The Virginia Department of Health (VDH) had 6,359 clients enrolled in the Virginia (VA) Acquired Immunodeficiency Syndrome (AIDS) Drug Assistance Program (ADAP) as of March 31, 2017. Approximately 76% of VA ADAP clients are currently receiving medications through insurance support mechanisms (i.e., Affordable Care Act (ACA), Medicare Part D, and Insurance Continuation), and 24% are directly receiving medications distributed through local health departments (LHDs) or other clinic sites. Providing medication through purchasing insurance plays a key role in ADAP sustainability and has allowed ADAP to avoid implementing a waiting list since the elimination of its prior waiting list in 2012.

Background

VA ADAP provides access to life-saving medications for the treatment of Human Immunodeficiency Virus (HIV) and related illnesses for low-income clients through the direct provision of medications or by paying insurance premiums and/or co-payments on the client’s behalf. The program is supported with federal Ryan White Treatment Extension Act Part B grant funding, which is distributed to jurisdictions utilizing a formula based on the number of HIV and AIDS cases in each state or territory. VA ADAP also receives an annual appropriation of $200,000 from state general funds. Other funding sources include Medicaid reimbursements for clients who receive retroactive eligibility and rebates on eligible medications from pharmaceutical manufacturers.

Accomplishments

• As of March 31, 2017, VA ADAP successfully supported enrollment of 3,695 clients through ACA plans, with 570 persons newly enrolled into ACA plans in 2017. Cost savings to ADAP from insurance enrollment enabled VDH to support more core medical and support services for people living with HIV in the state.

• The continuing collaboration between VDH and statewide ADAP stakeholders contributed to enrollment success. VDH provided regular updates on enrollment progress through multiple communication strategies and worked proactively with partners to identify and solve challenges to maximize insurance enrollment.

Challenges

• VDH experienced difficulties with receiving and processing information on enrollment into ACA plans.

• Several variables will affect future program need, including potential changes to ACA and the stability of rebates from the pharmaceutical industry. For 2018, three major challenges will be the shortened ACA open enrollment period, which at 45 days is half the time of open enrollment periods since the start of the ACA, the loss of at least two insurers from the health insurance Marketplace, and the exclusion of ADAP clients’ HIV medical providers from some carrier networks.

Recommendations

• Current projections indicate that program resources will enable VA ADAP to serve all eligible clients if ACA and other insurance plan options and enrollment remain stable. If ACA were repealed, however, VA ADAP would face significant cost increases. This could result in a large shortfall for the program and a waiting list for ADAP services. Monitoring of all variables and reassessment, therefore, will be necessary to determine if resources are adequate to serve all eligible clients in both the current and upcoming grant year.

• In order to maintain adequate insurance enrollment to ensure sustainability, VA ADAP needs to increase its insurance analysis capabilities and enrollment capacity. VDH is implementing multiple new strategies to meet these needs.