Employer-Based Health Insurance Premium Payment (EB-HIPP) Program for ADAP Clients

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On May 15, 2018, the Office of AIDS (OA) and AIDS Drug Assistance Program (ADAP) announced the implementation of an employer-based health insurance premium payment (EB-HIPP) Program. New and existing ADAP clients who are enrolled in an employer-based health insurance plan are now eligible to receive premium assistance for their portion of their insurance premium.

EB-HIPP will pay medical and dental premiums, and it will also pay for vision premiums that are included in a medical or dental premium.  EB-HIPP It will also pay the even pays for medical out of pocket (MOOP) expenses!

Eligibility for EB-HIPP is based on the following requirements:

  • Be enrolled in ADAP
  • Be employed and enrolled in an employer-based insurance program
  • Employment verified with paystub dated within last three months
  • The employer must agree to participate in the EB-HIPP program

Medicare Part D Premium Payment Program (MDPP) Now Offers Medigap Premium Payment Program for ADAP Clients

Effective June 14, 2018, the Office of AIDS (OA) and AIDS Drug Assistance Program (ADAP) has also expanded their MDPP Program benefits to include payment of Medigap premiums. Medigap insurance is private insurance that helps pay for some of the health care costs that are not covered by traditional Medicare, such as copayments, coinsurance, and deductibles. New and existing MDPP clients will now be eligible to receive assistance with their Medigap insurance premiums, as well as medical out of pocket (MOOP) expenses for Medicare outpatient claims.

Note: EB-HIPP must pay the client’s portion of their premium in order for the client to receive MOOP benefits

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Latinx LGBTQ+ Mental Health

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Each Mind Matters1(EMM) recently collaborated with a group of LGBTQ+ community leaders and stakeholders to come together and create informational materials on mental health issues faced by Latinx LGBTQ+. The materials focus on three key segments: young adults, older adults, and providers working with Latinx youth.

Latinx LGBTQ+ Youth Mental Health Provider Fact Sheet2

This fact sheet helps providers working with Latinx LGBTQ+ youth address the complex connections that can have an impact on a young person’s life, such as sexual orientation, gender identity, race/ethnicity, and immigration status. The fact sheet provides relevant resources and best practices within a culturally responsive framework.

EMM also created a fully bilingual in Spanish and English resource online, which covers key terms for providers working with Latinx LGBTQ+ youth, things to consider as mental health professionals serving Latinx LGBTQ+ immigrant youth, and seeking benefits. At this time there are no printed copies available; however, the pamphlet is available free to download3.

EMM website is a resource for mental health and LGBTQ+ topics:

 

  1. https://www.eachmindmatters.org/
  2. https://emmresourcecenter.org/resources/latinx-lgtbq-immigrant-youthjovenes-inmigrantes-latinx-lgbtq-fact-sheet
  3. https://emmresourcecenter.org/system/files/2018-02/Latinx%20LGBTQ%20Immigrant%20Youth_Provider%20Fact%20Sheet_0.pdf
  4. https://www.eachmindmatters.org/wp-content/uploads/2017/11/Latinx_A_Brief_Guidebook.pdf
  5. http://www.eachmindmatters.org/wp-content/uploads/2017/06/Be-True-Be-You-LGBTQ-Booklet-DIGITAL.pdf
  6. http://www.eachmindmatters.org/wp-content/uploads/2017/06/LGBTQ-Mental-Health-Aging-Guide-DIGITAL.pdf

Stay the Course, the Fight is Not Over! – – National Black HIV/AIDS Awareness Day

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Across the United States on Wednesday, February 7, 2018, there will be individuals and organizations participating in National Black HIV/Aids Awareness Day to promote HIV education, testing, community involvement and treatment in black communities. This year’s theme is “Stay the Course, the Fight is Not Over!”

Education

The statistics show there is a need for this day of awareness. In the United States, there were 972,813 individuals living with HIV, 42 percent of which are African American. Of the 40,040 newly diagnosed cases, 44 percent are African American. In 2016, there were 16,010 individuals living with HIV in San Francisco. Twelve percent of this population was African American. In the same year, there were 223 newly diagnosed HIV cases in San Francisco, 15 percent were African American individuals. Good news—there was a small percentage drop in newly diagnosed HIV cases between 2015 and 2016 in San Francisco.*

Testing

San Francisco Aids Foundation offers free, confidential HIV testing. You can find other testing sites in San Francisco here.  If you live outside of San Francisco, find a testing site near you.

 Community Involvement

National Black HIV/AIDS Awareness Day March & Vigil the Black Brothers Esteem, a prevention and support program of San Francisco AIDS Foundation has planned a march, which starts at 5:00 pm on the steps of San Francisco City Hall, and ends with the vigil at 6:00 pm at the African-American Arts and Cultural Center (726 Fulton Street).

Bayard Rustin LGBT Coalition is planning an event on Wednesday, February 7 at 9:00 am based on a Facebook Event.

In honor of National Black HIV/AIDS Awareness Day, San Francisco AIDS Foundation and Black Brothers Esteem (BBE) invite you to an open soirée celebrating black excellence and resilience in the gay community. The Royal Affair!  For a night of elegance, live entertainment, live music, food, and drinks. The event is entirely free and attendees are encouraged (but not required) to dress up and/ or wear a splash of purple. We will also be offering free on-site HIV testing. All attendees must be 21+

Friday, February 9, 2018, between 6:00 pm-9:00pm @ Mr. Smith’s, 34 Seventh Street, San Francisco

Treatment

HIV Treatment works! The CDC says more than 1.1 million people in the United States are living with HIV, and that staying in care and engaged in treatment helps people stay healthy, protect others, and live healthier lives.

*based on data HIV Epidemiology San Francisco 2106 Annual Report & 2015 Annual Report

Open Enrollment Is Still On!

Open Enrollment is Still On!

Open Enrollment Is Still On!

Despite numerous attempts this year at repealing the Affordable Care Act, open enrollment is still on! This year’s health insurance enrollment cycle begins on November 1, 2017 and ends on January 31, 2018. Enrolling is easy and may be done through Covered CA online, by phone (1-877-453-9198), or in-person with one of San Francisco’s many enrollment workers.

Covered CA Basics

Covered CA is the state’s health insurance marketplace where consumers may purchase new insurance, change insurance plans, or renew existing insurance coverage. Qualified individuals may also receive financial assistance to help pay for health insurance costs.

Health insurance plans available through Covered California are organized by metal tier—Bronze, Silver, Gold, and Platinum. Plans in the higher metal tiers have higher monthly premiums, but smaller co-pays. All plans sold through Covered CA provide essential health benefits including prescription drugs, mental health care, and emergency services.

This Years’ Changes

  • The federal government has eliminated cost-sharing reductions (CSRs) payments to insurance companies. CSRs help people enrolled in Enhanced Silver tier plans pay for out-of-pocket costs like deductibles and co-pays. Covered CA has taken steps to minimize the impact of the loss of CSR funding by adding a premium surcharge to silver-level plans only. The surcharge will be offset by an increase in advance premium tax credit, so most consumers will see their monthly premiums stay the same or decrease.
  • Anthem Blue Cross will no longer offer coverage options in San Francisco County. Affected members will receive an official notice that their plan is ending. The notice will contain information on new carrier options and how to switch carriers. Members may choose a new plan within 30 days of the date of the notice. If they do not, they will be automatically placed in the lowest cost plan that is in the same metal tier as their current plan.

Need help paying for health insurance costs?

Californians who are HIV-positive may access health insurance cost-savings programs through the California Office on AIDS. The Office of AIDS Health Insurance Premium Payment Program (OA-HIPP) and the AIDS Drug Assistance Program (ADAP) help pay insurance premiums, medication costs, and other out-of-pocket expenses. Enrollment into these programs must be done through a certified enrollment worker.

Get Help

Open enrollment can be a confusing time, regardless of who you are. If you are an HIV-positive San Francisco resident, you can contact PRC for additional help and information:  415-777-0333.

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.