Webinar Q&A: Supporting Health Coverage Enrollment for Ryan White HIV/AIDS Program Clients
ACE TA Center
The following questions and answers come from the August 10, 2016 ACE TA Center webinar, Supporting Health Coverage Enrollment for Ryan White HIV/AIDS Program Clients.
- Are the videos regarding health insurance available on DVD to play in a lobby setting?
See federal poverty levels, which are updated every year.
For those who do not fall under the umbrella coverage of Medicaid or Medicare, there are many different ways that the states and Part A programs are managing these complex environments. We would encourage you to be in touch with your state and local RWHAP programs to see what the options are in your area. Also, more states are adopting Medicaid expansion each year.
Certified application counselors (CACs) and navigators are both very familiar with the health coverage application process. A CAC receives specific training in order to become certified in providing assistance with enrollment into health insurance. A navigator is an individual trained to help consumers, small businesses and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. In either case, these individuals and organizations are required to be unbiased.
Clients could also access and use tools from the website instead of taking a paper copy. This could also allow for more privacy. In addition, organizations are welcome to use information from the ACE TA Center’s resources to create materials that will be most suitable for your clients.
In order to help maintain confidentiality of HIV status, forms can be kept by the Case Manager rather than having the client take them with him or her.
We are exploring ways to post a version you can download for that purpose. In the meantime if you have internet in your lobby, waiting room or other area where you want to show the videos, you can certainly play it via YouTube.
If you are interested in downloading a copy of the videos, or need the videos in a different format to play at your organization, please email us and we will do our best to assist you.
The Ryan White HIV/AIDS Program permits its recipients to provide premium and cost-sharing assistance, but the types of assistance vary by state. We encourage you to be in touch with your state and local RWHAP programs to see what the options are in your area.
Applications vary by state and we suggest working with a local Ryan White Program case manager (or directly with your ADAP program) to complete the application process. Here is a link to NASTAD’s ADAP Coordinator Directory.
If this person is eligible for Medicaid, she can apply anytime. Otherwise she will need to wait until the next Marketplace open enrollment period, unless she has a life event or other special circumstance that would open a special enrollment period for her.
We would encourage you to look for an enrollment assister in your community that your organization can partner with. You can start by looking at https://localhelp.healthcare.gov. You may find that not all organizations are well versed in the plan needs of PLWH, so you’ll want to provide some orientation on the specific needs of people living with HIV. Helpful resources can be found on our enrollment assisters page, where we’ve posted a video and a fact sheets for enrollment assisters who are new to supporting people living with HIV through the enrollment process.
We suggest you visit our Tools & Resources section, where we provide key concepts and information
Such as the following:
- Plain Language Guide
- Getting Coverage For the First Time
- Making the Most of Your Coverage
- Tax Credits and How to File Taxes
You may find our webinar titled “Access to Health Coverage for Immigrants Living with HIV” helpful. The webinar page also links to our quick reference guide on this topic.
We encourage you to send enrollment assisters to www.targethiv.org/assisters. The ACE TA Center staff does provide some limited training and education to navigators and CACs. For example, we presented to over 600 enrollment assisters on a CMS-sponsored national enrollment assister call in early July.
The premium tax credit is only available to people without another offer of affordable and adequate coverage. Therefore, in many cases, this will mean that people with employer-sponsored coverage will not be eligible for the premium tax credit because they have access to affordable and coverage that provides specific essential health benefits.
It is a best practice, for HIV service organizations that have the resources, to consider getting a staff person trained as a CAC. This person would then have expertise to assist clients with enrollment.
Just like different health plans cover different medications, different health plans allow you to get your medications from different pharmacies (called “in-network pharmacies”). The best way to get the most current information is to call the insurance company or visit their website to find out which pharmacies are in-network, and whether specific pharmacies are required.
For general assister guidance, including training and resources, we recommend signing up for the CMS assister webinars.
In addition, Families USA offers an online resource center for health care coverage assisters and navigators. This resource is not HIV-specific and does not include information regarding the Ryan White Program or ADAP, but does offer a variety of helpful information regarding the enrollment process.