The Affordable Care Act: Implications for AIDS Service Organizations and PLWH
Q&A Highlights 10/30/14
The Affordable Care Act: Implications for AIDS Service Organizations and PLWH
(Robert Greenwald and Carmel Shachar)
# / Questions / Answers /1. / Could you speak to the future of Medicaid expansion in states that currently have not chosen to expand Medicaid? / Since the last presidential election, there have been 12 governors that have come out in favor of the Medicaid expansion. It’s difficult in those states to move forward, but—like the original Medicaid program, the CHIP program, and every other federal program that all 50 states participate in—it is expected that over time more states will enroll. As we get more information about the positive effects of the ACA, it is important that we make the case that there is a cost in terms of individual and public health as well as economic opportunity that comes with not expanding.
2. / How would an HIV/AIDS Service Organization start the process to become a provider for an insurance entity to deliver case management services and housing services? / There are a few routes for this. One would be to work primarily with providers. You could go to a provider and let them know that you are willing to subcontract to provide case management services as part of an ACO. You also could go directly to the health insurance entity and make the case that you could provide these case management services for providers who don’t have the capabilities to do so themselves. The best thing to do is to find out where the health insurers and providers in your state are in terms of incorporating and financing these new health care delivery models, and then see how you can plug into that.
3. / As ASOs move to a fee for service model, what types of credentialed professionals would it be helpful to have to be able to bill Medicaid and private insurance? / There can be a range. It certainly would be helpful to have more traditional providers like doctors or certain types of nurses in certain states. Depending on the type of insurer, it is possible that you could provide some of these services without being a traditional provider. For example, Medicaid currently just requires that a physician’s sign-off recommending preventive services; you don’t necessarily need to be credentialed to provide those services and bill for them. The specifics for this are all really location specific, so we recommend reaching out to your state Medicaid office or to different insurers to find out which practitioners can bill.
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