Connecting My Practice

HIV care providers face numerous changes to the health care system in the coming months and years. It is important to take steps to ensure that your practice is prepared.

In order to ready your practice for the implementation of health reform changes that will begin in 2014, there are a few keys things at HIV providers in every state can do.

Learn About Your State

Health Reform is happening differently in every state. The State Insurance Exchanges, state Medicaid program, Medicaid managed care, and Ryan White program will look different in each state after 2014.

The most important thing you can do is to educate yourself and your staff on the changes to the systems of coverage and care in your state.

Health Reform & My State

Connect to Insurers in the State Insurance Exchange (Marketplace)

Starting in 2014, every state will have a brand new State Health Insurance Exchange (Marketplace) where patients will be able to purchase new health insurance plans. In order for patients to have full access to you, as an HIV provider, you must be included in the provider networks of the plans offered in the Exchange (Marketplace).

Health care providers must contract to each of the insurers offering plans in the Exchange individually in order to be included in thier provider network.

HIV providers may be able to take advantage of an important advantage in contracting with these plans, through designation as an “Essential Community Provider.”

Connecting Your Practice to the Insurance Exchanges (Marketplaces)

Connect to Medicaid and Medicaid Managed Care

Starting in 2014, every state will have the option to expand the Medicaid program to cover all low-income patients without categorization. Some states have taken up the Expansion. Some have not, but will likely do so in the future.

It is important that HIV providers are fully connected to the Medicaid program in your state in order to have access to the patients who will newly be covered by Medicaid under the ACA.

Many states are also making the move to enroll some portion of the Medicaid population in managed care. Each state has different systems, but connecting to them is vital in order for HIV providers to have access to those patients.

In most states, HIV providers must contract with Medicaid managed care plans similarly to contracting with private insurance plans.

Health Reform & Medicaid

Further Assistance

AAHIVM has prepared the following document to provide direction to HIV providers in fully connecting their practice to all the available systems of coverage in your state after health reform is implemented, and therefore having access to the patients in those systems.

Health Reform and My Practice: A Guide for HIV Providers