1. Providing Assistance During Catastrophic Illness
May 19
Providing Assistance During Catastrophic Illness
Julie C. Palas, J.D., Executive Director

2. May 19
The Commission
The James “Tiger” Morton Catastrophic Illness Commission (JTMCIC) was created during the regular session of the West Virginia Legislature as a last resort for West Virginia citizens where death is imminent and no other resources exists.
Commission members are Governor-appointed citizens from across the state.
The Commission is administered through the Office of the Cabinet Secretary of WVDHHR.
(A nurse, doctor, social worker, lawyer and two citizen members at-large)

3. Respected ombudsman and legislative liaison, and a
James “Tiger” Morton
The Catastrophic Illness Commission is lovingly dedicated to the memory of James “Tiger” Morton who was a:
Helper of countless people in dire need of medical and personal assistance
Respected ombudsman and legislative liaison, and a
Compassionate and caring friend
August 22,
December 27, 2000

4. The Need
You may wonder, “Is the JTMCIC is still essential to assist West Virginians who have a life threatening illnesses after they have exhausted all other resources now that the Affordable Health Care Act is in effect and requires mandatory insurance coverage?” Well . . .

5. The Need (cont’d)
. . . there are approximately 10% of our West Virginia citizens that are uninsured – about 116,000 individuals of our state’s population. Also, many West Virginians live just above the poverty level and are not eligible for state assistance benefits, but are struggling to afford insurance.

6. The Need (cont’d)
With these facts, the picture becomes clearer that gaps in service still exist in providing treatment and life-saving procedures for those in dire need while facing a catastrophic illness That is when the JTMCIC can step in to provide assistance to eligible applicants.

7. The first step in applying for assistance is to call 304-558-9027.
May 19
How to Apply
The first step in applying for assistance is to call
An application will be taken over the phone. We ask for the applicant’s demographics, source of income, assets, social security number, physician’s name, diagnosis, cost of treatment, etc. All information is confidential and protected.
A decision will usually be made within one week.

8. Be a West Virginia citizen.
Eligibility
To be eligible for JTMCIC funds, a client must meet the following guidelines:
Be a West Virginia citizen.
Have a condition that meets the definition of Catastrophic Illness, which means there is an imminent risk of death if assistance does not occur.
Have exhausted all other resources, including Medicaid and Hill-Burton Funds (Charity Care at hospitals - 3 remain at the Elgon Clinic/Elgon; Marshall /Huntington; WVU/Morgantown).
Must apply for insurance through ACA

9. In fact, before receiving assistance from the Commission –
Eligibility (cont’d)
In fact, before receiving assistance from the Commission –
an eligible applicant must apply for and be denied coverage by Medicaid,
and
apply for insurance coverage through the Marketplace Exchange program of the Affordable Care Act.
DENIED

10. Proven and accepted medical procedures
Covered Expenses
There are specific parameters for distribution of funds from the JTMCIC. A few examples are:
Proven and accepted medical procedures
Transportation costs for the approved medical procedure to medical facilities for patient and one family member
Medicine that prevents rejection and/or reoccurrence of a life threatening illness

11. Maintenance of acute prescriptions Durable medical equipment
Non-covered Expenses
There are specific expenses that are not covered by the Commission. A few examples are:
Maintenance of acute prescriptions
Durable medical equipment
Experimental treatments and procedures
Home modifications or remodeling
Co-pays for those insured
Medical bills more than one month old prior to application.  

12. Additional Information
Applications are accepted directly from a patient; however, involvement from the medical facility is preferred.
The Commission makes direct
payment to the provider of the
service through the West Virginia
Medicaid program.
All services must be preauthorized
through the Executive Director.

13. The Clients
Paid Medicaid rate for medical treatment 64 year old female with colorectal cancer 52 year old male colon cancer patient who lost his insurance after losing his job due to cancer, covered 3 weeks until he was covered under his wife’s insurance. 31 year old female with heart disease 75 year old male requiring by-pass surgery 64 year old female with fallopian/uterine cancer

14. The Clients
Paid transportation related expenses
4 year old male undergoing a bone marrow transplant, covered parent’s lodging and meals out of state
49 year old female lymphoma patient undergoing a bone marrow transplant, provided lodging post-surgery
Over 1,000 in all -- also connecting clients to other entities’ services by providing referral assistance information, such as co-pay assistance nonprofits and local health providers.

15. The Client Survey
Ages QofL before JTMCIC help? After? # said 10 (highest) JTMCIC helpful getting medical help? # said 10 (highest) Recommend JTMCIC to others? (all who answered) Medicaid? Male 28 Yes 15 No 38 Female 30

16. It would be nice if [the] fund were available to more people . . .
The Client Survey
Client Quote
It would be nice if [the] fund were available to more people . . .
The financial burden was extremely hard on my family and without the help [from JTMCIC], I am not sure what we would have done.

17. Funds are allocated each year from the WV Legislature.
May 19
The Funding
Funds are allocated each year from the WV Legislature.
Initially received $1,000,000 a year and now the allocation is just over $100,000 a year.
The Commission can accept contributions, gifts, property and grants from both private and corporate donors.
As a 170(c) government entity providing for a public purpose, donations are tax-deductible.

18. The Hope
As a reminder, in many cases before catastrophic illness occurs, there are ways we can help ourselves – such as practice preventative behaviors to avoid illness and also to secure insurance through the ACA Marketplace Exchange or Expanded Medicaid coverage to provide the necessary coverage if and when major illness does strike. Learn about what options are available to you!

19. QUESTIONS? Julie C. Palas, J.D. State Capitol Complex
May 19
Contact Information
QUESTIONS?
Julie C. Palas, J.D.
State Capitol Complex
Bldg. 6, Ste. 850, Rm. 8D
Charleston, WV 25305
Phone:
Fax:
Each of our lives weave together to make the fabric of our State stronger. Every life matters.