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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

HIV/AIDS:
Social Security Insurance
 

We offer a monthly newsletter dealing with the various issues surrounding infectious diseases.  To find out more click HERE.

   

Main topics can be found within the left column; sub-topics and/or research reports can be found near the bottom of this page.  Thank you

Complete text of the Social Security Administrative Policy for Infectious Diseases; and the methods for applying for assistance that can help.

Document Name

Description

File Size

2007-Coverage through the “Doughnut Hole” Unlike most forms of insurance, the Medicare Part D prescription drug program has a hole in its middle. This coverage gap, colloquially known as the “doughnut hole,” is perhaps the most bizarre and troublesome aspect of the Part D drug program. After beneficiaries reach their initial limit of total drug expenses ($2,250 in 2006), they have no prescription drug coverage until their total drug expenses reach a catastrophic threshold for the year ($5,100 in 2006). While beneficiaries are in the doughnut hole, they must continue to pay their monthly premiums, although they do not receive any drug benefits. Only after they have spent thousands of dollars of their own money to get out of the hole ($2,850 in 2006), in addition to their monthly premiums, does their coverage resume. Pdf 534 kb
A History of the Disability Listings In order to facilitate the process, the Social Security Administration created a list of diseases and conditions which were felt to be incompatible with substantial gainful activity (gainful employment). Persons who were not engaged in substantial gainful activity, and whose conditions met the requirements of one or more of the listed conditions, were considered disabled. Called the listings, the criteria proved so useful that they were retained and revised periodically, and have been kept in continuous use ever since. Pdf 248 kb
Compassionate Allowances Under titles II and XVI of the Social Security Act (the Act), we pay benefits to individuals who meet our rules for entitlement and have medically determinable physical or mental impairments that are severe enough to meet the definition of disability in the Act. The rules for determining disability can be very complicated, but some individuals have such serious medical conditions that their conditions obviously meet our disability standards. Pdf 53 kb
A CONSUMER’S GUIDE TO HEALTH INSURANCE This booklet, developed by the Vermont Department of Banking, Insurance, Securities and Health Care Administration, helps you understand health insurance and how it works.  It explains the different types of insurance policies available to you and what to expect once you have health insurance.  With a little knowledge, you can choose the right kind of coverage for you and your family.   
Guilty until proven innocent-Dealing with a flawed SSDI Application process The Social Security Disability Insurance system, which is supposed to protect workers from suddenly losing all sources of income with an unexpected disability, is seriously flawed and becoming more so. There's a widespread national myth that people are "faking it". I understand that Connecticut spent over a million dollars to unroot all those fakers in their system, and only found 6  
Handbook (Increase download time-large file) SSA handbook for filing 8.1 mg PDF
Health and Disability insurance and Social Security Disability Patients with chronic illnesses unfortunately must advocate for themselves, whether it be with a doctor or an insurance company. Knowing your rights will help. If you have internet access, you have access to the best research tool in the world. 487 kb pdf
HIV and Public Benefits: Your Legal Rights-Jan. 2002 Many people who need to apply for public benefits, like Social Security, Food Stamps or a Medicaid card, have no idea where to begin.  And once they start the process, they often find it extremely confusing and frustrating.  This booklet is designed to make that process easier to understand, and to provide the information you need to get the benefits you are entitled to. 110 kb pdf
HIV Testing, Confidentiality, and Discrimination: An Outline of Legal Protections for Persons with HIV in Connecticut Informational booklet 94 kb pdf
Home-care use and Expenditures among Medicaid Beneficiaries with AIDS This article compares the use and cost of home-care services among traditional Medicaid recipients with AIDS and among participants in a statewide HIV-specific home and community-based Medicaid waiver program in New Jersey, using Medicaid claims and AIDS surveillance data 62 kb pdf

How States Can Make More Patients Eligible for Part D’s Full Low Income Subsidy/Extra Help at Little or Even No State Cost

 

Medicare patients with incomes (using the SSI income counting rules and disregards)  under 135% of the Federal Poverty Level, or FPL ($1103 monthly for one) and with assets (other than a home of any value; any vehicles of any value; and a separate burial fund up to $1500 per person) under $6.000 ($9,000 per couple) qualify for full Low Income Subsidy (LIS) Extra Help Medicare Part D prescription coverage: No deductible or premium; no donut hole; co-pays of only $1/$2 per generic and $3/$5 per brand name drug. Co-pays and income and asset levels will rise with inflation yearly, as will the non-Extra Help Part D premiums, deductibles and donut hole and catastrophic thresholds.  
HUD-Homeless Management Information Systems

(Large file-please allow extra time for download)

This program requires organizations providing services to the homeless to collect certain data and report that data to HUD for use in a federal database.  Although the exact terms of use of the database vary by region, at a minimum the data will be accessible to other service providers within the same region.  The stated purposes of the program include allowing HUD to get an unduplicated count of homeless persons and to encourage coordination among different providers.  The collection of this information, however, poses some very serious privacy concerns.  Particularly troubling is that service providers are encouraged/required to report HIV status, medical treatment, and mental health status (among other information) in a format that does nothing to protect the privacy of the individuals involved - their names, social security numbers and other identifying information will also be available in the database.  Whether a person sought treatment from an HIV-related care provider would also be included in the database.  While HUD has encouraged the use of certain security protections for the data, we are also concerned that the required protections do not appear to go far enough to protect the confidentiality of this information.  1006 kb pdf
MEDICAID AND PERSONS WITH DISABILITIES Special Medicaid Eligibility Provisions for Persons with Disabilities for New York Pdf 163 kb
Medicare Stand-Alone Prescription Drug Plans By state  
MSP PROGRAMS OFFER $88.50 MORE IN SOCIAL SECURITY CHECKS, PRESCRIPTIONS WITH SMALL CO-PAYS AND EVEN---FOR MANY-- COVERAGE OF MEDICARE DEDUCTIBLES AND CO-PAYMENTS

The little-known Medical Savings Programs (MSPs) can mean an extra $88.50 monthly in Social Security checks in 2006 and extra medical and prescription drug benefits for disabled and elderly persons who are on Medicare but are not also on SSI or Medicaid already.

 

 
Pulling away the safety nets The Safety Net She Believed In Was Pulled Away When She Fell Debra Potter made a good living selling disability coverage. But like many working Americans, she learned the hard way that federal law now favors insurers.  
Sample Disability Policies The following sample policy statements are for various types of disability policies.  Generally, disability leaves are granted with pay, or with pay provided through an insurance plan, and without loss of credit for the employee’s length of service with the company for short-term disability.  The following samples are for illustration purposes only.  The policy terms and conditions available from your insurer could be quite different from the terms set out in these policies.  These policies, however, should be useful in giving you a sense of how a disability policy is structured and the types of issues you’ll need to discuss with your insurer.  

We offer a monthly newsletter dealing with the various issues surrounding infectious diseases.  To find out more click HERE.

Social Security and Poverty Among the Elderly In 1997, women accounted for more than three of every five elderly people lifted from poverty by Social Security. 132 kb pdf
Social Security findings should play key role ''As long as the worker can engage in 'substantial gainful activity,' he is not disabled even if the only work that he is capable of doing is only part time. E.g., Brewer v. Chater, 103 F.3d 1384, 1391-92 (7th Cir. 1997); 20 C.F.R. §404.1572(a). Of course, the work must not be so meager as not to be substantial and gainful. See 20 C.F.R. §§404.1573(e), 404.1574(a), (b). But the same, it turns out, is true under ITT's disability plan  
SSA ISSUES RULES IMPORTANT TO BENEFICIARIES IF SSA DECIDES THAT THEIR CONDITIONS ARE NO LONG DISABLING For over two decades, federal law has required that the Social Security Administration continue payment of disability benefits to a person whom SSA has determined if SSA determines that the person is participating in a vocational rehabilitation program and there is a likelihood that completing the program will make it less likely that the person will need to resume receipt of Social Security or Supplemental Security Income disability benefits in the future...The purpose of this paper is to explain the new regulations and to alert people with disabilities, their families, schools, service providers, and advocates that these regulations will take effect on July 25, 2005 and will be of significant benefit to some individuals who otherwise would lose their benefits when SSA decides that they currently are no longer disabled  
STATE ELIGIBILITY POLICIES WHICH DISCRIMINATE AGAINST THE DISABLED IN THE MEDICAID, MEDICAID WAIVER EXPANSION, CHIP, AND STATE-FUNDED HEALTH & PHARMACY ASSISTANCE PROGRAMS Some state Medicaid, Medicaid waiver expansion, Child Health Insurance (CHIP), state-funded health assistance and state pharmacy assistance programs (SPAPs) have rules that deny eligibility, coverage, equal income levels or benefits to disabled and aged persons.  
State Medicaid Actions—2005: What the States Said, Did and Plan to Do States faced gaping budget deficits that required lawmakers to cut program spending, including that for higher education, social services and health care.  During this period the states reduced spending by $236 billion due to shortfalls in revenue. 1675 kb pdf
State Medicaid Buy-In Programs: Implementation Status, Enrollment and Program Design Features By state and features of each  
State Pharmaceutical Assistance Program (SPAP) Legislation & Policy Changes To Coordinate With & Supplement Part D: Issues, Possibilities & Challenges for HIV, Disabled & Other Patients Several states passed legislation and/or regulations creating, altering or--in once case-- abolishing SPAPs in response to the coming implementation of Medicare Part D, especially to coordinating with and supplement drug coverage for those Low Income Subsidy (LIS)/”Extra Help” patients with incomes under 150% FPL.   SPAPs can cover drugs not on individual Part D plans’ formularies; pay LIS/Extra Help patients’ co-pays, coinsurance, deductibles and premiums; do likewise for slightly “richer’ limited income patients (as some newly-created or adapted SPAPs will do); and---if they meet CMS standards—have such drug payments count toward True Out Of Pocket (‘TrOOP”) credit for moving patients over 150% FPL through and out of the donut hole and into Part D’s catastrophic coverage.  
Widening State Pharmacy Assistance Programs (SPAPs) for the Aged Only to Cover the Disabled Too While state Medicaid programs appear to be prohibited by the new law in most, if not all, cases from offering secondary, "wraparound" drug coverage to "dual eligibles" [those Medicare patients who are also poor enough to be on Medicaid too] this is not so for SPAPs. They're allowed to be secondary, "wraparound" payers if they choose to do so. Given state budget problems, some may propose terminating SPAP programs to save state funds, on the [disingenuous] grounds that the new Medicare drug benefit makes the state program unnecessary. But either way, enactment of the Medicare Part D  drug benefit means enormous savings to SPAPs---in addition to the savings states will get from Part D displacing some state Medicaid drug expenses.  For example, Pennsylvania was predicted to save $150 million just from the preliminary Medicare interim $600 drug discount card program; New Jersey’s savings were to be $90 million; Connecticut’s were to be $15 million; and all SPAPs will save proportionately at least as much when the full, permanent Part D program becomes primary payer in 2006.    

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