Blue Cross decision affects some HIV/AIDS enrollees

HIV News LogoBlue Cross and Blue Shield of Louisiana said Monday that it will no longer allow community groups to use money from a federal program for HIV/AIDS patients to enroll those patients in insurance plans offered under the Affordable Care Act.

“Our policy is that effective March 1, 2014, we will only accept individual members’ premium payments from the policyholder or an immediate family member/blood relative or legal guardian of the policyholder,” Blue Cross spokesman John Maginnis said. “We will no longer accept third-party payments.”

Blue Cross – Blue Shield

That stance flies directly in the face of the most recent instructions from the federal Centers for Medicare and Medicaid Services.

CMS says federal rules do not prevent the use of what are called federal “Ryan White funds” to pay for health care plans, a point that it made clear last week in encouraging insurers to accept those payments.

“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 agency said in a more forceful statement issued Monday.

Blue Cross says CMS’ most recent directive is quite different than instructions issued in November, which “strongly advised” insurers against accepting any third-party payments.

Maginnis said the insurer is reviewing and considering the new information to decide whether it is helpful in addressing the company’s concerns about taking third-party payments.

CMS said the November third-party instructions were an effort to stop hospitals, other providers and commercial entities from paying premiums for individuals.

A few hospitals had attempted to enroll some of their most costly patients, the chronic users of the emergency room, through the online federal insurance marketplace.

At issue is the use of “Ryan White Program” funds, the single-largest federal program specifically for people with HIV. In the 2012 fiscal year, Louisiana received $50.7 million in Ryan White funds.

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