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Early Intervention Program (EIP)

Manages Washington State’s AIDS Drug Assistance Program (ADAP)

Housed at the Department of Health

EHIP is EIP’s contracted Insurance Benefits Manager

Ramsell Corporation is EIP’s contracted Pharmacy Benefits Manager

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EIP Eligibility Requirements Have proof of HIV positive status

Live in Washington State

Have a gross monthly income at or below 400% of the Federal Poverty Level (FPL)

If at or below 138% FPL and if eligible for Medicaid, clients are required to enroll into Medicaid through the WAHealthPlanFinder

Clients eligible for Medicaid are not eligible for EIP or EHIP

Must renew eligibility every six months after being approved for EIP

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EIP Funding EIP receives federal ADAP earmark funding from Part B of

the Ryan White Care Act

ADAP-AIDS Drug Assistance Programs

Programs in all 50 states that provide approved HIV treatment drugs to Low Income people with HIV

States administer the federal funds differently

WA State was one of the first to use the funds to provide premium assistance

Program began in 1987 to pay for AZT. Expanded in 1990 with the Ryan White Care Act

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EIP

Provides it own Medical Benefits Management

EHIP

Insurance Benefits Manager

Ramsell Corp

Pharmacy Benefits Manager

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Ramsell Corporation

Pharmacy Benefits Manager for EIP

Adjudicates all medication claims, whether it be full pay or co-pay

A Ramsell card is issued when a client becomes eligible for EIP

Manages contracts for over 1000 pharmacies across the state

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Early Intervention Program (EIP) EIP in-house medical benefits management provides:

Covers HIV related care (Dr. appointments and lab work) with contracted providers

Covers Dental and Mental Health with contracted providers

Pays towards deductible, but only for EIP covered services with a contracted provider

Covers all HIV medications

If Uninsured, EIP covers drugs based on their formulary

If Insured, EIP covers all prescription drug co-pays

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Evergreen Health Insurance Program

(EHIP) Contracted with DOH Early Intervention Program (EIP) as their

Insurance Benefits Manager

EHIP is a program of Lifelong, a non-profit that has been serving the HIV community for over 30 years

Pays health insurance premiums for people living with HIV that are EIP eligible

Insurance experts and a resource for EIP, HIV Case Managers, and Clients

Clients must be enrolled in EIP to be eligible for EHIP

EIP determines eligibility for both programs

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History Originally, WA State’s ADAP program was managed by DSHS

EHIP was set up by Lifelong (formally NW AIDS Foundation) in 1991 to manage the premium assistance program

Management of ADAP was moved to DOH in 1993

First year of the ACA brought dramatic changes to EHIP

Over 1000 clients became eligible for Expanded Medicaid

1250 clients moved from WSHIP to an ACA plan or Apple Health

Premium Assistance fell from $23,000,000 to under $10,000,000

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Comprehensive Coverage WA State was one of the first ADAPs to provide premium

assistance rather than just paying for HIV Medications

Philosophy is that comprehensive medical coverage removes barriers to adherence to medications

End AIDS Washington Goals by 2020 Reduce the rate of new HIV diagnoses by 50%

Increase suppressed viral loads by 80%

Reduce morality rates for PLWH by 25%

Reduce HIV-related health disparities

Improve quality of life for PLWH

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EHIP Staff

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• Program Manager

• Three Insurance Advocates

• Insurance Coordinator

• Payment Supervisor

• Quality Analyst

EHIP Can Pay For: Approved Silver & Gold Exchange Plans on the

WAHealthplanfinder.org

Medicare Part D (PDP Plans) & Medicare Part C (MAPD plans)

Employee Sponsored Insurance Plans (ESI or Group Plans)

HWD’s (Health Care for Workers with Disabilities)

WSHIP plans for clients currently enrolled

Individual Plans outside the Exchange

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EHIP Cannot Pay For: Stand-alone dental, vision, life, etc. Medicare Part A Medicare Part B Medicare Supplement Insurance (Medigap) Medicare Advantage plans without Rx coverage Catastrophic plans* Bronze level plans* HSA’s, FSA’s & HRA’s* QHP’s & Individual plans not on EIP/EHIP’s approved list* COBRA’s*

*Exceptions can be made if already enrolled and outside Open Enrollment period; required to change during the next Open Enrollment to an approved plan

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How to Enroll into EHIP

If client is new to EIP and EHIP, submit EIP application and indicate yes to premium assistance

If client is existing EIP client, submit “New Enrollment/New Payable” form to EHIP

Submit bills & all required additional paperwork to EHIP

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Documentation Required Medicare Part C & D

Bill (submit as soon as received)

HWD Bill (submit as soon as

received) Retirement Plan

Bill (submit as soon as received)

Summary of Benefits (SOB) Drug Formulary

COBRA (existing plan only) Bill (submit as soon as

received) Summary of Benefits (SOB) Drug Formulary

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Qualified Health Plan (QHP) Plan Selection Confirmation

page or bill Individual Plans

Bill (submit as soon as received)

Employer Sponsored Insurance (ESI) Employer Form Summary of Benefits Drug Formulary

2018 Premium Assistance Numbers Total clients Served – 2,379

Total months of coverage paid for – 22,556

Total amount of premiums paid – $10,542,762.08

58% of clients enrolled in EIP receive EHIP Premium Assistance

Large number of clients enrolled in Medicare have a $0 premium due to subsidy programs

Clients enrolled in ESI’s often do not need premium assistance or employer does not accept EHIP payments

Between 4% and 9% of EIP enrollees remain uninsured yearly

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2019 Preliminary Enrollment Numbers Qualified Health Plans-852

Individual Plans-186 (Will increase as we receive January premium confirmations)

Medicare Part D Plans-284

Medicare Part C Plans-461

HWD Plans-22

ESI/Group/Retirement Plans-114

WSHIP-219

Total as of 1/7/2019: 2138

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Questions?

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