What is the Health Insurance Continuation Program (HICP)?

Transcription

1 What is the Health Insurance Continuation Program (HICP)? HICP is one of the five program components specified in the Ryan White CARE Act for which Title II funds may be spent. Eligible Metropolitan Areas (EMAs), funded under Title I, may also elect to support HICP programs. HICP provides a continuum of health insurance coverage for people living with HIV disease (PLWH). HICP offers transitional coverage by extending an individual s existing health insurance until they become eligible for Medicaid or Medicare. Some HICPs also provide uninsured individuals health insurance coverage by buying into risk-pools HICPs often work closely with public programs to transition clients as they become eligible for public benefits.

2 HICP plays an important role in enhancing the continuity and comprehensiveness of care for PLWH by: Maintaining a continuum of coverage in health care services for participants which will enable them to receive earlier, ongoing, clinical treatment for HIV. Sharing the cost of providing care to PLWH across private and public health insurance programs, thus reducing the fiscal impact on publicly funded programs. Forestalling or possibly eliminating the necessity of clients who are eligible for COBRA* to use up all of their resources before becoming Medicaid-eligible. Allowing clients to continue working part-time without risking a loss of insurance coverage. This is in contrast to public health insurance (e.g., Medicaid) where rising income results in a loss of eligibility and services. Providing assistance until persons disabled by HIV disease can qualify for Medicaid or Medicare. Consolidated Omnibus Reconciliation Act (COBRA) is Federal legislation that requires employer s to offer individuals leaving their workforce continued health insurance coverage, at their expense, under the employer s group plan.

3 Many HICPs share the following characteristics: Eligibility criteria include an AIDS diagnosis, maximum income (as a percentage of the Federal poverty level), a cap on assets, and residency within a State. Coverage of HIV-related care and prescription drugs costs. Coverage of COBRA premiums. Continuation of premium payments when COBRA group coverage expires. Exclusion of Medicaid-eligible individuals since Ryan White is the payer of last resort. Implementation specifics of HICPs may vary from State to State because health insurance is primarily governed by State law.

4 Localities Providing HICPs Number of States and EMAs with HICPs States* EMAs Calendar Year Calendar Year Calendar Year ** 8 Calendar Year The total number of HICP Programs continues to increase each year. During calendar year 1998, a total of 37 States/EMAs provided a HICP. New operators were Arkansas, Ft. Lauderdale, FL, Jersey City, NJ, Paterson, NJ and Ft. Worth, TX. A list of localities with HICPs is found in the Appendix. All HICP localities provide a continuation of health insurance coverage. In addition, Alaska, Louisiana and Portland, Oregon provide riskpools. * Instead of having a single State-wide program, three States provide HICPs through their consortia. For the purposes of this report, all consortia programs in the same state were counted as one. **Although Wyoming provided a HICP program during calendar year 1997, they did not report any information regarding their program. As of 1997, Virginia s Health Insurance Program is administered by Medicaid. RWCA dollars were not needed to support this program.

5 Fiscal Allocations States EMAs FY 1996 Allocation $7,557,540 $1,276,161 FY 1997 Allocation $7,617,335 $1,293,570 FY 1998 Allocation $9,754,986 $2,191,161 FY 1999 Allocation $12,023,570 $3,045,270 The increase in the total number of HICP participants is also reflected in the increase in the funding allocated to this program. There was a slight increase in funding among states and EMAs from FY96 to FY97. From FY97 to FY98, there was a 28% increase among states and a 69% increase among EMAs. Funding in FY99 increased by 23% among states and 39% among EMAs. During FY 1999, the median allocation among state HICPs was $228,247. Allocations ranged from $7,500 in South Dakota to $2,577,136 in Florida.

6 Total Clients Served The total number of clients increased by 36% from 1995 to There was a 16% increase in participants from 1997 (6,675) to 1998 (7,759) ,759 6,675 5,700 6,080 48% 38% 32% 33% New Clients Continuing Clients

7 Percent of Clients by Race/Ethnicity About two-thirds (65%) of the clients participating in the 1998 HICP identified as White, non-hispanic. African American (non- Hispanic) and Hispanic clients comprised 18% and 15% of the clients served by HICPs, respectively. Am. Indian 1% Asian/P.I. 1% Hispanic 15% White 65% Asian/ Pacific Islanders, American Indian, Aleutian, Eskimo, and Alaska Native clients comprised 2% of the clients population. Black 18%

8 Health Insurance Continuation Program (HICP) Number of Clients by Race/Ethnicity by Year 6,000 5,000 4,000 4,130 4,380 4,700 5, ,000 2,000 1, , , White Black Hispanic Asian/P.I. Am. Indian Across racial/ethnic categories, the proportion of clients utilizing HICP has remained similar since Overall, White, non-hispanic clients represented 71% of the clients, African-Americans 14%, Hispanics 14%, and Asians/Pacific Islanders and Native Americans each represented 1% of the clients. From 1995 through 1998, the proportion of White clients decreased by 9%, while that of African Americans and Hispanics increased by 6% and 4%, respectively. The proportion of clients served among Asian/Pacific Islanders and American Indians/Alaska Natives has been approximately the same since 1995.

9 Appendix 1998 Health Insurance Continuation Program (HICP) Localities with HICP Programs States Eligible Metropolitan Areas Alaska New Hampshire Austin, TX Arkansas New Jersey Dallas, TX California New Mexico Ft. Lauderdale, FL Colorado Nevada Ft. Worth, TX Delaware Ohio Jersey City, NJ Florida Rhode Island Kansas City, MO Georgia South Dakota New Orleans, LA Hawaii Texas Paterson, NJ Illinois Utah Portland, OR Indiana Washington St. Louis, MO Kansas West Virginia San Antonio, TX Kentucky Wisconsin Louisiana Montana States and EMAs in bold first operated a HICP in 1998.

10 Appendix 1998 Health Insurance Continuation Program (HICP) Localities with HICP Programs WASHINGTON Portland, OR NEVADA CALIFORNIA MONTANA NEW HAMPSHIRE SOUTH DAKOTA WISCONSIN RHODE ISLAND Paterson, NJ Jersey City, NJ NEW JERSEY INDIANA ILLINOIS OHIO DELAWARE UTAH Kansas City,MO WEST VIRGINIA COLORADO KANSAS St. Louis,MO KENTUCKY ALASKA ARKANSAS NEW MEXICO TEXAS Ft. Worth,TX Dallas,TX GEORGIA LOUISIANA Austin,TX FLORIDA New Orleans,LA San Antonio,TX Ft. Lauderdale, FL HAWAII Eligible Metropolitan Areas