Archive for the ‘Affordable Care Act’ Category
Health plan benefits for transgender individuals
If you or a loved one are transgender, please read the update below about coverage for transgender-related care.
You may have heard about a new regulatory directive issued to California health plans by the California Department of Managed Health Care (DMHC) on April 9, 2013. The directive requires health plans with benefits that are regulated by the DMHC to provide transgender individuals with the same benefits that are available to non-transgender individuals.*
We want you to know that Kaiser Permanente’s health plans regulated by the DMHC now include coverage for medically necessary health care services for transgender individuals including, for example, behavioral health services, hormone therapy, and transgender surgery. General exclusions and limitations that apply to all services also apply to transgender services.
Some of our health plans were previously permitted to exclude coverage for transgender surgery. We are no longer applying that exclusion in our DMHC-regulated health plans. If you’re enrolled in one of those health plans, this means that you now have transgender surgery benefits even if your current Evidence of Coverage document lists transgender surgery as an exclusion. Also, for our DMHC-regulated health plans that previously covered transgender surgery and included a lifetime dollar limit on the surgery benefits, as of April 9, 2013, we are no longer applying those dollar limits.
For more information about these benefits, please contact our Member Service Contact Center at1-800-464-4000 (toll free). Learn more about transgender issues in our health encyclopedia.
Our Medi-Cal plans, KPIC insurance plans, and Kaiser Permanente employee benefit plans also include coverage for these services. Medicare and Federal Employees Health Benefits (FEHB) plans, and most employer self-funded plans administered by Kaiser Permanente, do not include coverage for transgender surgery. Beginning January 1, 2014, FEHB plans will provide coverage for transgender surgery.
On August 8, 2013 – Mr. Tom Donohoe, Director of the UCLA Pacific AIDS Education and Training Center, presented on the Affordable Care Act. The presentation was given as part of the HIV Community and Research Colloquia Series hosted by the Los Angeles County (LAC) Commission on HIV and the UCLA Center for HIV Identification, Prevention, and Treatment Services (CHIPTS). The presentation specifically focused on Covered California (California’s health insurance marketplace) and how it impacts consumers living with HIV in Los Angeles County. Using case-based examples, the presentation helped to dispel misconceptions about what health care reform will do and not do for these populations infected and affected by HIV. The event was attended by over 130 participants, including members of the LAC’s Commission on HIV, local HIV service providers, key community stakeholders, and consumers of HIV prevention and care services. For a copy of the slides presented at the meeting, please click here. To view the presentation, please click below.
The presentation was followed by a panel discussion. The panelists included Derrick Butler, MD of THE Clinic, Aaron Fox of the LA Gay & Lesbian Center, John Riley of AIDS Project Los Angeles, Carlos Vega-Matos of Los Angeles County Division of HIV and STD Programs, and Michael Kelly. To view the panel discussion, please click below.
Whether you’re for it or against it, health care reform can be a hard nut to track — and that’s before all the fighting and defending and saboteurs and exceptions. Kiddie though it may seem, share it with someone you care about; it could very literally save his or her life one day.
|Send Us Your HIV Health Reform Resources!Have you developed materials related to health care reform targeted for people with HIV? If so, send them to us so we can share them with the world!
We don’t think anyone should have to reinvent the wheel. We know some of you have created great materials that others could adapt for their own states.
Please email them to John Peller. We prefer formats that others can modify, such as the original Word or PowerPoint slides.
Below are a few examples of the materials that other organizations have created and shared with HIVHealthReform.org for evryone to use.
• The Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School has developed a Marketplace Health Plan Assesment Tool. Learn how to use this tool during our October 1 webinar (Register).
• Market Place Information Brochure for People Living with HIV (Word):Created by the Duke University School of Law AIDS Legal Project, this clear and simple brochure explains the marketplace, how insurance works, and how ADAP and Ryan White can help.
• Health Reform Passport (Word): Created by the AIDS Foundation of Chicago, this can be used to help consumers gather a list of the information they need to bring with them when they enroll in the exchange.
• A Customizable Frequently Asked Questions Document about the Affordable Care Act designed for Ryan White Program Clients. This was created by Harder+Company Community Research, and the San Francisco HIV Health Care Reform Task Force.
Two HIV Health Reform Webinars in Time for Open Enrollment Oct. 1
On October 1 – the day of this webinar – health insurance marketplaces across the country will reveal the health plans they will offer. It is also the day that people can start to sign up for a plan.
But how can we make sure people with HIV enroll in the best plan for them?
To help you evaluate the insurance plans in your state, the Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School has developed a health plan assessment tool that can help you figure out which plans are particularly well-or ill-suited for people with HIV.
On this webinar, we will train you to use the assessment tool. We’ll describe the steps necessary for evaluating a plan, highlighting the key provisions that will have the biggest impact on access to care and treatment, along with affordability. We’ll also go over a workbook and worksheet you can use to assess and compare the plans that are available in your state.
The second webinar in the “We Can Do It” series will take place Thursday, October 3rd, at 3:00-4:30 p.m. ET, 2:00-3:30 p.m. CT, 1:00 -2:30 p.m. MT, 12:00-1:30 p.m. PT (note the correct time for your time zone!)
People with HIV will be able to buy health insurance through online marketplaces in October. We’ll help you understand the tax credits and subsidies that make plans more affordable for low-income people, benefits that will be provided, coordination with ADAP and Ryan White programs, and other issues.
The “We Can Do It” series is focused on people working on the front lines of the HIV epidemic – case managers, peer navigators, planning council members, and others. Future webinars will cover Medicaid, the marketplaces, and the role of the Ryan White Program.
Click here for a flyer, which you can use as a promotional tool in your organization. Help us get the word out about this fantastic new webinar!
The White House Office of National AIDS Policy (ONAP) will be hosting two webcasts about improving outcomes along the HIV Care Continuum
From the White House Office of National AIDS Policy (ONAP):
The White House Office of National AIDS Policy (ONAP) will be hosting two webcasts to gather input from stakeholders and the community on what federal agencies can do to improve outcomes along the HIV Care Continuum.
The webcasts are free, and open to the public. They will be held on Monday, September 16 and Tuesday, September 24 from 1:00 pm-2:30 pm EDT. You will be able to provide input on the questions below by calling-in or via email.
Each webcast will begin with a brief update on the National HIV/AIDS Strategy and the HIV Care Continuum and be followed by input from the participants on the questions below.
In your on-going work to implement the National HIV/AIDS Strategy, and within the framework of the Care Continuum, please be prepared to discuss the following on each webcast:
- What structural, policy, and programmatic actions could be taken to improve care continuum outcomes?
- What actions could be taken so that evidence-based interventions focusing on the care continuum are further integrated into other proven approaches to addressing HIV? (e.g., housing, substance use treatment)?
- What are the research gaps, including implementation research gaps, along the care continuum?
- What actions are needed so that care continuum data are used effectively to monitor outcomes and drive real-time change across programs?
Please go to the following URL on the day of the Webcast to be connected:
September 16: http://services.choruscall.com/links/hrsa130916_WH.html
September 24: http://services.choruscall.com/links/hrsa130924_WH.html
Please feel free to forward this message to your colleagues and community partners. We hope you are able to participate.
from one of the HIV MHTF members:
I wanted to pass this info along due to the fact that much of our discussion in the Task Force meetings is on Healthcare Reform. This is a free online course through Coursera and the University of PA entitled, “Health Policy and the Affordable Care Act.” Of course, much of what we talk about in the meetings is regarding specifics to LA County and this course is an overview of the national policy, however, I thought it may still be of interest. The course starts on March 25th, so it’s kind of last minute – but I just found out about it yesterday. Again, it’s free to register. I’m taking another Coursera-based course right now and it’s a pretty great resource, in general.
Mental Health Clinician II
Mental Health Services
L.A. Gay & Lesbian Center
1625 N Schrader Blvd Los Angeles, CA 90028-6213
+1 (323) 993-7486 | +1 (323) 308-4044 (fax)
Visit us on the web at www.lagaycenter.org.
The ACA & HIV in LA County: What Do We Know Now? Where Are We Going?
Tuesday, January 29, 2013
Charles Drew University | UCLA
Pacific AIDS Education & Training Centers
Moderator: Phil Meyer
Tom Donohoe, MBA
Director, UCLA PAETC
Carlos Vega-Matos, MPA
Chief, HIV Care Services, Division of HIV/STD Programs
Craig Vincent-Jones, MHA
Executive Director, LA County Commission on HIV