Measuring the Impact of the Affordable Care Act: A Ryan White Clinic Case Study

Background. The Bluegrass Care Clinic (BCC) is a university-affiliated clinic at the University of Kentucky and has served as the safety net for HIV medical care since 1990 in central Kentucky. Since receiving Ryan White funding in 2002, the BCC has developed a multidisciplinary care team providing comprehensive HIV medical care and supportive services to 63 counties in Kentucky. Navigating Medicaid expansion and a state based health insurance marketplace as a result of the Affordable Care Act (ACA) has had a significant impact on a largely uninsured population. This case study will discuss the successful implementation and evaluation of ACA in a Ryan White academic based clinic in a largely rural state and may serve as a model for other medical clinics implementing ACA. Methods. This case study reviews the processes by which patients were identified and enrolled into newly available health insurance options. Additionally, the financial impact on Ryan White grant funds will be examined by comparing the cost effectiveness of insurance premium assistance of comprehensive HIV medical care by examining cost of services versus service utilization in years 2013 and 2014. Results. Of the 1029 patients seen in 2013, 44% (453 patients) were uninsured. During the 2014 ACA enrollment period, the BCC screened 96% of the previously uninsured patients for eligibility in Medicaid expansion or exchange based insurance plans. Ninety-two percent of those previously uninsured were eligible to obtain new insurance through ACA; of the 1214 patients receiving services at the BCC in 2014, only 12% remain uninsured. Subsequently, the BCC has seen a significant decrease in the need for grant funds to support services now covered by increased insurance coverage such as specialty referral appointments as well as laboratory, radiology and diagnostic testing. The BCC has thus reinvested funds into services such as mental health counseling and medical transportation services to address barriers to care for this population. Conclusion. The Affordable Care Act has had a significant impact on a vulnerable patient population in terms of availability of insurance and a notable financial impact for the BCC. Disclosures. All authors: No reported disclosure