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February 10, 2014

Louisiana Insurer Rejects Ryan White Funds for ACA Premiums

Blue Cross and Blue Shield of Louisiana will no longer accept third-party payments for its premiums as of March 1, 2014, Reuters reports. As a result, hundreds of people with HIV/AIDS in Louisiana receiving assistance under the federal Ryan White CARE Act who enrolled in plans under the Affordable Care Act (a.k.a. the health care reform law, or ACA) are in danger of losing their ACA health care coverage.

The situation is months in the making. In September 2013, the Centers for Medicare and Medicaid Services (CMS) informed insurers that Ryan White funds could be used to cover ACA health insurance premiums, deductibles and co-payments. However, in November, CMS warned it had concerns about supporting premiums because of the risk of fraud. Insurers told advocates the November warning required them to reject Ryan White payments.

To the contrary, a CMS spokesperson has now told Reuters that Ryan White payments can be used to pay premiums for ACA plans when it would be cost-effective for the Ryan White program. In other words, having people with HIV/AIDS enroll in ACA plans could save the government money. Blue Cross and Blue Shield of Louisiana has not responded to requests from Reuters to comment on this development.

The hundreds of people affected fall into a financial gap. They cannot enroll in Medicaid since Louisiana chose not to expand it under the ACA. Further, they cannot receive federal subsidies outside of the Ryan White program to pay for ACA premiums because they do not meet the minimum of at least being at 100 percent of the federal poverty line. Ryan White funds are their only option to pay premiums for ACA plans.

In response, Lambda Legal and the New Orleans AIDS Task Force have filed an administrative complaint with the U.S. Department of Health and Human Services Office of Civil Rights against Blue Cross and Blue Shield of Louisiana. Lambda Legal sent the insurer a letter January 27 asking it to reverse its policy and asked for a response by January 30. The insurer never responded.

To read the Reuters article, click here.

To read the Lambda Legal complaint, click here.

To read the Lambda Legal letter, click here.

Search: Louisiana, Blue Cross, Blue Shield, insurer, premium, ACA, Ryan White, Lambda Legal

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