Dawn Fukuda
Dawn Fukuda
For perhaps the first time in history, the end of HIV/AIDS and hepatitis is within our reach. Recent notable achievements provide promise for success, among them the release of the National HIV/AIDS Strategy (NHAS) and the Viral Hepatitis Action Plan (VHAP) and the passage of the Affordable Care Act (ACA). Collectively, these achievements have catalyzed the beginning of a radical transformation in our healthcare systems for communities impacted by HIV and hepatitis. In particular, the ACA represents an opportunity for the country to expand access to HIV/AIDS and hepatitis prevention, medical care, and health promotion services in profound and impactful ways. The systems-level changes advanced in the legislation also require state health departments to reassess their role in the context of an evolving health care system and the other sources of financing that may become available to support what have historically been public health functions—this is particularly the case for HIV/AIDS and viral hepatitis prevention and care services.

Preparing Health Department Programs for Health Reform Implementation

Expanding access to critical HIV/AIDS and hepatitis services will require health departments to:
  • Undertake an exhaustive inventory of direct care functions, services, and personnel we fund in medical and non-medical settings, and determine what components of the system might be covered under expanded health insurance coverage for our state residents.
  • Determine the sufficiency of reimbursement for these services, where there will be limitations in coverage—both service gaps and populations that will remain ineligible for coverage—and how long it will take for the new system to be fully established.
  • Become familiar with their state Medicaid program and the specific plans to enroll newly eligible clients, the scope of the state’s Essential Health Benefits package, and emerging opportunities for enhanced billing associated with HIV Health Homes.
Support for tailored, client-responsive, and intensive prevention and care services administered with resources from discretionary funding streams (notably the Center’s for Disease Control and Prevention [CDC] and the Health Resources and Services Administration [HRSA]) may vary among different health insurers (both public and private). Given this variability, health departments should consider enlisting the technical assistance of health insurance experts to:
  • Determine what types of services will be reimbursed in the new health insurance landscape.
  • Identify which provider types will be certified to bill third parties.
  • Determine the extent to which reimbursement rates will cover the full cost of providing essential prevention and care services to impacted population groups and regions.
Health department staff that is responsible for HIV/AIDS and hepatitis prevention and response programs must become adept at describing the specific ways in which public health investments complete gaps in the evolving health care system. In addition, health departments must leverage the opportunities of third party billing to support core public health activities that are essential to successful care and treatment at the patient-level, such as laboratory services, screening and vaccination, disease surveillance, and partner services.

The Continued Need for Public Health Programs

Access to prevention, screening, and medical care services under ACA will undoubtedly improve the opportunities for health promotion and disease prevention in our states and jurisdictions at both the individual- and population-level; however, access alone will not be sufficient particularly for our most vulnerable residents who may experience profound socioeconomic and psychosocial challenges, or may remain categorically ineligible for health insurance coverage. It remains a governmental responsibility (federal, state, and local) to protect and advance public health, particularly in the case of communicable disease. The scientific lessons that have emerged in recent years are clear. Our best chance to make progress in reducing new HIV infections in the country is to ensure that people living with HIV learn their status in a timely manner, access care and treatment, reach viral suppression, and sustain viral suppression long term. This will require investments in new diagnostic technologies, disease surveillance systems, engagement and retention in care interventions, and more effective and tolerable treatments. At this early stage in our country’s transformation of the health care system, it will certainly require a combination of health care reform initiatives and strategic public health investments to accomplish the goals of the National HIV/AIDS Strategy and Viral Hepatitis Action Plan and ultimately achieve a world free of HIV and hepatitis.

Dawn Fukuda, Sc.M., is the Director, Office of HIV/AIDS, Massachusetts Department of Public Health and Chair (Incoming), National Alliance of State and Territorial AIDS Directors (NASTAD). This article was originally published at AIDS.gov and NASTAD.org.