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Some Considerations for Ryan White Service Providers

March 18, 2013
by

Nicole Johns

on 13 September 2017

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Transcript of Some Considerations for Ryan White Service Providers

Federal Funding
ACA
Uncertainty
Goal
Start
What does the future hold for HIV services?
More Medicaid-eligible clients
Sustainable services that meet the needs of the community
Quest for the Future
2013 and beyond
Opportunities
51%
Medicaid
13%
Medicare
Funding Decreases
Sequester
Continuing
Resolution
>5%
Health Homes
Enhanced reimbursement for Primary Care
More people insured
Let's check our map
78%
of Ryan White clients live at or below poverty
Uninsured
Private
17%
Before we get started with our adventure, let's remind ourselves of a few key facts
1.5 trillion over 10 years
At least 80% of RW clients will be Medicaid Eligible with expansion
Health care system
Ryan White System
Payer of Last Resort?
Eligible Services?
Eligible Clients?
Certain networks or teams of health care providers
can form a Health Home
Enhanced reimbursement , temporarily
State Medicaid oversee Health Home programs, with federal approval
Eligible individuals have at least one chronic condition, includes HIV and mental health
Essential Health Benefits
Mental Health
Maternity
and infant care
Care coordination
Hospitalization
Ambulatory services
Behavioral Health
Substance Abuse
Disorder Services
7,400 ADAP clients
424,000 HIV tests
Across the board cuts of >5%
Includes kids' dental and vision
Preventative services,
include HIV tests
Tests, Labs, Xrays
Emergency services
Chronic disease management
Prescription drugs
Pediatric care
Rehabilitative and habiliative services
Adapting programs to fit the reimbursement models of the future health care system
Preparing for the shifting tides in the Ryan White Program
So what does that mean?
Ryan White will not be reauthorized this fall.
HRSA working on "administrative fixes" for outstanding issues
Supportive Congress members and HRSA are looking for community input on the future of Ryan White
White House and Congress are in support of the Ryan White program
Essential Community Providers
Must ensure a sufficient number and geographic distribution of community providers
Must ensure reasonable and timely access to a broad range of such providers
Any willing provider must be accepted into a network
Patient Navigator and Assister Programs
Philadelphia EMA
What we stand to lose nationally:
Health Insurance Plans:
Full transcript