Big Changes in Medi-Cal Programs for 2022!

The State of California has made some significant changes to the Medi-Cal program in 2022. As of May 1, 2022, eligibility for full-scope Medi-Cal has expanded to include adults who meet Medi-Cal eligibility requirements and are aged 50 or older, regardless of immigration status. This expansion will immediately impact individuals who are on restricted scope benefits, also known as emergency Medi-Cal. These individuals will not need to take any action to receive full-scope Medi-Cal, but will automatically be transitioned to it. If you are not on restricted scope Medi-Cal, then you will need to complete and submit an application to apply. However, while a social security number and/or immigration status may be requested, it is not required to complete the Medi-Cal application.

Additionally, as of July 1, 2022, the State of California has increased the asset limit for non-MAGI Medi-Cal programs. Non-MAGI Medi-Cal programs include the Aged, Blind and Disabled, Medi-Cal with share of cost, 250% Working Disabled Program, long-term care, and Medicare Savings Programs. Eligibility for these programs requires participants to meet an asset or resource limit in order to qualify for benefits. Effective July 1, 2022, the asset limit will be increased from $2,000 for a single person and $3,000 for couples to $130,000 for a single person plus $65,000 for each additional family member. This substantial increase in the asset limit will allow beneficiaries on these programs to save and build their resources without jeopardizing their Medi-Cal enrollment.

He had a dream . . .

In observance of Martin Luther King, Jr. Day, PRC encourages everyone to find ways to serve their community; even during the COVID-19 pandemic, there are creative ways to impact the community positively.

10 Ways to Serve the Community

1. Take care of yourself and others: Practice patience, kindness, and mindfulness. Encourage others to do the same!
2. Stay informed and calm: Only share information from credible sources like the local SF Dept. Public Health, state department of health or the CDC. Remember, when you stay calm, others will follow.
3. Protect yourself and others: As the COVID-19 pandemic continues to impact our daily lives, the most important way to serve the community is to help stop the spread of COVID -19: following mask mandates, adhering to travel restrictions, and maintaining social distancing.
4. Donate blood: Blood levels are at dire low levels, the need for blood donations is high. Donation centers have safe, healthy ways for you to donate. How to make an appointment in SF
5. Become a pen pal: Make an intentional effort to reach out to communicate with family, friends, those you have not talked to in a while to stay connected. It could be as simple as sending a positive affirmation note or postcard. Everyone enjoys receiving actual positive mail. (Organizations such as Home Instead, Project PenPal, Village Concepts, and many more have programs to match you with someone.)
6. Support local businesses: When possible, purchase gift cards to local shops businesses, and uplift those trying to keep afloat.
7. Organize a neighborhood cleanup: Walking a few blocks or in a local park to pick up the trash can make a big difference! (SF Public Works, SF Bay Keepers, SF Recreation & Parks, etc. all have volunteer programs)
8. Organize a warm clothing drive: Local gently used clothing or household goods to local organizations with a mission to provide needed items to those in need and career opportunities to those moving forward: St. Anthony’s, Community Thrift, Salvation Army, or Goodwill.
9. Volunteer at a local Food Bank or Dining Hall: Volunteer to help at the local food bank or dining halls that serve the unhoused in San Francisco (i.e., GLIDE,  St. Anthony’s, or SF-Marin Food Bank  and other organizations serving those in need.)
10. Donate: Non-profit community organizations need monetary gifts to make possible the essential work they do in our community. At PRC, we assist our community’s most vulnerable individuals through emergency financial assistance, residential behavioral health treatment, legal advocacy for access to necessary income and healthcare benefits, workforce development, social services, counseling, and supportive housing to effectively lift people up out of poverty, addiction, illness, and homelessness and offer them hope and a path to new opportunities. Consider supporting PRC in this important work.

Need some more inspiration? Check out these video references of Dr. King’s speeches:
• I Have a Dream speech by Martin Luther King, Jr. via Rare Facts on YouTube: http://tiny.cc/I_Have_A_Dream_63
• Martin Luther King, Jr., “What Is Your Life’s Blueprint?” via Beacon Press on YouTube: http://tiny.cc/MLK_Blue_Print
• Dr. Martin Luther King Jr.: A Leader and a Hero by Scholastic:
http://tiny.cc/MLK_Leader_Hero
 

Congratulations to SF HIV FOG for acceptance of their AIDS2020 Abstract

PRC would like to congratulation the San Francisco HIV Frontline Organizing Group (SF HIV FOG) for the acceptance of their AIDS2020 abstract: CREATING A PROFESSIONAL COMMUNITY OF FRONTLINE WORKERS AS AN INNOVATIVE METHOD TO IMPROVE THE CARE OF PEOPLE LIVING WITH HIV/AIDS.

Below is the poster which was shown at the virtual AIDS2020 conference, July 6 thru 10.

It is tax time again.

With all the recent tax reform changes, many people have many questions. Intuit has created a nice article that explains how the changes affect 2017 taxes (taxes you actually file in 2018) and changes that take effect next year during the 2018-tax filing season (taxes you file in 2019).  Below are some highlights, important dates, and resources to help you file your taxes.

Tax Penalty for Not Having Health Insurance

Individuals without qualifying health coverage for all or part of 2017 may still have to pay a tax penalty for the tax year 2017. A tax preparer or tax prep software may assist in calculating any penalty for not having health insurance.

For the tax year 2017, the penalty is the greater of 1) 2.5% of total household adjusted gross income, OR 2) $695 per adult and $347.50 per child, up to a maximum of $2,085 per family. The penalty amounts have not been set for the 2018 tax year and beyond.

In limited situations, some individuals may be exempt from the tax penalty.

Medical Expenses

If you itemize deductions in 2017, you may be able to deduct qualifying medical expenses to the extent they exceed 7.5% of your Adjusted Gross Income. See the IRS Publication for a full list of qualified medical expenses.

Deadline to File 2017 Taxes is April 7, 2018

The deadline to file your personal tax return for the tax year 2017 is Tuesday, April 17, 2018. (Why the change? Because April 15 falls on a Sunday, and Monday is Emancipation Day, observed in Washington D.C., the home of the IRS.) If you are not ready to prepare and file your return by the deadline, you may request a six-month extension with the IRS.

Free Tax Filing Assistance in San Francisco

Mission Economic Development Agency (MEDA)

Provides free tax services in English and Spanish. Call 2-1-1 (available 24/7 in 150 languages) to make an appointment.

Volunteer Income Tax Assistance (VITA)

Provides free tax return preparation for qualifying taxpayers. Visit the hyperlink above to locate a VITA or Tax Counseling for the Elderly (TCE) program near you.

Earn it! Keep it! Save it! A program of the United Way

Provides free tax services to qualifying taxpayers. Visit the hyperlink to find out about eligibility, what to bring to your meeting and the program sites near you.

AARP Foundation Tax-Aide

Offers free, individualized tax preparation for low to moderate-income taxpayers – especially those 50 and older – at more than 5,000 locations nationwide. Find a location near you by searching the link.

HEALTH TIP: U = U Got Questions?

U = U means undetectable equals untransmittable. This slogan refers to the fact that there is effectively no risk of sexually transmitting HIV when the virus is reduced to undetectable levels.

An undetectable viral load for people living with HIV means they will not transmit HIV to their partners. Active engagement in treatment as prevention is a key to maintaining an undetectable viral load and preventing HIV transmission. ‘Treatment as Prevention’ (TasP) is defined as any HIV prevention method that uses antiretroviral therapy (ART) to decrease the risk of HIV transmission to a sexual or needle-sharing partner. ART reduces HIV in blood, semen, vaginal fluid, and rectal fluid to very low levels, and as a result, lowers HIV transmission. ART can even lower viral load to undetectable levels.

Evidence from real-world studies including PARTNER and Opposites Attract shows the affect TasP and ART have on preventing HIV transmission in the PARTNER study that there were ZERO transmissions out of 58,000 condomless sex acts between people with undetectable HIV viral loads and their HIV-negative partners. In the Opposites Attract study, there were no transmissions out of 17,000 condomless sex acts between men. Since the advent of combination therapy, there have been no confirmed reports of anyone with an undetectable viral load sexually transmitting HIV.

An important aspect to TasP is regular viral load testing. Testing is recommended about 2-4 times a year for people who have a stable undetectable viral load. More frequent testing may be necessary and it is recommended that people speak with their doctors about appropriate care, treatment, and testing.

Evidence shows that with regular testing and continued treatment, people living with undetectable HIV viral loads may let go of fears about transmitting HIV to their partners. Instead, we can all focus on the fact undetectable does equal untransmitable.

References:

Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 Transmission. New England Journal of Medicine. 2016;0(July 18):1-10. http://www.nejm.org/doi/full/10.1056/NEJMoa1600693#t=article

Del Romero J, Castilla J, Hernando V, Rodríguez C, García S. Combined antiretroviral treatment and heterosexual transmission of HIV-1: cross sectional and prospective cohort study. British Medical Journal. 2010;340:c2205. http://www.bmj.com/content/bmj/340/bmj.c2205.full.pdf

Frieden TR, Foti KE, Mermin J. Applying Public Health Principles to the HIV Epidemic—How Are We Doing? New England Journal of Medicine. 2015;373(23):2281-2287. http://www.nejm.org/doi/full/10.1056/NEJMms1513641#t=article

i-Base. Q&A on the PARTNER study: how to interpret the zero transmission results. 2016; http://i-base.info/qa-on-the-partner-study/. Accessed 07/18/2016.

Loutfy M, Tyndall M, Baril J-G, Montaner JS, Kaul R, Hankins C. Canadian consensus statement on HIV and its transmission in the context of criminal law. Canadian Journal of Infectious Diseases and Medical Microbiology. 2014;25(3):135-140. http://www.hivlawandpolicy.org/resources/canadian-consensus-statement-hiv-and-its-transmission-context-criminal-law-mona-loutfy

Loutfy MR, Wu W, Letchumanan M, et al. Systematic review of HIV transmission between heterosexual serodiscordant couples where the HIV-positive partner is fully suppressed on antiretroviral therapy. PloS one. 2013;8(2):e55747. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055747

Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. Journal of the American Medical Association. 2016;316(2):171-181. http://jama.jamanetwork.com/article.aspx?articleid=2533066

Vernazza P. HIV-infizierte Menschen ohne andere STD sind unter wirksamer antiretroviraler Therapie sexuell nicht infektiös. 2008. http://www.aids.ch/de/downloads/pdfs/EKAF-Statment_2008-05-089.pdf

Vernazza PL, Bernard EJ. HIV is not transmitted under fully suppressive therapy: The Swiss Statement – eight years later Swiss Med Weekly 2016; http://bit.ly/SwissMedWeekly  Accessed Sept. 4, 2016, 146.

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.

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[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).

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[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.

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 15^th 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 5^th 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.

 

 

Changes to AIDS Drug Assistance Program Effective July 1, 2016

By Jeff Kosbie, Esq.

Big changes are coming to the AIDS Drugs Assistance Program (ADAP), Office of AIDS Health Insurance Premium Payment Program (OA-HIPP), and Medicare Part D Premium Payment Program.

On July 1, 2016, Ramsell will no longer administer ADAP. A.J. Boggs will take over program eligibility and enrollment. Magellan Rx will handle pharmacy benefits management. And Pool Administrators Inc. (PAI) will manage the OA-HIPP and Medicare Part D premium payment programs.

This post identifies important steps that you should take now and how you can stay informed as these changes roll out. As always, please call us at 415-777-0333 if you need more assistance.

New out-of-pocket expense coverage for OA-HIPP clients!

One of the most exciting changes is the addition of a new program to pay out-of-pocket medical expenses for OA-HIPP clients. We are still waiting for more details on this program. At present, we do not know if it will only cover HIV-related out-of-pocket costs or if it will cover all costs. This new program will be administered by PAI. If you are enrolled in OA-HIPP, you should receive a new ID card from PAI along with instructions on how to use it. We will also update you as we learn more.

What should I do now to avoid any disruption in my drug access?

• Keep an eye out for an informational letter from the State Office of AIDS and a welcome letter from Magellan Rx. The letter from Magellan Rx will include your new prescription benefit card. Please be sure to open this mail and keep your new prescription benefit card. The outside of the envelope will not say ADAP on it.
• Update your address with your enrollment worker. If you have changed your address within the last year, make sure your address is up to date with ADAP. If you are not sure if you updated your address, call your enrollment worker now. Any enrollment worker can update your ADAP profile, even if they did not initially enroll you.

We have included images of what the new Magellan prescription benefit card should look like along with the welcome letter that you should receive at the end of this blog post.

Will I need to switch pharmacies?

ADAP clients must use a pharmacy within the Magellan pharmacy network to access medication. Magellan Rx is contracted with over 6,000 pharmacies in California, and the majority of ADAP clients will not need to change pharmacies. If your pharmacy is not in the Magellan network, you should be contacted directly by the CA Office of AIDS (a division within the California Department of Public Health). Your ADAP enrollment worker should also receive a notification that you will need to change pharmacies. If Positive Resource Center handles your ADAP enrollment, we will be sure to update you immediately if we learn that your pharmacy is not included in the Magellan network. You may also call the California Department of Public Health (CDPH) at 844-421-7050 to confirm that your pharmacy is in the Magellan network.

Can I still use my Ramsell Prescription Benefit Card after July 1^st?

Your Ramsell card will be deactivated effective July 1^st. To avoid any problems at the pharmacy, we advise you to look out for your new Magellan Rx card and be sure to bring it with you. However, your program ID number will remain the same. The Office of AIDS assures us that you should still be able to access your drugs at the pharmacy without your new Magellan Rx card.

What if I have problems accessing my drugs on July 1^st?

Starting July 1^st, you can Magellan Rx’s live support team at 800-424-5906 to address any problems with program roll-out. We will also be posting any updates we learn about.

Will I still be able to get all of my drugs?

We have not been informed of any changes to the ADAP drug formulary. We will continue to update you if we learn of any changes.

How will the (re)enrollment process change?

All new clients will continue to have to see an ADAP enrollment worker to enroll. All existing clients will have to see an ADAP enrollment worker for their annual re-enrollment, on or before their birth date. When you visit an ADAP enrollment worker after July 1^st, your enrollment worker will create an account on A.J. Boggs portal with you. After that, you can update your account and do annual re-enrollments on your own.

We have been able to preview the new enrollment system and are excited for some of the changes. These include:

• Improved communication abilities, including secure email within the web access portal.
• Improved error checking to identify missing items before an application is submitted.
• Ability to provide additional explanatory comments on application forms.
• Tags to indicate when an applicant has changed an answer from their last application. These tags will help ensure that entered changes (e.g., in address or viral load) are intended.
• Interactive pharmacy locator, searchable by address. Starting July 1^st, this will be available without logging in at https://cdph.magellanrx.com.

 What about the six-month self-verification form?

You will continue to receive this in the mail. Please look for correspondence from A.J. Boggs. If you are enrolled in both ADAP and OA-HIPP, this process will be more streamlined. You will now be able to use the same SVF form to re-certify for both programs.

How can I keep up-to-date on any changes?

We expect to continue to receive more information as we get closer to the transition. We will remind you as key dates arrive and update you if we learn anything new. Call Positive Resource Center at 415-777-0333 and follow us on Facebook and Twitter (#UpOnADAP).

 

 

 

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.

We’ve Been Nominated!

Get Excited! We’re excited to announce that we’ve been nominated for not one but two awards, including “Best Employer: Nonprofit” and “Most Community-Oriented Employer” for the 2016 Work Local Awards, Presented by: Local Wise.

The Work Local Awards shines the spotlight on the boutiques, cafes, nonprofits, startups, and all the local employers that make our local communities thrive. Positive Resource Center prides itself on being an organization that is truly engaged with the needs and concerns of people in San Francisco who are living with HIV/AIDS and or have a mental disability. Positive Resource remains the only place for people living with HIV/AIDS or mental disabilities to get comprehensive benefits counseling and employment services in San Francisco. For more than 29 years Positive Resource Center has been providing crucial services to the community. Since our inception, we have helped our client’s access lifesaving disability income and gainful employment, ultimately providing them with a baseline of financial and healthcare security.

Positive Resource Center exists for the community, we thrive with the community, and more importantly we are the community! Again, we would like to thank Local Wise for nominating Positive Resource Center for these prestigious awards. Please check out the links below to learn more about our services and to RSVP for the award ceremony on April 28^th, 2016.

 

Thank you,

Positive Resource Center: http://www.positiveresource.org/

Localwise: https://www.localwisejobs.com/

RSVP Link for Work Local Awards Ceremony: https://www.eventbrite.com/e/work-local-awards-tickets-22673329539