Florida Phasing Out Project AIDS Care, Other Medicaid Waivers

Thousands of Floridians living with AIDS could be losing financial assistance they say is essential to living a normal life, and some AIDS groups are worried the state won’t carry through on its promises.

On a recent Tuesday morning, Brandi Geoit sits at a conference table at the West Coast Aids Foundation headquarters. Across from her in the small New Port Richey office with butter-yellow walls is Dwight Pollard, a 61-year-old man living with AIDS.

Geoit tells him a new Florida law means patients like him could lose some of the financial help they’re getting through Medicaid.

“We’re not sure if you would keep your Medicaid because you’re still pending for your social security. And you haven’t qualified for Medicare yet because you’re still not old enough,” Geoit said.

Pollard no longer works, and depends on a special Medicaid waiver to cover his health care costs. Medication alone can cost $15,000 a month.

His partner, Ed Glorius, was sitting next to Pollard as he heard the news.

“It just doesn’t make sense,” Glorius said. “It doesn’t make sense to put people’s lives in turmoil. We’re better off than most and I’m freaking out. I’m waking up first thing in the morning thinking about this every day.”

Pollard is one of about 8,000 Floridians with AIDS who get help paying for doctor visits, medications and various home health services through this Medicaid waiver fund, which is called Project AIDS Care. Last month, Gov. Rick Scott signed a bill formally eliminating this waiver for AIDS, along with waivers for cystic fibrosis, developmental disabilities and elder care.

Florida’s Agency for Health Care Administration said while the waiver is going away, AIDS patients in Florida will not see a loss or gap in services. The agency declined repeated requests for interviews, but issued a written statement, explaining transition into a Medicaid Managed Medical Assistance plan.

“We will continue to provide the same services through the same providers for these individuals. The PAC (Project AIDS Care) waiver is essentially a waiver that expanded Medicaid eligibility to those diagnosed with HIV/AIDS and allowed the recipients to access needed medical services (e.g., physician services) and drugs. Given the advances in pharmaceuticals available to treat HIV/AIDS, most PAC recipients in the waiver only need those medical services and case management. With this transition, their eligibility will be maintained and they will continue to have access to the medical services, drugs and case management under the MMA waiver through the health plans. They will see no reduction in services and will be able to continue to see the medical professional they always have.”

The agency said patients will go into the Medicaid Long Term Care program starting this month. Everyone will be transitioned into it by Jan. 1, 2018.

But Geoit estimates 90 percent of her clients will not meet the requirements for long term care, which normally applies to people needing round the clock nursing.

She said her clients will definitely lose certain services that Medicaid doesn’t cover. Massages for those with neuropathy? Gone. Pest control? Gone. And services that are currently covered – like delivered meals, adult diapers and wheelchair ramps – could be lost, too.

So, she’s asked the state to clarify how it’s now different.

“When we asked them, they said, ‘Don’t worry. Reassure your client that they’ll be taken care of.’ And when we asked them point-blank what happened, you know, we were under the impression that a single adult still does not qualify for Medicaid. Has this changed? And they ended the conference call,” Geoit said.

Her program – a non-profit – exists only to manage the Project Aids Care waiver money for 325 clients in seven counties including Pasco, Pinellas and Hillsborough. With the new law, Geoit said her foundation will shut its doors by the end of the year.

For Dwight Pollard and his partner, the State Agency for Health Care Administration’s lack of answers is a concern.

“You don’t need the stress of how you’re going to pay or how you’re going to do this,” Pollard said.

But that’s his reality. And Pollard said until the state agency can give clear answers, he’ll keep searching for other programs that can help pay for his life saving medications.

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HIV Health Reform Newsletter

Register for the Webinar: Make the ACA Private Insurance Expansion Work for People with HIV

This fall, people with HIV will be able to enroll in subsidized private insurance plans, called Qualified Health Plans (QHPs), through health insurance marketplaces (also called exchanges).
On this webinar, we’ll help you understand some critical components of the marketplace to get you ready to enroll yourself or clients: How will the tax subsidies work? How are the marketplaces structured, and who’s running them? How do HIV programs like ADAP fit in? What policies can states implement to make the marketplaces work for people with HIV?

Click here to register.
Our speakers include Amy Killelea of National Alliance of State and Territorial AIDS Directors (NASTAD), and Claire McAndrew of Families USA. Anne Donnelly of Project Inform and Courtney Mulhern-Pearson of San Francisco AIDS Foundation will discuss some of the benefits and pitfalls of marketplace implementation in California.
Click here to register for the webinar on Thursday, March 14 at 12:30 p.m. PT / 1:30 MT / 2:30 CT / 3:30 E

What does Obamacare mean for HIV/AIDS patients

by Mercenda Senecharles Queens Ledger
Nov 14, 2012

The Affordable Care Act (ACA), or what many may call the “Obamacare,” is met to ensure the best quality healthcare for all Americans, regardless of age, sex, and gender or health status. The Affordable Care Act will also address the problem of insurers denying coverage to children living with HIV/AIDS.
Insurance companies will no longer be able to impose lifetime caps on benefits. These changes will begin to improve access to coverage for people living with HIV/AIDS. It is a known fact that people living with HIV and AIDS have in the past, and even in recent history, received less than adequate healthcare.
An estimated one-third of Americans diagnosed with HIV aren’t receiving any kind of treatment. One reason, and probably the hardest to overcome, is simply that they are unable to afford it.
The ACA will encourage states to expand Medicaid provisions, but the federal government cannot require these states to comply. States such as Texas have already said bluntly that they will not cooperate with these Medicaid provisions or rules.
Is the Affordable Care Act destined to be a failure for those living with HIV/AIDS, since several states are unwilling to comply with federal provisions? Should states have the option to decline or not comply with these various implications or provisions?
We are already failing to close the gaps among those who do not have adequate healthcare due to overall lack of support among government officials and policy makers. Many would agree that the
federal government should have the authority to mandate such ACA guidelines for all states to follow.
Medicaid is the biggest provider of coverage for people living with HIV, according to the Kaiser Foundation. Medicaid programs make up about half of the federal spending on HIV. The individuals who cannot receive coverage through Medicaid will have to depend on the Ryan White Act, which provides funding to about a half-million people with HIV/AIDS each year.
The Affordable Care Act calls for new investments in community health teams to manage chronic disease. The new law also recognizes the value of patient-centered medical homes as an effective way to strengthen the quality of care, especially for people with complex chronic conditions.
Healthcare issues should be of major concern in this country. The ACA will set us on the necessary path to become a society less involved in the benefits of “I” and more in the idea of “we.” This nation is known as an innovator, and with the Affordable Care Act we can continue this trend and further impress the ideas of equality of care for all citizens.

Read more: Greenpoint Star – What does Obamacare mean for HIV AIDS patients

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