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
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