In the United States there are many ways to get help paying for medical care, pharmaceuticals, income and services you may need if you are HIV positive, or have a family member that is. There are also programs in some states that can help you pay for the continuation of private insurance policies you may have through your work should you become too sick to continue working. The following is a simplified flow chart to help you understand some of you options. Below the chart is a written explanation of each program.

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.

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.

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.”

Title I, which is now Part A, covers large metropolitan areas with high numbers of HIV cases. The federal government may contract with the county, city, or non-government agency to administer the funds locally. The decisions as to how much funding, and to which service categories the funds will be spent is usually decided locally by a Care Council planning body made up of administrators, providers of services, and consumers.