Case Examples Julie Cross Health & Disability Policy Consultant - PowerPoint PPT Presentation

Case Examples Julie Cross Health & Disability Policy Consultant

 Age 41 Automatically eligible for  Medicaid  Single, no children Eligibility based on income   Unemployed Uninsured alone. Income under 133%  Income $220 mo county relief FPL  HIV Symptomatic May need Ryan White   Fatigue, weakness, chronic support for things that aren’t diarrhea, depression, anxiety covered under a Medicaid  Denied disability claim, SSI and package Medicaid  Health care through Ryan White funded public health clinic ADAP Current Profile 2014 Health Care Reform Uninsured Medicaid Eligible

 Age 49  Eligible to purchase insurance through the insurance exchange  Single, one adult child  Eligible for insurance subsidy  Self-Employed, $20k (133%-400% FPL)  Uninsured  Able to access medications  HIV Symptomatic through insurance  Wasting syndrome, chronic  Exchange rules will allow her to sinusitis, fatigue, cardiac shop for a policy that meets her complications medication/health care needs  May need RW support to pay  Community health clinic and premiums and out-of-pocket ADAP. Unable to obtain two costs and get dental and vision medications not on ADAP care formulary. Current Profile 2014 Health Care Reform Uninsured Insurance Eligible

 Medicare eligibility will continue  Age 56  2010: will receive $250 donut  Domestic Partner, No Children hole rebate  AIDS, Disabled  2011: ADAP will count towards TrOOP  SSDI $22K  Everardo will not be stuck in the  Medicare Eligible donut hole for the year  Enrolled in Part D drug plan.  While he is in the donut hole he ADAP pays wrap-around costs will receive a 50% discount on the brand name drugs he needs  Pays $300 month for non-ADAP that aren’t covered by ADAP formulary medications when  His coverage will advance to the stuck in donut hole 9mos year. Part D catastrophic level  Instead of paying 100% cost of drugs he will only be required to pay 5% or low co-pay. Current Profile 2010 Health Care Reform Medicare ADAP as TrOOP

 Age 51 Ineligible for Medicaid  Ineligible for coverage   Married, one child through the insurance  Family is undocumented exchange/subsidy  Uninsured, working part-time Exempt from insurance  $15k mandates  AIDS, Disabled Ongoing need for support   Community/RW Funded through public/community health clinic, ADAP health system and ADAP Current Profile 2014 Health Care Reform Uninsured Uninsured