Skip to main content

Asian & Pacific Islander American Health Forum: Health Care

Health Care for Me

Home Asian & Pacific Islander Coalition on HIV/AIDS

Asian & Pacific Islander Coalition on HIV/AIDS

A Provider Perspective

The Affordable Care Act (ACA), particularly aspects related to pre-existing conditions, has increased our HIV-positive patients’ access to medical services in a timely manner. Our HIV primary care clinic exists to provide access to primary care services, particularly targeting Asian & Pacific Islanders, the LGBT community and other people of color. We serve a significant number of patients who are uninsured. AIDS Drug Assistance Program (ADAP), a Ryan White-funded program, has served as a payor of last resort for people not eligible for private insurance or Medicaid. Although New York State has one of the most generous ADAPs in the country, it only covers HIV medications and HIV primary care, but does not cover services such as surgery, X-rays and CT scans. Prior to the ACA, if a patient with ADAP coverage needed a service that is not provided by APICHA (e.g., biopsies), he or she would need to be referred to a medical facility that accepts ADAP or a municipal hospital. With the passage of the ACA and the creation of the New York Bridge Plan, HIV-positive patients are able to purchase health insurance and access services from providers who accept the Bridge Plan. Individuals are eligible for the Bridge Plan if they 1) have a pre-existing medical condition such as HIV, 2) have not had health insurance for six months, and 3) are legal US residents.

Example: An uninsured, HIV-positive APICHA patient had rapidly growing, disfiguring masses on his face and neck. According to his provider, he needed a biopsy and CT scan performed in a timely manner. The patient’s options were to buy private insurance, go to a private surgeon and pay out of pocket or wait three months for an appointment at a hospital. Prior to the ACA, one can purchase insurance but there were severe restrictions to people with pre-existing conditions (e.g., coverage for HIV-positive individuals would not be effective immediately for HIV-related services for 6-12 months from purchase). Paying out of pocket was not a viable option because the patient did not have the financial resources. The remaining option was to access the services at a municipal hospital, but the earliest available appointment was about three months.

While waiting for the hospital appointment, a case manager assisted the patient in enrolling in the Bridge Plan. Within weeks, the patient’s enrollment into the Bridge Plan was accepted. With this coverage, clinic staff was able to make an appointment within two days for a biopsy and CT scan with a private provider. As a result of immediate access to biopsy and CT scan, our medical provider was able to identify and treat the disfiguring condition.