The Ryan White Program and Insurance Purchasing in the ACA Era: An Early Look at Five States

As a result of health insurance reforms under the ACA, along with the payer of last resort provision, it has become increasingly common for ADAPs and other Ryan White grantees to use program funds to provide insurance premium assistance to support client enrollment into QHPs. This brief provided a look at early experiences with QHP insurance purchasing during the first open enrollment period in five states, focusing on QHP purchasing within ADAP. The states observed here each had past experience with insurance purchasing, but not all states were able to translate that experience into supporting QHP coverage during the first open enrollment under the ACA. It appeared that those ADAPs with the most insurance purchasing experience were better able to translate that experience into insurance purchasing of QHPs. In addition, while ADAPs in each of the five states faced obstacles launching QHP insurance purchasing programs in the first open enrollment period, those operating in states opposed to ACA implementation appeared to have the greatest difficulty getting these programs off the ground. As a result, access to QHP coverage with premium and cost-sharing assistance, varied for clients across states.

Looking ahead, as ACA implementation continues, the Ryan White Program will play an important role in all states, as a provider of critical services to people with and affected by HIV, as well as a purchaser of insurance on behalf of clients. This latter role will likely grow and become increasingly important, especially as HRSA continues to require grantees to “vigorously pursue” client enrollment into coverage, enforcing the payer of last resort requirement. As enrollment continues and challenges are addressed in the coming years, it will be important to monitor insurance purchasing activities in order to assess how different state approaches impact cost-effectiveness, insurance access, and ultimately health outcomes of clients.