WHITTIER STREET HEALTH CENTERNOVEMBER 7 , 2014

L A U R E N D U N NH D A P I N S U R A N C E / B E N E F I T S R E S O U R C E T E A M

S P E C I A L I S T

G E O R G E H A S T I E , M P HH D A P I N S U R A N C E / B E N E F I T S R E S O U R C E T E A M

P R O J E C T M A N A G E R

N AT H A N PA Q U E T H D A P / C H I I E N R O L L M E N T S P E C I A L I S T

COMMUNITY RESEARCH INITIATIVE OF NEW ENGLAND

Massachusetts HIV Drug Assistance Program

(HDAP)

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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

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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.

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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.

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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]

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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.

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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.

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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.

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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

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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.

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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

Note: HDAP cannot current accept documentation from MassHealth or the Health Connector for the proof of residence requirement.

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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

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 .