best state for HIV coverage/benefits?
Mar 26, 2012
I can't find how to ask the question: What is the best state to live in for HIV coverage/benefits for indigent clients?
I know Ryan White is direct in Indiana where I'm from and lived in Santa Fe New Mexico and Ryan White was direct there as well. California has become a nightmare for coverage and have been triaged out of the Desert Ads Project to a straight clinic that is worthless to me. I'm over 33 years HIV, long-term survivor and I will not put up with this! I am going to see if Dr Trevor Hawkins is still in Santa Fe where the benefits where extraordinary and that is my question really. Is Santa still considered one of the best states to live in for HIV benefits coverage,? Any other states you could suggest would be deeply appreciated Rick 52 yo bi-male, X-HIV nurse b4. during and post epidemic onset, no opportunistic infections, ave. 700 t-cells and worked with the best of the best doctors in the past and sick and tired of the Riverside County crap I've been delt! This state is in bad shape!
Response from Mr. Chambers
You ask an excellent question, but there are too many factors to be able to name a state or two and be done with it. You specifically ask about indigent HIV clients, so that pretty much limits any discussion of health insurance itself, with one exception.
The federal Affordable Care Act provides for new plans called Pre-Existing Conditions Insurance Plans (PCIP) and they are up and running in all states. Anyone who is otherwise unable to buy health insurance (read HIV+) and have been without any health insurance for at least six months can purchase coverage under the PCIP plans. The California Office of AIDS has taken that a step further and, in order to stretch their ADAP dollars, they will pay the premiums for the PCIP plan. It is unknown if other states are contemplating similar programs. However, that doesn't help a lot for the truly indigent since there are still deductibles and copays under PCIP plans.
So, let's focus on ADAP, the AIDS Drug Assistance Programs, offered in the various states funded with Ryan White dollars and Medicaid which is where indigent patients must go for treatment.
Both of those programs vary significantly by state. Some states that offer ADAP coverage severely limits what drugs they cover. Some have waiting lists to get on ADAP; some cover only one medication in each classification. Other states are extremely broad, although that list is getting shorter quickly as states grapple with their own budget deficit which is causing them to reduce their contributions to ADAP programs. The best suggestion there would be to do a websearch for "ADAP [name a state]." They will tell you about waiting lists and formularies.
Medicaid has the same general requirements for eligibility, but the services they provide vary dramatically by state as well. Some states are so overrun with Medicaid patients they are cutting back on all but the mandated coverages; it is requiring longer and longer waits to get to a specialist; some are forcing everyone onto HMOs. Unfortunately, checking their websites don't help much. Yet, there are some states, usually smaller and less metropolitan, that seem to be able to provide needed treatment more quickly and with less hassle. However, that can change quickly as well.
Probably your best bet for both ADAP and Medicaid is to contact several AIDS Service Organizations in the states you are considering moving to and talk to several about what their clients experience.
I don't know of any table that lists states from best to worst. Even if there were it would quickly be outdated as states battle their budget deficits and cut programs and services. Many dramatic reductions are frequently debated and receive a lot of attention but the actual changes can't be known until they are set into law.
I know this is a long answer and is not the direct answer you need. It is really best for you to do the research as suggested based on where you are considering moving.
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