How Can AIDS Service Organizations Diversify Funding and Reach More People Under the Affordable Care Act?

Health care reform under the Patient Protection and Affordable Care Act (ACA) has created new opportunities for AIDS service organizations (ASOs) in the U.S. wishing to diversify funding and expand services, according to Carmel Shachar, the staff attorney at the Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School.

Speaking at a National Center for Innovation in HIV Care (NCIHC) webinar entitled "The Affordable Care Act: Implications for AIDS Service Organizations and People Living With HIV/AIDS," Shachar stated that the ACA made it possible for ASOs to work alongside traditional health care providers and receive reimbursement through public and private insurance systems.

"Several developments in Medicaid represent great opportunities for ASOs to get involved and get paid for [delivering] services to Medicaid clients," Shachar said.

"Originally, in order to be certified as a Medicaid practitioner, you needed to be a traditional health care provider, such as a doctor or a hospital. Recently, however, CMS (the Centers for Medicare and Medicaid Services) changed its position and now only requires that preventive services are recommended by a physician, but they can be delivered by other providers. This really opens the door to have AIDS service organizations work with physicians to provide preventive services such as testing."

Under the ACA, preventive services (such as testing for HIV, hepatitis C and sexually transmitted infections [STIs]) are offered free of charge to most people with public or private health insurance, explained Robert Greenwald, the director of CHLPI.

"The rapidly increasing availability of preventive services represents another significant opportunity for AIDS service organizations, who have more experience with HIV, hepatitis C and STI counseling and screening than [traditional health care providers] do," Greenwald said.

"The Affordable Care Act provides several new opportunities, through these initiatives, for integrating community-based providers and AIDS service providers, in particular, into health reforms."

Shachar encouraged ASOs to reach out to traditional health care providers and advocate for service integration.

"ASOs should absolutely be pushing for more integration with the Medicaid world," she said.

"We're seeing partial integration of non-medical providers, primarily around food and nutrition issues, in which food and nutrition advocacy organizations have successfully advocated for the inclusion of nutrition services in dual-eligible integration projects and other Medicaid programs, which represents millions of dollars that could be flowing to these services."

While integrated models of care are being tested within the public system, Shachar admitted change had been slower within the private sector.

"Private insurers have been reluctant to embrace ASOs but that hurdle is not insurmountable," Shachar said.

"Insurers are worried about making themselves too attractive to consumers living with HIV. However, they need to understand that it's simply the reality that they are going to see more enrollees living with HIV on their plans regardless, and ASOs need to be more proactive about making the case to insurers and providers that they will ultimately benefit by incorporating greater care coordination for this population."

The NCIHC is currently holding a series of webinars for Ryan White-funded ASOs and community-based organizations. Further information is available on the center's website.

Katherine Moriarty is a consultant and freelance writer, based in Vancouver. She has 10 years of experience in the intersecting fields of public health and community development, with a focus on bloodborne virus policy and programming.