November 17 , 2017 

Action Alert: Stop Health Care Sabotage! 

The tax fight in Congress is really a fight about health care.

Just in time for Thanksgiving, Republicans are promoting a tax bill that would take away health coverage for millions. The bill would repeal the individual mandate and increase pressure to gut safety net programs like Medicaid in future budgets. Any cuts to Medicaid will hurt those most in need. This includes 74 million Medicaid recipients who are veterans, women, children, people with chronic conditions like HIV and diabetes, and hard-working Americans who count on Medicaid for health insurance (60 percent of Medicaid recipients are working).

Over the last several months we have witnessed triumphs and setbacks in our efforts to preserve access to health care for all Americans. Medicaid and the ACA have repeatedly come under attack, and we have stood strong in the face of immense obstacles. The struggle continues.

President Trump and his administration have issued executive orders and regulations to undermine existing laws and make signing up for health coverage more difficult. In the 2018 budget passed by Congress, Medicaid could face a $1 trillion cut to give tax cuts to the wealthy.

This is unacceptable! Here's what you can do:
  Tell your elected officials to oppose any bill that harms health coverage or safety net programs.
Send a message to Congress telling them to stop Medicaid cuts. Remember, Medicaid is US:

Checkpoint: Ending the HIV/AIDS Epidemic by 2020
Ending the Epidemic (ETE) by 2020 - it's a goal within our reach, but significant work remains if we are to succeed. We must double down on existing efforts and implement strategies that are proven to be effective. This is a critical juncture, and we must leverage every opportunity to prevent HIV transmission, keep people living with HIV healthy, address social factors that undermine public health, and invest in improving care systems for people living with HIV.

Improving Care Systems

Undetectable = Untransmittable

Being engaged in treatment and care is essential for people living with HIV to become virally suppressed. We must invest in viral load suppression (VLS) as a critical tool to give people living with HIV the chance to live longer, healthier lives and to prevent HIV transmission. Heath care experts, including the Centers for Disease Control (CDC), agree that a person with HIV who has an undetectable viral load cannot transmit the virus to others. We now know that undetectable equals untransmittable (U=U).
Providing incentives to Medicaid patients who achieve and sustain viral load suppression could help more people living with HIV to become virally suppressed. This approach is in line with the ETE Blueprint recommendation that promotes incentives as a means of fostering and achieving VLS. Medicaid Managed Care plans are encouraged to provide non-cash incentives that could be used in this way.
  • VLS incentives are cost effective and promote quality improvement.
  • Cost savings result from decreased high-cost care, such as hospital admissions.
  • The decrease contributes to the DSRIP goal to reduce avoidable hospitalizations by 25 percent.
  • Providing $100 quarterly incentives to the Medicaid Managed Care members who are currently in treatment would yield an estimated savings of $0.12 for every $1 spent.
Increasing VLS in this population would also maximize the effectiveness of $2.1 billion New York State Medicaid spends on HIV care. Approximately $750 million - one third - of that funding pay s for antiretroviral treatment. However, New York State is not fully realizing the clinical outcomes and benefits of the $187 million in antiretroviral treatment costs for the 25 percent of HIV-positive Medicaid recipients who are not virally suppressed.

HIV Quality Metrics

The New York State Department of Health should enhance  HIV quality measures and reporting requirements, as this would provide a critical opportunity for New York State to track and assess trends in outcome metrics through health plans. Enhancing quality measures and reporting requirements would also ensure maximum value for the more than $2.1 billion in annual Medicaid spending for HIV care and services. New HIV quality measures would also help address HIV health disparities and advance our progress towards ending the New York State AIDS epidemic by 2020.

New York State 2015 HIV surveillance data reveals service gaps in the HIV care continuum, as evidenced by a statewide viral suppression rate of only 67 percent (far short of our ETE target of 85 percent). The following measures would have a big impact:
  • Including a standard panel of preventive screenings, such as HIV testing, in the annual comprehensive primary care provider visit.
  • Testing viral load every six months for HIV positive individuals.
  • Improving viral load suppression through consistent and effective treatment. 
NYS AIDS Institute Value Based Payment Fund

Amida Care supports the creation of a $20 million fund within the New York State AIDS Institute for HIV providers to invest in the uptake of Value Based Payment (VBP) arrangements. Community-based primary care and supportive service providers are critical to efforts to innovate and achieve the state 's E TE goals. These providers are experts in engaging underserved populations in care and providing culturally and linguistically appropriate services that help to sustain that care. There is a precedent for such a fund in New York State: in 2017, the New York State Office of Mental Health invested $60 million in behavioral health VBP readiness. Funds from this program will assist behavioral health providers to prepare for transition to VBP.

Employment and Housing Have a Critical Impact on Health 
Transition to Work

We are advocating for the implementation of a 24-month HIV/AIDS Services Administration (HASA) workforce readiness program where benefits remain in place while income and hours worked increase. The readiness program will allow time to adjust to the demands of sustained employment and encourage living wage employment.

Flexibility would facilitate employment, support health and quality of life, and realize cost savings when public assistance is no longer required. During this transition, public assistance for housing, nutrition, and health care must be kept in place for people living with HIV who are able to work, for long enough that they are able to attain a living wage. Medicaid benefits should remain in place without being contingent on working.

Our goal is to build in greater flexibility without being punitive. This approach is cost effective since people who would otherwise be dependent on public assistance would transition to living wage employment. If 5 percent of people living with AIDS in New York City who are eligible for Medicaid transitioned to work after a two-year grace period, the city could save $134 million on housing benefits after 10 years. If this community earned enough to leave Medicaid, New York State would save an additional $887 million after 10 years.

Amida Care has submitted a recommendation to take this approach to the New York State Ending the Epidemic Workforce subcommittee.

Expanding Housing Access Beyond New York City

An estimated 3,700 New Yorkers with HIV who reside outside of New York City are homeless or do not live in a stable housing environment. This poses a formidable barrier to retaining them in care and providing access to HIV treatment that leads to viral suppression.

Amida Care recommends expanding access to rental assistance for people living with HIV who live outside the limits of New York City. This will improve individual and community heath, reduce costly use of homeless shelters, and generate offset savings by preventing new HIV infections and reducing avoidable crisis care.
Stand Strong and Take Action

Join national advocacy efforts to preserve access to health care for people living with HIV by participating in AIDS Watch.