Complete text of the Social Security Administrative
Policy for Infectious Diseases; and the methods for applying for
assistance that can help.
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Document Name |
Description |
File Size
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2005 Medicaid and Medicare Cutbacks |
Federal
legislation & state responses to Hurricanes Katrina & Rita
were still pending on 9/30 & aren’t addressed in this
issue.
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2005-06 State Medicaid Cuts & Expansions:
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Proposed
cuts in funding & Enacted draft # 1, January 1, 2006 |
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2006- State Medicaid and Health Cuts & Expansions |
Current
changes in Medicaid cutback and expenses |
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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 |
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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 |
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A CONSUMER’S GUIDE TO HEALTH INSURANCE
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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. |
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Guilty until proven innocent-Dealing with a flawed SSDI
Application process
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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 |
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Handbook
(Increase download time-large file) |
SSA handbook for filing |
8.1 mg PDF
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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 |
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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 |
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HIV Testing, Confidentiality, and Discrimination: An Outline
of Legal Protections for Persons with HIV in Connecticut |
Informational booklet |
94 kb pdf |
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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 |
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How States Can Make More Patients Eligible for Part D’s Full
Low Income Subsidy/Extra Help at Little or Even No State
Cost
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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.
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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 |
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MEDICAID AND PERSONS WITH DISABILITIES |
Special
Medicaid Eligibility Provisions for Persons with Disabilities
for New York |
Pdf 163 kb |
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Medicaid Watch: State Medicaid and Health Cuts & Expansions |
July 5,
2006-- resources to oppose state health cutbacks. |
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Medicaid Watch: State Medicaid and Health Cuts & Expansions |
October 1,
2006 Medicaid and Health Cuts & Expansions |
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Medicaid Watch: State Medicaid and Health Cuts & Expansions
1-2007 |
Planned
cutbacks on Medicaid and other healthcare coverage |
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Medicaid Watch: State Medicaid and Health Cuts & Expansions
4-07 |
Cuts in
Medicaid within the US |
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Medicare Stand-Alone Prescription Drug Plans |
By state |
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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.
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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. |
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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. |
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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 |
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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 |
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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 |
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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. |
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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 |
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State Medicaid Buy-In Programs:
Implementation Status, Enrollment and Program Design
Features |
By state and
features of each |
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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. |
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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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