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Author Topic: A Question to Case Managers  (Read 4563 times)

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Offline thunter34

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A Question to Case Managers
« on: February 28, 2007, 09:38:43 AM »
With all due respect, I ask the following:

What exactly do you folks do?  I mean, other than sign things?  I'm asking because I need to know what my expectations of case management should be. My experience thus far has been that I need a Case Manager's Signature for most endeavors beyond just seeing a doctor or picking up pills.  But other than that prized signature, I don't know what it is that you are supposed to be providing.  Back when I started in "the system", I had once inquired about vocational rehab once I got my health back enough to start working again.  My CM spent about 20 or 30 minutes clicking around Monster.com and printed off a few job leads...and that was that.  I was going to need to find a new apartment back then, so I asked about housing assistance.  My CM said there was a department a few floors above that handled all that (and this department would require her signature, of course), but she didn't really know what all was involved with all that (other than their need for her signature).  With my finances spinning out of control at the time (as if they still aren't- HA!), I asked about stuff like food stamps and that sort of stuff.  She sent me to another lady's office who gave me forms to take with me, but otherwise said it was something that I could do on my own that didn't need her (What?  No signature required?!) 

I should mention that I have been stiffed on a couple of appointments with my latest CM.  I'm in the process of getting myself ''back in the system for Case Management".  This is because my old CM left and I didn't know it.  She left, and the new one came in.  I didn't have another appointment scheduled around that time, and after awhile my file got closed...so I am now having to reverify that I have AIDS and that I'm not currently shooting smack and stuff.

I'm just wondering so I can hopefully make a better go of it this time.  I need to know when my expectations are legit and when I am being brushed off.

Many thanks.

« Last Edit: February 28, 2007, 09:41:03 AM by thunter34 »
AIDS isn't for sissies.

Offline Miss Philicia

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Re: A Question to Case Managers
« Reply #1 on: February 28, 2007, 09:54:03 AM »
Welcome to Case Management.
"Iíve slept with enough men to know that Iím not gay"

Offline mjmel

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Re: A Question to Case Managers
« Reply #2 on: February 28, 2007, 10:00:57 AM »
Interesting. That's the third time in the last three days that I've noted people in Georgia having problems with case workers.  I get the best AND quick efforts from my case worker in Ohio and there's only a hiccup now and again within THE SYSTEM.
What a mess for you, Tim.

edited to remove sarcasm \ bad habit.
« Last Edit: February 28, 2007, 11:34:45 AM by mjmel »

Offline thunter34

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Re: A Question to Case Managers
« Reply #3 on: February 28, 2007, 10:12:31 AM »
Philly, are you saying that this is par for the course with Case Management?  Nothing unusual? 

I have to say that I am relatively satisfied with my ASO in the doctor and pill arenas.  The CM side has always just blown.  I should add that I know they do one other thing besides sign things.  They make copies.  Lots and lots of copies.  Of what, though?  Probably their signatures.

To be honest, I don't believe this experience of mine is universally applicable to all CM's.  There are one or two on this board that I am crossing my fingers and hoping to hear from. 
AIDS isn't for sissies.

Offline jkinatl2

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Re: A Question to Case Managers
« Reply #4 on: February 28, 2007, 10:18:53 AM »
My experiences with AID Atlants have been less than stellar. By the time a CW managed to locate a resource, I had already googled it on the web.

"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

Welcome Thread

Offline Miss Philicia

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Re: A Question to Case Managers
« Reply #5 on: February 28, 2007, 10:24:33 AM »
Philly, are you saying that this is par for the course with Case Management?  Nothing unusual? 

More of less, yeah.  I suppose it depends on who you encounter, but I've never found it smooth sailing outside of the Drs/Pills are like you have noted.

I think if you're actually homeless though they kick in.
"Iíve slept with enough men to know that Iím not gay"

Offline thunter34

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Re: A Question to Case Managers
« Reply #6 on: February 28, 2007, 10:29:32 AM »
My experiences with AID Atlants have been less than stellar. By the time a CW managed to locate a resource, I had already googled it on the web.

That's what I'm saying.  Just like the vocational rehab thing I mentioned.  As much as I appreciated sitting there watching her browse Monster, I could have tackled that one on my own at home without making the trip to see her.  I've been suprised at how little they seem to know about resources and who the contact people are- even within their own building.  I would think she would have been able to rattle off the housing assistance person's name off the top of her head rather than have to look it up.  I could just walk the halls and knock on doors to find that out myself as fast or faster.  Trouble is, those people would then tell me that I needed a CM signature to work the mojo for whatever the process involved was.  And that signature would require that I go through the whole CM enrollment process.  It seems like I don't really need a CM for any reason other than that The System says I need one.

So what is it that they are theoretically supposed to be able to do for me?  I'm still lost on that part.
AIDS isn't for sissies.

Offline aztecan

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Re: A Question to Case Managers
« Reply #7 on: February 28, 2007, 10:32:30 AM »
Hey Tim,

Unfortunately, case management - and the agencies in which they operate - differ from state to state and even within regions within a state.

I can tell you as a case manager, we do things a bit differently. First, you should never have had your file closed becuase of lack of contact.

I don't know how they do things in your neck of the woods, but here, I am required to contact each client each month. That means actual conversation, not a voice mail message saying, "Hey Mark, I'm doing fine."

Once a quarter, I am required to have face-to-face contact with a client. Sounds simple enough, but for some of my clients, it is like puling teeth. They are busy people too, so I understand and will accommodate them with after hours meetings or, sometimes, weekends.

As far as what I do, well, in a nutshell, I try to connect people with what they need.

I enroll them in my agency, in ADAP, in the New Mexico Medical Insurance Pool, food bank, the Pets Are Wonderful Support Program (PAWS).

I also discuss such things as Advanced Directives with each client, so they can have a designee should things get dicey, and also have the documentation needed for someone to choose cremation after death, even if their damn families don't like it.

I am requried to talk to clients about their health, how they are feeling, any needs they may have, etc. This includes emotional support/support groups. I have the authority to give a client two sessions with a therapist should they desire it. After that, the therapist will let the agency know what he believes the clieint's needs are and how many sessions he may require and how often.

I am required to talk to clients about medication adherence. This is a biggie at the moment and there is a real push to try to help clients, especially those newly on meds. If a client is having problems, such as side effects, I contact the doctor and we have a set down to discuss the issue.

I also am required to have Patient Care Conferences with all of the doctors who treat my clients. This means I have to have a meeting with each doctor, discuss in depth what the client's needs, problems, etc., are and what, if anything, the case manager can do to assist the client in overcoming any problems.

I also help clients obtain travel reimbursement, mileage and per diem when they have to travel to obtain medical care.

The doctors also have now call me, and I presume other case managers, when something comes up and they need assistance. This happened recently when a client needed to be placed into a nursing home. I arranged for the nursing home, the hospital arranged for an ambulance to take the person to Albuquerque and I and a volunteer packed up the client's apartment and put everything into storage..

I also make home visits, especially for my clients who live out in the boonies. I cover an area of roughly 10,000 square miles, so there is a lot of open country.

I recently had to have a client admitted to a behavioral health unit. Not one of my most pleasant duties, but necessary. The client went willingly after I talked to him for a while. Had he not, I would have been required to contact the police and have them pick up the individual for his own safety. There are legal repercussions should I have failed to do this.

I also do HIV 101 for new clients and for client's families. That is why I never go to the WW forum. I get enough of that face to face.

Oh, I almost forgot, I also can enroll people in HOPWA (Housing Assistance for People With AIDS). Unfortunately, there are only two slots available in my area - meaning everyone else is out of luck. I can't do anything about it, but remember this when you are talking to your congressman about AIDS or HIV funding.

I should say there are different types of HOPWA. There is TBRA (Tenant-Based Rental Assistance), for which I have only two slots. this is the ongoing rental assistance.
There is STRMU, which is an acronym for something I can never recall) which is for emergency assistance for those about to be evicted, about to have the electricity shut off, etc.
Then there is Home TRBR, which is available only to those living in rural areas and is of limited term (6 months). It is aimed as helping people become established.

My clients range in age from five months to 63 years, are male and female, gay and straight, married, single, divorced and widowed, who have supportive families and families who have disowned them. Some are parents, some have parents who hit on me.  :o (I told her she didn't melt my butter, but she still persists.)

So, I hope this helps answer your question.



(Whose spell check still isn't working.)
« Last Edit: February 28, 2007, 10:47:14 AM by aztecan »
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline Miss Philicia

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Re: A Question to Case Managers
« Reply #8 on: February 28, 2007, 10:39:23 AM »
Tim, case management varies on a state by state basis so it's really hard to answer your questions about Georgia.  In New York for example, when you enroll in ADAP I don't recall you really needed a case manager.  You just obtain the forms and apply directly, though my guess is that most people still get them through a 3rd party oganization like GMHC (Gay Men's Health Crisis).  GMHC is NYC's largest ASO, but they don't have you assigned to an actual case manager for something as routine as ADAP.  For things like that they have "drop by" hours certain days of the week, and while you meet with volunteers they kind of field you first to see how much "management" you really need.  You had to be in need of a bit of such management to get actually taken up to a higher floor for "real" case management.

Here in Pennsylvania though it's all different.  To access any services you MUST have a case manager assigned it seems.  It's set up pretty different, and to get a case manager you have to first get approved to see one by the state health department by calling through their offices in the state capital.  It's pretty painless though but it does seem to add an additional step into the equation after seeing how NY does it.

But this is the American Way.  We hate federal-anything so we leave it to the states to handle, and thus we have 50 ways of doing it some better than others, and they seem to take little from each other in what processes work better than others.  Obviously somewhere like NY and California have many more years dealing with these services on a wide scale than most other states and you think how they did it would be looked at by others.  Maybe it is looked at -- I don't know.
"Iíve slept with enough men to know that Iím not gay"

Offline David_CA

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Re: A Question to Case Managers
« Reply #9 on: February 28, 2007, 10:52:48 AM »
I don't have to deal with case managers or ASO's (fortunately), but I think YOU are the exception in that you genuinely care.  Maybe CM's should be HIV+.  I think that would improve things a bit. 

When I was dealing with the folks from the State Dept. of Health after our names were turned in as syphilis and HIV contacts, the couldn't have cared less about our health.  Mostly, they were concerned with why I wouldn't allow them to test me for HIV (I didn't want to hear it from somebody I didn't know, had never seen) and with telling me how they could legally force me to be treated for syphilis.  I never found out if this was true or not, but it sure left a lasting bad impression of the Department of Health, which is unrelated to the County's Health Dept.  Hubby's had fairly good dealings with them and their assistance.

Black Friday 03-03-2006
03-23-06 CD4 359 @27.4% VL 75,938
06-01-06 CD4 462 @24.3% VL > 100,000
08-15-06 CD4 388 @22.8% VL >  "
10-21-06 CD4 285 @21.9% VL >  "
  Atripla started 12-01-2006
01-08-07 CD4 429 @26.8% VL 1872!
05-08-07 CD4 478 @28.1% VL 740
08-03-07 CD4 509 @31.8% VL 370
11-06-07 CD4 570 @30.0% VL 140
02-21-08 CD4 648 @32.4% VL 600
05-19-08 CD4 695 @33.1% VL < 48 undetectable!
08-21-08 CD4 725 @34.5%
11-11-08 CD4 672 @39.5%
02-11-09 CD4 773 @36.8%
05-11-09 CD4 615 @36.2%
08-19-09 CD4 770 @38.5%
11-19-09 CD4 944 @33.7%
02-17-10 CD4 678 @39.9%  
06-03-10 CD4 768 @34.9%
09-21-10 CD4 685 @40.3%
01-10-11 CD4 908 @36.3%
05-23-11 CD4 846 @36.8% VL 80
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Offline Lwood

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Re: A Question to Case Managers
« Reply #10 on: February 28, 2007, 10:55:13 AM »
From day 1 my sessions with my case manager have consisted of me signing form after form then answering questions form a checklist,  " are you being abused by your partner "  " do you have suicidal Thoughts"  " Have You been admitted to the Hospital "   " Would you Like Counseling "  and so forth...

One Glaring item that has been missing is  " HIV 101"  if it werent for the reccomendation from the caseworker that I visit AIDSmeds.com when I set up an Intake apontment  on the day of my diagnosis, I wouldnt have been told anything other than " Take these and You'll be Fine "   Im due for another update soon, and Ill definitely ask about how they educate newly diagnosed people, nothing like rattling the cage a little . Maybe Theyll give me a job. wouldnt that be special.
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Offline aztecan

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Re: A Question to Case Managers
« Reply #11 on: February 28, 2007, 11:07:14 AM »
Hey Philly,
Yes, things really do differ. Part of the difference is a system like New York's wouldn't work in New Mexico, which is both a larger state and a smaller population.

Here, you technically don't need to be enrolled in an ASO to apply for ADAP, but they will tell you to contact an ASO anyway.

Also, the state changed how ADAP is managed. Now, people may get emergency supplies of meds from ADAP, but they must enroll in the medical insurance pool. This gives the person full coverage under Blue Cross/Blue Shield.

However, there are premiums involved. We have a program at my ASO that pays the premiums for all those enrolled in MIP, so it isn't an issue. (I also enroll people in that.) But, if you are doing it on your own, you have to pay the premiums, which range from $250 to $500 a month, depending on age.

We operate under a system called a Health Management Alliance. Think HMO, but run by non-profits.

My agency is an HMA agency, meaning we handle all the paperwork for the state and provide the various services.

We were the first state in the union to adopt this. It was developed because we are basically a rural state and all of the services were concentrated in Albuquerque or Santa Fe. People in outlying areas did without.

Thanks to the HMA system, that is not the case any longer, althought I still have to argue with people about discrepancies in services.  >:(

While I work in conjunction with the Public Health Department, helping them when a positive test comes back, (did I mention I also do testing, as well as pre- and post-testing counseling?) by reporting it to them (no, not by name, initially, just by number.), we don't actually work together.

Nobody goes through the state to get services, it is the other way around. Like I said, each state is different.


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

Offline thunter34

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Re: A Question to Case Managers
« Reply #12 on: February 28, 2007, 11:11:14 AM »
A few things....

Mark, will you be my Case Manager?  I'm afraid I know what your answer to that will have to be, but there was a bit of joy in the asking anyway.  House calls?!  HA HA HA HA HA !!    As IF !  Like I said, the CM's at my ASO don't even venture beyond their own floor in the building.  And (obviously) they don't have any contact requirement like what you describe.  Actually, there must be some kind of contact requirement CM's and clients because that is what my CM told me about having to re-enroll.  She had tried to call me and didn't get through...so I got tossed from the program.  Apparently, if we don't keep in contact enough with them, they automatically boot us from the system.  In my case, my old CM left her job somewhere midway through this time frame and the new one tried to contact me sometime during the latter part of it.  So there you have it.

It sound like my service scope is more similar to philly's than aztecan's.  Here, it seems that you have to have a Case Manager assigned to access any services- but they don't necessarily help guide you through these services.  And they certainly don't alert you to any services offered.  They don't initiate that kind of communication- they answer if asked...and only if the question is phrased properly.  You have to know what to ask for and how to ask for it.  By the time you get yourself honed to that level, having to include them in the process seems somewhat extraneous.

By the way...I had an appontment scheduled for 10 am  today to continue this enrollment dealie.  I have been sick for days and did not think I should go yet.  I have to go down tomorrow or friday for meds anyway.  I called and left a message asking if I could get rescheduled for either day this week.  This was at 8 am.  They open at 8:30.  I haven't heard anything back from her as of yet.  I would think that she would have had a chance to hear her messages by now.  My suspicion is that she probably would not have been there if I would have taken the trip today.  That would have really burned my burger if so.  We shall see.

EDITIED TO SAY:  I goofed.  I meant they opended at 8:30, not 10.  Made that adjustment to the post. 

« Last Edit: February 28, 2007, 11:30:53 AM by thunter34 »
AIDS isn't for sissies.

Offline aztecan

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Re: A Question to Case Managers
« Reply #13 on: February 28, 2007, 11:13:40 AM »
OOPS, forgot a few things.

I also put together Prevention for Positives programs to help clients and anyone who is positive, client or not, deal with things like disclosure, the social impacts of living with HIV, dating, etc.

Luckily, I have help with this. Lordy, I haven't dated in so long, I'm sure my information is out of date. Do they still wear those poodle skirts at the hop?  ;)

Oh, and I also do harm reduction. That's a fancy term for syringe exchange. New Mexico law mandates that sites be set up for intravenous drug users to be able to exchange their used syringes for clean, new ones.

I operate the only such site in Northwest New Mexico. I truly believe it helps., but it does bite into my Saturdays.

Anyway, in a nutshell, that's what I do.


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

Offline Miss Philicia

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Re: A Question to Case Managers
« Reply #14 on: February 28, 2007, 11:32:41 AM »
Yeah, see if I had a CM like Mark I would feel like everything is on the up and up.  But with pretty much everyone I've encountered now over many years and in two states I'm always left feeling I wasn't getting all the available information, and indeed when I fished around myself invariably I was not.  I'm not really sure how to correct this situation but it just makes me leery of the whole thing.  And because it's state by state it makes it harder to know what's what.

And like Tim, I got booted from my last CM too because when I moved 7 blocks to my new apartment and she couldn't contact me (I told her to use my cell phone and not my old apartment's land line because I had moved) she closed my case.  So fucking tired because it was right when I *NEEDED* her to help me with Medicare Part D.  So I was fucking screwed, or potentially screwed, because of her ineptness... and it was not the first thing she fucked up with me either, though it *WAS* the last.
"Iíve slept with enough men to know that Iím not gay"

Offline poet

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Re: A Question to Case Managers
« Reply #15 on: February 28, 2007, 11:34:19 AM »
Tim, I just sent this thread to one of the case managers for the Aids Support Group of Cape Cod to see if she is in and, if so, if kshe felt like sending me an email listing what she does for comparison.  I have seen her (and others) deal with housing issues, rent checks and such).  The cm.'s here are often out of the office driving clients to doctors or other appointments or picking them up for events at the office which could simply be social things.  My cm. was nice enough to spot me last Summer as I was trying to carry bags of soil for my garden.  Since he had the van, he got me and the bags to where I live.  We also have a food pantry at both locations, so her work would link clients with food needs to food.  

When I lived in NYC and had GMHC, I would get a yearly, semi-annual phone call from a volunteer checking to see if I was still around and if I had any needs.  While in NYC, I actually didn't need them for anything, largely because, as Philly has posted, ADAP in NY is so smooth and easy to deal with.  Had I needed counseling, legal help, they would have been there.  Best, Win
Winthrop Smith has published three collections of poetry: Ghetto: From The First Five; The Weigh-In: Collected Poems; Skin Check: New York Poems.  The last was published in December 2006.  He has a work-in-progress underway titled Starting Positions.

Offline thunter34

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Re: A Question to Case Managers
« Reply #16 on: February 28, 2007, 11:37:20 AM »
Mark, you are clearly a different animal altogether from what roams these plains.  Reading your replies has shown me perhaps not what I can expect from my CM, but what I can wish for.  

Thanks.  And BTW...you're one of the ones I was ''crossing my fingers hoping to hear from'' up above.  Appreciate the time you have taken to share with me here.  I've gotten more meaningful dialogue from you in this thread than I have from all of my CM experience in Atlanta to date.  What's that tell ya?

PS-  Can't wait to see what gets written if Moffie happens to stumble upon this thread.

AIDS isn't for sissies.

Offline racingmind

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Re: A Question to Case Managers
« Reply #17 on: February 28, 2007, 11:58:40 AM »
My case worker is a grad student who is pretty much clueless.  I never hear from her. I had to meet with her after the first three months to state that I still desired case management.  I said I did, although I don't know why. She really hasn't done anything for me except to give me an ADAP application which I asked her to help me fill out, but has yet to do so.  I haven't pushed on that since I haven't been prescribed meds yet.

Also, she doesn't seem to know much about HIV at all.  I say things and her face lights up like; "oh, I didn't know that."  This is why I think there should be more HIV+ case workers in these offices. 

Well, in conclusion, case management is pretty lousy where I'm from.  But I still want my name in the system in case I ever need to dive head first into the red tape of actually obtaining some needed services.  Luckily, all I have needed so far is some therapy (which they stopped offering me because I could not afford it and there was no more money in whatever state fund to pay my therapist for her services).  Based on this, I shutter to think what it would be like if I ever need more services.... :-\
Tested Negative: 5/06
Tested Positive: 9/06 
9/06: CD4: 442 (28%) VL: +100,000
10/06: CD4: 323 (25%) VL: 243,440
11/06: CD4: 405 (28%) VL: 124,324
12/06: CD4: 450 (29%) VL: 114,600
1/07: CD4: 440 (27%) VL: 75,286
3/07: CD4: 459 (30%) VL: 44,860
5/07: CD4: 353 (24%) VL: 50,852
7/07: CD4: 437 (29%) VL: 39,475
9/07: CD4: 237 (32%) VL: 372,774
10/07: CD4: 324 (27%) VL: 115,454 
Started Atripla: 10/07
11/07: CD4: 524 (?%) VL: Undetectable!
2/08: CD4: 653 (35%) VL: undetectable
5/08: CD4: 822 (40%) VL: undetectable
8/08: CD4: 626 (35%) VL: undetectable
12/08: CD4: 619 (36%) VL: undetectable
3/09: CD4: 802 (38%) VL: undetectable
7/09: CD4: 1027 (43%) VL: not tested
10/09: CD4: 1045 (43%) VL: undetectable

Offline Moffie65

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Re: A Question to Case Managers
« Reply #18 on: February 28, 2007, 12:35:28 PM »
I agree, Mark is the poster child for a "real" Case Manager, and we should all be so very lucky to have one like him, but more often than not, that is not the case.


Here is an excerpt from the Ryan White Title II manual that I just copied from the HHS site.

Chapter 1
Overview of Title II  TOP


The Title II program was created to make grants to States and territories "to enable them to improve the quality, availability, and organization of health care and support services for individuals and families with HIV disease." Eligible Title II grantees include the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam and the following U.S. territories: American Samoa, the Commonwealth of the Northern Mariana Islands, the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau. Since its inception, the Title II program has funded a range of primary medical care and support services, described below. Five program categories exist for States to deliver services, giving them flexibility to meet their diverse needs (see below, Title II Program Categories).


Title II has five program areas under which States can
deliver HIV/AIDS care. This feature of Title II reflects how
health care environments differ substantially from State to
State, giving States flexibility to respond to unique needs
across their jurisdictions. The five programs are:

(1) Services Provided Directly by States or State Contracts,
(2) HIV Care Consortia,
(3) Home- and Community-based Services
(4) Health Insurance Coverage, and
(5) Medications to Treat HIV Disease (AIDS Drug Assistance Program, ADAP).

Eligible Services  TOP

Title II funds can be used to deliver the following services:

Ambulatory (non-hospital) health care, including HIV specialty care; substance abuse and mental health treatment; oral health; home health; hospice; and
Comprehensive treatment services including treatment education, antiretroviral therapies, and prophylaxis/treatment for opportunistic infections.
Case management that prevents unnecessary hospitalization or delays in releases.
Support services that "facilitate, enhance, support, or sustain the delivery, continuity, or benefits of health services for individuals and families with HIV disease."
Outreach and early intervention services (EIS) to identify people with HIV disease who know their HIV status but are not receiving HIV-related services in order to bring them into care. EIS can be funded as long as the grantee can demonstrate that other sources of funds are insufficient to meet current needs.
Title II Program Categories  TOP

There are five mechanisms States and Territories can use to deliver Title II-funded services. They range from funds just for HIV-related drug costs to two programs-consortia and State Direct Services-that are much like Title I in such respects as planning and in providing a range of health and support services. This feature of Title II reflects how health care environments differ substantially from State to State and the flexibility they need to respond to unique needs.

1. AIDS Drug Assistance Program (ADAP). Primarily for medications that treat HIV disease but limited funds can be used to buy health insurance. States can also spend up to 5 percent of their ADAP award (and as much as 10 percent if they prove it is critical) on adherence support to help patients correctly follow complex drug regimens and on medical monitoring. States have considerable latitude in designing their ADAP programs in terms of drugs to cover and eligibility criteria. ADAP is the second largest CARE Act program, after Title I.

2. Consortia. Groups comprised of providers, consumers, and others who perform a planning and advisory function to regions, or the entire State, in determining needs and delivering essential health and support services (see below). Consortia identify service needs, plan how they can be met, and in some cases actually deliver services and in others do so through funding agreements.

3. State Direct Services. Health care and support services provided directly by the State or under contract. In some cases, States have opted to use this mechanism instead of directing funds through consortia but must document that this a more efficient way to deliver care.

4. Health Insurance Continuity Programs. State programs that provide coverage for eligible low-income people with HIV disease, either by helping them maintain existing health insurance coverage or purchasing new coverage. Funds may not be used for creating or administering a risk pool or to pay for State Medicaid assistance.

5. Home- and Community-based Services. Skilled health services provided according to a written care plan developed by a case management team of health professionals. Services do not include inpatient hospitalization, nursing home care, or placement in other long-term care facilities.

States may award funds to public, nonprofit entities and additionally to private, for-profit entities if they are the only available providers of quality HIV care in the area. Eligible organizations include, for example, community-based organizations, ambulatory care facilities, community health centers, substance abuse treatment programs, mental health programs, and faith-based programs.


Services that may be provided by consortia, and directly by States, include the following:

Essential Health Services: Medical and nursing care; substance abuse treatment; dental care; diagnostics; monitoring; prophylactic treatment for opportunistic infections; treatment education to take place in the context of health care delivery; medical follow-up services; mental health, developmental, and rehabilitation services; and home-based health and hospice care.
Essential Support Services: As with Title I, the Amendments of 2000 require that Title II fund support services that enhance access to care. The services > that may be funded include case management, transportation, attendant care, homemaker services, day or respite care, benefits advocacy (e.g., working for access to Social Security benefits or Medicaid), nutrition services, housing referral services, and child welfare and family services (including foster care and adoption services).

I don't care what state you live in, this is the Bible and Case Managers are supposed to not only know this information, but be able to connect you with anything covered in the above.  If they won't, can't or don't have the knowledge to do so, then they are not doing their job.  Period!

Here is the link to the information and to the whole manual.  For just this chapter..  http://hab.hrsa.gov/tools/title2/t2SecVChap1.htm#SecVChap1a
For the whole manual, which should be on your favorites list of everyone on this site....  http://hab.hrsa.gov/tools/title2/

I do hope this helps.
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 thunter34

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  • His name is Carl.
Re: A Question to Case Managers
« Reply #19 on: February 28, 2007, 12:48:20 PM »
Thanks, Moffie!  I am going to give that a thorough read right now, but just glancing over it is causing the same response I had when I read Mark's replies:  I'm getting the giggles.  Perhaps at the immediate recognition of the ridiculous gap between what ought to be happening and what really is.  Perhaps just the garden variety ''laugh to keep from crying'' giggles.  I'm pretty sure it's some sort of coping mechanism thing that's going on, though.

EDITIED TO SAY:  Thanks especially for the links.  And, yes...they shall now and forever be favorited by me.
« Last Edit: February 28, 2007, 12:54:12 PM by thunter34 »
AIDS isn't for sissies.

Offline skeebo1969

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Re: A Question to Case Managers
« Reply #20 on: February 28, 2007, 01:30:44 PM »

  Thanks for the links Moffie.   Tim H, I am in the same boat you are in as far as case management is concerned.  I am up for re-certification soon and cannot even get my CM to return my calls.  I have called him almost daily for the last month leaving messages all the while and he just refuses to call me back.  This comes after we had a brief sit down and I basically told him in a very nice way how much it would mean to me if he would at least return my calls, which he promised he would do finally.  My clinic sees clients of all desires and needs.  It is your average health clinic and from what I was told by the assistant director they use Ryan White funds to pay a portion of the RN's and LPNs salary there all the while complaining they have no funds for programs. Mean while the RN and LPN also work with the non positive patients who come into the clinic.  It is definitely a mess in my opinion, but then again I am from Miami where the care almost seemed infinite.  The small hick town I live in now is much different.  I guess this is what I get for not doing my  homework first before moving here.

  Hell I cannot even get a definitive answer as to what is going on with my health.  Here for the past month my liver has been acting crazy.  Taking 2-3 naps daily and still tired after a good 8 hours of sleep at night.   I went in for what I thought was to be a screening for Hepatitis A, B, and C.  When I called three weeks later to get the results, I of course was not called back until I left roughly 5 messages asking them to call back.   When the RN (who also oversees CM) finally did call she let me know I had the antibodies for hep A.  I am guessing this is from my immunizations in Miami.. I think..  She could not tell me what I was really concerned about and that was whether I had hep C.   Of course I was originally tested a month ago to rule out hep C and well...  Ho hum.... I still don't have a definitive answer.

  Almost makes me want to burn something down ;D ;D.  I'm joking really...

  Edited to change their to there...LMAO
« Last Edit: February 28, 2007, 02:04:55 PM by skeebo1969 »
I despise the song Love is in the Air, you should too.

Offline thunter34

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Re: A Question to Case Managers
« Reply #21 on: February 28, 2007, 01:49:42 PM »
Yeah.  I've gotten the distinct impression a time or two that I have been stiffed on appointments or not called back as a punishment or retaliation for having to reschedule appointments.  After I got stiffed the last time around, I called and called about it.  When I eventually got my CM and asked her what had happened, she made some off-hand comment about how she missed an appointment but I missed one, too....something like that.  I felt the temptation to ask her if she did remember or was in fact aware that   I HAD AIDS   and little things like tend to crop up that require a call to reschedule.  But I held my tongue out of concern that I might get on her bad side and she might not sign something for me someday...or perhaps I might get accidentally unenrolled again.
AIDS isn't for sissies.

Offline Miss Philicia

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Re: A Question to Case Managers
« Reply #22 on: February 28, 2007, 02:00:27 PM »
I'll admit that I've had such bad run in's at ASO's that I've been forced to go over some heads and have confrontations with supervisors.  And guess what?  It works quite well.
"Iíve slept with enough men to know that Iím not gay"

Offline Bucko

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Re: A Question to Case Managers
« Reply #23 on: February 28, 2007, 02:09:55 PM »

Case management in Florida's just a complete joke. I've gone through 'em like Kleenex, with one seeming less competent than the last. Perhaps they aren't properly qualified, perhaps they are overworked. Or perhaps they just feel alienated by the culture gap between themselves and gay men.

I had one who refused to call me "Brent". Despite my continued requests to do so, she would never refer to me as other than Mr S******. This was not trivial. How can I trust that someone cares about my well-being if she can't honor such a simple request.

I've had them all and am frankly dismayed by the ineptitude and utter lack of compassion here. I understand that it is common practice in Florida to make services so heinous that one will seek private alternatives. Whereas at first i found such a possibility absurd, it now seems to be the only explanation possible.

(Who misses his CW in Connecticut)
Blessed with brains, talent and gorgeous tits.

The revolutionary smart set reads The Spin Cycle at least once every day.

Blathering on AIDSmeds since 2005, provocative from birth

Offline Queen Tokelove

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Re: A Question to Case Managers
« Reply #24 on: February 28, 2007, 02:21:34 PM »
I can definitely relate to what you are saying about case managers. I've had 3 in total since I have been with the ASO. The one I have now is totally clueless and not much help to me at all. I had her trying to find out how I could get my eyes taken care of, you know exam and more contacts or glasses so that I can see. I guess you know I haven't heard from her in months. I just throw my hands up and usually just gets info from the receptionist or the clinic nurse.

And when I do see her, it's about signing papers. Like I said before in a different thread, she might be helpful to someone newly diagnosed but she is no help to me. That is why I haven't went over her head to complain.
Started Atripla/Ziagen on 9/13/07.
10/31/07 CD4-265 VL- undetectable
2/6/08 CD4- 401 VL- undetectable
5/7/08 CD4- 705 VL- undetectable
6/4/08 CD4- 775 VL- undetectable
8/6/08 CD4- 805 VL- undetectable
11/13/08 CD4- 774 VL--undetectable
2/4/09  CD4- 484  VL- 18,000 (2 months off meds)
3/3/09---Starting Back on Meds---
4/27/09 CD4- 664 VL-- undetectable
6/17/09 CD4- 438 VL- 439
8/09 CD4- 404 VL- 1,600
01-22-10-- CD4- 525 VL- 59,000
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Offline budndallastx

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Re: A Question to Case Managers
« Reply #25 on: February 28, 2007, 02:41:36 PM »
Reading through this thread, I am amazed at what sounds like 'case mis-management' in Georgia. 

Philly is correct in encouraging you to begin escalating up the case manager's food chain.  Talk to her supervisor!  Shoot, they aren't following the guidelines set out by the Congress so why not shoot an email to your congressman?  It's interesting to watch the action one gets when people higher up start looking over their shoulder.

I have read a lot of your posts and you're a very eloquent man.  Use that skill on a nice letter to the congressman or senator.  It never hurts and it appears can't get worse from what you're experiencing.

Meds since: 11/20/2006
Sustiva / Truvada
12/08/2008 VL:<48 CD4 622 (38%)   
9/8/2008 VL:<48 CD4 573 (30%)
5/2008 VL:<48 CD4 464 (30%)
1/2008  VL: <50  CD4 425(28%)
9/2007   VL: <50  CD4 465 (27%)
6/2007   VL: <50   CD4 443 (26%)
3/2007  VL: <50   CD4 385 (25%)
12/2006 - VL: <50   CD4: 384 (25%)
11/2006 - VL:  22K  CD4: 208 (18%)


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