Health Resources & Services Administration Grant: Enhancing Capacity for Affordable Care Act Enrollment

Under the Affordable Care Act, options for health care coverage for Person Living With HIV and AIDS (PLWH)  are expanded through private insurance market reforms, an expansion of Medicaid eligibility, and the establishment of Health Insurance Marketplaces (also referred to as Exchanges).These health care coverage options may be reviewed at   http://hab.hrsa.gov/affordablecareact/keyprovisions.pdf. More general information about the Affordable Care Act may be found at www.healthcare.gov

By statute, RWHAP 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 another payment source (Sections 2605(a)(6), 2617(b)(7)(F), 2664(f)(1) and 2671(i) of the Public Health Service (PHS) Act.).  This means that grantees and subgrantees must assure that they make reasonable efforts to secure non-RWHAP funds whenever possible for services to individual clients.  Grantees and their subgrantees are expected to vigorously pursue eligibility for other funding sources  (e.g., Medicaid, CHIP, Medicare, state-funded HIV/AIDS programs, employer-sponsored health insurance coverage, and/or other private health insurance, etc.) to extend finite RWHAP grant resources to new clients and/or needed services

Grantees and subgrantees should also assure that individual clients are enrolled in any appropriate health care coverage whenever possible or applicable, and informed about the financial or coverage consequences[[]1] if they choose not to enroll.  Grantees and subgrantees are reminded that as new guaranteed issue requirements[[]2] take effect beginning January 1, 2014, PLWH will have access to private insurance plans from which they historically have been excluded due to pre-existing condition discrimination.  Many states are also expanding their Medicaid programs.  Please note that the RWHAP will continue to be the payer of last resort and will continue to provide comprehensive HIV health care and supportive services not covered by, or limited under, public or private health insurance plans.

The purpose of Supporting the Continuum of Care: Building Ryan White Program Grantee Capacity to Enroll Eligible Clients in ACA Supported Health Coverage is to build the capacity of RWHAP grantees and related providers to provide outreach to PLWH and to screen and enroll eligible PLWH in expanded health insurance during the annual open enrollment period beginning in October 2013. The announcement will fund one Cooperative Agreement to provide  technical assistance to accomplish three main objectives:  1. To assess RWHAP grantees’ technical assistance needs related to building capacity for outreach and enrollment of minority PLWH into expanded health insurance options; 2.  To work with HRSA, CDC, SAMSHA and CMS to assess best practices for minority client outreach and enrollment activities that would facilitate access to health care in the Medicaid expansion and Health Insurance Marketplaces (Exchanges); and 3.  Work with HHS agencies and national organization partners to develop strategies, tools, and trainings for RWHAP grantees to utilize for outreach and enrollment activities. 

The geographic range of the proposal is nationwide and will focus on the racial and ethnic minority clients currently served by the RWHAP.  The main activities for the three objectives are: 
To assess RWHAP grantees’ technical assistance needs related to building capacity for outreach and enrollment of minority PLWH into expanded health insurance options:
Conduct a needs assessment of RWHAP grantees within the first two months of the cooperative agreement; and
Share results with federal partners in HHS and other stakeholders.
To work with HRSA, CDC, SAMSHA and CMS to assess best practices for minority client outreach and enrollment activities that would facilitate access to health care in the Medicaid expansion and Health Insurance Marketplaces (Exchanges):
Review current and prior best practices e.g. Massachusetts and other state health care expansions, CHIP expansions, Medicare Part D; and
Develop a matrix of best practice activities for minority client outreach and enrollment activities,
Work with HHS agencies and national organization partners to develop strategies, tools, and trainings for RWHAP grantees to utilize for outreach and enrollment activities:
Develop and deliver tools and trainings to RWHAP grantees from October 2013 and on an ongoing basis into 2015; and
Maintain tools and trainings on website for sharing and future use.

The time phase for this assessment is the first six months of the project.

[[]1] Under the Affordable Care Act, starting in 2014, you must be enrolled in a health insurance plan that meets basic minimum standards. If you aren’t, you may be required to pay an assessment. See HealthCare.gov, Glossary: Individual Responsibility, http://www.healthcare.gov/glossary/i/individualresponsibility.html

[[]2] Guaranteed issue is a  requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services.