Health Care Reform Will Challenge New York’s AIDS Service Providers
Posted by David Thorpe , September 01, 2010 at 5:50pm
Health care reform will mean new mazes to navigate for New Yorkers with HIV.
Lillian Anglada was worried before a recent presentation about how federal health-care reform will affect New York State–and she was still worried afterwards.
“There’s going to be a lot of confusion, especially when there is a language barrier,” said Anglada, a member of the board of the Latino Commission on AIDS, a consumer adviser for the Manhattan HIV Care Network, and the founder and president of Caring Hands For Positive Women. “Some folks might not understand. Some people will stop going to medical appointments.”
Anglada and about 100 predominantly Latino advocates, service providers and New Yorkers living with HIV/AIDS attended a Latinos Unidos Contra El SIDA (LUCES) forum last Friday in lower Manhattan where AIDS Institute Director Humberto Cruz and Assistant Director Jackie Treanor attempted to explain the impact of federal health-care reform on New York State and in particular New Yorkers living with HIV/AIDS. The presentation didn’t contain much new information–the health-care reform legislation doesn’t go into full effect until 2014, and state government is just beginning the process of evaluating how to conform to it.
However, Cruz and Treanor raised some of the key issues facing the AIDS community as 2014 approaches.
One major challenge for service providers who help poor New Yorkers with HIV will be explaining health care reforms to their clients. Seventy-two percent of people receiving Ryan White assistance have income levels below 200 percent of the federal poverty level, and it’s unclear how many will be eligible for Medicaid once health care reform goes into effect. The Medicaid cut off will be 133% of the federal poverty level, or $14,404 for a single adult.
Said Housing Works Vice President for Community Follow-Up & Harm Reduction Programs Michael Clarke, “What concerns me right now is how best to communicate the complex insurance information to our clients, and getting staff trained so they are able to assist clients.”
New Demands
At the same time, the AIDS Institute is bracing for an increased demand for HIV supportive services such as transportation, housing and case management. Last Friday Cruz said that 300,000 more New Yorkers will be eligible for Medicaid when health care reform goes into effect. “Insurance does not equal access,” he noted.
That increased demand for supportive services will put pressure on the Ryan White Care Act dollars, which are intended to pay for gaps in such services. “We need discussions with the Human Resources Services Administration in preparation for Ryan White reauthorization,” said Cruz.
In an email after the presentation, Treanor said, “New York’s challenge under federal health reform will be to align much of what the state has done ‘ahead of the curve’- in terms of public coverage expansions and simplifications, insurance reforms, and payment and system reforms—with the new requirements and opportunities under federal health reforms.” Treanor also said that New York State is “actively engaged with the Centers for Medicare and Medicaid Services … regarding a range of issues that need to be addressed and resolved.”
Despite potential problems, health care reform will likely mean a tremendous improvement in the lives of people with HIV, whether its huge increases in funding for community health clinics, closing the dreaded donut hole or new rules that insurers cannot set benefit limits, drop people when they get sick, reject people because of pre-existing conditions, and that insurers must provide “essential” benefits (which will vary state by state). HIV testing must be included on the list of preventive screenings in new health care plans.
CitiWide Harm Reduction Executive Director Robert Cordero was happy about the emphasis on prevention (including $30 million from the feds’ Prevention and Public Health Fund) and by Cruz’s assurance that there will be improved care coordination for dual Medicare-Medicaid eligibles. “That coordination is crucial as low-income people living with HIV/AIDS age into or qualify for the Medicare program,” Cordero said.
One group that won’t benefit? Undocumented immigrants. Even legal immigrants face a five-year exclusion from the new health plans that go into effect in 2014. “What will happen to the undocumented?” said Anglada. “I’m very worried.” Cruz is too. “This is a big challenge for New York State.”
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