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Author Topic: Ryan White Eligibility  (Read 4271 times)

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Offline Longe

  • member
  • Posts: 1
Ryan White Eligibility
« on: June 07, 2006, 03:50:46 PM »
I have been searching the internet, but do not know where to find the answers. I have been having my $114. Kaiser insurance premium subsidized by the Ryan White Fund here in Honolulu, through the Life Foundation.
 
Now they say they will not pay it anymore.  Here is what my case worker passed on to me:
 
"Iíve been informed that this is the last month that this will be paid, since you would qualify for Medicaid if you spent down your IRA. Granted, we both agree that this is not a feasible option, but the committee has to go by the book on these kinds of things. They were also concerned because this was becoming a recurring, monthly request."
 
They wanted to know why Medicaid does not pay for my premiums & I told them that I do not qualify, as I have about $10,000. in IRAs that I would rather not draw from, due to having to pay taxes & being penalized for early withdrawal.
 
Now they are saying I must spend it, regardless of the financial consequences.
 
My question is if any of you know if with my circumstances as they are, if I should still qualify for Ryan White funding for my insurance premiums, or legally, I should not be allowed access to them unless I am totally wiped out financially?  I am on disability & only make about $600. a month!
 
Please let me know, and where I can get proof, if it is in my favor. Thanks!

Aloha

Offline Dachshund

  • Member
  • Posts: 5,958
Re: Ryan White Eligibility
« Reply #1 on: June 07, 2006, 04:05:07 PM »
I am not sure of the laws of Hawaii,but here in Tennessee you must spend down your assets to under two thousand before you qualify. If you are on disability your caseworker should be able to answer your questions. I'm not a lawyer but maybe there is a way to transfer your assets...check legal aid in your area and I am sure you will get plenty of advice here.

Good luck,
Hal

Offline Oceanbeach

  • Member
  • Posts: 3,565
Re: Ryan White Eligibility
« Reply #2 on: June 07, 2006, 06:14:46 PM »
The new proposed legislation on the RWCA is nearly impossible to work with.  Written into this new legislation is terms like "core medical service" and "medical case management," neither of these terms are defined by the GAO or Congress and the final vote is expected in the Full Senate and House of Representatives in a little as a week to two months.  The Ryan White CARE Act is the payer of last resort in every state and is developed and allocated for persons who are under insured or do not have insurance.

When I moved from the islands over 15 years ago, any person who worked a minimum of 20 hours per week was supplied with full medical insurance, paid by the employer.  This had created an economy of 19 hour per week employees.

There are 1.1 million persons living with HIV/AIDS in the U.S. and an additional 40,000 new infections every year.  I am a member of the Funding Allocations Working Group (FAWG) in Sonoma County, California.  For the first time since the RWCA was enacted, FAWG has been asked to develop a budget for only 1 year instead of 2 years.  This is because we know what the budget amount will be for the next Fiscal Year but the future of any federal funding for any services.  We have to advise the Sonoma County Commission on AIDS on which services can be cut or eliminated for a few thousand persons living with HIV/AIDS so the Commission can advise the Board of Supervisors where to make the cuts.  Living with an AIDS diagnosis for the past 10 years, being 100% dependent upon the services provided by Medicare, MediCal (Medicaid) and RWCA, this is not an easy task and the decisions will be hard and painful for many people.

There are Fiscal Agents working right now in every state in every jurisdiction who are trying to find ways to maintain quality services and treatment on continuously reduced budgets.  I recommend if you are still able to work, keep you job.  If you still have medical insurance, do anything to keep it.

A Forum member from Kentucky provided State Health Facts from Kaiser Family Foundation. The information on this site is valued and quite astounding.  You can find this by clicking on my site www.Commission-on-AIDS.org on the front page click on COA Kentucky.  This will give you a lot of information but maybe not the information you need.  It is worth a try.  Have the best day
Michael

Offline hallmark

  • Member
  • Posts: 5
Re: Ryan White Eligibility
« Reply #3 on: June 07, 2006, 09:18:47 PM »
All my case manager tells me is "there is nothing I can do and good luck". I am also in Tennessee. And you dare to question anything at the regional meetings! Mark

Offline Oceanbeach

  • Member
  • Posts: 3,565
Re: Ryan White Eligibility
« Reply #4 on: June 07, 2006, 10:29:42 PM »
When we fail to question, we do not get the answers.  If I may point out the Summary of the Four Agreements used in our Planning Counsil meetings.
1. Be impeccable with your word
2. Don't take anything personally
3. Don't make assumptions
4. Always do your best

Have the best day
Michael

www.Commission-on-AIDS.org

Offline trai

  • Member
  • Posts: 70
Re: Ryan White Eligibility
« Reply #5 on: June 08, 2006, 12:31:45 AM »
You need to contact the group who administers ADAP (title 1 andtitle 2 funding for your state)  Which will be a state organization.  They will send you a form for adap funding.  ADAP is allowed to cover private medical premiums and prefers to do so...as it is cheaper then using RW funding as a whole.  Incidentally RW ADAP funding will also pay cobra if you change jobs and exceed the income limits...to continue your private coverage during that period until you receive new coverage with you new employer.

And no where in the RW care act does it require you to spend down your assets...it only looks at current income.  However the indvidual state might...

Medicaid might require that but RW care act does not.

I am not sure who handles your state's ADAP funding...mostly likely the Department of Health Services or something like that. 

Hope that helps.

Here is the contact info for you

http://www.atdn.org/access/states/hi/hi.html

T Rai

« Last Edit: June 08, 2006, 09:31:15 AM by trai »
12/2003  Tested Neg
02/2003  Tested Neg
08/04/2004   Tested Poz
08/05/2004   514     51536       
08/23/2004   516       81600    
01/07/2005   449       27500    
07/01/2005   308       35600    
07/21/2005   527       8140    
09/15/2005   512       3950    
12/02/2005   434       0    
03/15/2006   309       0 
10/   /2006    356      0  
01/08/2007   311       7899    
05/10/2007   345       9133    KS Diagnosis Started Meds for First time.
07/05/2007   692       793
10/   /2007    626       0
01    /2008    ???        0
07/08/2008   6something  0
08/   /2008  Stopped meds

06/2010   ???      0

Offline edfu

  • Member
  • Posts: 1,084
Re: Ryan White Eligibility
« Reply #6 on: June 08, 2006, 06:54:22 AM »
Trai, ADAP regulations must vary from state to state.  In New York State, for example, ADAP looks at BOTH income and assets to determine eligibility; you can have $0 income, but if you have assets, like IRA's, you must spend them down. 

When I was diagnosed, I was unemployed, with no income and with no health insurance, but I had 401K assets over the minimum allowed.  I could not receive ADAP.  I needed to go on HAART immediately, and I was reluctant to spend down what I needed for everyday expenses (rent, food, etc.)  to pay for my drug cocktail and medical care.  I entered a clinical study for 3 years, where I received HAART.

In the meantime I acquired health insurance but did not use it for one year because of preexisting condition.  New York State has another program, AHIP (AIDS Health Insurance Program), which looks ONLY at income and not assets, and which will pay health-insurance premiums.  I still have no income, so I was able to have AHIP pay my monthly insurance premiums.  The study has ended, and I now have been able to use my health insurance for my drug and doctor costs.

The stress of all of this probably damaged me as much as my HIV.                 
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline aztecan

  • Member
  • Posts: 5,398
  • 29 years positive, 57 years a pain in the butt
Re: Ryan White Eligibility
« Reply #7 on: June 08, 2006, 07:54:21 AM »
ADAP regs, just like Medicaid, vary from state to state.
Here in New Mexico, it is based on income, but ADAP here doesn't cover insurance premiums. That is covered by another program run by the state.
Another difference are the ADAP formularies and how the medications are provided. Here, the formulary covers most of the HIV meds, some only with prior approval, but not too much else.
Also, you must receive the drugs from the state Department of Health pharmacy, not a local pharmacy. They are mailed to you and you must refill them each month.

How things work depend a great deal upon which state you reside.

Good luck with your dilemma. I wish there were more I could tell you.

HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline trai

  • Member
  • Posts: 70
Re: Ryan White Eligibility
« Reply #8 on: June 08, 2006, 09:29:54 AM »
Hey y'all I do think I said that states might have individual requirements....in my post...re-reading it to make sure...however the actual act does not other then being HIV + and an income of 400% or less of the federal poverty level.

And incidentally Hawaii does have a 10,000 dollar limit on assets not including home and car.  The info the person needs and who to contact is in the link for his/her state.  As I provided that as well. 

I am not going to argue about where the funding comes from state to state...but I would be willing to bet...that if even it is not the department that admins adap...it is still adap dollars paying for insurance if you check.  But hey I could be wrong there, as there are 50 states...so 50 different regulations.

But I stand by what I said.

T Rai
« Last Edit: June 08, 2006, 10:01:13 AM by trai »
12/2003  Tested Neg
02/2003  Tested Neg
08/04/2004   Tested Poz
08/05/2004   514     51536       
08/23/2004   516       81600    
01/07/2005   449       27500    
07/01/2005   308       35600    
07/21/2005   527       8140    
09/15/2005   512       3950    
12/02/2005   434       0    
03/15/2006   309       0 
10/   /2006    356      0  
01/08/2007   311       7899    
05/10/2007   345       9133    KS Diagnosis Started Meds for First time.
07/05/2007   692       793
10/   /2007    626       0
01    /2008    ???        0
07/08/2008   6something  0
08/   /2008  Stopped meds

06/2010   ???      0

Offline Moffie65

  • Member
  • Posts: 1,755
  • Living POZ since 1983
Re: Ryan White Eligibility
« Reply #9 on: June 08, 2006, 10:20:45 AM »
One of the problems here Trai, and Michael; is that the Ryan White Care Act, (the legislation) and the manual itself are chock full of the words, "may", "can", "should", "maybe" and several other words that muddle the true content and purpose of the law.  This leaves the States ample leeway for interpretation.  I have been blown off by the State of Arizona on more than one occasion in the last six years, due to this very vague law.

Now to this issue specifically.  There is no way in hell that you will be able to keep this IRA funded in "YOUR" name.  There is no accommodation made for having a $10,000 asset in the bank and still garner support from a program which by it's very nature is called "the insurer of last resort".  I have several suggestions which include a condo or home purchase if you do not have a home; gifting to someone else in your family you trust, and several more ways to deal with this.  However, the one thing that will stay sure is that you will not be able to keep the $10,000 and still draw on Ryan White for your care. 

I don't even want to discuss why you even ask this question in a forum that is riddled with people that are totally incapable of even going food shopping without assistance, but then I guess it really doesn't matter why.  I do hope you figure out a way to deal with this, but I strongly suggest you get busy NOW, and deal with it before you are into a financial situation that force you into the few choices that many of us deal with daily.

In Love and Support.
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline trai

  • Member
  • Posts: 70
Re: Ryan White Eligibility
« Reply #10 on: June 08, 2006, 01:05:01 PM »
Maoffie while I agree with you about the vagueness in the RW act.....it still does have a lot of specific guidelines that must be followed...and even if a state such as Hawaii imposing more strick guidelines....a person can find that infomation.

For Lange case....in Hawaii...it states:

    * Assists those who, because of HIV-associated diseases, are no longer able to work and unable to pay their insurance premiums.
    * To qualify for participation an individual must be entitled to continue his/her insurance under COBRA, and should be informed as to this eligibility at the time of job termination.
    * Must have a physician certification of HIV seropositivity and inability to continue working.
    * Must be a resident of the State of Hawaii.
    * Must meet income and assets criterias.
    * Must not be eligible for health insurance through a spouse parent or legal guardian.

So I am not sure what the exact income and asset criteria is for this program in Hawaii...but the contact info is there...and it will be up for the person to follow up now...

All we can do is provide relevant info...and if possible point people in the right direction.
12/2003  Tested Neg
02/2003  Tested Neg
08/04/2004   Tested Poz
08/05/2004   514     51536       
08/23/2004   516       81600    
01/07/2005   449       27500    
07/01/2005   308       35600    
07/21/2005   527       8140    
09/15/2005   512       3950    
12/02/2005   434       0    
03/15/2006   309       0 
10/   /2006    356      0  
01/08/2007   311       7899    
05/10/2007   345       9133    KS Diagnosis Started Meds for First time.
07/05/2007   692       793
10/   /2007    626       0
01    /2008    ???        0
07/08/2008   6something  0
08/   /2008  Stopped meds

06/2010   ???      0

Offline Moffie65

  • Member
  • Posts: 1,755
  • Living POZ since 1983
Re: Ryan White Eligibility
« Reply #11 on: June 08, 2006, 01:11:28 PM »
Trai,

You are correct, and I have no idea what the income/asset level is for HI also.  This is one of those "The states may determine" parts of the legislation and I got caught in it. 

Sorry if I made a mis-statement that was  confusing. 

In Love.
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline Oceanbeach

  • Member
  • Posts: 3,565
Re: Ryan White Eligibility
« Reply #12 on: June 09, 2006, 07:08:02 AM »
Nice sweater Trai, did you get it at Nordy's?, Harrods?, Macy's?  Have the best day
Michael

www.Commission-on-AIDS.org

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Ryan White Eligibility
« Reply #13 on: June 10, 2006, 01:43:30 AM »
One of the axioms that goes along with HIV infection past the primary (non medicated) stage seems to be "prepare to be poor." It might take a decade or more, but it happens to almost everyone... especially once you begin to be sick.

Honest to God/dess, I would listen to Moffie on this. Ten thousand dollars will disappear very quickly when it is used for HIV treatment.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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