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Helping Clients Who Lose Their Health Coverage

Friday, May 8, 2020

TargetHIV

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From the ACE TA Center Listserv - Updates about:

  • How to help clients that are losing their health coverage due to job loss or change, or other life events.
  • The new HHS COVID-19 Reimbursement Portal for health care providers to process claims related to COVID-19 services for uninsured individuals.
  • Use of CARES Act supplemental awards for premiums and copayments.

Helping clients that lose their health coverage 

Now more than ever, it’s important to ensure Ryan White HIV/AIDS Program (RWHAP) clients are enrolled into and maintain health coverage. The RWHAP is not health insurance, but funds can be used to help clients get and keep their health insurance coverage. In many cases RWHAP funds can be used to pay monthly premium payments and copayments.

If a RWHAP client loses health coverage, there are a number of actions to take:

  1. Make sure the client contacts their doctor immediately and makes a plan to ensure they maintain an adequate supply of medications. If needed, they can also reach out to their local ADAP or case manager for assistance making that connection.
  2. Consider what health coverage options the client may be eligible for.
  • See if they qualify for a Marketplace Special Enrollment Period (SEP), which would allow them to enroll in a Marketplace plan outside of the Open Enrollment Period. Access ACE TA Center materials on SEPs. Many clients qualify for financial assistance through the Marketplace.
  • Remember that Medicaid and CHIP enrollment are open year-round and applications can be accessed through HealthCare.gov. If they are eligible, they will be contacted by their state agency to complete enrollment.
  • Some clients may be eligible for coverage continuation through COBRA. However, COBRA can be expensive and may not be the best fit depending on coverage needs, so it's important to consider all options.
  • It's important to consider all options, including Marketplace coverage, Medicaid, Medicare, and private insurance.

For those clients already enrolled in Marketplace coverage: If their income or household size changes, they should report these changes on their Marketplace application as soon as possible. Reporting these changes will help make sure clients get the right amount of financial assistance through premium tax credits, which will help reduce the amount of their monthly premium payment.

Note: If an individual received a stimulus check (up to $1,200 per eligible adult plus $500 per eligible child), they do not need to report this as additional income on their Marketplace application.

Learn more about Marketplace coverage, SEPs, income changes, and other options for managing coverage changes due to the COVID-19 emergency

New! HHS claims reimbursement portal 

Last week HHS, through HRSA, launched a new COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured program. This program allows health care providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 individuals on or after February 4, 2020 to submit claims electronically for reimbursement.

You can learn more about the program and access the portal to request reimbursement. We encourage you to share this information with RWHAP providers who may qualify for reimbursement.

New! Use of CARES Act supplemental awards for premiums and copayment

Last week HRSA announced that funds provided by the CARES Act supplemental award to RWHAP recipients can also be used to pay for health insurance premiums and copayments. Visit the HRSA HAB Coronavirus Disease 2019 (COVID-19) Frequently Asked Questions page for all information related to COVID-19 and the RWHAP, including this announcement.

Have a question about this or other health coverage policy updates? Email the ACE TA Center

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