Starting in 2014, many of your patients will have new options to receive health coverage through new systems in their state. In order to make sure your patients do not have interruptions in care, or lose access to you, as their provider, you can use the following resources:
What is changing for your patients?
If your patients already have health insurance coverage, that fulfills the Individual Mandate requirement, then they do not have to obtain additional insurance, or change insurance coverage.
If they do not have insurance, and live in state that is Expanding Medicaid, they may be newly qualified for the state Medicaid program, or for Medicaid managed care programs in the state.
If they do not have health insurance coverage, and do not qualify for Medicaid, they may be able to purchase health Insurance in the new State Insurance Exchange (Marketplace).
Many patients may be confused about exactly what is happening with the implementation of health reform in their state. You can provide them basic information about health reform in your state.
Helping Your Patients Enroll
If your patients already have health insurance coverage, that fulfills the Individual Mandate requirement, then they do not have to obtain additional insurance, or change insurance coverage.
If they do not have insurance, and live in state that is Expanding Medicaid, they may be newly qualified for the state Medicaid program, or for Medicaid managed care programs in the state.
If they do not have health insurance coverage, and do not qualify for Medicaid, they may be able to purchase health Insurance in the new State Insurance Exchange (Marketplace).
Many patients may be confused about exactly what is happening with the implementation of health reform in their state. You can provide them basic information about health reform in your state.Many systems have been set up to assist in Patient Enrollment nation-wide. Patients can enroll in many different ways, and can take advantage of a single-form application to determine what programs and assistance they qualify for under health reform. Learn More about patient enrollment, and what you as a provider can do to help your patients.
Learn More:
The ACA also provides new opportunities to play a direct role in patient enrollment efforts. Patient Navigators and Certified Enrollment Counselors are available in every state to help patients enroll in either health insurance plans offered in the state Insurance Exchanges or in Medicaid in their state.
As a provider, you may be able to identify a member of your staff become certified, and receive training to assist patient enrollment among your patients.
Connecting Your Practice
HIV providers will need to make an effort to connect to the new systems of care in their state in order to retain access to their patients after 2014.. Providers must contract with health insurers offering plans in the exchanges individually, and also with any Medicaid managed care plans within the state.
Learn More: Connecting My Practice
Inform Your Patients about Your Network
It is essential for providers to inform patients about which networks they are included in. Otherwise, patients purchasing new insurance plans in the Exchanges may unintentionally select a plan that their preferred provider is not in-network for.
Similarly, patients with new coverage under Medicaid or eligible for managed care plans, should be informed whether you will stil be their primary care provider under Medicaid after 2014.
Additional Information
Issue Brief: Outreach and Enrollment Within HIV/AIDS Programs – NASTAD document.
Clarifications Regarding Medicaid by Ryan White HIV/AIDS Program– HRSA HIV/AIDS Bureau
Clarifications on Ryan White Program Eligibility– HRSA HIV/AIDS Bureau
Outreach and Enrollment Toolkit– Michigan Primary Care Association
Health Insurance Marketplace Guide– Centers for Medicare and Medicaid Services