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Author Topic: They're trying to SCREW you: "MEDICAID CHOICE"  (Read 4267 times)

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Offline allopathicholistic

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They're trying to SCREW you: "MEDICAID CHOICE"
« on: August 06, 2006, 10:03:46 AM »
Hi all! Not sure if this is New York City-specific or what (probably) but anyway this is a good FYI  :)

If you're on Medicaid you might get official-looking notices in the mail saying the following (Here's where I amuse you with my mock Wizard of Oz ominous deep voice) oh you have to switch to Medicaid Choice OR ELSE! blah blah blah

FYI Medicaid Choice is an *INFERIOR* HMO-partnered bullshit which they say is cost-saving (yeah, for them!) . The notices will say you gotta switch no if's and's or but's and make it seem like a *CRIME* if you don't  :o ....WELL boys and girls I'm here to tell you, if you're HIV positive, those notices are BULLSHIT ... If you're HIV poz you are fully entitled to stay on regular Medicaid which is far superior, no if's and's or but's. If you follow the notices like a good little lamb to the slaughter you will pay the price. Literally - in your pocketbook.

When I mentioned the letters and the way they were worded to my ASO, they laughed with disgust and said "Yeah, man, that's how they GIT'cha!! Anytime you get letters of that nature, bring it to us and we'll educate you on the dirt."  So apparently they have firsthand experience with alot of the bullshit scare-the-sheep tactics out there.

With Love,
Alex - who says "Don't let 'em GIT'cha!"... Those fucks
« Last Edit: August 08, 2006, 12:58:52 AM by allopathicholistic »

Offline J.R.E.

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Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #1 on: August 06, 2006, 10:09:29 AM »

Thanks for the heads up !! There is soo much about this, that just baffles this already baffled brain !!

Current Meds ; Viramune, Epzicom, 20mg of Atorvastatin, 25 mg of Hydrochlorothiazide.
Amlodipine Besolate 5mg-- Updated 9/24/2017

Diagnosed positive in 1985,.. In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started on  HAART on October 24th, 2003.

 As of 9/18/2017,  Viral load remains <40
CD 4 @358 /  CD4 % @ 13

 66 years young.

Offline aztecan

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  • 32 years positive, 60 years a pain in the butt
Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #2 on: August 06, 2006, 11:34:16 AM »
Hey Alex,
That may be something that is New York-specific. I haven't heard of anything like that here in the Land of Enchantment.

Back in 1996, the state (New Mexico) tried to lump all the HIV folks on Medicaid with all the other Medicaid. There was a hue and cry from among the people (namely us) because this would have effectively done away with ASOs, case management and much of the HIV-specific care that is necessary and unavailable under "normal" Medicaid at the time.

The state was dead set on creating managed care here. So, a deal was worked out. Instead of lumping everyone together, a separate system was set up called a Health Management Alliance (not to be confused with an HMO)

At any rate, now we have a separate system that allows those with HIV to access care without being lumped in with mom's giving birth or all of the working poor.

It sounds much like New York is trying to do the same thing New Mexico started out to do. If it persists or if they try to make it mandatory, the only hope will be for you and your postive brothers and sisters to raise holy hell.

Good catch though. NEVER let the bastards see you sweat!

In solidarity,


(Whose socialist tendencies are becoming more evident the longer we have unpruned shrubs in the White House.)
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline alisenjafi

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Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #3 on: August 06, 2006, 11:53:19 AM »

From USAToday 7/26/06:

This article in USA Today about the “doughnut hole” in Medicare’s prescription drug coverage focuses on seniors but includes a look at how some special categories, including people living with HIV/AIDS are affected. 
The online version has additional information on how the plan works.  You can read it at http://www.usatoday.com/news/health/2006-07-26-drug-hole_x.htm,
The article is also cited in today’s Kaiser Daily Report
More patients fall into a hole in drug benefit

Updated 7/26/2006 11:09 PM ET
By Richard Wolf, USA TODAY
WASHINGTON — Seniors and disabled people who have chronic health problems are increasingly entering a gap in Medicare's prescription-drug coverage and finding that they could have to pay thousands of dollars out of pocket. That's already creating a political issue for the fall elections.
An estimated 3.4 million people will have drug expenses that push them into the coverage gap, when they must pay the full cost of prescriptions. The gap, which Congress calls the "doughnut hole," begins when drug expenses total $2,250, including the amount paid by insurance. It continues until a beneficiary has spent $3,600, an amount that will increase in future years.

David Madison, 67, of Lakewood, Colo., was diagnosed with pancreatic cancer in May and fell into the coverage gap this month. One prescription eats up 20% of his $34,000 annual income. "I really don't know where the money's going to come from," he told a Democratic Senate panel last week.

Democrats, aiming to capitalize on the coverage gap, calculate that Medicare beneficiaries with average drug costs will reach it Sept. 22. Their "Doughnut Hole Day" is six weeks before fall elections, when control of Congress is at stake.

"People with diabetes, heart conditions, hypertension and mental disorders may all be hitting the doughnut hole starting now and heading into the election season," says Lindsey Spindle of Avalere Health, a consulting firm.

The U.S. Chamber of Commerce is betting that despite the gap, the prescription-drug law is a winning political issue. It is running TV and radio ads starting today praising senators and House members, mostly Republicans, who voted for the law in 2003.

After a rough start caused by the chaotic transfer of 5.8 million low-income people from Medicaid to Medicare drug coverage, the program has rebounded. By May 15, the enrollment deadline for most people, more than 38 million people on Medicare had drug coverage through the program, employers or other government insurance.

Now Republicans who heralded the program risk bad publicity in the months before the November elections. Democrats have made proposals to eliminate the gap or alleviate its impact. "Some like to say that under the Medicare prescription plan, the pharmaceutical companies got the doughnut and seniors got the hole," says Democratic Sen. Byron Dorgan of North Dakota.

A USA TODAY/Gallup Poll in April, however, found voters by 2-to-1 were more likely to back members of Congress who voted for the prescription-drug law. "If that's what they're running on, it's going to fizzle on them," says Republican Rep. E. Clay Shaw of Florida. Most seniors, he says, "are very satisfied and saving a lot of money."

Mark McClellan, head of the Centers for Medicare and Medicaid Services, says the program is a big gain for most seniors, who had little or no drug coverage in the past. "The typical beneficiary is not going to have any doughnut hole" because typical drug costs aren't high enough, he says. Those who do will have received at least $1,500 in government assistance first.

The coverage gap is hardest on people not poor enough to qualify for extra financial help under the program but who still cannot afford $3,600 or more for their drugs.

Drug manufacturers donated 35 million prescriptions worth $5.1 billion last year, but many companies stopped offering free drugs when the Medicare benefit became available. Medicare officials are trying to get those programs going again. In those cases, however, the value of the free drugs doesn't count toward the $3,600 that beneficiaries must pay before Medicare offers 95% coverage.

The coverage gap was written into the law as a way to hold down costs to taxpayers. Because the prescription-drug program is complicated, many beneficiaries didn't know about the gap.

A study by PricewaterhouseCoopers estimated that 3.4 million people would reach the gap this year. About 2.4 million people paid higher premiums for plans that offer coverage in the gap.

Many people with expensive medical conditions such as AIDS, cancer and multiple sclerosis have reached the gap already. Others, such as those with diabetes and mental illness, are entering it now or will soon. People who take several medications also are at risk.

Ray Brown, a 51-year-old Milwaukee resident who relies on expensive drugs because of a ruptured disc in his spine, was surprised last week when a Wal-Mart pharmacist said his bill was more than $400. Brown left with only his pain medicine, leaving behind a muscle relaxant and arthritis medication. "That was the only one I could afford," he says.

The gap is particularly hard on people with costly conditions:

•Many cancer patients who take expensive drugs such as Gleevec and Tarceva, which cost about $2,500 a month, didn't understand the doughnut hole when they signed up, says Sarah Barber of the American Cancer Society. "People were overwhelmed with finding a plan that covered the drugs that they needed," she says.

•Some people with multiple sclerosis, whose drugs cost $1,300 to $2,000 a month, began reaching the gap in February. Many had received their drugs free from manufacturers and were "very shocked" when drug companies stopped or restricted those programs, says Kim Calder of the National Multiple Sclerosis Society.

•People with HIV/AIDS, who often take 20 or more drugs a day, began hitting the gap several months ago. Most are struggling with the cost, says Nancy Ordover of Gay Men's Health Crisis in New York City. Some are interrupting their drug regimens, at great risk, she says. "It's starting to have a deterrent effect."

 Well I guess after the gut threads we will all be put on yogurt!
"You shut your mouth
how can you say
I go about things the wrong way
I am human and I need to be loved
just like everybody else does"
The Smiths

Offline Lovinglife

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  • Life is too short for fussing & fighting my friend
Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #4 on: August 06, 2006, 12:21:43 PM »
I do not call it the "donut hole", I like to call it the "black hole".  From my understanding Sept 22 is the day the a good percentage of people will fall into that hole, never to return.  The nightmare surrounding this issue is scary to say the least.  I won't work in fear of falling myself.  Thanks for the article and hold on to what you have, ask questions, and keep faith.
Life is not measured by the number of breaths we take but by the moments that take our breath away.

Offline Miss Philicia

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Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #5 on: August 06, 2006, 01:10:49 PM »
As far as I know if you are on Medicare Part D that donut hole should be covered by ADAP.  That is if you qualified for ADAP before you were using Medicare Part D.  Or at least that was my understanding.

I need to figure out how to get ADAP to pay for my Medicare Part D premium.  I think if you're under a certain income amount they will do so, though I don't know what that amount is in Pennsylvania where I live.  It's on my "to do" list for this coming week.  I've already gone ahead and paid for 3 months premium out of pocket.
"I’ve slept with enough men to know that I’m not gay"

Offline RapidRod

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Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #6 on: August 06, 2006, 02:31:36 PM »
Ohio is coming out with Medicaid Choice, HMO which most doctors will not take. I will know more in a few weeks.

Offline allopathicholistic

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Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #7 on: August 08, 2006, 10:47:30 AM »
Ohio is coming out with Medicaid Choice, HMO which most doctors will not take. I will know more in a few weeks.

I'll wager the letters will mention NOTHING to inform poz folks they're exempt from being forced to switch from regular Medicaid to "Medicaid Choice" ... The New York letters stated NOTHING. In fact they were written with a tone - like to scare you

Thank you Rod - definitely let us here on the forums know what you know  8)

Offline Eldon

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Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #8 on: August 08, 2006, 11:25:14 PM »
Hello Alex, it is Eldon. Thank you for the update on Medicaid. I'll keep a close watch to see what is going on for real.

Offline randym431

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Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #9 on: August 09, 2006, 01:41:15 AM »
I'm not on medicaid or gov insurance but my niece is an expert on all this.

Another one to look out for is "humana" suppliment insurance. (not sure of the spelling on humana)

(do you mean medicare?)

Medicare is a federal health insurance program for people age 65 and older, certain people under 65 with disabilities and certain people with kidney disease. Medicaid, which is administered by the states, is a program of health coverage for certain people with low incomes or very high medical bills. Eligibility for Medicare depends on age or disability only; eligibility for Medicaid depends on age, disability or family status and on an individual’s (or family’s) income and resources.

« Last Edit: August 09, 2006, 01:49:15 AM by randym431 »

Offline allopathicholistic

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Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #10 on: August 09, 2006, 01:58:21 AM »
(do you mean medicare?)

Nuh-uh. Medicaid

What's the dirt on Humana?


Offline Miss Philicia

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Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #11 on: August 09, 2006, 01:59:04 PM »
I have Humana for my Medicare Part D coverage.  It's just a private insurer for primary payment, ADAP pays for the remainder whereas previously they paid for all of it.  You could get Medicare supplemental insurance for Part B.  I've never done so and I've not had any problem getting physicians just to accept my Medicare Part B by itself.

Sounds to me like randy may be confused with Medicare vs. Medicaid.
« Last Edit: August 09, 2006, 02:00:57 PM by philly267 »
"I’ve slept with enough men to know that I’m not gay"

Offline RapidRod

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Re: They're trying to SCREW you: "MEDICAID CHOICE"
« Reply #12 on: August 09, 2006, 02:40:45 PM »
Randy, my brother in law just turned 50 and he's on medicare not medicaid.


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