OFFICE OF AIDS NOW PAYS FIRST MONTH’S HEALTH INSURANCE PREMIUM PAYMENT

By Chuan Teng, Esq.

Managing Legal Director

CA Office of AIDS’s Health Insurance Premium Payment program (OA-HIPP) now pays the first month’s premium (“binder payment”) for eligible health insurance plans (Management Memo 2016-18). Individuals must enroll in OA-HIPP within 48 hours of enrolling in a health insurance plan to access the binder payment benefit via OA-HIPP.

Individuals who miss the 48 hour deadline for binder payment may be eligible for limited special funding through AIDS Emergency Fund. See below.

HEALTH INSURANCE PLANS ELIGIBLE FOR OA-HIPP BINDER PAYMENT

The following health insurance plans sold through Covered CA are eligible for OA-HIPP binder payment.

  • Blue Shield
  • Kaiser
  • Anthem Blue Cross (non-Covered CA plans also eligible)
  • Health Net

HOW TO ENROLL (FOR NEW OA-HIPP ENROLLMENT)

New clients must enroll in OA-HIPP with a certified ADAP/OA-HIPP enrollment worker within 48 hours of enrolling in an eligible health insurance plan to access binder payment.

NEW CLIENTS: Immediately after health insurance plan enrollment, submit to an enrollment worker a Covered California Enrollment History or Current Enrollment summary page which includes the following information:

      • Premium amount
      • Health plan name and medal tier
      • Advanced Premium Tax Credit taken
      • Health plan billing address (if available)

(*A screenshot or screen-print(s) from the Covered California account is permissible.)

ENROLLMENT WORKERS: Submit enrollment documentation through the A.J. Boggs portal by creating an Update Form using the People Picker tool and inform your ADAP Advisor of a new pending OA-HIPP application within 48 hours of the client’s health insurance enrollment.


[1] Existing OA-HIPP clients must update their health insurance information in the A.J. Boggs portal as soon as possible to ensure ongoing premium payments.

    • STEP 1: Create an Update Form by using the People Picker tool to upload the enrollment documentation in the “most recent Covered California medical plan billing statement[2] field under the “Insurance Assistance” tab in the A.J. Boggs portal.
    • STEP 2: Enter the Covered California enrollment confirmation number located in the top left corner of all summaries into the “Member or Subscriber ID” field.
    • STEP 3: Promptly notify ADAP Advisor that a new OA-HIPP application has been submitted and requires initial payment so the application is prioritized for review/approval.
    • STEP 4 (Follow-Up Steps Required AFTER Enrollment): Upload client’s billing statement with the client’s health plan member ID/policy number to the A.J. Boggs portal by creating an Update Form. The client will receive a health plan billing statement from his/her health plan once initial payment is made by OA-HIPP.

If the client misses the 48-hour deadline to enroll in OA-HIPP for binder payment, the client will need to make the initial premium payment out-of-pocket to secure health insurance. See below for special funding.

LIMITED SPECIAL FUNDING FROM AIDS EMERGENCY FUND

Limited special funding through AIDS Emergency Fund is available for individuals who miss the 48-hour deadline to enroll in OA-HIPP to access a binder payment. HIV-positive San Francisco residents may be eligible for special funding. For more information, contact AIDS Emergency Fund (415-558-6999 x 228).


[1] Existing OA-HIPP clients must update their health insurance information in the A.J. Boggs portal as soon as possible to ensure ongoing premium payments.

[2] A billing statement is not required at the initial OA-HIPP enrollment. However, a billing statement must be uploaded in the A.J. Boggs portal after the binder payment is made and the health plan issues a billing statement to the client. See Step 4.

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OPEN ENROLLMENT IS STILL IN PROGRESS!

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By Adrienne Mendle, Esq.

ATTENTION ALL HEALTH CONSUMERS!

OPEN ENROLLMENT IS STILL IN PROGRESS! 

From now until January 31, 2017, eligible Californians can sign up for health insurance on Covered CA AND may be able to receive subsidies to help pay for monthly premiums!

 You’ve probably heard about rising premiums on the healthcare exchanges. Although this is true, don’t despair – premium subsidies are also increasing! In addition, California offers significant financial support for HIV+ individuals eligible to purchase health plans on Covered CA.

 California’s Office of AIDS offers two programs to help pay for health care: ADAP and OA-HIPP. The Aids Drug Assistance Program (ADAP) pays for costs and co-pays associated with HIV-related prescription medication for qualifying individuals making less than 500% of the federal poverty level ($59,400 per year for a household of one). The Office of AIDS Health Insurance Premium Payment (OA-HIPP) program pays for monthly health insurance premiums and has recently begun paying co-pays for outpatient out-of-pocket medical costs, like doctor’s visits and labs. To qualify for this program, you must be enrolled in a private health plan (not through your employer) and be enrolled in ADAP.

 Starting this year, OA-HIPP is also making “Binder Payments” (AKA the first month’s premium) for new Covered CA enrollees! If you sign up for OA-HIPP within 48 hours of enrolling in a Covered CA health plan, OA-HIPP will initiate a Binder Payment on your behalf, activating your new health coverage.

 If you would like coverage starting on January 1, 2017, you will need to sign up for a health plan by December 15, 2016. Open Enrollment ends January 31, 2017; after that, you will need a Special Enrollment Period to sign up for a Covered CA health plan.

 PRC’s Equal Access to Healthcare Program is here to help you through Open Enrollment! Do you need to enroll in a health plan for 2017? Do you need to renew your health plan for 2017? Curious as to whether you are eligible for ADAP and OA-HIPP? Need assistance with something else? Give us a call at 415-777-0333! Our dedicated team of attorneys and advocates would love to talk to you about your healthcare needs.

Trainings for Our Community

By Chuan Teng, Esq.

Managing Legal Director

 The Equal Access to Healthcare Program (EAHP) is holding a Spanish Language Immigration and Public Benefits Workshop on Thursday, September 15th from 10-2 p.m. at the Civic Center Library. This workshop will be conducted in Spanish and will address public benefits available to immigrant clients. Providers and clients are welcome to attend.

 Additionally, EAHP with the SF HIV Front Line Organizing Group (FOG) is hosting the Second Annual Open Enrollment Boot Camp on Wednesday, October 5th at UCSF Mission Bay from 9-5 p.m. This boot camp will offer training and resources to front line HIV-service providers on health insurance open enrollment and how to help clients make informed health coverage choices.

 For more information, please contact chuant@positiveresource.org.

 

 

PRC Now Provides ADAP and OA-HIPP Enrollment Assistance!

By Chuan Teng,

Positive Resource Center’s Equal Access to Healthcare Program (EAHP) now offers enrollment and re-certification assistance with the AIDS Drug Assistance Program (ADAP) and the Office of AIDS Health Insurance Premium Payment program (OA-HIPP).

ADAP and OA-HIPP provide assistance with paying prescription co-pays and health insurance premium payments. HIV-positive individuals making less than $58,850/year may be eligible for assistance. Couples and families may also be eligible, as income rules depend on household income and size.

In addition to these new services, EAHP also provides healthcare access consultation and legal representation on many other issues. HIV-positive San Francisco residents may access services by calling 415-777-0333.

Open Enrollment Closes January 30, 2016

Open Enrollment Deadline

By,

Chuan Teng

Open enrollment closes on January 30, 2016, so now is the time to purchase health insurance. For many, finding a health insurance plan that meets basic needs and works in coordination with other public benefits such as the AIDS Drug Assistance Program (ADAP) and the Health Insurance Payment Program (HIPP) is a daunting task. Positive Resource Center’s benefits counselors are available to help with healthcare coordination and planning.

Here are some tips for buying health insurance:

  • Check to see what insurance plans are accepted by your doctor
  • Make sure your prescriptions are covered under prospective insurance plans
  • Find out co-pay amounts for routine services and any special procedures you expect to undergo in the next year
  • Find out maximum out of pocket annual limits
  • Find out monthly premiums

If you are HIV-positive and a San Francisco resident, call Positive Resource Center for help at 415-777-0333. Remember, open enrollment closes on January 30, 2016, so make sure you are covered today. Don’t forget—you can enroll in Medi-Cal anytime, even outside the open enrollment period. Finally, stay connected with Positive Resource Center to learn about new ADAP and HIPP enrollment services to come in 2016!

 

The Positive Resource Center (PRC) Would Like to Introduce our New Team Members:

Positive Resource Center (PRC) is gearing up for a New Year, New possibilities, and of course New amazing staff members. We are excited to introduce and welcome the following individuals to PRC:

Adam Fitch

Employment Specialist for the Employment Services Program

  • Adam graduated from California State University, East Bay with an M.A. in History, and joined the PRC team in June of 2015. Prior to PRC, Adam worked on housing issues with people living with HIV/AIDS, and has over 12 years in the field of non-profits and community service. Adam works as an employment specialist with PRC, and is proud to share his knowledge and experience to help others find rewarding employment opportunities. Adam enjoys reading, traveling, and his family when he is not fighting social injustice.

Adam writes, “Employment for people living with disabilities is the pressing concern for the community and I am proud to be serving a population I care deeply about.”

 

Adrienne Mendle

Staff Attorney for the Equal Access to Healthcare Program

  • Adrienne graduated from Harvard Law School, where she focused on issues of healthcare access. Working with Planned Parenthood Affiliates of California, Adrienne helped advise health centers around the state on Medi-Cal law. At Harvard’s Public Health Law and Policy Clinic, she provided technical assistance to state AIDS Drug Assistance Programs as they implemented the Affordable Care Act. She looks forward to continuing her work in healthcare advocacy with PRC.

Adrienne writes, “Navigating the American healthcare system is a complicated undertaking even for society’s best off. For our clients, facilitating access to the complex ecosystem of services to which they are beneficiaries serves to reduce one major barrier to opportunity and health.”

 

Beth Mazie

Staff Attorney for the Equal Access to Healthcare Program

  • Beth Mazie was a Staff Attorney at Rubicon Legal Services in their Social Security disability advocacy program for fifteen years. She has represented hundreds of clients at Social Security hearings and further on in the appeal process. Prior to her work at the Rubicon, Beth worked as a supported living specialist for Golden Gate Regional Center, as an attorney at Disability Rights Education and Defense Fund (DREDF) and as a volunteer at Community Alliance for Special Education (CASE), advising parents of their rights under special education laws. She is currently a volunteer mediator with Community Boards.  

Beth writes, ” I enjoy using my skills to help people learn about and access resources and benefits that enable them to stabilize and improve their lives”.

 

Billy Allen

Program Assistant for the Employment Services Program

  • Billy worked on catalog photo shoots but always felt drawn to return to the non-profit sector. He has worked in HIV prevention doing theater-in-education programs for youth and as an event coordinator for Equality California and Under One Roof. For the past two years, Billy has been taking night classes at CCSF in pursuit of his BA.

Billy writes, “I find a lot of joy and personal fulfilment in seeing clients self-actualize. It is very inspirational. The aspect of working peer to peer, helping clients navigate beyond and transcending their disability is extremely rewarding.”

 

Hollis Fleischer

Computer Training Associate for the Employment Services Program

  • Hollis graduated from San Francisco State University in May 2015 earning a degree in Rehabilitation Counseling. Hollis knows firsthand the stigma that people with disabilities face. Hollis has worked in the community helping Individuals with mental illness believe that recovery is possible. It became her focus in 2012 to help people who are disabled focus on their strengths and abilities in order to find employment.

Hollis writes, “I am pleased to be here at PRC doing work that empowers people with disabilities to find work which utilizes their strengths and abilities.”

 

Kevin Lesh

Staff Attorney for the Benefits Counseling Program

  • Throughout his 15 years of legal practice, Kevin has advocated for numerous non-profit and public-interest causes, including: civil rights, disability rights, human rights, Native American rights, animal rights, and environmental protection. Accordingly, Kevin has defended and promoted the interests of disenfranchised groups and individuals around the country, and he has worked on the non-profit side (as a staff attorney for organizations), the public side (as a government attorney), and the private side (as a private practitioner). In addition to his work, Kevin enjoys volunteering for various non-profit causes. 

Kevin believes that “Everyone has a moral obligation to give back to the world, which starts with assisting those who are the most vulnerable.”   

Martin Fernandez

Front Office/ Volunteer Coordinator

  • Martin brings extensive experience in administrative management. Before joining PRC, Martin was an Advocacy Assistant with the People With Disabilities Foundation. Prior to that, he was an Executive Assistant for Elliot & Mayock, LLP.  We are thrilled that Martin has decided to join the PRC team.

Martin writes, “I’ve recently moved from corporate America and so glad  to now be a part of changing people’s lives for the better”.

Sergio Perez

Director of Finance

  • Sergio comes to PRC with over 10 years of non-profit accounting and finance experience, most recently working at Project Open Hand where he held the position of Controller. Prior to that, Sergio was the Senior Accountant at Action for Boston Community Development, Inc., the largest anti-poverty agency in New England providing low-income residents across the city of Boston with housing assistance, fuel assistance, and child care assistance. Prior to his transition over to the non-profit sector, he spent the first couple of years of his career working at PricewaterhouseCoopers in Boston as an auditor in the financial services industry.

Sergio writes, “With my career ranging from corporate to mission-based non-profit organizations, my work has kept me humbled and grounded and has given me the ability to understand, help, and communicate with people across all walks of life and along a variety professions.”

 

Symantha Chapman

Employment Specialist for the Employment Services Program

  • Symantha graduated from California State University East Bay earning a degree in Business Administration. She previously worked at Fred Finch Youth Center, Oakland, working with dual diagnosis children. Her hobbies include spending time with her family and camping.

“The greatest success we’ll know is helping others succeed and grow.” 

                                            -Gregory Scott Reid

 

Teena Rodriguez

Operations and Human Resources Manager

  • Teena has over 10 years of HR experience, having held increasing HR positions for Cypress Lawn Cemetery Association, Pacific Gateway Concessions, Hilton Hotels, and most recently Westside Community Services. She also holds numerous certifications in HIPAA, Fire Safety, HR and Sexual Harassment. Teena states, “ I specifically look for solutions that will be beneficial for both the employer and the employees.  I strive to focus on programs that benefit the employees and that are cost efficient for the company”.

 Teena writes, “Due to experiencing challenges within the healthcare industry, as well as dealing with other disabilities in my own personal life, I wanted to join a company that focuses on assisting the community. PRC is the perfect fit and I am happy to be a part of such a great organization”.

 

 

Tuquan Harrison

Legal Assistant for the Equal Access to Healthcare Program

  • Tuquan Harrison is the new Legal Assistant for the Equal Access to Healthcare Program at Positive Resource Center, San Francisco. He has a strong commitment to HIV/AIDS education and community work that began early in my life. While in high school, he began interning at Manual Arts Teen Clinic in South Los Angeles providing peer-based sex education and counseling to LGBTQ students of color. Tuquan continued this work through my undergraduate career creating university programing that focused on HIV/AIDS awareness and (de) stigmatizing mental health in the LGBTQ community. He also volunteers for the Black Brothers Esteem Group at the San Francisco AIDS Foundation.

Tuquan writes,I want my life’s work to be in the service of those who are left in the margins of our society. Joining Positive Resource Center will allow me to continue doing this important work and I am excited to apply my passion and dynamic expertise to this wonderful organization.”

 

WELCOME TO THE POSITIVE RESOURCE CENTER

 

 

Open Enrollment Boot Camp

Positive Resource Center (PRC) is very proud to be the sponsor for San Francisco’s first Open Enrollment Boot Camp for front line HIV workers, which happened last Wednesday, October 21st!

The learning objectives for the training were to:

  • Explain how to navigate clients through enrollment in Covered CA, ADAP, OA-HIPP, and Medi-Cal Expansion.
  • Describe the different roles SF HIV Frontline Workers play in supporting client benefits continuity.
  • Identify at least two ways to collaborate with other providers to resolve client benefits issues.

Boot camp was attended by over 60 social workers, case managers, ADAP enrollment workers, peer navigators, and many more whose shared goal is to better serve San Francisco’s HIV community.

PRC is honored to support the work of front line workers, and reminds everyone that Open Enrollment starts this Sunday, November 1st!