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.

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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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ADAP Assistance has Changed!

ADAP web graphicImportant income eligibility changes have been made to AIDS DRUG ASSISTANCE PROGRAM (ADAP) and OFFICE OF AIDS- HEALTH INSURANCE PREMIUM PAYMENT (OAHIPP) program. Because of these changes, many more people may be eligible for these programs, and eligibility may discontinue for others.

As of June 24, 2015, the income eligibility criteria for ADAP/OAHIPP changed to individuals with a Modified Adjusted Gross Income (MAGI) that does not exceed 500% of the Federal Poverty Level per year based on family size and household income. Now, single individuals with a MAGI of no more than $58,850 per year may be eligible for ADAP/OA-HIPP. For a household of two, the income limit is $79,650. Previously, the maximum qualifying income limit was $50,000 adjusted gross income per person. The old rule did not consider family size or household income.

For more information about changes to ADAP/OAHIPP, please contact our Equal Access to Healthcare Program at 415-777-0333.

Happy Birthday to the Equal Access to Healthcare Program

The end of June marked an important milestone for the Equal Access to Healthcare Program (EAHP): the end of the program’s first full year!

Just to name a few of EAHP’s accomplishments this year, EAHP attorneys and advocates served over 250 clients, completed over a dozen outreach and provider training events for community partners, and of all closed cases, over 95% of our clients obtained, preserved, or increased healthcare access. For more information on EAHP’s accomplishments as well as our policy recommendations to help expand access to care, look for our upcoming annual report.

To celebrate EAHP’s first birthday, a few of the staff members on the team have reflected on their experiences with EAHP:

Chuan Teng, Supervising Attorney

Chuan Teng, Supervising Attorney

“The ACA has provided greater healthcare access for our clients, but healthcare navigation is still very confusing, if not more confusing than it was pre-ACA. Our clients require more information about how to access the right insurance to meet healthcare needs, reducing out-of-pocket costs, and ensuring that healthcare programs work together seamlessly. I’m thankful the S.F. HIV community has access to EAHP services, but I do wonder about the millions of others who do not and face complicated healthcare access challenges.” Continue reading

ACA+HIV: A Frontline View

Earlier this month, San Francisco HIV frontline workers convened to discuss San Francisco’s HIV systems of care and the effect of the Affordable Care Act (ACA) on these systems.

Over 50 frontline workers from 19 different organizations joined the conversation. Participants included case managers, benefits counselors, social workers, peer advocates, and medical providers.

San Francisco HIV Frontline Workers

Andy Scheer presents on changes in the HIV Systems of Care

The meeting opened with welcomes from Dean Goodwin, HIV Health Services Administrator of the San Francisco Department of Public Health and Shannon Weber of Getting to Zero, a coalition of organizations whose goal is to get to zero new HIV infections, zero HIV deaths, and zero HIV stigma in San Francisco.

Following their remarks, Andy Scheer, a medical social worker at SF City Clinic, gave a presentation on the ACA and changes in San Francisco’s HIV systems of care. Andy’s comments addressed greater accessibility of health insurance through Medi-Cal expansion and Covered CA (the healthcare marketplace established by the ACA); the intersection between health insurance, public benefits, and taxes; the impact of same-sex marriage on access to government benefits; and changes at the local level, such as SFDPH’s shift away from a specialized care clinic model to an integrated treatment model.

Keeping up with all these changes is challenging, and in a quick survey of participating frontline workers, seven out of ten responded that the ACA makes them want to “hide under their desk.” However, attendees recognized the importance of HIV frontline workers being fully informed and having up-to-date information about systems of care to best serve San Francisco’s HIV positive community. Though it is difficult to keep up with and adapt to all of the changes in HIV systems of care, the continued hard work of frontline workers is worthwhile because the changes brought by the ACA will ultimately strengthen the healthcare system and make care more accessible. Continue reading