Financial Help

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• Medicaid
• Ticket to Work and Work Incentive Improvement Act (TWWIIA)
• 1902c Waiver and 1115 Demonstration Waiver
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
• Financial Support During Pregnancy
• AIDS Drug Assistance Programs (ADAPs)
• U.S. Department of Housing and Urban Development (HUD)
• Clinical Trials
• Additional Information on Financial Help

Paying for health care in today's society is challenging. Having HIV/AIDS can be extra costly. With the rising costs of HIV/AIDS drugs, many people find it hard to buy the medicines they need. Other people may have problems getting the housing they need. There are services that can help people with HIV/AIDS.

Medicaid

Medicaid is a health program sponsored by the federal government that gives health care to people with low incomes. Most adults with HIV disease who qualify for Medicaid:

• are disabled
• have low income
• have limited assets
• have families with dependent children and meet certain income and resource standards

States must provide these services to people who qualify for Medicaid:

• inpatient hospitalization
• outpatient hospitalization
• rural health clinics
• other lab and x-ray services
• nursing facility services (except institutional mental disease) for people ages 21 and older
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
• Family planning services and supplies
• Physician services and medical and surgical services of a dentist

Currently, all states cover FDA-approved prescribed drugs, including various drugs for treatment of AIDS-related opportunistic infections (OIs) and drugs for treatment of primary HIV disease, such as protease inhibitors and nucleoside and nonnucleoside reverse transcriptase inhibitors. There are also additional services that states may elect to cover, such as case management, prevention services, and hospice care.

Whether or not you can get Medicaid will depend on the state where you live — each state has different rules on who can get into the program. You apply to Medicaid in the state where you live. You can get an application at your local Medicaid office. The phone number for your local office can be found in the blue pages of your phone book. A lot of times, the number is under "medical assistance." If you have trouble finding the local Medicaid office phone number in your phone book, call your local Social Security office. They can give you the phone number and address of your local Medicaid office.

Ticket to Work and Work Incentive Improvement Act (TWWIIA)

For those who are disabled, still working, and make too much money to qualify for Medicaid, the Ticket to Work and Work Incentive Improvement Act (TWWIIA) may be an option. It gives states the option to extend Medicaid coverage to people with disabilities who wish to work by increasing the amount of income they may earn. States have the option to provide Medicaid to working people with disabilities whose earnings are too high for them to qualify for Medicaid under the current rules. States can cover employed individuals with a medically improved disability who lose Medicaid coverage even if their medical conditions have improved to the point where they are no longer disabled under the Supplemental Security Income (SSI) definition of disability. A person is not required to be getting SSI in order to be eligible. However, if not getting social security, the State decides if he or she is disabled. The Social Security Administration (SSA) administers this program.

1902c Waiver and 1115 Demonstration Waiver

The Social Security Act offers multiple waivers to allow states flexibility in operating Medicaid programs. These waivers give state officials an opportunity to expand health care coverage to the uninsured and help individuals and families with public health programs. Eligibility for these waivers can not be determined by the federal government. Each state has its own process and standard for participation. The below waivers are offered to people with HIV/AIDS.

• 1902c Waiver allows states to waive certain Medicaid requirements so they can target specific populations, like people with HIV/AIDS. There are 16 states that offer this waiver for people with HIV/AIDS. With this waiver, states can offer services like case management and homemaker services to people with HIV/AIDS.

• 1115 Demonstration Waiver is another way for states to tailor programs for people with HIV/AIDS. The Medicaid programs in Massachusetts, Maine, and Washington, D.C. offer a wide range of Medicaid services to people with HIV/AIDS who aren't disabled. States must apply for the waiver. Because of constraints of this waiver, states that do have it aren't able to provide these special services to a lot of people.

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service is Medicaid's comprehensive and preventive child health program for individuals under the age of 21. EPSDT offers Medicaid-eligible individuals under age 21 access to Medicaid services that are medically reasonable and necessary whether or not they are covered under the States' Medicaid plan.

Financial Support During Pregnancy

If you are pregnant, Medicaid may pay for your prenatal care. If you are pregnant and HIV positive, Medicaid might pay for counseling, medicine to lower the risk of passing HIV to your baby, and treatment for HIV. You can stay on Medicaid for up to 90 days after you deliver your baby. It may continue for one year after you deliver your baby — that depends on the rules in your state. Each state makes its own Medicaid rules. If you don't think you qualify for Medicaid, check again. You may be able to get it while pregnant because the income limits are raised for pregnant women in all states to provide prenatal care and HIV treatment. To find out if you meet the requirements, contact your local or county medical assistance, welfare, or social services office. The number is listed in the blue pages of your telephone book. If you are unable to find that number, contact your state Medicaid office.

AIDS Drug Assistance Programs (ADAPs)

AIDS Drug Assistance Programs (ADAPs) provide HIV drugs to people with HIV/AIDS who don't have health insurance or have private health insurance that doesn't pay for the drugs. For example, it covers people with low incomes who may not be disabled and can't get public health insurance, like Medicaid. This drug program is run by your state and may have different rules than other states. Below are the contact numbers for ADAPs in your state.

Unfortunately, many states don't have enough money to help everyone who applies. Another way to get help is to apply to patient assistance programs run by drug companies.

Patient assistance programs are offered by some drug companies to give medicines at a lower cost or for free to people who can't afford them. Ask your doctor to contact the program for you.

U.S. Department of Housing and Urban Development (HUD)

The U.S. Department of Housing and Urban Development (HUD), Office of HIV/AIDS Housing runs the Housing Opportunities for Persons with AIDS (HOPWA) program. Their programs provide HIV/AIDS housing that includes short- and long-term rental assistance, live-in medical facilities, and housing sites developed exclusively for people living with AIDS.

Clinical Trials

Clinical trials offer people with HIV a way to try new HIV medicines that aren't yet available to the public. AIDS clinical trials are research studies in which new treatments for AIDS and HIV infection are tested in humans. These studies help determine if the drugs are useful and safe in treating HIV disease. These HIV drugs are free for the person in the trial. See the research and trials section for more information about clinical trials.

Additional Information on Financial Help:

Publications

1.   Housing Opportunities for Persons with AIDS (HOPWA) - HOPWA was created by the U.S. Department of Housing and Urban Development to provide housing assistance and related supportive services to people with HIV/AIDS.

   http://www.hud.gov/offices/cpd/aidshousing/programs/index.cfm

2.   Medicaid Buy-In For Working People With Disabilities - States can extend Medicaid coverage to certain disabled people who work. This fact sheet explains more about the program and who qualifies.

   http://www.socialsecurity.gov/disabilityresearch/wi/buyin.htm

3.   Social Security For People Living With HIV/AIDS - If you have HIV/AIDS and cannot work, you may qualify for disability benefits from the Social Security Administration. This publication provides information about how to qualify and file for the benefits.

   http://www.ssa.gov/pubs/10019.html

4.   What You Need To Know When You Get Disability Benefits - This on-line resource answers some common questions you may have after receiving disability benefits. It provides information on reporting changes that could affect your benefits, reviewing of your case, and returning to work.

   http://www.ssa.gov/pubs/10153.html

5. Drug Company Patient Assistance Programs (Copyright © ATDN) - This online resource offers information on government and drug company sponsored programs that help pay for the drugs you need.

   http://www.atdn.org/access/pa.html

6. State HIV/AIDS Program Directory (Copyright © NASTAD) - This is a list from the web site of the National Alliance of State and Territorial AIDS Directors of how to contact the HIV/AIDS program in your state.

   http://www.nastad.org/About/res_state_Directory.aspx

Organizations

1.   Center for Medicare and Medicaid Services, HHS
2.   HIV/AIDS Bureau, HRSA, HHS
3.   Office of HIV/AIDS Housing, Community Planning and Development, HUD
4.   Ryan White CARE Act TARGET Center
5.   Social Security Administration Office of Public Inquiries
6. National AIDS Fund
7. Project Inform

= Indicates Federal Resources

Content last updated January 25, 2008.