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Los Angeles Begins Transitioning Ryan White Beneficiaries to Healthy Way LA

July 1, 2012 marked the first day of transitioning Ryan White (RW) beneficiaries to the L.A. County Low-Income Health Program (LIHP), Healthy Way LA (HWLA).  L.A. County maintained a goal of preserving the HIV/AIDS delivery system and providing continuity of care while operating under LADHS constraints. With approximately 5,000 RW beneficiaries affected, L.A. County is the second most impacted county in California behind San Francisco. Much to counties’ benefit, the CMS approved a waiver amendment on June 28, 2012 that will establish an HIV Incentive Transition Program within the existing Delivery System Reform Incentive Pool (DSRIP) to help finance moving RW patients to LIHPs including HWLA.

L.A. County Department of Health Services (LADHS), in partnership with Department of Public Health (LADPH) and Department of Mental Health (LADMH) have prioritized providing RW beneficiaries continuity in medical homes and specialty care, expanding medication access, supporting patient transition and providing troubleshooting assistance, as described below.  Information for RW patients may be accessed online.

  • All RW providers signed HWLA Community Partner (CP) agreements, which will ensure that patients will not have to change doctors.  RW patients will be offered a broader array of services under HWLA.
  • By contracting with the CHAIN specialty network, LADHS is able to preserve access to HIV specialty providers currently accessed by RW patients
  • HWLA will offer an expanded formulary including non-HIV drugs, an expanded pharmacy network for HIV patients and improved reimbursement mechanisms through a pharmacy administrator contract.  For providers with pharmacies, there is an added dispensing fee option.
  • Local AIDS Drug Assistance Program (ADAP) enrollment workers received training on changes occurring to the program, transition coverage, HWLA, and assistance on applying for HWLA using YourBenefitsNow starting July 1
  • With changes in the new enrollment system, providers and pharmacy system, HWLA’s member services line will provide support for urgent problems, LADHS pharmacy staff will be on call to ensure patients receive medications, and HWLA staff will be available for questions, technical problems and billing inquiries.  Account Managers will be available to work on issues encountered by CPs.

LADMH is continuing to build on the HWLA system established by LADHS.  LADMH is offering contracts to new RW CPs for serving patients with moderate mental illness (Tier 2) and offering a linkage to its network for the severely mentally ill (Tier 1).  LADMH will offer RW CPs training in the Mental Health Intervention Program (MHIP), an evidence-based practice for Tier 2 services, and as well as ongoing technical assistance.

RW patients will be screened for HWLA eligibility according to birth month as a part of their annual redetermination for ADAP. The County has estimated about 400 RW patients will transition to HWLA throughout the month of July.  All HIV patients eligible for HWLA must apply.  A series of grace periods have been established by the State and County to keep patients in ADAP until HWLA enrollment or denial occurs. Once patients receive their approval for HWLA, they will be dis-enrolled from ADAP and RW, and obtain care and medications through HWLA. Patients denied coverage will be re-certified for ADAP and continue care through RW/ADAP.

Unlike other counties, L.A. County will retain its LIHP eligibility at less than 133% FPL, seeing the cost shift as a temporary issue that will be resolved by the Medicaid expansion in 2014.  At that time, counties will receive 100% federal match for newly eligible Medicaid patients until 2019.  The County will continue to work in partnership with community providers to ensure a smooth transition for HIV patients.

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