Health & Fitness

AIDS Outreach Center put some insurance assistance on hold

The AIDS Outreach Center has temporarily stopped assisting clients with their co-pays for medicine, doctor visits, lab bills and other miscellaneous expenses so it can focus on helping clients pay insurance premiums.

The emergency move was outlined in a letter sent to 374 people who participate in an insurance assistance program for people with HIV. About 15 percent of those clients typically receive help paying their insurance premiums, according to the outreach center.

“This is temporary,” said Shannon Hilgart, executive director of the AIDS Outreach Center. “We are working hard and fast on gathering as much information as we can so that we can project our spending — so that we do not have to come to a grinding halt in the spending for insurance premiums.”

The letter stirred fears among clients who rely on the co-pay assistance.

“It came as a shock,” said Christoper Darwin, 50, who receives help paying for HIV medicine. “The co-pays for the medication are an integral part of any HIV/AIDS program.”

But the outreach center said they had to act in order to avert a potential crisis.

The issue surfaced for the social service agency in recent weeks as it enrolled 24 new clients who need help paying for premiums. The newly enrolled clients’ assistance was projected to cost about $230,000 this year — an amount that nearly half of the agency’s 2013 available funds for insurance assistance.

The new people enrolled by the outreach center had recently signed up for insurance through the Affordable Care Act. The agency is working to figure out how to manage the issue and ensure that it can help clients with insurance needs.

“The great unknown is that so many additional people are getting insurance through the Affordable Care Act,” Hilgart said.

Program review needed

That new demand becomes more of an issue for the agency because they don’t know exactly how much money they will end up receiving for the program this year, she said.

Aurelio Rodriguez, associate executive director for the outreach center, said in past years the premium assistance costs to their program has been constant. They had not anticipated the impact of newly-insured clients.

The insurance assistance is available to people with HIV who meet certain income thresholds, Rodriguez said. The outreach center helps about 1,600 people with a range of offerings, but most are not in the insurance assistance program, he said.

Hilgart said the agency relies on federal and state grant dollars, that are administered through the Tarrant County Public Health department, to pay for the insurance help.

The outreach center and the public health department have been meeting to figure how to address this issue.

Margie Drake, HIV grants manager for the Tarrant County Public Health Department, said because the dynamics have changed with the the Affordable Care Act, funding allocations may be reviewed.

Allocations of HIV grant dollars are made at a local level by a body of volunteers known as the Planning Council, she said. They can study trends and other data to determine if the money granted for the insurance program could change, Drake said.

“The Planning Council has to make that determination,” Drake said.

Struggling to balance

The outreach center has received some funding for this year totaling $262,881. They expect to get more funding early this summer, but are taking this emergency measure so they don’t run out of money.

Last year, the outreach received a total of $417,616 in federal dollars that help clients with insurance costs, according to the Tarrant County Health Department.

While the outreach center assesses this situation, they are urging clients who relied on the co-pays to contact case manager to figure out where they can help paying for medicines and their other needs.

Darwin said it is critical that clients be told where to get help. People who are struggling to balance wallets and medical costs could end up making choices that could affect public health, he said.

Darwin said people will be forced to choose to pay for bills or buy medicine.

“There is no instruction given,” Darwin said of the letter. “I know if I am freaking out, other people are as well.”