SFGate reported that Lambda Legal filed a lawsuit on behalf of an HIV-positive Louisiana man against Blue Cross and Blue Shield (BCBS) of Louisiana, stating that BCBS violated the Affordable Care Act (ACA) by refusing to accept Ryan White funds for HIV and AIDS care. The plaintiff has received Ryan White support since HIV treatment resulted in an increase to a $650 BCBS monthly premium five years ago. Approximately three weeks ago, the plaintiff’s AIDS taskforce caseworker notified him that BCBS would stop accepting Ryan White payments. Without insurance, his HIV medication cost would be $1,306 each month. State Department of Health and Hospitals Spokesperson Olivia Watkins stated that more than 2,400 of Louisiana’s 19,400 HIV-positive residents received Ryan White program assistance as of January 7, 2014.
BCBS of Louisiana Spokesperson John Maginnis responded that the company instituted the policy change to ensure that third-party payers such as the Ryan White program did not steer patients to specific products or health providers. Although the US Department of Health and Human Services (HHS) had advised insurers in November 2013 to reject third-party payments from hospitals or healthcare providers, HHS clarified on February 7 that the instruction did not apply to state and federal programs or to qualified health plans for people enrolled through Indian tribes or urban Indian organizations.
BCBS did not reinstate its policy, even after the Centers for Medicaid and Medicare Services rejected the insurer’s justification for refusing Ryan White support. Other large Louisiana insurers, Louisiana Health Cooperative and Vantage Health Plan, also would stop taking Ryan White funds after March 1. A Lambda Legal attorney stated that the policy change violated ACA provisions guaranteeing care for people with pre-existing conditions, and the suit was necessary to assure that HIV-positive people had consistent care and uninterrupted access to medications.