By Tammye Nash | Senior Editor

Rising need, rising costs forcing program officials to prioritize goals, stop co-payment, doctor visit assistance

An increase in the number of clients seeking assistance and in the cost of helping each client is forcing Resource Center of Dallas to cut back on its Insurance Assistance Program, center officials announced this week.

Letters signed by Bret Camp, the center’s associate executive director of health and medical services, and by Jennifer Hurn, HIV client services coordinator, were mailed to clients on Monday, Sept. 21.

The letters explain that the center is instituting "cost-saving measures" that include prioritizing the programs to preserve most of the limited funds available for COBRA and health insurance programs allocated through the end of the fiscal year on March 31.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions passed by Congress in 1986 amends the Employee Retirement Income Security Act, the Internal Revenue Code and the Public Health Service Act to allow individuals to continue group health coverage that otherwise might be terminated, for instance when an employee enrolled in a company health insurance program leaves his or her job.

Camp explained that such a situation can be especially difficult for people with HIV/AIDS. If they lose their job and the health insurance associated with it and go without insurance for a specific length of time, even if they get coverage under a different insurance program, the cost of their HIV-related healthcare won’t be covered under the new plan because it is a pre-existing condition.

The cutbacks are "something that is happening not just in Dallas, but across Texas and the whole United States," Camp said. "Funding for the insurance assistance program comes out of the Ryan White Treatment Modernization Act. Those funds were allocated back in 2008 and are based on the level of need in 2008.

"We weren’t anticipating the economic turbulence we have been experiencing this year. It’s a situation that has cost a lot of people their jobs and left a lot of people needing help with their insurance premiums," he said.

Hurn noted that the changes are prompted not by a decrease in funding but by drastic increases in need and cost.

"We’ve seen our number of clients increase by 40 percent, and the costs have increased by 25 percent," Hurn said. "The economic stimulus program allows people to have to pay only 35 percent of COBRA costs. But that program expires at the end of December, and when that happens, we’ll see costs go up even more, despite the changes we’re making now."

Craig Hess, the center’s insurance assistance coordinator, explained that the American Recovery and Reinvestment Act of 2009 provided individuals paying for COBRA to maintain their insurance coverage by paying only 35 percent of the total cost for the first nine months of the 18 months for which they are eligible for the program.

But no new clients can be added to the program after Dec. 31, although those still in the initial nine-month period will continue to get the discount.

"It’s been a real challenge for Craig and Jennifer to manage this. Every client has different insurance with different premiums and different medication co-pays and different sets of medications," Camp said.

The letter sent to clients this week with Camp’s signature explains that services are being prioritized, with COBRA and health insurance premiums coming first on the list.

"The loss of health insurance is irreversible, and that’s why that is our highest priority," Camp said. "If an insurance company doesn’t get that payment, they can drop a client."

Pharmacy co-pays that "put an undue burden on the client" are the second priority, with Camp explaining some people have co-pays of several hundred dollars on the medicines they are required to take to manage their HIV. Without assistance from the program, he said, some could not afford the medications that keep them alive.

Next on the priority list is pharmacy co-pays above the patient assistance programs offered by some pharmaceutical companies, followed by doctor’s visit co-pay fees and then deductibles.

Camp’s letter said the center cannot, at this time, continue to assist with doctor’s visit co-pays or deductibles.

The second letter, signed by Hurn, explained that the center will no longer pay for costs for medicines that can be covered under pharmaceutical companies’ assistance program. It includes a partial list of which companies offer such programs and which medications are included.

"We included the information to help get people started in the right direction. We are also giving that same information to the pharmacies we work with," Hurn said.

"In setting these priorities, we were attempting to set up a kind of triage situation, trying to get the resources we will still have available to the people with the greatest need and the least ability to pay for it themselves," she added. "We are also suggesting that people get in touch with their case managers and pharmacists and ask them to steer them into programs."

Camp said his department is working with the committee that allocates local Ryan White funds "to find money other places that we can put into" the insurance assistance program.

But he acknowledged that he doesn’t expect to be able to reverse the cuts before the end of the fiscal year, and in fact, "I am concerned that there will have to be further cuts before then."

But Hess urged clients in the program "not to panic. That’s the main thing. We know this is very difficult, but let’s address it on an intellectual level and work out a plan. We have to stay cool, calm and collected and come up with a plan."

Camp added, "I really wish it were different. But this is what we have to do. There’s no way around it."

Clients seeking information about changes in Resource Center Dallas’ insurance assistance program can contact Jennifer Hurn at 214-540-4431.

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