by Amy Killelea, Senior Manager, Health Care Access, NASTAD
The Affordable Care Act (ACA) presents an unparalleled opportunity to decrease HIV and viral hepatitis infection rates, increase early access to care and treatment, and promote health equity. However, in order to use the ACA as a set of tools to meet these goals, we as a community must be prepared to not only adapt to the changes the ACA will bring, but to innovate along with a changing health care landscape. The ACA’s Medicaid health home program – which provides states with enhanced federal funding to offer a set of care coordination services to Medicaid beneficiaries living with chronic conditions – provides an opportunity to leverage the expertise and “whole person” models of care that are the hallmark of the Ryan White Program. On World AIDS Day, the Secretary of the Department of Health and Human Services (HHS) announced the Department’s increased support and commitment to working with states to ensure that this program includes people living with HIV, including codifying HIV as a qualifying condition in formal rulemaking (HIV is currently included as qualifying condition through informal guidance). It is now up to states to take advantage of this program to improve care and treatment for people living with HIV and viral hepatitis.
States and the Medicaid Health Home Option
Since the enactment of the ACA, many states have taken advantage of the Medicaid health home option to improve care for people living with chronic conditions through the state’s Medicaid program. The health home option allows states to draw down an enhanced 90 percent federal match for two years for provision of “care coordination services” (such as referrals, peer support services, and treatment management services) to eligible individuals. The ACA included a non-exclusive list of qualifying conditions, which did not include HIV; however subsequent guidance and a forthcoming federal rule list HIV as an eligible condition. Because states have flexibility to add to the list of eligible chronic conditions with federal approval, some states are also using the health home program to offer care coordination services for people living with hepatitis C (for example, Oregon’s proposal lists hepatitis C and HIV/AIDS as qualifying conditions). The Centers for Medicare and Medicaid Services (CMS) has published a list of all approved and pending state plans.
State health departments should stay tuned for NASTAD resources analyzing and sharing state health home program models that have included HIV and viral hepatitis.