CMS: Obamacare Provides 'Tremendous Opportunities' for 'People Living With HIV/AIDS'

May 2, 2013 - 8:09 AM

AIDS March

Marco Benjamin, 32, of New Brunswick, N.J., second from right, who is HIV positive, walks in the AIDS March in Washington, Sunday, July 22, 2012. (AP Photo/Jacquelyn Martin)

(CNSNews.com) - "The Affordable Care Act’s expansion of Medicaid provides tremendous opportunities to improve the health of the uninsured, especially for those with complex and chronic health conditions, including people living with HIV/AIDS," says the Centers for Medicare and Mediaid Services.

In an "informational bulletin" issued on Wednesday, CMS discusses the transition to Obamacare, specifically how Medicaid beneficiaries with HIV and AIDS can "reap the full benefits of the Affordable Care Act while preserving the protections and benefits of the federal Ryan White program."

The Ryan White program provides grants to states, cities and clinics for HIV/AIDS health care and support services, including medications used to fight the virus.

By law, the Ryan White Program is the "payer of last resort," which means that Ryan White funds may not be used for any item or service for which payment has been made, or “can reasonably be expected to be made,” by any other payer, including Medicaid.

But as CMS noted, enrollment in Medicaid and the Ryan White program "can be fluid."

The explanation itself is complicated, but here it is: "Individuals may transition from the (Ryan White program) to Medicaid temporarily; the (Ryan White program) may continue to provide support for limited or uncovered Medicaid services; individuals may receive retroactive Medicaid eligibility status, and the (Ryan White program) may need to back-bill Medicaid for Medicaid-reimbursable services or medications."

But never fear: CMS says under Obamacare, Medicard eligibility should be more stable in some states. Nevertheless, "key coordination challenges" will continue to exist.

To help Medicaid agencies and Ryan White grant recipients plan for the transition to Obamacare, CMS is planning a series of webinars to encourage everyone involved to "coordinate with one another."

"With consistent collaboration by all parties, we can help ensure that beneficiaries with HIV and AIDS reap the full benefits of the Affordable Care Act while preserving the protections and benefits of the Ryan White HIV/AIDS Programs as they plan for transitions ahead."

CMS says that in the United States, approximately 50,000 people become infected with HIV each year, and there are more than 1.1 million Americans living with HIV. Currently, Medicaid is the most significant source of coverage for HIV/AIDS patients, although many of them lack coverage altogether.

CMS says the Affordable Care Act "seeks to increase access to health care coverage for PLWH ('People Living With HIV/AIDS') through a number of health insurance reforms, including the ban on exclusion based on pre-existing conditions; the new Marketplace through which individuals will be able to purchase insurance with premium tax credits and cost sharing reductions for eligible individuals, and the expansion of Medicaid to low-income adults with incomes up to 133 percent of the Federal Poverty Level in states that adopt the new adult group."