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February 10, 2014

Louisiana Insurer Rejects Ryan White Funds for ACA Premiums

Blue Cross and Blue Shield of Louisiana will no longer accept third-party payments for its premiums as of March 1, 2014, Reuters reports. As a result, hundreds of people with HIV/AIDS in Louisiana receiving assistance under the federal Ryan White CARE Act who enrolled in plans under the Affordable Care Act (a.k.a. the health care reform law, or ACA) are in danger of losing their ACA health care coverage.

The situation is months in the making. In September 2013, the Centers for Medicare and Medicaid Services (CMS) informed insurers that Ryan White funds could be used to cover ACA health insurance premiums, deductibles and co-payments. However, in November, CMS warned it had concerns about supporting premiums because of the risk of fraud. Insurers told advocates the November warning required them to reject Ryan White payments.

To the contrary, a CMS spokesperson has now told Reuters that Ryan White payments can be used to pay premiums for ACA plans when it would be cost-effective for the Ryan White program. In other words, having people with HIV/AIDS enroll in ACA plans could save the government money. Blue Cross and Blue Shield of Louisiana has not responded to requests from Reuters to comment on this development.

The hundreds of people affected fall into a financial gap. They cannot enroll in Medicaid since Louisiana chose not to expand it under the ACA. Further, they cannot receive federal subsidies outside of the Ryan White program to pay for ACA premiums because they do not meet the minimum of at least being at 100 percent of the federal poverty line. Ryan White funds are their only option to pay premiums for ACA plans.

In response, Lambda Legal and the New Orleans AIDS Task Force have filed an administrative complaint with the U.S. Department of Health and Human Services Office of Civil Rights against Blue Cross and Blue Shield of Louisiana. Lambda Legal sent the insurer a letter January 27 asking it to reverse its policy and asked for a response by January 30. The insurer never responded.

To read the Reuters article, click here.

To read the Lambda Legal complaint, click here.

To read the Lambda Legal letter, click here.

Search: Louisiana, Blue Cross, Blue Shield, insurer, premium, ACA, Ryan White, Lambda Legal


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  comments 1 - 9 (of 9 total)    

Richard, Chicago, 2014-02-20 10:19:04
Let's be adults. Insurance companies including BC/BS want us to die. They make no money from our premiums, whoever pays them. Under the law their only duty is to their shareholders. We will have to be very, very aggressive to stay alive throughout this. The ACA is about the worst thing that could have happened to those of us with HIV / AIDS and anyone connected with the financial side of the health insurance industry should, in a more morally grounded world, be held accountable for the ACA.

Jery, Sioux Falls, 2014-02-12 19:22:35
At the end of the day, this just seems plain stupid. BCBS wants your insurance premium money, but not if it came from Ryan White Funding. The CMS has clarified its position and now BCBS is being intransigent. I wonder what kind of medical legalese it'll come up with to refuse more expensive treatments needed if people get sick from this childish tug-of-war?

jim, la crosse, 2014-02-12 16:46:05
wow... I have been + for 18 years in june...it is hard to believe that things have gotten worse instead of better. ACA has done nothing so far, but triple my premium and reduced my coverage over the last 3 years...I am treated at one of the best clinics in the world, and nothing is any different, they make the same mistakes. I was really hoping things would get better...life is very frustrating living with hiv. it continues to look like the only way to retire is on disability

Michael, Haslett, 2014-02-12 04:51:33
I feel it is ahame that BCBS has desided not to accept Ryan White Funds to help pay the premiums of those with HIV, causing them to have to pay full premiums for the rest of the year before they can switch to another insurer who does accept Ryan White funding to help them. Now that BCBS in one state decides not to accept it could start a trend to have BCBS in all states to decide not to accept putting millions of others into the same situation. We must do something now about this.

Andrew, Atlanta, 2014-02-11 09:38:27
I do not think is is discrimination against gay persons, HIV positive persons, but it appears to be a tactile move driven by BCBS balance sheets. They have not been shy about pushing the envelope in the past and I’m sure they will do it again. After all is an insurance company, human lives x risk factors =$. They never gave a damn about the people who are sick …and never will

Andrew, Atlanta, 2014-02-11 09:37:35
It is a common practice with hospitals and some physician groups to carry a fund for Cobra benefits assistance and has been done so for years. It seems that was OK then. Now onto the topic of Fraud, this entire system currently is not prepared to vet every ACA applicant’s income, tobacco use, etc.. it is on the honor system until the links to SS and IRS are implemented. In other words the ACA model in its entirety has certain risk levels of fraud

Andrew, Atlanta, 2014-02-11 09:36:51
I have been in healthcare revenue cycle administration for 30 years and have been watching closely the details within the ACA and its effect on patients and providers. It was determined beck in the summer of 2013 that hospitals charitable trust can create endowment funds to cover patients that arrive for treatment who do not have coverage or their coverage is at a lower level (Bronze) and the treatment plan expected would necessitate higher level coverage.

Andrew, Atlanta, 2014-02-11 09:35:56
This situation in LA is (in my opinion) insurance companies taking any position they can find to not insure high cost illnesses. In this case they have chosen the most vulnerable people in a state where they will suffer little to no community backlash.

Derek Brown, Lafayette, 2014-02-11 00:14:31
This frightens me to no end. I am so disappointed in political people for denying Medicaid expansion in Republican states. Why? Just to prove a point.

comments 1 - 9 (of 9 total)    


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