Category Care Coordination

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Care Coordination

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People living with HIV/AIDS are eligible to enroll in Care Coordination with HIV Alliance, which is funded by the Ryan White Care Act.  HIV Alliance serves people living in Clatsop, Coos, Curry, Douglas, Josephine, Jackson, Klamath, Lake, Lane, Lincoln, and Marion Counties.   Enrollment is voluntary and confidential.  Once enrolled, Care Coordinators and RN Case Managers will help with planning and managing your healthcare.  As a participant you will have the benefit of having access to a well developed information and service network within your community.  The intent of our program is to improve your access to services and help you with many decisions involved in living with HIV.  We take a holistic approach, understanding that all aspects of a persons health & wellness should be addressed.

Guys Like Us

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Guys Like Us  is a group for HIV positive men. Groups are available in Lane, Douglas, and Marion Counties. It is a great opportunity to meet other HIV+ guys who are facing some of the same issues. Dinner is provided. Incentives will be given. The group is facilitated by our Prevention Manager Paul Homan. Paul Homan is a gay man living with HIV. He was first diagnosed in 2003. This is a confidential group. Please fill out the form below to learn about upcoming groups.

[contact-form][contact-field label=’Name’ type=’name’ required=’1’/][contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Comment’ type=’textarea’ required=’1’/][/contact-form]Guys Like Us  is a group for HIV positive men.  Groups are available in Lane, Douglas, and Marion Counties.  It is a great opportunity to meet other HIV+ guys who are facing some of the same issues.  Dinner is provided.  Incentives will be given.  The group is facilitated by our Prevention Manager Paul Homan.  Paul Homan is a gay man living with HIV.  He was first diagnosed in 2003.  This is a confidential group.  Please fill out the form below to learn about upcoming groups.

[contact-form][contact-field label=’Name’ type=’name’ required=’1’/][contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Comment’ type=’textarea’ required=’1’/][/contact-form]

Medicare

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Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.  If you’re in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.

Medicare is funded through two trust accounts held by the U.S. Treasury:

  • Hospital Insurance Trust Fund which pays for:
    • Medicare Part A:
      • Hospital care
      • Skilled nursing facility care
      • Nursing home care (as long as custodial care isn’t the only care you need)
      • Hospice
      • Home health services
  • Supplementary Medical Insurance Trust Fund which pays for:
    • Medicare Part B:
      • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
      • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.  You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.  Part B covers things like:
        • Clinical research
        • Ambulance services
        • Durable medical equipment (DME)
        • Mental Health
          • Inpatient
          • Outpatient
        • Partial hospitalization
        • Getting a second opinion before surgery
        • Limited outpatient prescription drugs
    • Medicare Part D:
      • Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty.  To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

For more information on Medicare visit Medicare.gov The Official U.S. Government Site for Medicare or contact your Care Coordinator.

Health Fair

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This event allows clients to recieve a variety of health related support services.  It includes care packages, partner HIV testing, dental services, healthy cooking info and food bags, and education materials.  Clients can have their blood pressure read and even meet with a pharmacist about their medication.

Visit the Client Social Events Calendar for more information including times and locations by county.

Qualified Medicare Beneficiary

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The Qualified Medicare Beneficiaries (QMB) program helps people who have Medicare pay for their medical care. To receive benefits from the QMB program you must be receiving Part A (Hospital insurance benefits) coverage of Medicare. Your income and resources must fall within certain limits. Income limits are changed annually based on the federal cost of living adjustment.  QMB has four benefit packages based on an individual’s income. The amounts listed are for 2014-2015.

Qualified Medicare Beneficiaries – Basic (QMB-BAS). In this benefit package the Department of Human Services pays for eligible clients’ Medicare premiums, deductibles and co-insurance. The income limit for this program is set at 100 percent of the poverty level or $973 for an individual and $1,311 for a couple.

Qualified Medicare Beneficiaries – Disabled Worker (QMB-DW). In this package the Department pays for the Medicare Part A premiums for some disabled workers who lost eligibility for Social Security because they are working. The income limit for this program is set at 200 percent of the poverty level or $1,945 for single person and $2,622 for a couple.

Qualified Medicare Beneficiaries – Specified Low-Income Medicare Beneficiary (QMB-SMB and SMF). In this benefit package, the Department only pays for the Medicare Part B premiums of eligible clients. The federal government pays for a portion of the cost of the SMB and SMF programs.

SMB – The income limit for SMB is set at 120 percent of the poverty level or $1,167 for individuals or $1,573 for a couple. The federal government pays 60 percent of this benefit.

SMF – The federal government also mandates that we serve people with incomes between 120 percent and 135 percent of the poverty level which equals $1,313 for an individual and $1,770 for a couple. This is called the SMF benefit. Unfortunately, we are only allowed to serve a specific number of people each year in this category. Once we reach our maximum number we must shut down enrollment. The federal government pays 100 percent of the SMF program.

Please note: Institutionalized clients (e.g. Nursing Facility residents) are not eligible for the SMF program.

For all QMB programs the allowed resource (asset) limit is set at $7,160 per individual or $10,750 per couple in 2014. This does not include your home, car, burial plan ($1,500) and merchandise.

For more information visit the Department of Human Services website.

Low Income Subsidy

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Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is also known as the Low Income Subsidy (LIS).  The Extra Help is estimated to be worth about $4,000 per year.  Extra Help pays for the costs of monthly premiums,  annual deductibles, and prescription co-payments related to a Medicare prescription drug plan.

To qualify for the Extra Help:

  • You must reside in one of the 50 states or the District of Columbia;
  • Your resources must be limited to $13,440 for an individual or $26,860 for a married couple living together.  Resources include such things as bank accounts, stocks and bonds. We do not count your home, car or any life insurance policy as resources
  • Your annual income must be limited to $17,235 for an individual or $23,265 for a married couple living together. Even if your annual income is higher, you still may be able to get some help. Some examples where your income may be higher are if you or your spouse support other family members that live with you or have earnings from work.

Your eligibility for assistance can be determined by either the Social Security Administration (SSA) or you Senior Services office.  To apply online or get more information on Low Income Subsidy visit the Social Security website.

Want to Quit Tobacco?

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Did you know that Oregonians living with HIV are 2 times more likely to smoke than adults statewide? Tobacco use is an even bigger issue for people living with HIV (PLWH) than for others. For PLWH tobacco use can:
o put you at greater risk of tobacco-related conditions like cancers, cardiac disease, and strokes
o make your HIV medications less effective
o decrease your quality of life
o possible lead to premature death
CAREAssist members who use tobacco and wish to quit are eligible to receive services from the Oregon Tobacco Quit Line(1-800-784-8669). CAREAssist members are also eligible for a variety of resources, including prescription medication and nicotine replacement (patches, gum or lozenges) to help you quit.

For those of you who do not have CAREAssist, tobacco cessation is also available.  Contact your Care Coordinator and they will help you find resources accepted through your private insurance.