Funded by the Ryan White Program through Baltimore City Health Department Presented by: Cyd Lacanienta, MSW July 21, 2015 InterGroup Synergy & Planning Collaborative, Inc. for the Greater Baltimore HIV Health Services Planning Council
Thanks to: ◦ Members of the PLWH/A Committee, the Continuum of Care Committee, and the Comprehensive Planning Committee ◦ BCHD Staff ◦ DHMH Staff ◦ Panelists ◦ PC leadership and PC ◦ PCSO staff
In 2014, the PLWH/A Committee, the Comprehensive Planning Committee and the Continuum of Care Committee requested community forums to gather information on how clients are faring with implementation of Maryland health care reform beginning in January 2014.
Lead committee: PLWH/A Committee The PLWH/A Committee chose to focus on the following: 1. Ascertaining whether there are barriers to access to care for PLWH/As in the region 2. Providing the community with information on navigating through the new health insurance landscape
Lead committees: COCC and CPC The committees wanted to know: ◦ The case managers’ perspectives on The issues their clients are experiencing related to enrollment in coverage and access to care The challenges and benefits case managers have encountered in helping clients navigate coverage and care ◦ The Ryan White administrators’ perspectives on: The use of Ryan White funds as the payer of last resort Client challenges in accessing care
All attendees were asked to complete a demographics questionnaire before the start of the forum. This information provided a baseline of the population that was participating in the forum.
16 – HIV Negative 35% 30 – HIV Positive 65%
5 – 7 – Ages Ages 60-69 20-29 8 – Ages 30-39 18 – Ages 8 – Ages 50-59 40-49
20 - Male 28 - Female
1 – Asian/ Pacific 1 – Islander Multiracial 9 – White, Non- Hispanic 35 – Black, Non- Hispanic
1- No Answer 7 – Live in Funded Housing 4- Live with Roommate 21- Live with Family 13 – Live Alone
15 – HIV Negative and Not Applicable 2- HIV 29 – HIV Positive Positive and Not in and in Care Care
19 – Yes 31% 27 – No 59%
14 - Yes 32 - No
1 - No 4 - NA 41 - Yes
2 - NA 2 - Fair 3 - Average 10 - 29 - Good Excellent
2 - 3 - Yes NA 41 - No
3 - NA 43 - Yes
65% of the participants were HIV positive, which was the intended forum audience. Nearly 72% were over the age of 40, and participants were predominantly black, non- Hispanic. This is fairly representative of the EMA. More than half of the participants were women. This is not representative of the epidemic in Baltimore. All but two of the HIV positive participants indicated being in care, but less than half noted having insurance through Medicaid or the Exchange.
Participants in this session discussed their experiences with accessing care. This particularly focused on trying to get insurance coverage and problems or challenges with accessing insurance coverage. There were 20 total participants in this breakout group.
1 - NA 19 - Yes
2 - 2 - NA Other 11 - Medicaid 4 – Private Insurance 3 - MADAP 4 - Medicare
Insurance Pre-ACA New Insurance ACA 1 - 1 - NA NA 3 - Yes 19 - Yes 16 - No
Access Problems Noted: 2 - • Insurance was flagged 3 - Yes following arrest, and it took NA over 30 days to obtain insurance through Maryland Health Connection. • Application still pending after 30+ days and there is no way to check status. 15 - No Lapse in medications and medical coverage. Phone application was faster but is no longer an option.
6 - No 14 - NA
Specialty Care Access Problems 1 - Noted: Yes 3 - NA • Prior authorization is needed for these services and notification of need is often when client is in specialty care office. 16 - No
Services Covered by Ryan White as Noted per Respondent: 4 - NA 1. Dental, vision, nutrition 7 - Yes 2. Dental 3. Dental 4. Dental 5. Co-pays 6. Co-pays 9 - No
If they currently have insurance coverage, respondents were asked who helped them get that coverage. No answer options were listed. These are in the respondents’ own words. Answer by respondent: 1. Case management team 2. Parents 3. Parent, job 4. Myself 5. Employer 4 - 6. Case manager Employer 7. Previous employer 8. Employer 6 – Case 9. Case manager Manager 10. Social worker 11. Case manager 12. Social worker 3 – Social 13. Case manager Worker 14. Case manager 15. Social worker 2 - 1 - Family Self
Respondents were asked to describe their overall experience with accessing health insurance to cover their medical needs. Responses: 1. So far everything is a green light no problems 2. As a case manager the processes are not smooth 3. I have Medicare 4. No problems or issues at all 5. Great 6. Generally good 7. Excellent 8. I need insurance covering my surgery 9. Good 10. Smooth no ripples 11. Great 12. I am satisfied with my insurance
All but one respondent had insurance coverage, and 42% had Medicaid. Few gained new insurance with ACA. Largest problem with access to care reported was amount of time it takes to get coverage. For these clients, PAC to Medicaid transition was smooth. Few problems noted once coverage is obtained.
Even with insurance coverage, need for Ryan White is still reported. Particular areas of need for Ryan White noted were with oral health and co-pays. Clients rely heavily on the knowledge of their case managers and social workers to get insurance coverage and access to the services they need.
Participants in this session discussed their experiences with medical services. This session particularly focused on specialty care, need for Ryan White and how medical services are covered for clients. There were 17 total participants in this breakout group.
1 - No 16 - Yes
5 - No 12 - Yes
1 - Dietitian 5 - Other 7 – Infectious Disease 2 - Heart 3- Substance Abuse 3 - Neurology 3 – 1 – Skin Care Physical Therapy 6 – Mental Health 2 – Stomach/ Liver
Access Issues Noted per Respondent: 2 - NA • Mental health therapist not 4 - Yes addressing how I learn or retain information. • Sometimes • Not enough slots. Insurance 11 - No doesn’t cover high co-pay. • Chiropractor
Explanation for Ryan White Access per Respondent: • Whatever my insurance doesn’t cover 6 - Yes • In the past 11 - No • Co-pays • Dental and mental health
1 - Other 4 - MADAP 7 – Out of Pocket 6 - Medicaid 2 – Private Insurance 2 – 2 - Ryan Medicare White
2 - Other 4 - MADAP 6 – Out of Pocket 4 - Medicaid 2 – Private Insurance 4 - 2 – Medicare Ryan White
1 - Other 2 – Health 1 – Family/ 5 – Personal Provider Friend Vehicle 9 – Public Transportation
Respondents were asked to detail positive experiences with using insurance to cover health care. Experiences as noted per respondent: 1. My PCP pays close attention to my needs and addresses them accordingly. 2. Satisfied 3. I can get access to care before it is necessary. 4. My insurance pays for all my medical needs. I struggle to pay co-pays. 5. I get all my meds on time even when I had a red flag on my insurance. 6. Knowledge 7. Insurance follows up with brochures and emails and updates with health care needs. 8. Finances- don’t have to pay for prescriptions. 9. Immunizations are cheaper, along with basics like eye or ear exams. 10. Not very favorable. There are always bills coming in the mail.
Respondents were asked about their negative experiences or gaps with insurance for their health needs. Experiences as noted per respondent: Getting a mental health therapist that is willing to 1. address my needs. None 2. When I switched from Medical Assistance to private 3. insurance there was a gap for 5-6 months with no coverage. It just took too long to get coverage and I was real 4. depressed. Surgery is needed. 5. Drug coverage – donut. 6. Co-pays 7. My chiropractor. I don’t go any longer. 8.
94% of respondents have received PMC in past year, and 71% are seeing specialists. Infectious disease and mental health professionals are the most frequently utilized specialty providers. Respondents noted some gaps in insurance coverage, particularly oral health, co- payments, and mental health.
29% reported out-of-pocket costs for co- payments and 25% reported out-of-pocket costs for medications. These are both issues Ryan White can help address. Respondent concerns noted once they are on insurance include gaps in coverage while changing types of insurance, co-payments, and drug coverage. Again, these are instances in which Ryan White can help PLWH/As.
Participants in this session discussed their experiences with accessing supportive services, or services the complement medical treatment. Particular attention was paid to accessibility of these services through insurance and the need for Ryan White coverage of these services. There were 27 total participants in this breakout group.
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