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From our friends at HIV Health Reform

Breaking News: Louisiana Insurer Refuses Ryan White Payments; Legal Complaint Filed

Update: 7 PM ET, Monday, February 14: BCBS of LA released a statement saying they are reviewing the CMS FAQ released Friday, February 7. However, the statement reiterates their current policy that they will not take Ryan White premium payments.

Given the coverage gaps that still exist for people with HIV/AIDS, these individuals still need help paying for their share of premiums, even after federal subsidies. However, some insurers – most notably Blue Cross Blue Shield of Louisiana (BCBS) – have refused premium payments from the Ryan White Program.

Ensuring that people living with HIV/AIDS receive Ryan White support is important in all states, but more so in ones like Louisiana that did not expand Medicaid to cover the lowest-income people with HIV.


BCBS’s actions first received national attention when the HIV Health Care Access Working Group wrote to the company on January 27, 2014, urging it to accept third-party premium payments from the Ryan White Program:

Ryan White Program/ADAP insurance assistance programs that assist qualified low income clients with the purchase of health insurance are explicitly allowed (and encouraged) by the Health Resources and Services Administration (HRSA), the federal agency that oversees the Ryan White Program, as well as the Center for Consumer Information and Insurance Oversight (CCIIO).

The issue attracted national media attention in early February with a Reuters article (AIDS Patients in Obamacare Limbo as Insurers Reject Checks):

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 the interpretation of federal rules about preventing Obamacare fraud.[…]

The state’s largest carrier 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.

HIV/AIDS advocates have taken to social media outlets such as Twitter using the hash tag #bcbsfail to voice their disapproval of the BCBS practices.

Earlier guidance from CMS has contributed to confusion on the issue. In November 2013, CMS issued a FAQ document encouraging marketplace plans to reject payment from third parties such as hospitals, other health care providers, and other commercial entities. The FAQ did not mention the Ryan White Program.

However, on February 7, the same day they received inquiries from the media, CMS clarified that the agency was not referring to the Ryan White Program in the November statement. CMS released a FAQ on February 7 saying that health plans and “marketplaces are encouraged to accept such payments.” An agency spokesperson noted, “Given the importance of access to care for people with HIV/AIDS, CMS is considering amending those rules to require issuers to accept these [Ryan White Program] payments.”

Amending federal rules may be a lengthy process. To spur more immediate action, Lambda Legal and AIDSLaw of Louisiana on February 10 filed a legal complaint against BCBS urging them to accept Ryan White Program premium payments. The four-page letter notes that refusing these payments “acts as a potent device to keep people living with HIV from BCBS’s insurance rolls”:

Not only is BCBS ’s unfounded policy jeopardizing the lives of Louisiana residents living with HIV, but we are concerned that BCBS in fact is engaged in actionable discrimination in violation of the ACA (as well as potentially running afoul of other federal and state laws)… We fear that BCBS’s abrupt and suspect decision to reject [Ryan White Program] premium subsidies amounts to discrimination in violation of the federal law.




The New York Times February 8, 2014 “AIDS Patients in Obamacare Limbo as Insurers Reject Checks
Reuters February 9, 2014 “CMS may require Obamacare insurers to accept Ryan White payments
HIV Health Care Access Working Group Letter to Blue Cross Blue Shield of Louisiana Regarding Third Party Payers (PDF)
HIV Health Care Access Working Group Letter to Health and Human Services Regarding Third Party Payers (PDF)
November 4, 2013 CMS FAQ on Third Party Payments
February 7, 2014 CMS FAQ on Third Party Payments
Lambda Legal and AIDSLaw of Louisiana complaint

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