Lousiana Obamacare insurer unmoved by legal challenge on its AIDS policy

Reuters News
Posted: Feb 10, 2014 5:48 PM

By Sharon Begley

(Reuters) - A stand-off between Blue Cross and Blue Shield of Louisiana and the federal government over healthcare coverage for people with HIV-AIDS escalated on Monday, as a gay-rights group filed a legal complaint against the insurer, which reiterated a policy at odds with federal regulations.

Lambda Legal, a non-profit that works for the civil rights of gay people and others, filed an administrative complaint against Louisiana Blue, saying the company's stance "violates critical non-discrimination provisions of the Affordable Care Act" or ACA, President Barack Obama's healthcare reform law.

Reuters reported on Saturday that hundreds of people with HIV/AIDS in Louisiana who purchased health insurance under the ACA are at risk of being thrown out of the plans they selected. The customers had paid their premiums with funds from a federal program that, for 23 years, has subsidized insurance for people with HIV-AIDS, but Louisiana Blue Cross said it would not accept those checks because any third-party payments opened the door to fraud.

Over the weekend, the Centers for Medicare and Medicaid Services, the lead Obamacare agency, issued stronger guidance on whether insurers must accept payments from the 1990 Ryan White Act program. CMS said it is considering going beyond "encouraging" insurers to accept Ryan White funds to pay for health care plans to "requiring" them to do so.

On Monday, Louisiana Blue repeated its opposition to accepting payments from the Ryan White program for policies it sells through Healthcare.gov, the Obamacare portal.

The insurer has "received the latest communication" from CMS, said Louisiana Blue spokesman John Maginnis, but for now "our policy is that effective March 1, 2014, we will only accept individual members' premium payments from the policyholder," or an immediate relative, and "will no longer accept third-party payments."

"There are very few of our individual members who will be affected by this," he said.

Lucy Cordts of the New Orleans NO/AIDS Task Force, which has been scrambling to help affected Louisiana Blue customers, said several hundred people with HIV-AIDS had used Ryan White payments for their monthly premiums and could be kicked out of the Obamacare plan they purchased.

Of the hundreds of people with HIV-AIDS who are trying to use Ryan White Act funds to pay Obamacare insurance premiums, many are too poor to qualify for ACA subsidies, which go to people whose income is 100 percent to 400 percent of the federal poverty level.

Those with lower incomes, including many people with HIV-AIDS, were supposed to be covered by Medicaid, the joint federal-state health insurance program for the poor, but Louisiana did not expand the program as the ACA intended so as to make them eligible.

Louisiana Blue has cited the need to prevent "potential fraud, waste and abuse" as its reason for refusing third-party payments, including those from the government.

Healthcare advocates are concerned, however, that the policy is instead an effort to minimize the number of people with HIV-AIDS the company insures.

Louisiana Blue "has the best drug plans for HIV," said Moriba Karamoko, director of the Louisiana Consumer Healthcare Coalition, who has been trying to help resolve the impasse. "They're the only ones that cover the single-tablet regimen" prescribed to control HIV; other plans cover multi-pill HIV treatment, which patients find onerous.

"They're worried that they'll end up with everybody" with HIV-AIDS, said Karamoko.

The Lambda Legal complaint, filed with the Office of Civil Rights at the U.S. Department of Health and Human Services, CMS's parent agency, asks the government to investigate the insurer and could lead to a faster resolution than a lawsuit, explained Lambda director of constitutional litigation Susan Sommer.

Louisiana Blue's decision to reject Ryan White payments for the premiums of people with HIV-AIDS "seems to be an effort to discriminate against people with HIV," she said. "Every day (the company) keeps this policy is a day it deters people with HIV from signing up for one of its plans."

The company said it is aware of the complaint but would not comment further.

(Reporting by Sharon Begley in New York; Editing by Alden Bentley)