Closing the Gap: Financing Insurance Services with ADAP
The use of highly active antiretroviral treatment (HAART) has had enormously beneficial effects for many people living with HIV/AIDS (PLWH) but has sent the costs of treating HIV disease soaring, and States have struggled to provide these drugs to low income, underserved PLWH. The Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB) has adopted innovative policies in the implementation of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act to help States provide these treatments.
In 1999, HRSA/HAB issued HAB Policy Notice 99-01, “The Use of Title II ADAP Funds to Purchase Health Insurance.” This policy allows a portion of a State’s AIDS Drug Assistance Program (ADAP) grant to subsidize the purchase of new health insurance policies or to finance the continuation of health insurance policies for persons qualifying for ADAP. The policy’s intent is to expand the use of ADAP resources to serve more clients, to increase the number of medications on a State’s ADAP formulary, and to finance medications, as well as medical care, through the purchase of continued or new insurance policies with ADAP resources.
HAB Policy 99-01 requires that insurance drug formularies at least match the State’s ADAP formulary, that the insurance services purchased not be “deemed inadequate” in terms of their provision of primary care, and the total annual amount spent on insurance premiums not be greater than the annual cost of maintaining that same population on the existing ADAP. Two other HRSA policies allow States to use a portion of their Title II grants to pay for premiums for insurance continuation and to pay for public or private health insurance co-payments and deductibles. In addition, States may use Title I and State general revenue funds to purchase or continue health insurance. Fourteen States have reported the implementation of health insurance continuation and/or purchase programs.