AIDS patients in Obamacare limbo as insurers reject checks

U.S. President Barack Obama speaks during a visit to Michigan State University in Lansing, Michigan. Credit: Reuters
U.S. President Barack Obama speaks during a visit to Michigan State University in Lansing, Michigan.
Credit: Reuters

Hundreds of people with HIV/AIDS in Louisiana trying to obtain coverage under President Barack Obama’s healthcare reform are in danger of being thrown out of the insurance plan they selected in a dispute over federal subsidies and the interpretation of federal rules about preventing Obamacare fraud.

Some healthcare advocates see discrimination in the move, but Blue Cross and Blue Shield of Louisiana says it is not trying to keep people with HIV/AIDS from enrolling in one of its policies under the Affordable Care Act, also known as Obamacare.

The state’s largest carrier is rejecting checks from a federal program designed to help these patients pay for AIDS drugs and insurance premiums, and has begun notifying customers that their enrollment in its Obamacare plans will be discontinued.

The carrier says it no longer will accept third-party payments, such as those under the 1990 Ryan White Act, which many people with HIV/AIDS use to pay their premiums.

“In no event will coverage be provided to any subscribers, as of March 1, 2014, unless the premiums are paid by the subscriber (or a relative) unless otherwise required by law,” Blue Cross Blue Shield of Louisiana spokesman John Maginnis told Reuters.

AIDS FUNDS EXEMPT FROM FRAUD CONCERNS

The dispute goes back to a series of statements from Centers for Medicare and Medicaid Services (CMS), the lead Obamacare agency.

In September, CMS informed insurers that Ryan White funds “may be used to cover the cost of private health insurance premiums, deductibles, and co-payments” for Obamacare plans.

In November, however, it warned “hospitals, other healthcare providers, and other commercial entities” that it has “significant concerns” about their supporting premium payments and helping Obamacare consumers pay deductibles and other costs, citing the risk of fraud.

The insurers told healthcare advocates that the November guidance requires them to reject payments from the Ryan White program in order to combat fraud, said Robert Greenwald, managing director of the Legal Services Center of Harvard Law School, a position Louisiana Blue still maintains.

“As an anti-fraud measure, Blue Cross and Blue Shield of Louisiana has implemented a policy, across our individual health insurance market, of not accepting premium payments from any third parties who are not related” to the subscriber, Maginnis said.

On Friday, CMS spokeswoman Tasha Bradley told Reuters that, to the contrary, Ryan White grantees “may use funds to pay for premiums on behalf of eligible enrollees in Marketplace plans, when it is cost-effective for the Ryan White program,” meaning that having people with HIV/AIDS enroll in insurance under Obamacare could save the government money.

“The third-party payer guidance CMS released (in November) does not apply to” Ryan White programs.

Maginnis did not respond to further requests, sent after business hours, for comment on CMS’s Friday statement.

Hundreds of indigent HIV/AIDS patients are dependent on Ryan White payments for Obamacare because they fall into a gap. They are not eligible for Medicaid, the joint federal-state health insurance program for the poor, because Louisiana did not expand the low-income program, and Obamacare federal subsidies don’t kick in until people are at 100 percent of the federal poverty level.

Before Obamacare, the 1990 Ryan White Act offered people with HIV/AIDS federal financial help in paying for AIDS drugs and health insurance premiums, especially in state-run, high-risk pools.

Obamacare, which bans insurers from discriminating against people with preexisting conditions, was designed to replace these high-risk pools.

Starting on October 1, AIDS advocates and others in Louisiana “were enrolling anyone and everyone we could” through the Obamacare exchange, said Lucy Cordts of the New Orleans NO/AIDS Task Force.

Last month, her clients and those of other AIDS groups began to hear from Louisiana Blue that their enrollments were in limbo because the company would not accept the Ryan White checks for premium payments.

The only other carrier that is refusing to accept such payments is Blue Cross Blue Shield of North Dakota, according to a CMS official.

North Dakota Blue “restricts premium payment from third parties including employers, providers, and state agencies,” said spokeswoman Andrea Dinneen, but “is currently reviewing its eligibility policies with respect to recipients of Ryan White Program funding.”

‘SURE LOOKS LIKE DISCRIMINATION’

Healthcare advocates are worried that the refusal to accept Ryan White payments is an effort by insurers to keep AIDS patients from enrolling in their plans and last month began pressing the issue, including with the office of Democratic Senator Mary Landrieu.

In an email reviewed by Reuters, a healthcare expert on Landrieu’s staff wrote, “BCBS LA told me their decision was not due to the CMS guidance or any confusion (as we thought before) but was in fact due to adverse selection concerns. I have also recently learned North Dakota’s BCBS plan has implemented the same policy.”

Jessica Stone, the Landrieu staff member, declined to elaborate on the email further or to discuss her interactions with Louisiana Blue.

Adverse selection refers to the situation where an insurer attracts patients with chronic conditions and expensive care. Louisiana Blue’s action “sure looks to us like discrimination against sick people,” said John Peller, vice president for policy at the AIDS Foundation of Chicago.

Asked if it were engaging in efforts to avoid adverse selection by refusing to accept Ryan White payments for would-be customers with HIV/AIDS, Louisiana Blue said it was not trying to keep such customers out of its plans. “We welcome all Louisiana residents who chose Blue Cross and Blue Shield of Louisiana,” said Maginnis.



News
Entertainment
Sports
Lifestyle
National

Mutant worms stay sober, even on alcohol

U.S. researchers have developed "mutant worms" that do not get drunk by alcohol, a breakthrough that could lead to new treatment for people trying to quit drinking

Local

K-9 nose helps capture $150K in cocaine at…

A furry, four-legged security agent helped authorities stop an illegal cocaine shipment from sneaking past JFK customs.

National

Minnesota man asked to leave Southwest flight after…

A man and his two sons were asked to leave a Southwest Airlines flight after the man sent a tweet complaining about being treated rudely by a gate agent.

National

Man sues hospital after surprise penis amputation

An Alabama man who went in to a hospital last month for a circumcision awoke after surgery to find his penis had been amputated, his lawyer said on Thursday.

Movies

Review: Brett Ratner's big 'Hercules' movie is small…

The latest "Hercules," starring Dwayne Johnson as the half-god beefcake of Greek myth, strips its hero and tale of most of its fantastical elements.

Arts

Scientists recreate world's smallest Monet copy

Scientists have reproduced a famous Impressionist painting using nano-printing, to create what has been described as the world's smallest work of art. Reworked at the…

Television

Jerry Seinfeld is ambidextrous, and other Reddit AMA…

See some of the weirder highlights of Jerry Seinfeld's recent Reddit AMA.

Going Out

Grab a pedestrian and start dancing at What…

As a New Yorker, I’ve mastered the art of focusing my gaze straight ahead. Though it occasionally piques my interest, the absurdities that play out…

NFL

2014 NFL Fantasy Football Top 100 overall player…

2014 NFL Fantasy Football Top 100 overall player rankings

U.S. Soccer

NYCFC announce signing of Frank Lampard

The tease of a big signing Thursday by new MLS side NYCFC ended up being one rumored for weeks. England midfielder Frank Lampard agreed to…

NBA

NBA great LeBron James sends 800 cupcake apologies…

By Kim PalmerCLEVELAND (Reuters) - NBA star LeBron James, whose recent return to the Cleveland Cavaliers in his home state of Ohio sparked a frenzy…

NFL

Jerry Reese confident with Giants, skipping countdown clocks…

Last year, Giants GM Jerry Reese installed a countdown clock in the locker room to inspire Big Blue to play in their own stadium for Super Bowl XLVIII.

Tech

Forget Wi-Fi: Li-Fi could be the future

Li-Fi technology – developed by Mexican company Sisoft – is wireless internet connectivity using specialized LED light.

Tech

Weather app Climendo might be the most accurate…

The wait for a truly accurate weather forecast could finally be over thanks to a nifty new app called Climendo.

Tech

Napkin Table puts focus off the phone and…

Michael Jan, a design student at Tunghai University in Taiwan, has invented a serviette-picnic blanket hybrid called the Napkin Table.

Style

Essie's new Color Boutique

Essie launches high-tech kiosks at major airports and malls across the country.

Comments

1

  1. my co-worker’s aunt makes $70 hourly on the computer. She has been without a job for seven months but last month her paycheck was $19034 just working on the computer for a few hours. Read more on this web site

    w­w­w­.­j­o­b­s­6­1­.­c­o­m