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EFFECTIVE ELIGIBILITY DETERMINATION FOR CARE ACT …：有效的合格鉴定为医疗法案…
EFFECTIVE ELIGIBILITY DETERMINATION FOR THE CARE ACT AND OTHER SYSTEMS The CARE Act is the payer of last resort Grantees must ensure that clients meet eligibility criteria for CARE Act services Including ADAP, insurance continuation, and direct services CARE Act grantees must ensure that alternate payment sources are pursued Grantees must establish and monitor procedures to ensure that their subgrantees verify and document client eligibility Direct service grantees and subgrantees must document that their clients are screened for and enrolled in eligible programs and their benefits are coordinated after enrollment Medicare, Medicaid, VA health care benefits, private health insurance Other programs include public housing, drug or mental health treatment, or Food Stamps Income assistance, including disability income and Temporary Assistance to Needy Families (TANF) Grantees must coordinate with other funders to ensure that CARE Act funds are the payer of last resort These and other HAB requirements are subject to audit Eligibility Determination: Pieces of the Puzzle There is a vast array of entitlement and discretionary programs that HIV+ clients may be eligible for today and tomorrow Eligibility criteria (the short list) Medicaid Eligibility For HIV/AIDS Beneficiaries Medicaid and HIV/AIDS Social Security Administration (SSA) delegates the review of SSI applications to States Substantial variability in the acceptance rates of SSI applications from HIV+ individuals Initial denial rates tend to be very high Significant changes are being made to State Medicaid programs due to the Deficit Reduction Act (DRA) Example: beneficiaries and applicants must document their US citizenship Disability claims are taking longer than ever to process Many State and federal entitlement programs have had layoffs or are working with inexperienced staff Medicare Eligibility For HIV/AIDS Beneficiaries Commercial Insurance Coverage is primarily through group benefits via employers or assoc
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