HIV CARE UNDER THE AFFORDABLE CARE ACT:ADAP’S IN THE NEW ERA

Richard Aleshire, MSW

Program Manager, HIV Client Services

Office of Infectious Disease

Washington State Department of Health

June 4, 2015

WHAT IS THE WORK OF HIV CLIENT SERVICES?

Vision:End HIV by preventing new infections in Washington State

Mission:The mission of HIV Client Services is to suppress viral load by ensuring access to quality services for people living with HIV in Washington State.

WHAT SERVICES ARE PROVIDED BY HIV CLIENT SERVICES?Community-based programs (funding to 15 agencies)

Medical Case Management (primarily – 85% of granted funds go to this category)

Medical Transportation Food Bank and Home-delivered Meals Medical Nutrition Therapy Substance Abuse – Outpatient treatment

Centrally-operated program from DOH (statewide): Washington’s AIDS Drug Assistance Program (ADAP) known in

Washington as the Early Intervention Program (EIP)

PrEP DAP (Pre-Exposure Prophylaxis Drug Assistance Program)

WHAT IS AN ADAP?

1987 – The US Congress appropriated funds to the AZT Program to assist States pay for the only approved antiretroviral (ARV) at the time

1990 – Incorporated this funding into the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, now known as the Ryan White Program

1996 – Congress began separately earmarking funds that went to the States under Part B of the Ryan White Program

The Washington State Legislature also provided general funds state to pay for HIV meds in the late 80’s

WHAT DOES ADAP (EIP) PAY FOR? Insurance-based program – we, through the Evergreen Health

Insurance Program – EHIP), purchase insurance for individuals We then wrap-around the clients’ insurances We pay for:

Insurance premiums Co-pays for medications on our formulary (over 250 –

including all ARV’s, mental health meds and HepC meds) Co-pays for medical visits, lab work related to a client’s HIV Dental services

For clients without insurance we pay full cost for their medications, medical visits, lab work, dental

As the recipient of federal funds we ensure that we are “payer of last resort” and that we “vigorously pursue” clients getting onto insurance

HOW IS ONE ELIGIBLE FOR EIP?

Live in Washington State Documentation of HIV+ Status Make less than 400% of the Federal Poverty Level

(FPL) or about $47,080 per year for a single individual or $97,000 for a family of four

Ensure the client has no other access to coverage (“payer of last resort”)

Apply for insurance as eligible during open enrollment

Apply for Medicaid if apparently eligible and below 138% of the FPL

HOW HAS EIP CHANGED SINCE ACA?

Over 1,200 clients became eligible for expanded Medicaid

Over 600 clients were able to be offered lower cost insurance through our State’s health benefit exchange (wahealthplanfinder.org) (paid by EIP/EHIP)

Lowered costs to DOH allowing us to increase eligibility from 300 to 400% of the FPL and to be consistent with requirement allowing tax credits

Changed our income calculation to be consistent with Medicaid and Health Benefit Exchange’s use of MAGI (modified adjusted gross income)

Allowed us to offer PrEP DAP

WHAT IS PREP? PrEP means Pre-Exposure Prophylaxis PrEP is the use of anti-HIV medication that keeps HIV

negative people from becoming infected (Truvada) PrEP was approved by the FDA in July, 2012 for use to

reduce the risk of HIV infection and has been shown to be safe and effective

PrEP is highly effective against HIV when taken every day PrEP can interfere with HIV’s ability to copy itself in the

body after a person has been exposed PrEP can prevent HIV from establishing an infection and

making a person sick CDC recommends PrEP be considered for people who are

HIV-negative and at substantial risk for HIV infection

WHAT IS PREP DAP?

PrEP DAP (Pre-Exposure Prophylaxis Drug Assistance Program) provides coverage for medication (Truvada) that can decrease an HIV-negative person’s risk of becoming positive

PrEP DAP launched in April 2014 with a low eligibility criteria Washington State resident Documentation of current HIV-negative status No income restriction

PrEP DAP built on infrastructure of ADAP Funded with non-federal dollars due to restrictions

from our federal funding sources at HRSA and CDC

WHERE ARE WE NOW WITH PREP DAP?

Gender: Female (3%) Male (96%) Other gender (<1%) Transgender (FtM) (<1%)

Insurance Status: Uninsured (13%) Insured (87%)

Ethnicity: Non-Hispanic/Latino(a) (72%) Hispanic/Latino(a) (15%) No Answer (13%)

Race: Alaskan Native/American Indian (<1%) Native Hawaiian/Pacific Islander (<1%) Other (2%) Black/African American (3%) Asian (4%) Multi Race (6%) No Answer (7%) White/Caucasian (77%)

369 Applications Received318 Active PrEP DAP Clients

36 Denied15 Incomplete Apps

What is END AIDS Washington?Governor Jay Inslee announced a commitment to End AIDS in Washington. The governor issued a proclamation on World AIDS Day 2014 (12-1-2014) that appoints an HIV Planning Steering Group (HPSG) to develop a statewide plan for reducing the rate of new HIV diagnoses by 50 percent by 2020.

Why else are we doing this???

QUESTIONS?