Individuals living with chronic and life-threatening illnesses, such as cancer, autoimmune diseases, and bleeding conditions, rely on patient assistance programs to help cover the high costs of managing their conditions. For the chronically ill and patients suffering from rare diseases, the costs to simply maintain their health insurance can be prohibitive.


Charitable patient assistance programs provide a critical service that can mean the difference between life and death for many of these patients – and at no added cost to the public.

 
 
 
 

Yet, a new regulatory measure barring such assistance has left many of our nation’s most vulnerable patients with no other choice but to default on their premium payments.

On March 19, 2014, the Centers for Medicare & Medicaid Services (CMS) issued federal guidance on third-party insurance payments for the new Exchange plans offered under the Affordable Care Act (ACA). In direct contradiction to the standard currently used by Medicare for non-profit charity, third-party payers, CMS failed to include non-profits on the list of acceptable arrangements for patients covered by qualified health plans (QHPs).

As a result, health plans can now deny coverage to patients by rejecting the premium and cost-sharing assistance they were receiving from non-profit third parties. Exemptions have been extended to the Ryan White HIV/AIDS Program, Indian Tribes, and other state and federal programs – but not non-profits.

This harmful guidance is enabling insurers to exclude patients with expensive – yet devastating – conditions from their plans, undermining the intent of the ACA and unraveling the safety net patient assistance groups have worked so hard to create. In fact, insurance companies in 41 states have already cited this rule to deny coverage to patients who receive non-profit assistance – and many others are likely to follow suit.