Guest column: The perfect storm

Hope and Help Center of Central Florida has served people with HIV and AIDS for 26 years. In the past several months there has been major upheaval in the system of care for a number of reasons, most stemming from the Affordable Care Act. Most have heard of the website freezing, and the State of Florida refusing millions of dollars in Medicaid funds from the federal government which would have helped the people who are less than 133% of the federal poverty line. Here are the other issues you may not have heard before.

Hope and Help Center has been contracted by multiple agencies, primarily Ryan White Parts A & B and the Health Council of South Florida, Inc., to provide financial assistance to eligible consumers such that they can maintain their private health insurance without major financial burden.

Prior to the June 2012 Supreme Court’s final ruling on the ACA, the programmatic and contractual requirements across all health insurance assistance programs administered by Hope and Help Center had remained relatively stagnant.

Clients were typically able to enroll in the insurance assistance programs without significant barriers and challenges. Unfortunately, there were less than 16-months between the SCOTUS’s ruling and ACA implementation to completely revise all federal, state, and local policies and procedures to comply with the legislative requirements under the new law.

Further complicating this transition was the fact that the list of insurance companies and, more importantly, the intricate details (e.g., copays, deductibles, formularies, providers, etc.) of each of their policies was not released in their entirety until September, 2013, less than a month before the open enrollment period was to begin.

This left very little time for national and state funders to (1) complete a detailed analysis of each plan, (2) determine the cost effectiveness of the plans versus other funding options, (3) develop eligibility and enrollment policies and procedures that would apply across all providers and comply with federal and state laws, and, finally (4) instruct social service providers, such as Hope and Help Center, on the enrollment processes in light of the challenges associated with the federal website portal.

As with any major systemic overhaul, significant glitches in the system were experienced, resulting in legitimate fear, frustration, and anger on behalf of those most significantly impacted; the clients. Unfortunately, as the front line provider of the insurance assistance program, Hope and Help Center staff was responsible for relaying the changes imposed by the Health Services and Resources Administration (HRSA) and various funders. Hope and Help Center, sometimes unfortunately, must strictly adhere to the contractual requirements of the funders, whether we agree with them or not. Hope and Help Center can only administer the programs within the scope of services defined in the contract with the funder.

The changes in healthcare legislation and funding have been very fluid recently, and often times the information is unclear, inaccurate, or rescinded with very little or no notice. Not only is this time of change frustrating for the clients, but also the agencies and staff that are responsible for implementing the changes.

While it is clear that some changes in the passing of the ACA are for the better (e.g., the elimination of the pre-existing condition clause), we are also experiencing the frustrations of this systemic overhaul (e.g., delays in accurate information and policy changes, those at greatest need falling through the cracks, etc.). Hope and Help Center’s Board of Directors, management, and staff are also frustrated with the seemingly endless and oftentimes contradictory changes in this “improved system.” If you currently are or were a Hope and Help Center client that is/was effected by the programmatic changes as they relate to the health insurance assistance programs, and you would like assistance in understanding your specific case in more detail, please contact us at 407.645.2577.

We welcome all inquiries and will do our best to clarify how the legal and programmatic changes affected your specific case.

Change is rarely easy, and is even more complicated and frustrating when we have little if any control over it. Many of the changes resulting from the implementation of the ACA are even scarier for those of us living with HIV/AIDS that are constantly being told to never lose our insurance, never miss an appointment with our medical provider, always get our labs done on-time, and never miss a dose of our life-saving anti-retrovirals.

We are hopeful that as the problems with the implementation of the law are addressed, policy and procedural quirks will be remedied so that all will have the healthcare that they deserve. Until that time, we ask for your patience while we wait to hear from the funders for further guidance.