Alpha Goodshepherd is worried.
HIV positive since 1998, he knows how important it is to take care of his health.
Until recently, the 51-year-old Lawrenceville resident took a drug to keep the virus at bay. Now, all he has is an empty pill bottle and a notice — that his insurance has been canceled.
Goodshepherd applied to the Georgia Department of Public Health on May 16 to have his $510 monthly insurance premium paid through a program called the Health Insurance Continuation Program. Although his request was approved, the state didn’t mail the check by the payment due date, and Goodshepherd’s coverage was dropped.
Metro area AIDS activists say it is not an isolated problem. Dozens of their clients have been put at risk of losing their health insurance because of paperwork snafus by the health department.
The Health Insurance Continuation Program is a federally funded program that pays the private insurance premiums for low-income people with HIV and AIDS. In some cases, those premiums can run as high as $1,100 a month.
“They said there is pretty much nothing they can do. They returned the check and denied my appeal,” Goodshepherd said of his insurance company. “It left me with over $10,000 in medical bills that I am unable to pay. I don’t know what I can do at this point.”
Paying private insurance premiums, while expensive, is cheaper than funneling the patients into the AIDS Drug Assistance Program, where the state picks up the tab for patients’ costly prescription drugs. Goodshepherd is trying to get into that program now, despite a long waiting list.
State Health Officer Dr. Brenda Fitzgerald, who became head of the Department of Public Health in February, acknowledged the Health Insurance Continuation Program had a spate of late payments in January. But she said new policies — and some personnel changes — has it back on sure footing.
“There certainly was a lot of difficulty in the past,” she said. “Clearly, letting the insurance lapse is unacceptable.”
Fitzgerald said two employees with HICP no longer work for the state as a result.
Dr. Anil Mangla, director of infectious diseases for the Department of Public Health, said new policies were instituted this year to process paperwork more quickly, ensuring payments are made on time. Officially, the department asks the nonprofits that vet applicants to submit paperwork to the state for the clients 30 days in advance, but Mangla said turnaround time is about two weeks.
The way the program works is that nonprofit organizations assist HIV-positive clients in filling out the health and financial forms required by the program and forward those papers on to the Department of Health, which cuts the premium checks and mails them to the insurance companies.
The General Assembly moved the Public Health out of the Department of Community Health July 1, making it an independent department for the first time. Mangla said he believes the simplified command structure of the new department should help with processing payments.
But officials with the nonprofits say their clients continue to have trouble. Fitzgerald and Mangla both initially said the problems were solved in January. But later, after The Atlanta Journal-Constitution provided them with specific examples, they acknowledged they continue to have problems.
One program participant, who asked to be identified only by his first name, James, out of fear of being discriminated against because of his HIV status, said his coverage lapsed in April and again in July when the state was late processing his payment.
“You can’t imagine what I had to go through to get this coverage. It has been so stressful,” he said.
Both times, James was within the grace period and not officially dropped by his insurer. But, according to his policy, he was not eligible for coverage until the check was received. This spring, he went six weeks without coverage.
“I couldn’t go to the doctor and couldn’t get my meds for all of April and half of May. That’s how you get resistant to AIDS medications — you don’t take them,” he said. “I had stockpiled some, so it wasn’t a full month that I had to go without, but it was some period of time.”
When the state was late paying again last month, James scraped together the $508.26 to pay his premium out of pocket.
Tracy Elliot, executive director of AID Atlanta, a nonprofit that assists HIV-positive clients with getting medical care and applying for government assistance, said it’s difficult to get a clear idea from the department why it takes so long to process insurance paperwork.
Health department spokesman Ryan Deal said there were several problems that contributed to the problems including “poor employee performance,” outdated computer software and incomplete paperwork submitted to the department.
Elliot’s staff was in close contact with the department’s HIV Unit in late June as clients waited for word their premiums were paid.
“We spent an inordinate amount of time in communication back and forth [with the health department]. ... We were monitoring it daily.”
According to time lines provided by both departments, checks for HICP were cut by Community Health on June 30 and delivered to the HIV Unit in Public Health on July 1. Mangla said public health employees stayed late to make sure the checks made it out and were postmarked by the end of the day.
Elliot said the first of the month is the payment deadline for many of the policies, so it would be up to the insurance companies to decide whether to accept payment received after that date.
“That time line is just too close in any case,” he said.
Goodshepherd enrolled in the state program with the help of AID Gwinnett. Tomi Stultz, director of client services, said dealing with state health officials is a constant struggle and late payments by the state are not uncommon.
“It’s happened throughout the year,” she said. So far, a dozen AID Gwinnett clients have had to appeal to get reinstated to their private insurance because of paperwork problems.
“One was actually in the hospital and was told [his insurance] was canceled,” she said. Stultz said in her agency’s cases, the state has been missing both the premium due date and the 30-day grace period.
Ryan said recent problems with the program appear to be “extremely limited.” Three patients have had their insurance lapse or be canceled as a result of the department’s problems in June.
“Arrangements have been made for two of the affected patients to receive medications through alternate programs,” he said. The department is waiting for the third patient to submit an application for help, he said.
HICP has a budget of $2 million a year from the U.S. Department of Health and Human Services and serves 364 people across the state.
Stultz said AID Gwinnett assists about 45 people in the insurance program. Enrollment has increased in recent years, a fact she attributes to the troubled economy.
“We’re seeing more now because people are losing jobs. They need COBRA, so we are seeing more people coming in needing help with premium,” she said.
Late payments from the state have been a problem for years, she said.
“We hand deliver [the applications] to the 12th floor at 2 Peachtree Street every Monday,” she said, referring to the department’s suite of downtown offices. “We just hope that it gets to whoever is reviewing in a timely manner. We can’t control anything that happens once we leave it there.”
Goodshepherd, who lives on $367 a week in short-term disability payments, has run out of his prescription drugs and is unsure what to do.
“I don’t know what is going on. I just know I need to get some medication,” he said. “At this point, I can’t even go to my doctors because I don’t have any coverage.”
Mangla said he would look into Goodshepherd’s case and believed the state could persuade his insurer to re-enroll him.
The problems in the health department are not limited to the insurance program.
The program coordinator of the department HIV Unit resigned last month amid an investigation into the awarding of federal HIV prevention contracts. The investigation into the contracts is complete, but department officials have said the report will not be released for several weeks.
Fitzgerald has ordered a top-down review of the office.
The AIDS activist group ACT Now! staged a small protest Friday outside the department’s downtown headquarters, demanding the findings of the investigation be made public. William Francis, ACT Now! executive director, said he met with department officials and was promised a meeting with Fitzgerald in the near future.
About the Author
