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Health Reform & Ryan White

The health reform law  passed in 2010, the Patient Protection and Affordable Care Act, or “Affordable Care Act (ACA)”, has implications for the Ryan White Program.

 

 

Background:

 

Starting in 2014 many of Ryan White patients who traditionally received care and treatment through the Ryan White program became eligible for coverage through other programs created under the ACA.

 

In states that Expanded Medicaid many Ryan White patients become newly eligible for Medicaid coverage.

 

For individuals not eligible for Medicaid, who did not have coverage through an employer or other source, new coverage opportunities became available to obtain coverage through the State Insurance Exchanges.

 

Payer-of-Last-Resort

 

Because the Ryan White Program has a “payer of last resort” requirement, patients who will have coverage under the new programs, must utilize that coverage first.

 

Ryan White grantees are required by law to “vigorously pursue” enrollment of eligible patients into these programs as a primary source of coverage and payment.

 

However, in cases where patients benefits or coverage is inadequate, including inadequate access to medications, or inadequate access to care, the Ryan White Program may be able to aid in supplementing some of these areas.

 

The program may also be able to assist with co-pays, deductibles, or other cost-sharing for some patients.

 

The availability of these forms of assistance differs from state to state.

 

 

Ryan White Providers

 

With the substantial change in patient coverage, it is important for Ryan White providers and clinics to integrate with state coverage systems, and become included in the networks of care of the Qualified Health Plans offered in for their state’s Exchange.

 

 

Additional Resources:

 

 

Eligibility 101: the Affordable Care Act and the Ryan White HIV/AIDS Program

 

Implementing ACA: Coordination Between CMS and Ryan White Program

 

Webinar: Ryan White and the Affordable Care Act: What You Need to Know

 

State by State: Modeling the Transition from Ryan White to Medicaid and Subsidized Private Insurance Under the ACA

 

Ryan White & the Affordable Care Act: What You Need to Know

 

Letter to Ryan White Providers from HRSA

 

Key Provisions of the Affordable Care Act for the Ryan White HIV/AIDS Program

 

Ryan White and Affordable Care Act Outreach, Enrollment and Benefits Counseling

 

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