Insurers Required to Accept Federal Funds for HIV/AIDS Coverage

Insurers that sell policies under the Patient Protection and Affordable Care Act (ACA) marketplace exchanges are now required, no longer just encouraged, to accept funds from a federal program for individuals with HIV/AIDS to pay health insurance premiums, according to a recent announcement from the Centers for Medicare and Medicaid Services (CMS).

This mandate comes in the wake of a dispute with Blue Cross Blue Shield of Louisiana earlier this year when the state’s largest carrier said it would begin rejecting checks from the Ryan White HIV/AIDS Program for its exchange policies.

The Ryan White program has helped low-income individuals with HIV and AIDS pay for medication and insurance premiums. Blue Cross Blue Shield of Louisiana said their decision to reject these funds from third party payments was in an effort to reduce potential fraud.

The CMS rule extends beyond the Ryan White program to include Indian tribes, tribal organizations, urban Indian organizations, and state and federal government programs.

Blue Cross Blue Shield of Louisiana said it would accept the payments only through November 15, 2014, when the next open enrollment period for the ACA exchanges begin.

Insurers that refuse to comply with this CMS mandate will face a penalty, although the CMS did not indicate what this penalty would entail.—Kerri Fitzgerald

Source: Thomson Reuters 2014. Insurers must accept funds from U.S. program that helps HIV-AIDs patients.