ADAP

If you are working but make under a certain percentage of the “National Poverty Level” (that can be found at http://aspe.hhs.gov/poverty/index.shtml ) be eligible for assistance through the “AIDS Drug Assistance Program (ADAP).” This program is a mix of Federal and State dollars that is administered by the providing State.

These programs usually cover all approved HIV antiviral drugs, but in some cases will carry on there formulary (list of medications that they will cover) additional complimentary medications to treat many of the side effects and conditions caused by the medication and HIV.

Some may qualify for ADAP while waiting for eligibility for other programs such as Medicaid or Medicare Part D.

To find out more you can go to the U.S. Department of Health and Human Services (HRSA) – HIV/AIDS Bureau web site at http://hab.hrsa.gov/programs/factsheets/adap1.htm , you can also visit you states’ Department of Health web site for exact formularies and qualification criteria.

Medicare

Medicare is available to Social Security retirees and those who qualify for Social Security Disability Insurance (SSDI – see SSDI below). If you should become disabled and can no longer work then you may qualify for SSDI, and after 24 months of disability you will automatically be enrolled in Medicare. Some states assist with premiums and co-pays through other programs such as Medicaid and ADAP.

Medicare Part A covers hospitalization (provided), and Part B (optional) covers your doctor visits, or you can choose Medicare Part C which covers both A & B in a Medicare Advantage Plan (HMO, PPO, etc.). Part D covers prescribed medications. Each has deductibles, premiums or both.

To find out more you can visit http://www.ssa.gov/mediinfo.htm , or call 1-800-633-4227. We also cover this in more detail in our Social Security Lesson.

Medicaid

Medicaid is a program administered by each state (a mix of state and federal funds) that covers medications and some medical care for those who have little or no income depending on whether you are blind, disabled, aged, or pregnant. Each state sets its own guidelines for eligibility and services.

Some states have a waiver that allows those with late stage HIV disease (AIDS), who require home bound services, a higher level of income in their financial eligibility criteria. An excellent paper that explains this can be found at http://www.cms.hhs.gov/TWWIA/Downloads/BuyInProgram.pdf (amounts in this paper are out of date) We also cover this in more detail in Medicare and Medicaid lessons, PowerPoint presentations, T.A.S.K./Student appendix under downloads. (Some are still under development.)

To find out more information in general go to the U.S. Department of Health and Human Services you can visit the http://www.cms.hhs.gov/home/medicaid.asp , or for state specific coverage and criteria fill out the search form at http://www.cms.hhs.gov/apps/contacts/ that will direct you to you state’s Medicaid sight.

Social Security Disability Insurance - SSDI

SSDI is disability insurance you pay into from you wedges (listed on you check as FICA). If you have worked recently enough and long enough you may qualify to receive an income each month based on your highest years wedges of the years you have worked. Each year you should be receiving a statement (unless you already receive SSDI) that will tell you how much income you can expect at retirement, and if disabled.

Important thresholds to remember

Above $900.00 is considered Substantial Gainful Activity (SGA)

Above $640 is considered a “Trial Work Period” month

 

Supplemental Security Income - SSI

SSI is basically an entitlement program (like welfare) that supplies income for those who are disabled and have little or no income and assets, and who have not worked long enough or recently enough to receive SSDI, or those who do qualify for SSDI but the income falls short of what SSI provides; the latter are considered dual eligible’s that qualify for both SSDI and SSI. Those who do qualify for SSI automatically receive Medicaid.

Source for the table below

http://www.fdhc.state.fl.us/Medicaid/index.shtml

 

SSI  MONTHLY  FEDERAL  BENEFIT  RATES  (FBRs)  AND     LIVING  ARRANGEMENTS     See the charts below to determine the maximum SSI benefit you can get in the following living arrangements if: your State does not add to the SSI monthly FBR, and you have no countable income (see SSI INCOME for more information). However, depending on what State you live in, you may receive a supplemental payment. See SSI BENEFITS for more information.   Live alone or pay your share of food and housing costs January 2007 Individual/Child $623 Couple $934 Live in the household of another January 2007 Individual/Child $415.34 Couple $622.67 Live in a Medicaid Institution January 2007 Individual/Child $30 Amounts given are general guidelines only. For more information about living arrangements, see our chapter on LIVING ARRANGEMENTS and the SSI Spotlight on Living Arrangements.

 

Further information on services supplied through the Social Security Administration (SSA) can be found at www.ssa.gov . We also cover this in greater detail in the Social Security & Medicare lessons and in T.A.S.K.

Ryan White Funding

“The Ryan White Emergency Care Act” provides funding for those who do not qualify for any other programs like Medicare, Medicaid, and ADAP (which is part of Ryan White). These funds cover a wide range of services designed to stabilize patients so they can more easily be treated. Usually these services are used until they can qualify for other programs. The funding is broken down in to different parts, previously called “Titles.” The Part/Title that you will qualify for depends on where you live and the number of HIV cases in that area.

Ryan White fundable services are now more focused on what is called “core services” Below is a list of services that can be covered.

FY 2007 Part A and Part B Fundable Program Services List

 

Part A and Part B Allowable Program Services
Core Medical Services
a.	Outpatient /Ambulatory health services
b.	AIDS Drug Assistance Program (ADAP) treatments
c.	AIDS Pharmaceutical Assistance (local)
d.	Oral health care
e.	Early Intervention Services
f.	Health Insurance Premium & Cost Sharing Assistance
g.	Home health care
h.	Home and Community-based Health Services
i.	Hospice Services
j.	Mental health services
k.	Medical Nutrition Therapy
l.	Medical Case Management (including Treatment Adherence)
m.	Substance abuse services–outpatient
Support Services
n.	Case Management (non-Medical)
o.	Child care services
p.	Emergency financial assistance
q.	Food bank/home-delivered meals
r	Health education/risk reduction
s	Housing services
t	Legal services
u	Linguistics Services
v	Medical Transportation Services
w	Outreach services
x	Psychosocial support services
y	Referral for health care/supportive services
z	Rehabilitation services
aa.	Respite care
ab.	Treatment adherence counseling

NOTE: Part A and B Ryan White grant funds may be used to support ONLY the service categories listed above. The Ryan White Program Service Category Definitions list includes additional categories that are fundable under Part C and/or Part D only.

 

Patient Assistance Programs

Patient Assistance Programs (PAP) are available to those who do not qualify for any of the above or other programs, and who cannot afford to buy medications. The pharmaceutical companies will supply needed medications after the patient, through their doctor, applies for and is accepted into the program. These programs can cover all needed medications whether HIV related or not. On our medication page we list these programs in the far right column so you don’t have to go hunting for them. Some companies use non-profits and associations to assist patients in the application process, such as: Partnership for Prescription Assistance (PPA) and Together Rx Access. These are listed when they apply.

2007 Federal Poverty Guidlines

Source:

SOURCE:  Federal Register, Vol. 72, No. 15, January 24, 2007, pp. 3147–3148

 

Persons in Family or Household	48 Contiguous States and D.C.	Alaska	Hawaii
1	$10,210	$12,770	$11,750
2	13,690	17,120	15,750
3	17,170	21,470	19,750
4	20,650	25,820	23,750
5	24,130	30,170	27,750
6	27,610	34,520	31,750
7	31,090	38,870	35,750
8	34,570	43,220	39,750
For each additional person, add	3,480	4,350	4,000