Posts Tagged ‘Ryan White’

Ryan White Eligibility

I would like to clarify the process for making the initial call to determine eligibility for Ryan White. If a person has never been enrolled in the Ryan White part A program, they must call 954-566-1417 initially to make an appointment. If the person wants to meet with someone to determine eligibility in a place other than the Hollywood office, they should request that at the time of the initial call. They will either schedule the appointment on the initial call or give the person the telephone number to call the site where they want to go. If a person was previously enrolled in Ryan White and wants to make an appointment to determine eligibility so they can re-enroll in the program, they can call the site directly where they had a case manager and meet with an eligibility specialist there.


Thank you again for inviting me. If anyone has any questions they can call me at 954-568-7373 ext. 2234


Nancy MacColl

Behavioral Health Counselor

Broward House, Inc.

2800 NE Andrews Ave.

Wilton Manors, FL 33311

Tel: 954-568-7373 x 2234

Fax: 954-563-5923

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From Tim:

I have been locked in a fierce battle for the Medicare Part D clients with ADAP regarding coverage once they reach Catastrophic. It seems as if I have lost. The answer I keep getting is that coverage for the “Doughnut Hole” is better than no coverage at all and that people with no other serious illness get assistance with their medication costs so they should be grateful they have not been cut entirely. Please get these clients to attend both the Tuesday SFAN meeting and the Wednesday Town Hall meeting as they really need for their voices to be heard. I have also been hit back with the idea that people chose not to vote on Election Day so we have to deal with the consequences. We desperately need Congress to provide additional funding and need to mobilize as a community.

Unless we can get them to change their mind, the rule is as follows for Medicare + ADAP:
1. Client must carefully pick a plan during the open enrollment plan which began today and runs through December 31, 2010 for plan to start on January 1, 2011.

2. They will be required to go to a retail pharmacy for their medications until they reach the Doughnut Hole. This will happen in January or February for most patients. They need to get the pharmacy to give them a print-out showing they have reached the Doughnut Hole and then they can briefly return to ADAP. ADAP will only assist them with HIV meds and Opportunistic Infection Drugs during this phase until the patient emerges from the Doughnut Hole and hits the “Catastrophic Phase.” Catastrophic occurs when the amount of True Out of Pocket Costs from the patient, ADAP and the 50% discount for Brand Name drugs provided by drug manufacturer’s reaches $4550. They are assuming that ADAP will only be assisting these clients for 2 months at most.

3. At this point, they will have to go back to retail pharmacy for remainder of year for ALL DRUGS and pay $2.50 generic, $6.30 brand, or 5% whichever is greater. For HIV drugs in particular it is going to be the 5% and can get really costly.

4. They need to work with their doctors to lower their costs, perhaps switching to low cost generics in any way possible to use the Walmart/Target $4 list, but ultimately their costs are going to increase A LOT. Some might want to join Medicare Advantage plans so they do not have to pay a premium. I have a feeling that Positive Healthcare Partners will be doing a big sell at the Town Hall meeting.

I know this is awful news, but I have fought this battle extremely hard without being able to win. I have given them specific examples yet I can get no one in power to see the harm this can cause. I have also been unsucessful in getting Ryan White Pharmacy to even consider helping those with Medicare Part D. I plan to keep fighting, but we really need to mobilize like we are back in the 1980’s again.

It is strongly encouraged that those who do not have many assets who may be above the 150% Federal Poverty Level ($16,245) apply for Extra Help at http://www.ssa.gov as they sometimes allow people with higher incomes on.

As far as those who are ADAP without Medicare, the change of reducing eligibility from 400% Poverty ($43,320) to 300% Poverty ($32,490) will not happen until February 1, 2011 instead of the December 1, 2010 we were dreading. If anyone in the group falls into this category, they need to meet with a Patient Assistance Program Navigator or their Case Manager to apply for Patient Assistance Programs as soon as possible. I have been told that these affected people “should” all be able to get all of their HIV medications from the Patient Asssistance Programs.

I hope you will post this or at least pass on to the group. If the SFAN meeting and the Town Hall meeting receive poor attendance, the will of Community Advocates will probably decrease.

I will assist any group member in any way that I can. Just ask.


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