CMS may require Obamacare insurers to accept Ryan White payments

Sun Feb 9, 2014 3:04pm EST

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(Reuters) - The U.S. Centers for Medicare and Medicaid Services (CMS), in an effort to keep insurers from denying coverage to people with HIV/AIDS, may strengthen its position on health plans accepting third-party payments, such as those under the 1990 Ryan White Act.

Hundreds of people with HIV/AIDS in Louisiana trying to obtain coverage under President Barack Obama's healthcare reform are in danger of being thrown out of the insurance plan they selected in a dispute over federal subsidies and interpretation of rules about preventing Obamacare fraud, Reuters reported on Saturday.

Blue Cross and Blue Shield of Louisiana, the state's largest health insurer, is rejecting checks from a federal program designed to help these patients pay for AIDS drugs and insurance premiums, and has begun notifying customers that their enrollment in its Obamacare plans will be discontinued.

The insurer insists it is not trying to keep people with HIV/AIDS from enrolling in one of its policies under the Affordable Care Act, but is instead rejecting third party premium payments in an effort to prevent potential fraud.

"Federal rules do not prevent the use of Ryan White funds to pay for health care plans," CMS said in a statement late on Saturday, adding that it had issued guidance "encouraging issuers and Marketplaces to accept such payments."

CMS suggested that such encouragement may not be enough to protect patients in need of expensive life-saving medicines.

"Given the importance of access to care for people with HIV/AIDS, CMS is considering amending those rules to require issuers to accept these payments," the lead Obamacare agency said.

The 1990 Ryan White Act offered people with HIV/AIDS federal financial help in paying for AIDS drugs and health insurance premiums, especially in state-run, high-risk pools. Obamacare, which bans insurers from discriminating against people with preexisting conditions, was designed to replace these high-risk pools.

Hundreds of HIV/AIDS patients are dependent on Ryan White payments for Obamacare because they fall into a coverage gap. They are not eligible for Medicaid, the joint federal-state health insurance program for the poor, because Louisiana did not expand the low-income program, and Obamacare federal subsidies don't kick in until people are at 100 percent of the federal poverty level.

(Reporting by Bill Berkrot and Sharon Begley; Editing by Bernard Orr)

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Comments (1)
Bakhtin wrote:
Preventing fraud is such a lame excuse. They are the only ones rejecting these cheques, and have accepted the cheques themselves for decades.

For ‘preventing fraud’ to fly it would require fraud to have been invented this year and exist only in Louisiana. They are just trying to manufacture a scandal to make Obamacare look bad, and don’t care who suffers in the process.

Feb 10, 2014 11:04am EST  --  Report as abuse
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