ADAPs and the First Open Enrollment Period

1. ADAPs and the First Open Enrollment Period Emily McCloskey National Alliance of State & Territorial AIDS Directors August 4, 2014

2. Presentation Agenda Inaugural Open Enrollment ADAP Transitions Looking Forward

3. Overview of NASTAD • NASTAD is an international non-profit association of U.S. state health department HIV/AIDS program directors who administer HIV/AIDS and viral hepatitis programs funded by U.S. state and federal governments. • NASTAD was established in 1992 as the voice of the states. • NASTAD is governed by a 20 member, elected Executive Committee charged with making policy and program decisions on behalf of the full membership. • NASTAD has a Washington, DC headquarters with 38 staff and field offices/programs in Bahamas, Botswana, Ethiopia, Guyana, Haiti, Trinidad, South Africa and Zambia with 65 staff.

4. NASTAD Mission and Vision Mission NASTAD strengthens state and territory-based leadership, expertise and advocacy and brings them to bear on reducing the incidence of HIV and viral hepatitis infections and on providing care and support to all who live with HIV/AIDS and viral hepatitis. Vision NASTAD’s vision is a world free of HIV/AIDS and viral hepatitis.

5. Inaugural Open Enrollment

6. Enrollment into Coverage:Where States stand on Medicaid ME VT WA NH* MT ND MN OR MA NY WI* SD ID MI* RI CT WY PA* NJ IA* NE OH DE IN* IL NV MD CO UT WV VA CA DC KS MO KY NC TN AZ SC OK AR* NM GA AL MS AK LA TX FL HI Implementing Expansion in 2014 (27 States including DC) Open Debate (5 States) Not Moving Forward at this Time (19 States) Source: Kaiser Family Foundation

7. The Inaugural Open Enrollment Period • A multitude of challenges: • Healthcare.gov and state exchanges • 3rd party payer issues • Limited coordination between Marketplaces and Medicaid • Availability of plan information • Formulary gaps • High cost sharing/co-insurance • Political environment in many states made it difficult for state employees to participate in ACA implementation activities • Many clients remain ineligible because their state has not expanded Medicaid

8. Insurance Assistance and Premiums: Prescription Drug Formulary Missing from USP classification system = combination therapies EHB Standard = same number of drugs per U.S. Pharmacopeia (USP) category/class as state’s benchmark plan

9. ADAP Transitions

10. HRSA/HAB Policies and ADAP Insurance Purchasing • HRSA encourages state ADAP/Part B Programs to use their Ryan White funding to help clients access insurance, as long as: • Formulary includes at least one drug in each class of core ARVs from the HHS Clinical Guidelines • It is cost-effective in aggregate as compared to purchasing medications • Other Ryan White Program grantees may also use their funds to help clients with the cost of insurance • The Ryan White Program is the payer of last resort and grantees must “vigorously pursue” client eligibility for public and private insurance • Grantees may not dis-enroll clients from services for failure to enroll in public or private insurance coverage • Ryan White Program funds may be used to cover services not covered or inadequately covered by public and private insurance

11. 25,000 ADAP Clients Transitioned to Medicaid Expansion and Qualified Health Plans (QHPs) NH VT WA ME ND NY MT MN OR WI SD MI ID CT WY PA NJ OH IA NE IN DE NV IL CO WV UT KY VA MD KS MO CA NC DC TN OK AZ AR SC NM GA AL MS AK TX LA FL HI

12. Enrollments in the West WA MT OR ID WY NV CO UT CA AZ NM AK HI

13. Enrollments in the Midwest ND MN WI SD MI OH IA NE IN IL KS MO

14. Enrollments in the East NH VT ME NY MA RI CT PA NJ OH DE WV MD DC

15. Enrollments in the South WV VA KY NC TN OK AR SC GA AL MS TX LA FL

16. Leveraging the ACA to Raise the Bars:Translating Coverage into Care and Treatment Adapted from West Virginia Ryan White Part B Program

17. Looking Forward

18. Enrollment into Coverage:Key Dates MARCH April 15th 30th Qualified Health Plans 31st PCIPs • Enrollment Deadline for a Plan Effective Date of May 1st • Deadline to switch plans • PCIP coverage ends • Enrollment Deadline for a Plan Effective Date of April 1st 31st CONTINUOUS ENROLLMENT Medicaid 2015 QHP Open Enrollment Period • November 15, 2014 to February 15, 2015 • Next open enrollment period pushed back

19. Enrollment into Coverage:Mapping ACA Coverage Transitions Churning Grantees are defining how to“vigorously pursue” client eligibility for Medicaid and QHP coverage

20. Addressing the “Medicaid Gap” in Non-Expansion States To help fill the gap… Ryan White Programs are: Purchasing insurance for those in the “Medicaid Gap” Providing safety net for those who cannot afford insurance or who are not otherwise eligible

21. Challenges and Priorities

22. Questions and Answers

23. Contact Information Emily McCloskey Manager, Policy and Legislative Affairs NASTAD Phone: (202) 434.8090 emccloskey@NASTAD.org www.NASTAD.org