Limits for Adults as a Percent of Federal Poverty Level, http://statehealthfacts.org/comparereport.jsp?rep=130&cat=4. For more information on Medicaid, see KFF, Medicaid: A Primer, http://www.kff.org/medicaid/7334.cfm.
bMedicare eligibility (national): ≥65, disabled (SSDI) or end-stage renal disease; must be a U.S. citizen or legal resident for at least 5 years. For more information on Medicare, see KFF, Medicare: A Primer, http://www.kff.org/medicare/7615.cfm.
cHealth insurance exchange: A key component of the ACA, exchanges are entities that will be set up in states to facilitate the purchasing of health insurance by qualified individuals and employers. All legal, non-incarcerated residents are eligible to purchase insurance through the exchanges. Additionally, all legal, non-incarcerated residents are eligible for subsidies, in the form of tax credits, if they do not have access to employer-sponsored insurance, Medicaid, or Medicare, and their incomes are between 100 and 400 percent of the FPL. In addition, if an employer plan does not cover at least 60 percent of average health expenses or the employee must pay more than 9.5 percent of his/her income for the premium, individuals, depending on income, may be eligible for a tax credit to offset premiums for coverage purchased through an exchange. Exchanges are required to be fully operational in every state by 2014. See KFF, State Health Facts, State Action Toward Creating Health Insurance Exchanges, http://www.statehealthfacts.org/comparemaptable.jsp?ind=962&cat=17.
dRyan White: The Ryan White HIV/AIDS Program, the single largest federal program designed specifically for people with HIV in the United States, provides care and services for people with HIV who are uninsured or underinsured, serving as payer of last resort. It includes ADAP. Federal funding is provided to states, cities, and providers but may not match the number of people who need services or the cost of their care. For more information, see KFF, The Ryan White Program, http://www.kff.org/hivaids/7582.cfm.
SOURCE: Adapted from KFF, 2012b.
The provisions of the ACA discussed in the following sections are likely to have the greatest impact on care and care coverage for people with HIV.
Pre-Existing Conditions, Rescission, and Limits on Coverage
Currently, children with pre-existing medical conditions (e.g., HIV/AIDS, diabetes) no longer can be denied health care insurance coverage (Keith et al., 2012; KFF, 2011a).8 Beginning in 2014, insurers also will no longer be able to deny coverage to or charge higher premiums for adults
8In addition, coverage must now be extended for dependent children on parental policies up to age 26 (Keith et al., 2012; KFF, 2011a). Since young adults, ages 20 to 29, have the highest rates of new HIV diagnoses among all age groups in the United States (CDC, 2012, Table 1a), extension of coverage for older dependent children is a potentially important source of coverage for HIV care for this population.