Back in the days of Ryan White funded services, getting access to HIV care was a pretty straight forward affair. As long as you made less than $44,000 a year, all of the your cost of care was covered. Ryan White funding included help for housing, food, dental care, transportation and more. We learned that if folks had stable housing, access to mental health and drug treatment programs, they did better medically. The one problem with Ryan White services was that they only covered HIV and related care. If you broke your leg or had some other non-HIV medical issue, you were out of luck.
Now with the advent of the Affordable Care Act (ACA or Obamacare), out patients have access to the full spectrum of medical services. As part of these changes, existing programs like MediCal and Medicare are now providing HMO type health insurance. Covered California, our local version of Obamacare, also offers HMO style choices.
For many of the CARE Program's patients, they've never had to navigate the complexities of an HMO plan. They could come directly to the CARE Clinic and receive services. Rather than MediCal paying the patient's medical bills directly, MediCal now pays insurance companies. Patients are required to have a primary care doctor that refers them to HIV specialty care, and the insurance companies first need to authorize the services. The insurance companies don't contract directly with doctors; instead they contract with medical groups, and if you see several specialists, they now have to belong to the same medical group.
Over the years, we've learned in HIV care that having a case manager, social worker, or nurse advocate for the patient makes for better health outcomes. Now more than ever, patients need help navigating the insurance and healthcare system.
To that end, CARE will be offering a benefits forum, so that clients can learn more about changes in their healthcare, sign up for programs that allow them to continue to see their specialists, and ask questions of experts in benefits, health insurance, and government programs. The forum will take place on Friday, April 24th from 11:00 to 2:00 pm on the campus of St. Mary Medical Center.
The forum takes place in the Parr Building, located between the parking structure and the CARE Dental Clinic. If you'd like to attend, call Jay Villareal at (562) 624-4987. Lunch will be provided.