IN THE LOOP
The news you need to know this week
Welcome to the latest edition of our update on the news you need to know and how it affects you and the communities we serve. These emails feature important updates, and you can sign up below! As always, thank you for your support of APLA Health, and please share this with others who may be interested.
Patient and Provider Survey — PrEP Use During COVID-19 Outbreak
The American Academy of HIV Medicine has developed two surveys to assess PrEP access/usage and risk behaviors during stay at home orders under the COVID-19 outbreak.
The first survey is for patients currently using PrEP who reside in a jurisdiction with a stay at home order. You can take the survey here. The second survey is for medical providers who may prescribe PrEP (MD/DO, PA, NP, PharmD in California and WA). You can take the survey here.
If you have any questions about the survey, email Scott Brawley at firstname.lastname@example.org.
Keeping Your Health Insurance When You Lose Your Job
If you recently lost employer-sponsored health insurance — and many have — there are several options available to maintain your health coverage. If you’ve lost your job you may be offered the option to pay for the health insurance you got through your employer. This is a federal program called COBRA and it lets you extend your insurance coverage for 18 months. In California another program called Cal-COBRA can provide an additional 18 months of insurance extension (there are exceptions to all of this based on the size of your employer and where the company and its health insurance are registered). Either way, COBRA premiums can be expensive, but for people living with HIV there is a state program that may be able to pay your COBRA premiums.
If you don’t qualify for state financial assistance and you can’t afford your COBRA premiums, you may be better off enrolling in Covered California or Medi-Cal if you qualify. See a breakdown of your options below.
You have 60 days from the date you lost your health insurance to decide if you want your COBRA extension. Once you elect to take COBRA you have 45 days to submit your first payment. Some employers cover health insurance through the end of the month when you get laid off. Some don’t. Either way, the counting of days begins on the date the group coverage ends. So if you lost your insurance on April 30, for instance, you would have a maximum of 105 days to make your decision and pay your premiums, but you would still be required to pay premiums back to May 1.
The best advice is don’t delay and if you don’t know which is the best option for you, contact an insurance specialist for assistance.
For People Living With HIV
For people living with HIV, there is a state program that will pay COBRA premiums: the Office of AIDS Health Insurance Premium Payment Program (OA-HIPP). The program will also cover any other out-of-pockets costs for your health coverage, including copays and deductibles.
In order to enroll in OA-HIPP, you first need to enroll in the state AIDS Drug Assistance Program (ADAP). You are eligible if you are a California resident, at least 18 years old, and your modified annual income is under 500 percent of the federal poverty level (about $63,800 for individuals, higher for families). ADAP is also available to non-citizens. Ryan White programs — including ADAP — are not included in the recently revised federal public charge rule and use of the program will not impact your immigration status.
You can learn more about OA-HIPP on the Office of AIDS website. The Office of AIDS also provides a directory of local enrollers to help get you into the program, including many at AIDS service organizations or medical providers. APLA Health’s benefits enrollers are also available at 213-201-1615.
Enrollment into the OA-HIPP program can be done virtually without an in-person appointment. Enrollers will help you gather the documentation you will need.
Insurance Options for People Who Lose Their Jobs but Aren’t Eligible for OA-HIPP
If you just lost your job, you may be able to afford your COBRA premiums now that the federal government is supplementing Unemployment Insurance by $600 a week, at least through the end of July. But that may depend on the cost of the COBRA premiums and how long you think you’re going to be unemployed.
If you expect to be unemployed long term, and if your COBRA premiums are too expensive, you might want to think about switching your coverage to Covered California.
Covered California is the state health insurance marketplace established through the Affordable Care Act (ACA). Covered California now provides federal and/or state subsidies for individuals with income up to 600 percent of the federal poverty level or (about $74,940 for individuals, higher for families).
If you like the health insurance you had through your employer, and if you have already met your annual out-of-pocket costs, then you might want to keep your plan on COBRA. This might work if you expect to be rehired by your employer sometime in the next several months.
But if your plan is expensive, and your out-of-pocket costs are very high, then you might be better off switching to a Covered California plan. That could mean you will need to meet another annual deductible, and sometimes switching plans may mean switching the doctors you see, but not always. Again, you will have to sort through the Covered California plans in your area to see which physician networks participate in those plans. The decision-making process can be daunting. You could call Covered California’s enrollers for assistance, but calling a professional insurance broker may be the best way to go.
Due to COVID-19, Covered California has made it so that you can apply for health insurance through June 30. Learn more at CoveredCA.com.
California’s Medi-Cal Program
California’s public health insurance plan, Med-Cal, is available to all individuals whose incomes fall below 138 percent of the federal poverty level (approximately $17,609 for individuals, higher for families). If your income falls into this range, Medi-Cal may be your best bet. Medi-Cal in California is available to non-citizens up to age 26 and because the state pays for coverage for non-citizens, the program will not impact immigration status or public charge.
Medi-Cal provides full medical and behavioral health and some dental coverage, hospitalization and prescription medications, all at no cost to beneficiaries. There is a broad range of providers for you to choose from, including all of California’s federally qualified health centers (FQHCs).
California’s Medi-Cal program will also now cover COVID-19 testing and treatment for all residents, regardless of income or immigration status. See more information in the next section.
You can apply for Medi-Cal online or you can enroll through a provider. APLA Health, for instance, operates three FQHCs — one in Baldwin Hills, one in Long Beach and our newest at the Olympic Health Center in mid-Wilshire. Our enrollers will help you apply. Or go to the Community Clinic Association of Los Angeles County (CCALAC) website for a directory of clinics near where you live.
Losing your job and your income is never easy. But keeping your health insurance — and your health — is well worth the time and effort it will take to sort through the programs that are available in California.
New COVID-19 Resources for California Immigrants
While recent federal stimulus bills have excluded many immigrants, California is taking steps to ensure immigrants have access to COVID-19 related health care and to help alleviate the negative financial impacts of the pandemic.
Direct Financial Assistance
Governor Newsom recently launched a new $75 million Disaster Relief Fund to provide one-time assistance for undocumented Californians impacted by COVID-19 who are ineligible for unemployment insurance benefits and other financial relief because of their immigration status. Approximately 150,000 undocumented Californians will receive a one-time cash benefit of $500 per adult with a cap of $1,000 per household.
The California Department of Social Services (CDSS) will select community-based organizations with expertise and experience serving undocumented communities to conduct targeted outreach, application assistance, and delivery of the disaster relief assistance. CDSS’ goal is for Californians to be able to access this relief through local community-based organizations starting mid-May 2020. A final date will be provided soon.
Newsom also announced that a group of the state’s philanthropic partners have committed to providing an additional $50 million to support undocumented Californians through the California Immigrant Resilience Fund. Those interested in supporting this fund can donate here.
Coverage for COVID-19 Testing and Treatment
Governor Newsom has also taken steps to ensure all Californians can get covered for COVID-19 testing and treatment, regardless of income or immigration status. Earlier this month, California’s Department of Health Care Services (DHCS) announced that COVID-19 testing and treatment services — including services rendered outside of a hospital emergency department — are being deemed as emergency services under Medi-Cal. This means that all Medi-Cal beneficiaries can receive COVID-19 testing and treatment for free, regardless of their scope of coverage or documentation status.
DHCS also created a special “presumptive eligibility” program (PE for COVID-19) that covers COVID-19 testing and treatment for individuals who are either uninsured or those with private insurance that does not cover COVID-19 testing and treatment. In order to access this program, you must enroll through a qualified provider. More information is available here.
Taken together these changes mean that COVID-19 testing and related treatment services will be covered for free through Medi-Cal, whether you are enrolled in full scope or restricted scope Medi-Cal, uninsured, or the COVID-19 testing and treatment is not covered by your current health insurance. COVID-19 related testing and treatment through Medi-Cal does not count under the public charge rule because it is the treatment of an emergency medical condition.
California also launched a resource guide for all immigrants to help them stay healthy and informed. The guide includes information about public charge, testing and treatment, housing, and much more. You can access the resource guide in English here and in Spanish here.
The Impact of COVID-19 on Los Angeles City and County Budgets
Los Angeles City and County have released budget projections for next year that reflect the magnitude of the economic impact of COVID-19. Officials forecast a $1 billion decline in County sales tax revenue for the fiscal year ending June 30, 2020, and a total decline of $2 billion by June 30, 2021.
The County has imposed hard freezes on hiring and purchasing and is working with all County departments to prepare for likely program reductions in the coming fiscal year. However, the Board of Supervisors have signaled they will ensure that the budget preserves essential programs and services that Angelenos rely on. While the County is incurring heavy expenses in response to the COVID-19 crisis, it is also working with the state and federal government to identify possible reimbursement options to ensure that the County has the funds necessary to maintain its vital role as a safety net for its most vulnerable residents.
It is important to note that the budget will mostly be impacted by reductions in County-generated funds, like the millions of dollars raised by the Measure H quarter-cent sales tax that fund the homeless initiative. The County has acknowledged that the homeless initiative budget will be hard hit, but has signaled a commitment to continue work on the initiative as much as possible, to prevent the homeless crisis from worsening.
For the City of Los Angeles, Mayor Garcetti has declared a “state of fiscal emergency” for the 2020-2021 budget, expecting a $231 million revenue shortfall for the fiscal year ending June 30, 2020, and up to $598 million by June 30, 2021. The City has also imposed a hiring freeze and plans to temporarily furlough some of its civilian workforce, for which city workers will see a 10% salary reduction. Like the County, the City is hoping for some reimbursement from state and federal funds and is working with each of its departments to develop plans for program reductions in the coming fiscal year. Notably, the City does not plan to reduce the portion of the budget that addresses the homeless crisis.
APLA Health wants to reassure our community that while the reduced budget projections will bring significant changes to City and County operations, these budget cuts should not impact the services that we deliver. APLA Health will continue to advocate for the resources and policies necessary to best meet the needs of the communities we serve.
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We will send you regular updates on issues and policies affecting the LGBT and/or HIV communities and urge you to call or e-mail your representatives about key political activity at the local, state, and federal levels.