The only three insurance companies in Louisiana that sell healthcare policies throughout the state under the Affordable Care Act  are rejecting payments from a federal program intended to help low-income HIV patients.

For 23 years, the Ryan White HIV/AIDS program has made grants to state, cities and non-profit organizations to help low-income people with HIV purchase health insurance.  Now, the Louisiana Health Cooperative, Vantage Health Plan, and Blue Cross and Blue Shield of Louisiana have made the decision to reject these payments.

The insurers told healthcare advocates that guidance issued by the Centers for Medicare and Medicaid Services, the lead Obamacare agency, prevented them from accepting third-party payments to pay for health insurance premiums for the new health plans.

That guidance, issued in November, was meant to prevent self-dealing or even fraud.  The worry is that some healthcare providers will steer people to specific health plans and offer to pay the premiums so they can make more money by billing the insurance company for those patients’ covered services.

Last week, CMS said the ban on third-party payments “does not apply” to those made on behalf of Obamacare enrollees by “state and federal government programs or grantees (such as the Ryan White HIV/AIDS Program).”

Lambda Legal, a non-profit group, filed an administrative complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services, CMS’s parent agency, against Louisiana Blue, Vantage and Louisiana Health Cooperative, arguing that their refusal to accept Ryan White payments flouted a key provision of the ACA, namely its requirement that insurers accept any customer regardless of health status.

Lambda is considering amending its complaint to include the other insurers who reject third-party payments.

“What we’re seeing in Louisiana is a crisis for low-income people with AIDS,” said Susan Sommer, director of constitutional litigation for Lambda Legal. “These are exactly the people the Affordable Care Act was designed to provide a safety net for.”