WHITTIER STREET HEALTH CENTER NOVEMBER 7, 2014 LAUREN DUNN HDAP INSURANCE/BENEFITS RESOURCE TEAM SPECIALIST GEORGE HASTIE, MPH HDAP INSURANCE/BENEFITS.

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Presentation transcript:

WHITTIER STREET HEALTH CENTER NOVEMBER 7, 2014 LAUREN DUNN HDAP INSURANCE/BENEFITS RESOURCE TEAM SPECIALIST GEORGE HASTIE, MPH HDAP INSURANCE/BENEFITS RESOURCE TEAM PROJECT MANAGER NATHAN PAQUET HDAP/CHII ENROLLMENT SPECIALIST COMMUNITY RESEARCH INITIATIVE OF NEW ENGLAND Massachusetts HIV Drug Assistance Program (HDAP)

What is HDAP? HIV Drug Assistance Program (HDAP): Statewide program, federally-funded through Ryan White Treatment Modernization Act Administered by Community Research Initiative of New England (CRI) on behalf of the MA Department of Public Health Office of HIV/AIDS 2

What is HDAP? How it works: Provides medication co-pay assistance for HIV+ Massachusetts residents HDAP reimburses pharmacies directly Provides temporary 100% prescription assistance for uninsured clients pending insurance enrollment/coverage Assists with the cost of health insurance (CHII) Co-pay: the fixed $ amount you are charged when filling a prescription at a pharmacy. 3

WHAT is HDAP/CHII? Comprehensive Health Insurance Initiative (CHII): Provides assistance with the cost of insurance premiums for: Non-group/small group plans Employee premium deductions Self-employed insurance COBRA MassHealth Health Connector plans Medicare Part D plans Premium: the $ amount you pay, usually monthly, for your health insurance plan. 4

Other HDAP Services In addition to assisting with medication co-pays and insurance premiums, HDAP also provides: Access to medications to reduce potential HIV transmission through the nPEP program Access to medications for HIV+ inmates in houses of correction Access to HIV resistance testing to assist in treatment decision-making [Quest Labs] 5

Who is eligible for HDAP/CHII? Eligibility : HIV+ Massachusetts residents Individuals with a gross annual income of up to 500% FPL ($58,350 in 2014) $4,060 more per dependent US citizenship is NOT required Must submit a new application every 6 months Gross Annual Income: the amount of $ you make each year before any taxes or other expenses are taken out of your paycheck. 6

HDAP/CHII Restrictions HDAP/CHII: Cannot make any payments directly to clients Limited formulary exclusion list Formulary: a list of prescription drugs covered by your health insurance. TIP: Before enrolling in a plan, always check the plan’s formulary to see if the medications you are prescribed are covered. 7

HDAP/CHII Restrictions HDAP/CHII (continued): If insured, medications must be covered by insurance in order for HDAP to pay HDAP/CHII does not cover deductibles or medical co-pays Deductible: the amount of $ you owe for health care before your insurance begins to pay. For example, if your deductible is $500, your plan won’t pay anything until you’ve paid or owe $500 for covered health care services. After that, your health insurance plan will pay for services. 8

HDAP as payer of last resort HDAP is mandated by HRSA to be the payer of last resort Other potential sources of coverage that HDAP enrollees must access, if eligible: MassHealth ConnectorCare Plans Medicare Part D COBRA Employer-sponsored group insurance MIC (Massachusetts Insurance Connection) VA (Veterans Administration) Insurance 9

HDAP/CHII Application Requirements Must provide proof of: Current Massachusetts residency Current income Medical eligibility (to be completed by a clinician) Insurance status All enrollees must reapply to MassHealth every 12 months, except for those currently covered by MassHealth or enrolled in MIC (Massachusetts Insurance Connection). If denied by MassHealth in the past 12 months, must provide a copy of the denial letter. 10

HDAP/CHII Proof of Residence Requirement To provide proof of current Massachusetts residency documentation should: Include identifiers Be within six months of the date application was received Frequently accepted documentation include: Bank Statement Lease Utility Bill or Insurance Premium Paystubs Case Manager or Provider Letter 11 Note: HDAP cannot current accept documentation from MassHealth or the Health Connector for the proof of residence requirement.

HDAP/CHII Proof of Residence Requirement The case manager or provider letter should include: A case manager or provider signature On agency letterhead A date Full residential address 12 Note: For clients who are homeless, the letter should state that the client is homeless and lives in City, State ZIP in place of the residential address.