1) Illinois Pre-Existing Condition Program transfer to federal program: The Illinois Pre-Existing Condition Program (IPXP) will transfer all enrollees to the federal Pre-Existing Condition Program (PCIP) effective July 1, 2013. The federal government made a decision to no longer fund state PCIPs because of limited funding. These programs were created by the Affordable Care Act (ACA) as a bridge to help people who could otherwise not get affordable health insurance because they have pre-existing conditions, such as HIV. Several hundred people with HIV are enrolled.
ACTION NEEDED: Anyone with HIV who is enrolled in IPXP should read the attached memo, watch their mail carefully, and send all information to ADAP as directed in the memo immediately to avoid coverage interruptions. ADAP will continue pay premiums and out-of-pocket costs for HIV medications in the federal program, but enrollees must act immediately to make sure they are enrolled.
2) ADAP to require certain Cook County clients to enroll in CountyCare: COOK COUNTY RESIDENTS ONLY! CountyCare is a new Medicaid program for Cook County residents ages 19-64 who are citizens or legal immigrants for five years and earning less than $15,282 for a single person. Because of the Ryan White payer of last resort requirement, anyone who is eligible must enroll within 90 days of receiving the ADAP letter (around Sept. 1). Once approved, clients will get medications through the CountyCare pharmacy network, which includes many neighborhood pharmacies. 150 or more ADAP clients who are receiving care at out-of-network facilities are likely to have to switch to an in-network provider, which could cause significant disruption for low-income people with HIV. For more information, check out AFC’s report and materials on CountyCare at www.aidschicago.org/countycare.
ACTION NEEDED: Read AFC’s CountyCare report at www.aidschicago.org/countycare. Agencies should work aggressively to help patients enroll (see attached document checklist in English and Spanish). If clients must transition to another provider, providers should work to maintain continuity of care. Clients who think they might be eligible should contact their case manager for assistance or call the County enrollment hotline at 312-864-8200.
Additional Information:
Click here to read the memo for IPXP enrollees
Click here to read the Illinois Department of Public Health’s memo on the impact to ADAP enrollment
AFC’s report contains additional recommendations for people living with HIV, Cook County, and the federal government.
AFC will hold three webinars for case managers and the community on CountyCare. Click here to register and learn more.
Please contact ADAP at 800?825?3518 or 217?524?5983 or any of us at AFC if you have questions.
