Heads up To ADAP Receipents : Make Sure They do ALL of Your Labs !!!!

[Lwood]

I recently found out the hard way that ADAP requires current VL and CD4 lab results in order to maintain  eligibility.
 When they ran my last bloodwork , there was no VL test done, due to an error somewhere down the line. Both my doc and I were a little perturbed, but all the other numbers were quite good so I chalked it up to human error, and decided that a 90 day wait to enter another dot on my graph wouldn't really cause that Large of a disturbance in The Force...
Well, apparently the ADAP Jedis dont see it quite the same way : A week or so later, I piled into the Millennium ShitCan and made the trip to my local Health Dept.Star for my Monthly refill, and as things would have it I was due for my 90 day "Paperwork Update"  and duely handed over my latest labs minus the VL result, for xeroxing and faxing to a Galaxy Far Far Away, I think its in Tallahassee.
I usually return the following day for my Goodies, because I just dont dig the vibe in the waiting room there at the Health Dept.
Jumping ahead a bit, I get a call asking if I had lost a page of my labs since they didn't see a current Viral Load and I explained that Jar Jar at my clinic had probably forgotten to check the box on the lab order but I could give them the previous set of labs which showed an undetectable Vl ....
" A current Viral Load , We Must Have. and less than 120 days old it must be."
To make a Long Long Story short Short, Several Phone calls were made, blood was drawn that day and Pills were dispensed from the Protease Nebula.

The Point of the story is that ADAP requires current labs, BOTH  VL and CD4 in order to keep your eligibility, Luckily the folks at my Health Dept are Terrific, as are the staff at my Clinic ( well except for JarJar ) and since the test results were 'en route' it was enough to satisfy the ADAP guideline and get the meds dispensed that day. This could have very easily have turned into a real mess, and caused a gap in treatment had it not been for a couple of outstanding People. So If you notice a missing Result on your labs, Point it out right away since you could wind up missing alot more than a dot on your Graph.

Lwood
Who was forced to watch the entire Star Wars Marathon this weekend.

 

 

[Dachshund]

I guess they figure no VL lab results would indicate that you have been cured and now use your meds solely as a laxative and dream enhancer.

Not to hijack but another word of warning concerning ADAP coverage. If doc orders a lab test you are not familiar with make sure it is covered by ADAP. Being over fifty my doc ordered a PSA level on my last set of labs. Soon thereafter I received a bill from the laboratory for $389 for that one test ADAP did not cover. For routine HIV bloodwork there is ADAP for everything else there's Mastercard.

Live long and prosper.

[Miss Philicia]

Shouldn't you qualify this?  I would suspect it's an ADAP requirement in your particular state.  Not a federal requirement that I know of, as I've not heard of this in Pennsylvania.

[Lisa]

It seems that individual states distribute their ADAP programs differently. Here in N.C., my ADAP approval is done once a year on the anniversay of my original application. We do update my care plan quarterly though.

[Miss Philicia]

There seems to be no annual renewal process of any kind here in Pennsylvania, nor was there ever in New York.  Once you qualified it seemed like you were on auto-pilot.

I can see them doing reassessments based on financial situations, as they change.  I don't see the point in doing it based on lab results.  Isn't the only medical qualifier an actual HIV diagnosis?  Only needs to be done once, everything else is needs based.

[Robert]

Out here in California we have to reapply once/year.  You must reapply 3 months  prior to your birthday so I start making plans in Sept.  Anyway, I made an appointment in Dec with my case manager, the same day I had to get blood drawn.  I had my previous blood drawn in Aug (I know I should have gone in Nov. but I guess I was busy with something and couldn't be bothered).  I told the case manager if he waited a week he could use the new results, but he said the August results would be fine.  Then he told me I needed to show I had applied for and was rejected for Medicade.  Of course I showed him my income statement which automatically disqualifies me, but that wasn't good enough.  He needed the rejection letter from the county.  Not a problem, just a hassle.

robert

[Lwood]

I pretty much figured that once you tested Pos. and met the residence and financial requirements ( or lack thereof) it was an 'Auto Pilot" situation as well, but aparently not which is why I posted this little incident. The ADAP lady explained that they " Were Really Cracking Down "  several montha ago when I did a renewal thing, and I never thought twice about it since Im pretty meticulous about keeping lab results and medical records in general, Hell, I still have ALL of my empty pill bottles ( which is becoming a problem, but I shant Digress )  My educated guess here is that theyre trying to 'crack down' on people selling their meds on the black market or otherwise perpetrating something scandalous..
This may well be a localized thing in Florida, but why take a chance... They also might want to make sure that yours still in some sort of supervised medical treatment, and not just blindly taking meds without followup,... in any event  Im keeping the T's crossed and I's dotted....

[Miss Philicia]

Well, for one thing considering that case management in entwined with my HIV clinic, and I go once a month, I'd certainly have seen large signs about this if it was some new thing in Pennsylvania.  I've been on ADAP for six years and have yet to encounter this.

[thunter34]

In Atlanta, you have to do all of this every 6 months.  And all of that Lwood mentioned applies.  I know.  I got caught in one of those little snafus back in October.  Fortunately, I was already in the process of taking care of it before my meds ran out- but not quite soon enough...had to go about 9 days without any meds whatsoever.

[Lwood]

I definitely plan to bend my ADAP  ladys ear about this next time , not to complain just to figure out why theyre being so strict. I mean its not like Im going to suddenly stop having HIV, and I surely dont want to come off like Im looking a 'Gift Horse in the Mouth' especially since I trot out of there with about $1200. bucks worth of Horsepills in my saddlebag every 30 days.
In any event,  At least my Fellow Floridians should be aware of this latest scrutiny, besides if your labs are done properly its a non issue, but a small mistake could  snowball into a real problem.

Is anyone else seeing an increased scrutiny of ADAP Guidelines in their State ??  There could be a POZ article in this ......

[Dachshund]

The rules have changed drastically in the three years I have had to rely on ADAP in the state of TN. The reason is funding, or lack thereof. Restrictions and guidelines continue to increase while coverage continues to dwindle. You got to be able to find money for bullets and bombs somewhere...but that's for another thread.

Every six months I must supply proof of residence, income and proof that my job does not offer insurance. You can add the state of TN to the growing list of states that now have waiting lists for ADAP.

[thunter34]

The rules have changed drastically in the three years I have had to rely on ADAP in the state of TN. The reason is funding, or lack thereof. Restrictions and guidelines continue to increase while coverage continues to dwindle. You got to be able to find money for bullets and bombs somewhere...but that's for another thread.

Every six months I must supply proof of residence, income and proof that my job does not offer insurance. You can add the state of TN to the growing list of states that now have waiting lists for ADAP.

So TN is in the 6 month group also?  They also started wanting people to provide income information for roommates and family members, too...people that don't even receive services from them.  These others can still officially decline on paper to provide this information, but I wonder how long that might last if the money keeps dwindling.  Little scares like the one I had in October really make for a nifty reality check.  Reminds me that I can go from the The Quick to The Dead in short order with a few strokes of a pen.

[Dachshund]

So TN is in the 6 month group also?  They also started wanting people to provide income information for roommates and family members, too...people that don't even receive services from them.  These others can still officially decline on paper to provide this information, but I wonder how long that might last if the money keeps dwindling.  Little scares like the one I had in October really make for a nifty reality check.  Reminds me that I can go from the The Quick to The Dead in short order with a few strokes of a pen.

TRUE THAT!

[Miss Philicia]

I'd be interested in what the cost of all this extra "vigilance" is versus how much abuse of the system they've actually caught.  I'm quite sure all of this extra bureaucratic bs is music to the ears for extra employment of government employees.

And that's just absurd to be checking every six months.

[Miss Philicia]

Additionally, can people posting in this thread list if these reassessment rules are new or old, and if the latter how long they have been in place?

[AlanBama]

I can't begin to count the number of times, over the years, that I have had to PROVE my HIV status for various programs...

Some of what they have you do is laughable, but I understand they are following procedures.   At AID Atlanta, every 6 months I had to go in and PROVE that I still had AIDS, my residency, etc...   Common sense tells you that once you have proved you have AIDS, and there is no cure.....why is it necessary to discuss it any further?

One agency (I forget which) always wanted to see my ORIGINAL disability award letter.   I can guarantee them that if Soc Security had not originally awarded me disability, they would not be depositing a check in my account each month now.

[thunter34]

You know, I consider myself very lucky that I didn't have have to face a waiting list issue for ADAP.  I was, of course, fast-tracked.  My t-cells demanded it.  I probably would have been dead within a few months without starting meds.  

Dachshund, are you also familiar with those financial questions that I mentioned?  Does TN also try to get financial info from family and roommates?  Just wondering if that part is also going on there in TN.  Like I said, these people can officially refuse to disclose this information (as of now, anyway), but that is something they will not readily tell you at the beginning.

EDITIED TO SAY:  Thank you, philly!  That is something I have been wondering!  I've wondered what the cost of all that additonal paperwork and man hours is.  Is there really a big HIV med abuse problem going on?  It's just not one the first areas I would think of for pulling one over on The Man, ya know?  I don't want to sound unappreciative of what I receive, but it does feel like a bit much sometimes with the recertification.  You barely get through doing it, and it's time to start getting all the papers together once again.  How many people's living/financial situations change that drastically (for the better, that is) within a six month time period?

[Miss Philicia]

What would the financial status of a roommate(s) have to do with ADAP eligibility?

[thunter34]

Additionally, can people posting in this thread list if these reassessment rules are new or old, and if the latter how long they have been in place?

I've only been in "the system" for a little over two years, so I can't say how old or new many of the guidelines are.  I can say that the request for the additional financial information of family and roommates came about roughly a year and a half ago.  That was a new tweaking to the rules they added then.  It was not requested on my first go around, but was the second or third time.


To philly:  I honestly can't say for sure.  They seemed to be saying that if I was the kept boy of a wealthy Sugar Daddy, that I could get dropped from the system- because this wealthy guy (and presumed loved one) would have the ability to pay for my pills.  Isn't that crazy?  That's how I came to find out that the information could be refused...because I started, um.....speaking in my "outside voice" at the ASO about how odd that the Fulton County court system could just officially declare that the relationship of two men together should have no legal merit- yet suddenly it could count for something in this area.  In other words, we won't recognize your relationship except as a means to cut you off from services.  I really did throw quite the hissy fit- one of my most memorable ones.  In order to get me to shut up and quit causing a scene, they all started muttering:  "It's OK!  It's OK!  They can refuse!  They can refuse!"  I have since heard from staff people there that there were some who did get the boot from the system because of this little snare.  These folks either weren't loud enough, mean enough or savvy enough of their rights to fight it- and they got walked over.

[Dachshund]

Timmy, I have not been asked questions concerning roomates, etc, but I imagine it is only a matter of time. I was required to list house/rental payment on my initial application, supply access to banking information and answer quite a few questions concerning my assets, or in my case lack of.

The new procedures timeline parallels with yours in GA. I don't think it has anything else to do with than the decrease in funding and the increase in infections. They use to offer dental...gone. Eye care...gone. Transportation to Dr...gone. Expanded pharma...gone. I'll shut up now I am getting depressed thinking about it.

[DavidinCA92284]

I recently asked a question of my case worker for ADAP in Palm Springs about "household" income qualifications for ADAP benefits.   Next year, every registered Domestic Partner has to file joint tax returns as if married .  .  . so my question was whether ADAP will require a Household income rather single.  The rep said that it is still a 'single' income system for qualification.   My concern for those without insurance and depend on ADAP for meds is whether that will continue in California.  IF Parnters are going to be considered "married" then why wouldn't ADAP benefits consider both incomes as sources?  One answer could be taht ADAP benefits are provided by the Federal Government and the feds don't acknowledge the unions.  Another answer could be that each state can set its own rules as to qualification.....but California could change their own rules and require a 'household' income as qualification rather than single.  This might get messy in California.

[Lwood]

Great,  Now Im shitting a brick about having to possibly come up with financial info about my Boyfriend next time. 
I already have to show them a letter stating that he provides 'Support and Housing' , however if they push the 'Household Income' thing he will quickly become my landlord,( with privelages ) and the rent will be something like 'in exchange for landscape care ' or some bullshit like that.
ADAP and Ryan White eligibility are the main reason that Im so cautious about re entering the job market, but thats another Topic..
 

Just to clarify, I have to do the 'Full ADAP "  re certification every 6 months, Ryan White too for that matter,  but they require a copy of my labs every 90 days, which is to say every time theyre done. No biggie, Im actually pretty proud of my labs, kind of like bringing home a good report card. Id stick them to the refrigerator door if I could but alas  Stainless steel isnt magnetic.

[mjmel]

Great,  Now Im shitting a brick about having to possibly come up with financial info about my Boyfriend next time. 
I already have to show them a letter stating that he provides 'Support and Housing' , however if they push the 'Household Income' thing he will quickly become my landlord,( with privileges ) and the rent will be something like 'in exchange for landscape care ' or some bullshit like that.

Exactly. Barter system valued at meager but in subsistence amount, I may add. Same old statement of income every six months....new date typed in when I open the Word doc.