Insurers will accept Ryan White funds through Nov. 15

The three major insurance companies in the state offering coverage through the federal insurance exchange have agreed to continue to accept premium payments through Nov. 15 from a federal program that helps HIV/AIDS patients cover their health care costs.

The agreement was struck amid a federal court hearing Monday during which U.S. District Judge Brian Jackson considered a long-term injunction that would have prevented the insurers from refusing to accept payments from the Ryan White HIV/AIDS Program, a federally funded program assisting low- and moderate-income residents with HIV/AIDS.

The three insurers had promised in a previous hearing to continue accepting the payments until March 31, which is when open enrollment ends.

The next open enrollment period begins Nov. 15.

“This will maintain critical health care coverage for lower-income Louisianians living with HIV through the current insurance plan year,” said Scott Schoettes, senior attorney and HIV National Project director at Lambda Legal, a national organization that advocates for the rights of HIV/AIDS victims, gay men, lesbians and transgender people.

“There was a sword of Damocles hanging over our client and other Louisianians, with these insurers having previously indicated that in just three weeks they would stop accepting the federal Ryan White Program insurance premium subsidies that enabled many people living with HIV to afford life-saving health coverage,” he said.

John East, represented by Lamda Legal, filed a lawsuit last month against Blue Cross and Blue Shield of Louisiana, Vantage Health Plan Inc. of Monroe and Louisiana Health Cooperative of New Orleans, alleging the organizations illegally discriminated against people with HIV/AIDS and violated the Affordable Care Act by refusing to accept premium payments from the Ryan White program.

East, who is insured through Blue Cross and Blue Shield, has a monthly premium of $1,306, which he cannot afford without the federal funds.

Blue Cross announced in February that it intended to stop accepting third-party payments, including Ryan White funds, for individual policies in an effort to deter fraud.

A Vantage Health Care spokesman subsequently confirmed the smaller companies would have to follow Blue Cross’ lead, and resource centers for HIV/AIDS reported Louisiana Health Cooperative also stopped accepting the payments.

Before the deal was struck Monday, Jackson expressed skepticism about the insurers’ claims that the policy change was made to protect them from fraud.

“It seems disingenuous, like there may be other motives going on here other than fraud,” he said, noting that he had not seen any evidence of fraud in the Ryan White program. “From a business perspective, you’re concerned about fraud and rightfully so, but where is the fraud in the Ryan White program?”

Anthony Shelley, an attorney representing Blue Cross, told the court that the federal Centers for Medicare and Medicaid Services is expected to issue an emergency rule regarding third-party payments this week. He said the rule could either make the case moot, or change the legal arguments surrounding the case.

Shelley, as well as the attorneys representing the other two companies, said the insurers would abide by the law if CMS mandated they accept the payments. But he said it’s also possible the new rule could favor their clients’ current position.

Critics of the Blue Cross decision to stop accepting payments have previously accused the company of deliberately misunderstanding CMS’s previous directives.

Blue Cross has said CMS “strongly advised” insurers against accepting any third-party payments in November; however, last month, CMS clarified the rules do not prevent the use of Ryan White funds to pay for health care plans.

Responding to Blue Cross’s announcement that it would stop accepting the payments, CMS said in a statement in February that it would consider “amending those rules to require issuers to accept these payments.”

The attorneys from both sides agreed to meet within 45 days of the issuance of the pending CMS rule to determine if they can come to a consensus.

“We wanted to have a temporary solution to the litigation where all the parties can sort out what CMS says,” Shelley said after the hearing. “This is an amicable way to deal with the situation.”