The Affordable Care Act (ACA): Preparing HIV and Viral Hepatitis Programs for Implementation

By Meico Whitlock July 22, 2013

In May at our 22nd Annual Meeting of state health department HIV and hepatitis program leaders in Washington, D.C., we had an opportunity to hear from federal and state leaders about Affordable Care Act (ACA) Implementation and its impact on HIV/AIDS and viral hepatitis program providers. Below is an interview with Amy Killelea, Senior Manager, Health Care Access at NASTAD and Maria Courogen, Director of Infectious Disease and Reproductive Health at the Washington State Department of Health who shared their highlights of the discussion.

NASTAD: Thank you for taking time to speak with us, Amy. Could you tell us about the plenary on the Affordable Care Act (ACA)?

Amy Killelea (AK): We heard from our federal partners and state health department leaders about ACA implementation.

Vicki Gottlich, Director, Consumer Support Group at the Centers for Medicare and Medicaid Services’ (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) focused us on CCIIO’s outreach enrollment efforts to prepare patient navigator programs and other assistors to be able conduct education and outreach to make sure people really know about the new coverage options starting in October 2013, when open enrollment starts, and are able to enroll in the plan and program that makes sense for them.

Melissa Harris, Acting Deputy Director at CMS gave us a great update about the incredible amount of work CMS is doing to prepare states for the Medicaid expansion with a focus on transition for vulnerable populations and expansion benefits decisions. Melissa also discussed other Medicaid reforms that are really designed to improve the quality and access of care for individual in the Medicaid program—things like care coordination within Medicaid which is particularly relevant for people living with HIV, the preventative services that Medicaid is now going to be covering, including HIV testing. There was also an update about the different models that states are using to do the Medicaid expansion, like premium assistance, which Arkansas is exploring. We also heard from Laura Cheever, Associate Administrator for the HIV/AIDS Bureau in HRSA, who gave us an update on the incredible amount of work that HRSA is doing, working very closely with CMS and CCIIO to develop guidance resources to really prepare state programs and grantees for these transitions that are going to be occurring during open enrollment starting in October. The Federal panel set the stage for what are states doing, how this trickles down to states, and what they are doing to implement. We also heard from Washington State, Colorado, and Tennessee, and a broad overview of the state implementation activities—no state is going to look the same. This is going to be very state-specific, and we heard from states that are expanding Medicaid, that are running their own state marketplaces. Additionally, we heard from Tennessee, which is not likely to expand Medicaid, at least in 2014, and will have a federally-facilitated marketplace. Overall, the planning looks different depending on what states you’re in and depending on that environment, so I think it was important for hear from people like Tennessee AIDS Director Jeanece Seals about how their programs are going to leverage and maximize private insurance. Lastly, we heard from Washington State about some of the planning and work that they’re doing, particularly with Medicaid. Going forward, I think there will be some real models and best practices that are already coming out of Washington State.

NASTAD: What action steps can someone who is a health department HIV or hepatitis program leader take back to their state?

AK: First, I’d say on the outreach and enrollment side, to figure out what training and resources are being developed at the federal level. If you’re in a federally-facilitated marketplace that your state is developing, or if you’re in a state-based marketplace, it’s very important to make sure that all the folks that are on the front lines conducting outreach and enrollment for people living with HIV have access to as much training and resources as possible to effectively direct clients where they need to go starting in October, when open enrollment starts. Second, if you’re in a state that’s not expanding Medicaid in 2014, it is crucial to look to the private insurance reforms, because there are real opportunities there, but I think it’s going to take some work to make sure that HIV programs are ready to truly use and maximize those private insurance reforms.

NASTAD: Thank you, Amy. Maria, speaking as a state health department leader, what did you take away from today’s plenary on the ACA?

Maria Courogen (MC): I work in Washington State, which is expanding Medicaid and has a state-based marketplace that will be going into place in preparation for 2014. Primarily, the work that we’re doing is focused on working with our Medicaid partners to make sure that the expanded version of Medicaid is going to meet the needs for our clients, and that our pharmaceutical benefits and provider networks are adequate for the new people who are going to be coming into the health care delivery system as a result of health reform. Overall, we’re spending a lot of time trying to prepare our case managers, providers, and clients around the changes, doing as much education as we can.

NASTAD: Thank you both for your time.

How else do you think states can prepare their HIV and viral hepatitis programs for open enrollment? Comment on this blog post and share your suggestions.