The Center on Halsted hosted a legal seminar Dec. 10 to discuss the Affordable Care Act (ACA) and its impact on LGBT families and people living with HIV.
The ACA, which President Obama signed in March 2010, introduced a slew of expansions and reforms in an effort to provide all Americans access to health care. One of the most notable and controversial of those reforms is the expansion of Medicaid.
"The [Medicaid expansion] is pretty great because not everyone has health care and not everyone is rich," said Ann Hilton Fisher, executive director of the AIDS Legal Council of Chicago.
Under current Medicaid eligibility, mostly low-income women with children and legally disabled people received benefits. By excluding low-income adults without children in most states, many vulnerable populations are left without care, including many single HIV-positive men.
"When we are talking about people who are ineligible fore Medicaid, we are mostly talking about single men, many who are African-American, many who are HIV-positiveand I don't think that's unrelated," said Fisher.
In some instances, HIV-positive people who have been diagnosed with AIDS are eligible for disability benefitsincluding Medicaidwhen they were not eligible for preventative health care as a low-income HIV-positive person.
"One of the cruel ironies of the [Medicaid] program is if you're really sick, you can get coverage, but if you're relatively healthy, you can't," said John Peller, vice president of policy at AIDS Foundation of Chicago.
When Medicaid provisions of the ACA go into effect, many of those adults making about $15,000 per year or less will become newly eligible for care, including those who are HIV-positive.
The Medicaid expansion will likely provide antiretroviral drug coverage and other benefits for HIV-related care, said Peller. Statistically, regularly taking antiretroviral drugs leads to lower viral loads, and in turn, people with lower viral loads are less likely to pass on the virus.
Each state legislature must approve a revised Medicaid reauthorization bill in order for the newly expanded benefits to go into effect.
The U.S. Supreme Court ruled in June that the federal government cannot force states to implement Medicaid reforms by withholding funding, so many conservative states are refusing to comply.
"This is incredibly shortsighted because the federal government will cover 100 percent of the cost of health care for low-income people until 2020, when it will cover 90 percent," said Peller. "It's an incredible deal for the states."
While the Medicaid reform does not begin until 2014, people may begin applying for the program Oct. 1, 2013. To prepare for the early enrollment date, the Illinois must approve a Medicaid reauthorization bill before leaving this session, said Peller.
A federal waiver has allowed Cook County to enroll eligible residents in Medicaid a year early through a program called CountyCare, expanding coverage to approximately 115,000 people in Chicago.
The ACA will also reform some standard private insurance company profit-boosting policies, like refusing coverage for pre-existing conditions and lifetime benefit caps.
"Insurance companies are for profit companies, and they are trying to make a profit for their shareholders," said Fisher. "A substantial amount of legislators will do nothing that goes against the insurance companies."
Video of the seminar will be available in searchable chapters on www.IllinoisLegalAid.org .