Health Resilience Ecosystem

Coverage is not
a product.
It is a lifeline.

For people living with HIV and other vulnerable populations, health insurance is the difference between viral suppression and preventable death. CoverageGateway exists to close that gap — for individuals, for programs, and for communities.

117K+
New HIV infections projected if Ryan White funding is cut — CROI 2026
73%
Projected rise in new HIV cases without Ryan White services — CROI 2026
91.4%
Viral suppression rate among Ryan White clients vs. 65% nationally — CDC 2024
🏛️ Funders & Government
CMS · Foundations · State agencies · Impact investors
CoverageGateway™
Coverage Intelligence Ecosystem
CARE-CROS™
Programs & organizations
FUNancial™
Individuals & consumers
Access
Prevention
Self-Sufficiency
The Urgency

The systems meant to protect the most vulnerable are under historic pressure.

While science has proven that insured people living with HIV achieve dramatically better health outcomes, federal funding cuts, Medicaid rollbacks, and ACA subsidy expirations are pushing more PWH toward coverage loss — at the exact moment new HIV diagnoses are rising.

$525M
Proposed Ryan White cuts
House Republicans' FY2026 budget would cut the Ryan White HIV/AIDS Program by approximately 20%, threatening care for 500,000+ low-income people with HIV who depend on it as their safety net.
Source: HealthLGBTQ / KFF, 2025–2026
26%
Projected ACA premium increase for 2026
Without ACA subsidy extension, average marketplace premiums are projected to rise 26% for 2026 — making coverage unaffordable for thousands of PWH who rely on subsidized marketplace plans.
Source: HIV-HCV Co-Infection Watch, 2025
40%
of all PWH are covered by Medicaid
Proposed Medicaid cuts under H.R. 1 — projected at nearly $1 trillion through 2034 — directly threaten the coverage of 40% of people living with HIV currently insured through Medicaid.
Source: CMS / KFF, 2025–2026

CoverageGateway's thesis: Health insurance is not just a financial product for people living with HIV — it is a clinical intervention. Research confirms that insured PWH achieve higher viral suppression, better ART adherence, and better quality of life. Putting insurance at the forefront is not a business strategy. It is a public health imperative.

The Evidence Base

Insurance access saves lives. The science is clear.

CoverageGateway is built on peer-reviewed evidence — not assumptions. Every product, tool, and intervention is grounded in what research and federal surveillance data tell us actually works.

"Among people living with HIV, those with insurance are more likely to adhere to ART, experience sustained viral suppression, and access mental health care — all factors associated with improved outcomes."

Journal of Acquired Immune Deficiency Syndromes, PMC 2024

"Higher financial literacy is linked to healthier behaviors, greater use of preventive services, and more effective management of health-related costs. Financial literacy enhances the ability to navigate complex insurance systems and make prudent choices regarding health."

PMC Financial Inclusion Survey Analysis, 2024

"Both higher levels of education and financial knowledge are related to a higher likelihood of obtaining health insurance coverage and a lower likelihood of having medical debt and engaging in cost avoidance."

Journal of Health Education & Behavior, 2024

"The Ryan White HIV/AIDS Program maintains viral suppression rates of 91.4% among clients — far exceeding the national average of 65% — demonstrating what is possible when access to coordinated care is sustained."

CDC National HIV Surveillance Report, 2024
The Coverage-to-Outcome Continuum
💔
Uninsured PWH
No ARV access, high viral loads, greater transmission risk, high emergency care costs, dependence on safety-net programs
📱
Financial & Insurance Literacy
FUNancial™ builds knowledge and confidence to navigate insurance options, understand costs, and make informed decisions
🏥
Coverage Access & Enrollment
CARE-CROS™ helps programs manage ACA enrollment, premium assistance, and ADAP coordination for their clients
💊
ART Adherence & Viral Suppression
Insured PWH achieve viral suppression at dramatically higher rates — protecting their health and reducing community transmission
🌱
Self-Sufficiency & Prevention
Stable coverage and financial literacy create pathways from safety-net dependence toward economic self-sufficiency and community resilience
Our Mission

Three outcomes. One ecosystem.

CoverageGateway is a mission-driven ecosystem — not a consulting firm and not a software company. Every product, every partnership, and every decision serves one of three interlocking outcomes.

🩺
Outcome 1
Access to Care & Prevention

Increase health insurance coverage among vulnerable populations — especially people living with HIV — so they can access the care, medications, and preventive services that keep them healthy and prevent new HIV transmissions in the community.

Serves
People living with HIV Uninsured populations At-risk communities Ryan White programs
🏛️
Outcome 2
Program Sustainability

Help Ryan White programs, 340B covered entities, and community organizations generate the revenue and operational capacity they need to serve more clients, sustain their teams, and remain viable as federal funding becomes less predictable.

Serves
Ryan White grantees 340B covered entities FQHCs Community health orgs
🌱
Outcome 3
Consumer Self-Sufficiency

Build the financial literacy, insurance literacy, and health literacy that empower individuals to navigate the system with confidence — reducing dependence on crisis-driven care and moving toward economic stability, voluntary insurance enrollment, and self-sufficiency.

Serves
Low-income individuals Young adults Gig workers Immigrant communities
The Ecosystem

Two integrated platforms. One mission.

CoverageGateway offers the right tool for each stakeholder — institution-facing for programs and organization-facing for consumers — designed to work together to create lasting impact.

Platform 1 — Institution Facing
✅ Live at carecros.com

CARE-CROS™

The only integrated premium assistance management system built specifically for Ryan White programs and 340B covered entities. CARE-CROS gives navigators and administrators the tools to manage ACA enrollment, premium assistance disbursement, 340B compliance, and coverage continuity — in one HIPAA-compliant platform.

M1–M6 PAMS Modules — eligibility screening, ACA plan selection, enrollment, PA management, coverage monitoring, self-sufficiency tracking
340B Compliance Engines — data ingestion, patient eligibility verification, ESP/Beacon monitoring, revenue reconciliation
ROPHI™ Analytics — Return on Public Health Investment framework quantifies the value of every dollar invested in premium assistance for grant reporting and funder communications
Client Self-Initiation — carecros.com/apply/[slug] lets prospective clients submit intake from any device before a navigator ever calls them
Visit CARE-CROS™ →
Live Dashboard — Broward County TGA
ACA-Enrolled Clients
1,598 (EMA benchmark)
Annual Premium Assistance Exposure
$10.7M
340B Revenue Opportunity (SEP Migration)
$4M–$6M estimated
Viral Suppression Rate — Ryan White Clients
91.4% (vs. 65% national)
HIPAA-intended · PHI encrypted · RLS entity isolation · Audit logging on all PHI access · BAA executed
Platform 2 — Consumer Facing
🔨 In Development — Broward Pilot 2026

FUNancial™

A consumer-facing financial and insurance literacy platform designed to meet vulnerable populations exactly where they are — regardless of education level, income, or prior knowledge. FUNancial builds the confidence and capability that leads to voluntary insurance enrollment and lasting self-sufficiency.

Six Learning Pathways — Money Basics, Credit Mastery, Insurance Literacy, Health & Financial Wellness, Protection Planning, Wealth Pathway
Gamified Progress Levels — Explorer → Builder → Stabilizer → Protector → Planner → Legacy Builder. Points, badges, savings challenges, and coverage retention rewards
AI Coaching — Personalized guidance on savings, credit improvement, insurance decisions, and financial planning in plain, accessible language
Multilingual & Accessible — Designed for populations with limited English proficiency, low prior literacy, and limited financial knowledge
Explore the Broward Pilot →
FUNancial™ — User Progress Journey
Module 1 — Money Basics
✅ Explorer Level Complete
Module 3 — Insurance Literacy
🔄 Builder Level — In Progress
Module 4 — Health & Financial Wellness
⏳ Unlocks next…
🏆
Coverage Retention Badge Earned
💰
30-Day Savings Challenge Complete
The Self-Sufficiency Pathway

From vulnerability to stability — a clear, supported path.

CoverageGateway does not just enroll people in insurance. It builds the knowledge, habits, and systems that help individuals move from financial vulnerability to lasting self-sufficiency — reducing their dependence on safety net programs over time.

💔
Uninsured & Vulnerable
No coverage, limited financial literacy, dependent on crisis-driven care and safety-net programs
📱
Literacy & Awareness
FUNancial™ builds financial and insurance literacy through gamified, accessible, culturally responsive education
🏥
Coverage Access
CARE-CROS™ connects programs and individuals to ACA plans, premium assistance, and 340B pharmacy savings
💊
Health Stability
Insured PWH achieve viral suppression, ART adherence, and better quality of life — protecting community health
🌱
Self-Sufficiency
Voluntary insurance enrollment, financial stability, reduced safety-net dependence, economic mobility
Who We Serve

Every stakeholder in the coverage ecosystem.

CoverageGateway serves multiple audiences — always in service of the same three outcomes: access to care and prevention, program sustainability, and consumer self-sufficiency.

People Living with HIV

PWH who are uninsured face dramatically worse health outcomes — lower viral suppression, reduced ART adherence, and greater risk of HIV transmission. CoverageGateway puts health insurance within reach and builds the financial confidence to keep it.

What You Need
Access to affordable ACA Marketplace plans that cover ARV therapy
Help understanding your insurance options in plain, clear language
Financial literacy that builds toward economic independence
A path from ADAP dependence to voluntary, self-funded coverage
Start Here
Find coverage through your Ryan White program
Start Your Coverage Journey →
Ryan White Programs

As federal funding becomes less predictable, Ryan White programs need new revenue strategies to remain viable. CARE-CROS™ helps programs manage premium assistance more effectively, capture 340B revenue, and demonstrate public health impact through the ROPHI™ framework.

What You Need
A platform to manage ACA enrollment and PA disbursements — not spreadsheets
340B compliance tools and revenue optimization for program sustainability
ROPHI™ data that demonstrates public health impact to funders and HIVPC leadership
Coverage continuity monitoring so no client falls through the cracks
For Ryan White Administrators
See what CARE-CROS™ can do for your program
Request a Demo →
340B Covered Entities

With manufacturer restrictions increasing and HRSA audit activity intensifying, 340B programs face growing compliance complexity and revenue risk. CoverageGateway offers both the technology platform and the consulting expertise to protect and grow your program.

What You Need
OPAIS registration support and compliance program development
ESP/Beacon submission management and manufacturer restriction navigation
Capture rate optimization — moving from below 65% toward the 90%+ benchmark
Audit preparation and HRSA audit response support
For 340B Administrators
Start with a free 340B eligibility assessment
Take the Free Assessment →
Funders & Government

As public health priorities shift and resources become constrained, funders need investments that demonstrate measurable impact, build toward sustainability, and reduce long-term safety-net dependence. CoverageGateway offers a scalable, evidence-based model with quantifiable outcomes.

What You Need
Investments that address root causes — not just symptoms of the coverage gap
Measurable outcomes: coverage rates, viral suppression, self-sufficiency progression
A replicable pilot model with a clear, independent evaluation framework
Technology infrastructure that scales without proportional cost increases
For Funders & Government Partners
Design a demonstration project with CoverageGateway
Discuss a Partnership →
Community Organizations

Faith-based organizations, CBOs, workforce development programs, and community health centers are on the frontlines of the coverage gap. CoverageGateway partners with community organizations to bring FUNancial literacy and insurance navigation directly to the communities they serve.

What You Need
Financial and insurance literacy curriculum your community can actually use
Tools your staff can deploy without specialized training
Referral pathways to Ryan White programs and ACA enrollment assistance
Impact data to support your own grant reporting and program evaluation
For Community Partners
Bring FUNancial™ literacy to your community
Explore a Community Partnership →
The Stakes

Why this work cannot wait.

These are not projections. They are documented, peer-reviewed evidence of what happens when coverage gaps go unaddressed — and what becomes possible when they are closed.

91.4%
Viral suppression rate among Ryan White clients — vs. 65% nationally, proving what coordinated coverage access achieves
CDC National HIV Surveillance, 2024
500K+
People with HIV served annually by Ryan White — the nation's HIV care safety net, now facing historic budget pressure
HRSA / MassMutual, 2025
$18B
Annual federal and state Medicaid spending on HIV care — confirming insurance coverage is the largest public health investment in PWH
CMS / HHS, 2025
7.8M
People projected to lose insurance by 2034 if H.R. 1 Medicaid changes are enacted — with PWH disproportionately affected
Congressional Budget Office, 2026
ROPHI™ Framework

What is your program's return on public health investment?

The ROPHI™ (Return on Public Health Investment) framework quantifies the value generated by premium assistance and 340B programs in terms that funders, boards, and HIVPC leadership understand.

ROPHI™ Quick Calculator

Estimate your program's annual return on premium assistance investment

Annual Premium Assistance Investment
Est. Annual 340B Revenue Opportunity
ROPHI™ Multiplier
Demonstration Project

Broward County, Florida — The Proving Ground

Broward County is home to one of the nation's most active Ryan White Part A programs, serving 1,598 ACA-enrolled clients with $10.7M in annual premium exposure. With CARE-CROS™ already live and FUNancial™ entering its pilot phase, Broward is where the full CoverageGateway ecosystem comes together for the first time.

The Broward pilot will generate the evidence base — coverage retention rates, viral suppression outcomes, self-sufficiency progression, and cost offsets — that positions CoverageGateway for national replication and funder investment in Ryan White EMAs across the country.

Become a Pilot Partner →

Broward FUNancial™ Pilot — 2026

Target Participants1,500–3,000
Duration12 months
Budget Range$350,000–$450,000
PlatformFUNancial™ + CARE-CROS™
Primary OutcomeCoverage retention rate
Secondary OutcomesLiteracy scores, viral suppression, self-sufficiency progression
EvaluationROPHI™ impact measurement framework
Replication TargetNational Ryan White EMAs
Why CoverageGateway

Built from the inside — not from the outside looking in.

🏥
Operational Experience Inside Ryan White Programs
Our founder serves as a senior program professional within the Fort Lauderdale EMA / Broward County Ryan White Part A Program — with direct, hands-on experience administering federal health programs for people living with HIV. This is not outsider expertise.
🎙️
2026 National Ryan White Conference — 2 Accepted Presentations
"Faith in Action: Engaging Faith-Based Communities" and "Enhancing Local HIV Response Coordination Through Multisector Partnerships" — both accepted for NRWC 2026, the premier national gathering of Ryan White professionals.
📊
ROPHI™ — Proprietary Impact Measurement Framework
The Return on Public Health Investment framework quantifies the value of premium assistance in terms funders understand — avoided emergency costs, viral suppression rates, and community-level transmission prevention.
⚖️
Florida 2-40 Licensed Insurance Agent & MPA
Deep expertise in ACA marketplace mechanics, APTC optimization, ADAP policy, and 340B compliance — backed by a Florida insurance license, a Master of Public Administration, and the Jim Moran Institute's Nonprofit Executive Program.
Founder & Manager
W. Cius, MPA, LIAB
Manager, CoverageGateway Technologies LLC · President, Fondation Jean Robert Cius, Inc.
Wismy Cius is a public health professional, entrepreneur, and nonprofit leader with deep roots in South Florida's HIV care and Ryan White program ecosystem. With an MPA, a Florida 2-40 Insurance License, and years of direct program administration experience, she brings operational expertise, policy knowledge, and community relationships that no outside consultant can replicate. CoverageGateway was built by someone who has lived this work — not someone who studied it from the outside.
MPA FL 2-40 Licensed Ryan White Administrator HIVPC Broward Jim Moran Institute Graduate NRWC 2026 Presenter NASTAD Network FJRC President

Build the next generation of
coverage, access, and resilience
with us.

Every stakeholder in the ecosystem has a role to play. Choose yours.

Get Started with CoverageGateway →