The health reform law passed in 2010, the Patient Protection and Affordable Care Act (the “ACA”), has implications for the Ryan White Program.
Starting in 2014 many of Ryan White patients who receive care and treatment through the Ryan White program will begin to receive coverage through other programs created under the ACA. A majority will become part of the new Medicaid expansion; another portion are likely to gain coverage through the State Insurance Exchanges.
Because Ryan White is a “payer of last resort” program, those patients who will have access to the new programs must use them first.
However, since the states have significant flexibility in establishing the new programs, it is possible that some former Ryan White patients may end up with insufficient benefits, inadequate access to medications, or possibly even less than adequate access to care. They may also see new or increased co-pays, deductibles, or other cost-sharing. It is possible that the Ryan White Program may be able to aid in supplementing some of these areas.
Ryan White providers and clinics will likely need to join these new systems, and become included in the new networks of care. Providers need to pay attention to the requirements and opportunities in their state to be included in the billing networks, referral networks, and care networks for their state’sExchanges and state Medicaid program.
The most significant provisions of the ACA do not take effect until 2014, and their overall effects will not become clear until sometime after that. The Ryan White Program as a whole will likely see many changes in the future. Some of these may include the types of patients accessing services, to what services are provided, how those services wrap around the new systems.