J. Boggs portal.
    • STEP 2: Enter the Covered California enrollment confirmation number located in the top left corner of all summaries into the “Member or Subscriber ID” field.
    • STEP 3: Promptly notify ADAP Advisor that a new OA-HIPP application has been submitted and requires initial payment so the application is prioritized for review/approval.
    • STEP 4 (Follow-Up Steps Required AFTER Enrollment): Upload client’s billing statement with the client’s health plan member ID/policy number to the A.J. Boggs portal by creating an Update Form. The client will receive a health plan billing statement from his/her health plan once initial payment is made by OA-HIPP.

If the client misses the 48-hour deadline to enroll in OA-HIPP for binder payment, the client will need to make the initial premium payment out-of-pocket to secure health insurance. See below for special funding.

LIMITED SPECIAL FUNDING FROM AIDS EMERGENCY FUND

Limited special funding through AIDS Emergency Fund is available for individuals who miss the 48-hour deadline to enroll in OA-HIPP to access a binder payment. HIV-positive San Francisco residents may be eligible for special funding. For more information, contact AIDS Emergency Fund (415-558-6999 x 228).


[1] Existing OA-HIPP clients must update their health insurance information in the A.J. Boggs portal as soon as possible to ensure ongoing premium payments.

[2] A billing statement is not required at the initial OA-HIPP enrollment. However, a billing statement must be uploaded in the A.J. Boggs portal after the binder payment is made and the health plan issues a billing statement to the client. See Step 4.

OPEN ENROLLMENT IS STILL IN PROGRESS!

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By Adrienne Mendle, Esq.

ATTENTION ALL HEALTH CONSUMERS!

OPEN ENROLLMENT IS STILL IN PROGRESS! 

From now until January 31, 2017, eligible Californians can sign up for health insurance on Covered CA AND may be able to receive subsidies to help pay for monthly premiums!

 You’ve probably heard about rising premiums on the healthcare exchanges. Although this is true, don’t despair – premium subsidies are also increasing! In addition, California offers significant financial support for HIV+ individuals eligible to purchase health plans on Covered CA.

 California’s Office of AIDS offers two programs to help pay for health care: ADAP and OA-HIPP. The Aids Drug Assistance Program (ADAP) pays for costs and co-pays associated with HIV-related prescription medication for qualifying individuals making less than 500% of the federal poverty level ($59,400 per year for a household of one). The Office of AIDS Health Insurance Premium Payment (OA-HIPP) program pays for monthly health insurance premiums and has recently begun paying co-pays for outpatient out-of-pocket medical costs, like doctor’s visits and labs. To qualify for this program, you must be enrolled in a private health plan (not through your employer) and be enrolled in ADAP.

 Starting this year, OA-HIPP is also making “Binder Payments” (AKA the first month’s premium) for new Covered CA enrollees! If you sign up for OA-HIPP within 48 hours of enrolling in a Covered CA health plan, OA-HIPP will initiate a Binder Payment on your behalf, activating your new health coverage.

 If you would like coverage starting on January 1, 2017, you will need to sign up for a health plan by December 15, 2016. Open Enrollment ends January 31, 2017; after that, you will need a Special Enrollment Period to sign up for a Covered CA health plan.

 PRC’s Equal Access to Healthcare Program is here to help you through Open Enrollment! Do you need to enroll in a health plan for 2017? Do you need to renew your health plan for 2017? Curious as to whether you are eligible for ADAP and OA-HIPP? Need assistance with something else? Give us a call at 415-777-0333! Our dedicated team of attorneys and advocates would love to talk to you about your healthcare needs.

Trainings for Our Community

By Chuan Teng, Esq.

Managing Legal Director

 The Equal Access to Healthcare Program (EAHP) is holding a Spanish Language Immigration and Public Benefits Workshop on Thursday, September 15th from 10-2 p.m. at the Civic Center Library. This workshop will be conducted in Spanish and will address public benefits available to immigrant clients. Providers and clients are welcome to attend.

 Additionally, EAHP with the SF HIV Front Line Organizing Group (FOG) is hosting the Second Annual Open Enrollment Boot Camp on Wednesday, October 5th at UCSF Mission Bay from 9-5 p.m. This boot camp will offer training and resources to front line HIV-service providers on health insurance open enrollment and how to help clients make informed health coverage choices.

 For more information, please contact chuant@positiveresource.org.

 

 

Changes to AIDS Drug Assistance Program Effective July 1, 2016

By Jeff Kosbie, Esq.

Big changes are coming to the AIDS Drugs Assistance Program (ADAP), Office of AIDS Health Insurance Premium Payment Program (OA-HIPP), and Medicare Part D Premium Payment Program.

On July 1, 2016, Ramsell will no longer administer ADAP. A.J. Boggs will take over program eligibility and enrollment. Magellan Rx will handle pharmacy benefits management. And Pool Administrators Inc. (PAI) will manage the OA-HIPP and Medicare Part D premium payment programs.

This post identifies important steps that you should take now and how you can stay informed as these changes roll out. As always, please call us at 415-777-0333 if you need more assistance.

New out-of-pocket expense coverage for OA-HIPP clients!

One of the most exciting changes is the addition of a new program to pay out-of-pocket medical expenses for OA-HIPP clients. We are still waiting for more details on this program. At present, we do not know if it will only cover HIV-related out-of-pocket costs or if it will cover all costs. This new program will be administered by PAI. If you are enrolled in OA-HIPP, you should receive a new ID card from PAI along with instructions on how to use it. We will also update you as we learn more.

What should I do now to avoid any disruption in my drug access?

  • Keep an eye out for an informational letter from the State Office of AIDS and a welcome letter from Magellan Rx. The letter from Magellan Rx will include your new prescription benefit card. Please be sure to open this mail and keep your new prescription benefit card. The outside of the envelope will not say ADAP on it.
  • Update your address with your enrollment worker. If you have changed your address within the last year, make sure your address is up to date with ADAP. If you are not sure if you updated your address, call your enrollment worker now. Any enrollment worker can update your ADAP profile, even if they did not initially enroll you.

We have included images of what the new Magellan prescription benefit card should look like along with the welcome letter that you should receive at the end of this blog post.

Will I need to switch pharmacies?

ADAP clients must use a pharmacy within the Magellan pharmacy network to access medication. Magellan Rx is contracted with over 6,000 pharmacies in California, and the majority of ADAP clients will not need to change pharmacies. If your pharmacy is not in the Magellan network, you should be contacted directly by the CA Office of AIDS (a division within the California Department of Public Health). Your ADAP enrollment worker should also receive a notification that you will need to change pharmacies. If Positive Resource Center handles your ADAP enrollment, we will be sure to update you immediately if we learn that your pharmacy is not included in the Magellan network. You may also call the California Department of Public Health (CDPH) at 844-421-7050 to confirm that your pharmacy is in the Magellan network.

Can I still use my Ramsell Prescription Benefit Card after July 1st?

Your Ramsell card will be deactivated effective July 1st. To avoid any problems at the pharmacy, we advise you to look out for your new Magellan Rx card and be sure to bring it with you. However, your program ID number will remain the same. The Office of AIDS assures us that you should still be able to access your drugs at the pharmacy without your new Magellan Rx card.

What if I have problems accessing my drugs on July 1st?

Starting July 1st, you can Magellan Rx’s live support team at 800-424-5906 to address any problems with program roll-out. We will also be posting any updates we learn about.

Will I still be able to get all of my drugs?

We have not been informed of any changes to the ADAP drug formulary. We will continue to update you if we learn of any changes.

How will the (re)enrollment process change?

All new clients will continue to have to see an ADAP enrollment worker to enroll. All existing clients will have to see an ADAP enrollment worker for their annual re-enrollment, on or before their birth date. When you visit an ADAP enrollment worker after July 1st, your enrollment worker will create an account on A.J. Boggs portal with you. After that, you can update your account and do annual re-enrollments on your own.

We have been able to preview the new enrollment system and are excited for some of the changes. These include:

  • Improved communication abilities, including secure email within the web access portal.
  • Improved error checking to identify missing items before an application is submitted.
  • Ability to provide additional explanatory comments on application forms.
  • Tags to indicate when an applicant has changed an answer from their last application. These tags will help ensure that entered changes (e.g., in address or viral load) are intended.
  • Interactive pharmacy locator, searchable by address. Starting July 1st, this will be available without logging in at https://cdph.magellanrx.com.

 What about the six-month self-verification form?

You will continue to receive this in the mail. Please look for correspondence from A.J. Boggs. If you are enrolled in both ADAP and OA-HIPP, this process will be more streamlined. You will now be able to use the same SVF form to re-certify for both programs.

How can I keep up-to-date on any changes?

We expect to continue to receive more information as we get closer to the transition. We will remind you as key dates arrive and update you if we learn anything new. Call Positive Resource Center at 415-777-0333 and follow us on Facebook and Twitter (#UpOnADAP).

 

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