Government State HIV

1604 days ago, 521 views
PowerPoint PPT Presentation

Presentation Transcript

Slide 1

Government & State HIV/AIDS Policy UCLA School of Public Health Epidemiology 227 April 23, 2010 Prof. Arleen Leibowitz UCLA School of Public Affairs

Slide 2

Outline Care and Treatment Medicaid Medicare Ryan White CARE Act Private Insurance and Health Reform Changes Testing and Prevention California issues Research Income Support and Housing Global Programs

Slide 3

Follow The Funding to Determine Priorities FY 2010 Federal HIV/AIDS Budget Request ($ Billions)

Slide 4

National Treatment Guidelines Call for Early Access to Treatment and Care But numerous PLWH are not in general think About 21% don't have the foggiest idea about their HIV status Only 55% of those meeting clinical criteria for ARV treatment get it Expanded rules HAART is expensive $12,000/year in ARV costs $20,000/year in absolute expenses

Slide 5

Insurance Status of HIV Patients in Care, 1996 Uninsured 20%

Slide 6

Federal Support for Care and Treatment (FY2010) Medicaid (Federal share) $4.7 B 34.6% Medicare $5.1 B 37.5% Ryan White $2.3 B 16.9% (ADAP $0.8 B) Veterans Affairs $0.8 B 5.9% SAMHSA $0.2 B 1.5% HOPWA $0.3 B 2.2% FEHBP $0.1 B 0.7% Total $13.5 B

Slide 7

Two Kinds of Federal Spending Mandatory spending Presumption that Congress must distribute subsidizing to meet statutory commitment – e.g., Medicare, Medicaid, SSI "Qualifications" Defined advantage Discretionary spending Congress settles on spending level every year Defined commitment Block stipends Examples: NIH, CDC, Ryan White, VA

Slide 8

Problems With Discretionary Spending Block concede implies that the monetary allowance does not increment to oblige expanded enlistment Health mind costs rise speedier than CPI, so yearly increments are "high" Long-term wellbeing ventures are disheartened by yearly spending process Prevention may lessen costs in long run, yet not in short Early treatment of HIV may spare cash in long run Share of optional spending is falling

Slide 9

Medicaid Created in 1965 Federal/state health care coverage program for low salary and incapacitated Federal government pays at least half of costs, more in low wage states (normal 55% of HIV $) Jointly regulated States set qualification criteria, subject to Federal minima States set advantages, subject to Federal commanded benefits

Slide 10

Current Medicaid Eligibility States must cover Certain poor ladies and kids Disabled who fit the bill for SSI (not able to participate in "considerable beneficial action by reason of… (a therapeutic condition) … .anticipated that would bring about death or that has kept going… up to 12 months") States set pay criteria State choice to cover Medically Needy who "spend down" to pay criteria

Slide 11

Medicaid Benefits Covers most administrations with no or insignificant cost-sharing Drugs, a discretionary administration, are secured in all states Optional administrations incorporate case administration, hospice Some states constrain administrations Number of Rx every month or year Number of MD visits

Slide 12

Medicaid – Current Policy Issues State inconstancy in Medically Needy pay qualification criteria Vermont 75% FPL Louisiana 7% FPL States can force restricts on optional administrations (drugs) Non-natives can not fit the bill for Medicaid Green-card holders must hold up 5 years Medicaid supplier installment levels are low, making access troublesome Medicaid rebate on medications of 15.1% not as much as what others get

Slide 13

Medicaid –Policy Issues (2) Catch-22 Medicaid qualification relies on upon being handicapped or having AIDS But early treatment of non-debilitated could deflect inability And diminish transmission Some states have 1115-waivers to give Medicaid to low wage individuals with HIV preceding handicap 1115 waiver requires "spending lack of bias" - Medicaid reserve funds >= extra Medicaid costs But, given cracked framework, inpatient investment funds of ARV treatment frequently go to Medicare, SSI or Ryan White

Slide 14

Medicaid –Policy Issues (3) Lose Medicaid if profit surpass edge, in any case, income may not take care of the expense of exorbitant ARV treatment Ticket to Work/Work Incentives Improvement Act of 1998 proceeds with Medicaid scope regardless of the possibility that individual comes back to work In retreats, states endeavor to cut Medicaid benefits Gov. Schwarzenegger proposed premiums for Medicaid Federal government raised its match rate amid subsidence

Slide 15

Health Care Reform and Medicaid Persons <133% of FPL are qualified for Medicaid from 2014 $14,404 for single individual; $29,327 for group of 4 Does not rely on upon inability Individuals w/o subordinate kids now will qualify Removes qualification variety by state, yet undocumented still not qualified 100% elected subsidizing for qualification developments in 2014-16, declining later to 90% Increases sedate 340b discount to 23.1%, yet some about-faces to government Provides 100% elected financing to raise Medicaid repayment rate to Medicare levels for essential care benefits in 2013, 2014 Encourages "therapeutic home" for those with incessant conditions

Slide 16

Medicare Created in 1965 Covers people 65+, people with ESRD, and long haul crippled Funded by finance charge on income, general incomes, recipient premiums for Part B and co-installments (Medicaid can pay understanding cost-sharing) Uniform all through U.S.

Slide 17

Medicare: Eligibility for Disabled must have adequate secured work history to quality for SSDI 29 Month Waiting period Federal law requires 5 month hold up after handicap assurance before getting SSDI installments 24-month sitting tight period for Medicare, taking after SSDI Medicaid scope for low salary people amid the 29 months

Slide 18

Medicare Benefits Hospital Outpatient (20% cost-sharing) Drugs have been secured since January 1, 2006 under Part D, private medication protection arranges Plans required to cover all ARVs Low wage endowment required for "the doughnut opening"

Slide 19

Medicare – Current Policy Issues Eligibility Must have adequate work history to meet all requirements for SSDI, an issue for youthful, poor people with HIV 29 month sit tight for Medicare qualification Catch-22 of incapacity prerequisite Cost-sharing High cost sharing if no supplemental scope No top on out-of-pocket spending Medicare "doughnut gap" When ADAP pays, doesn't forget about as "valid for pocket cost" (TROOP)

Slide 20

Health Reform and Medicare "doughnut" gap will be shut 2010- - $350 towards cost Phase-down coinsurance rate in doughnut gap from 100% to 25%, beginning 2011 by requiring half discount from producers in addition to government 25% appropriation ADAP installments will include as TROOP Part D No cost-sharing for secured preventive administrations (evaluated An or B by U.S. Preventive Services Task Force)

Slide 21

Ryan White Care Act CARE= Comprehensive AIDS Relief Emergency Enacted 1990 Administered by Health Resources and Services Administration (HRSA) Payer of final resort for 553,000 uninsured and underinsured PLWA Outpatient mind, including medicinal, dental, case administration, home wellbeing, hospice, lodging, transportation, drugs (through ADAP), protection continuation

Slide 22

Ryan White Funds Systems of Care Originally intended to furnish alleviation to urban areas with lopsided weight of looking after HIV/AIDS Part A: Emergency Relief (EMA, TGA) Part B: HIV Care (counting ADAP) Part C: Early Intervention Part D: Women, Infants, Children, Youth Part F AIDS Education and Training, Dental, SPNS

Slide 23

AIDS Drug Assistance Program (ADAP) Funded by Part B of Ryan White Care Act Congressional Earmark: $835 M (approx half) Plus state supplements (approx 25%) And discounts from medication makers (approx 25%) Other Federal subsidizing States set qualification 5 x FPL in NJ; 4 x FPL in CA; 2 x FPL Texas Disability not required Residency, not citizenship required ADAP is a piece concede States have utilized holding up records to apportion

Slide 24

ADAP (2) Drugs gave to 110,000 PLWH month to month in 2008 Cost/enrollee c. $1000/month Services HIV Medications Drug observing and adherence administrations Can buy medical coverage for qualified customers Drug Formularies Must incorporate no less than one solution w/I each ARV class Louisiana had 28 drugs; New York had 460

Slide 25

Ryan White – Current Policy Issues Discretionary concede program gives a square allow Growth in PLWHA builds interest for CARE Act administrations Medical costs increment quicker than CPI States have restricted capacity to supplement Resulted in sitting tight records for ADAP States set qualification rules, bringing about inconstancy States with less liberal Medicaid programs, require more Ryan White bolster Provides bolster for non-nationals

Slide 26

Ryan White – Policy Issues (2) 2006 Reauthorization of Ryan White Act changed financing equations for Parts An and B Funding now in light of reported HIV cases, not just AIDS cases Directs subsidizing to reflect developing plague California just started names reporting of HIV cases Required 75% of financing to be utilized for center medicinal administrations

Slide 27

ADAP - Policy Issues Coordination with Medicare Part D Payment for Part D co-pays, deductibles, premiums ADAPs can pay for medications in "doughnut gap" Increasing interest for ADAP as more PLWHA are not incapacitated, but rather require pharmaceutical Longer scaffold to Medicaid New, more exorbitant medications

Slide 28

ADAP - Policy Issues (2) Continued accessibility of remedy refunds? State financial situations test states' capacity to supplement ADAP States try to decrease models to slice costs Need to investigate cost control techniques that keep up customer get to (i.e. obtaining choices)

Slide 29

Health Reform and ADAP Insurance trades ought to lessen number of uninsured, and dependence on ADAP Would accommodate restorative care, not simply tranquilizes CARE/HIPP could buy protection ADAP will consider TROOP ADAP costs after doughnut gap ought to diminishing Cost of medications while in doughnut gap is decreased by half Effect on refunds? Impact of wellbeing change on Ryan White financing? Undocumented

Slide 30

Health Refo