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Ryan White Moving Forward and ACA Implementation

Ryan White Moving Forward and ACA Implementation

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Ryan White Moving Forward and ACA Implementation

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  1. Ryan White Moving Forward and ACA Implementation San Francisco Provides Access to Healthcare – SF PATH Celinda Cantú Data Administrator San Francisco Department of Public Health HIV Health Services

  2. Low Income Health Program (LIHP) • San Francisco ‘s LIHP program is called SF PATH (“San Francisco Provides Access To Healthcare”) • San Francisco’s LIHP is under the Department of Public Health • Provider network for SF PATH is Department of Public Health – same network as Health Care Coverage Initiative under previous 1115 Waiver: • 16 primary care clinics (all FQHcs) • 12 community oriented primary care clinics, including Tom Waddell, Castro Mission, Maxine Hall • 4 hospital-based primary care clinics, including Ward 86:Positive Health Practice • San Francisco General Hospital • Community Behavioral Health Services • Laguna Honda Hospital (short-term rehabilitation) • SF PATH was approved by State and CMS, and implemented on July 1, 2011 – currently  10,000 enrollees in SF PATH 10/2/2014

  3. Eligibility Criteria • Ryan White • SF PATH • Ryan White • (formally RW clients) 10/2/2014

  4. 10/2/2014

  5. HIV/AIDS Client Services Comparison for RW Eligible Clients Who Become/Are SF PATH or ACA Enrollee 10/2/2014

  6. LIHP Transition Milestones 10/2/2014

  7. State ADAP Screening for LIHP • On March 1, 2012, the ADAP enrollment/recertification process, accomplished through Ramsell (the ADAP statewide pharmacy benefits manager), began tracking client eligibility for SF PATH • New enrollment forms that include SF PATH-related questions have been activated on the Ramsell ADAP enrollment website for San Francisco • These forms require the ADAP Enrollment Worker to determine if the client may be eligible for SF PATH and track the client’s SF PATH application process • Any ADAP applicant who may qualify for LIHP must be referred to apply to LIHP • Access to the updated application can be obtained in the “Forms” section of the Ramsell secure website at: www.publichealthrx.com 10/2/2014

  8. Post ACA Implementation populations that will continue to receive medical services through Ryan White Funding • Residually ineligible individuals (undocumented and those documented with resident status of less than five years) • Other HIV populations at-risk to be under- served in capitated care systems: • Patients with significant behavioral health issues • At high risk for falling out of care • Often are 86-ed out of multiple programs • At higher risk for depression, chaotic substance use, violence and suicide than general population • Have limited insight to modify behavior • Don’t meet criteria for “mental disability” • DSM5 Axis II “Personality Disorder” fixed traits or diagnosis • Important to move beyond labels to see what is needed both for patient and system • Borderline is often over diagnosed and underdiagnosed • Often described as “low threshold patients” • HIV elders 10/2/2014

  9. Continuing Challenges • Given uncertainty of RWPA funding in future years • Focus on sustainability- if RWP does decrease which services could be integrated into emerging primary care system? • Which services categories of service have funding streams in addition to RWP? • Use Gardner Cascade as a tool to assist in determining service funding priorities • Federal government is placing increased importance on clinical health care outcomes • what does the data show for what are considered “support service categories”? 10/2/2014

  10. Conclusions and Opportunities • CY 2014 is a unique opportunity to determine the best way for RWP services and funding can wrap around ACA services • HHS can help ensure successful payer transitions while maintaining continuity of care both of which will be a more immediate and on-going need • HHS will focus on reviewing and potentially expanding services within a given service category as well as expanded and new uses of existing RW service categories • HHSPC should sustain and improve the strength and coordination of multiple partnerships : • HIV Care and Prevention Services. • Consumer, Provider, Council and SF DPH 10/2/2014