Eligibility
The applicant must be:
- under age 65
- HIV positive
- not institutionalized and
- have an income of 200% of FPL or less
| Family Size | 200% FPL |
| 1 | $1,432 |
| 2 | $1,935 |
| 3 | $2,439 |
| 4 | $2,942 |
| 5 | $3,445 |
| Additional Persons | +$504 |
If these applicants are not eligible for MassHealth Standard or CommonHealth they will receive MassHealth Family Assistance. After demonstration that gross income is equal or less than 200% of FPL the individual can receive MassHealth fee-for-service for up to 60 days while the Division awaits verification of HIV+ status. After this verification the individual will be enrolled in either:
HIV Premium Assistance with "Wrap" - MassHealth would pay for group insurance premiums (such as those offered through an employer) with the addition of Family Assistance services that are not covered by the employer's plan. This would be on a fee-for-service basis.
HIV Purchase of Medical Benefits - those who don't have access to other health insurance would be enrolled in MassHealth's Primary Care Clinician (PCC) plan - their managed care plan.
Benefits
Benefits include doctor visits, diagnostic services, medications, inpatient hospitalization,
inpatient and out patient mental health and substance abuse services, dental care, hearing aides,
medical equipment and supplies, eyeglasses and more.
Please note that Family Assistance plan does not cover transportation (except ambulances in an emergency) and nursing facility services among other services.
Advocacy Tips (courtesy of Sandy McLaughlin)
- If possible send the HIV+ verification letter with application to ensure confidentiality. If it is not received within 60 days DMA will send out a letter requesting it, which could compromise confidentiality.
- People who are HIV+ AND disabled, but are over-income for MassHealth Standard are generally eligible for CommonHealth. Under CommonHealth these folks would formerly be subject to a one-time deductible - this will now be waived for the HIV+ population.
- Questions can be directed to one of our HIV/AIDS social workers. Also Edith Kenneally will be presenting to our department on May 31 (as detailed later in this newsletter) and will cover this program.
Please see the new MassHealth member booklets (revised 4/01) now available on the Founders 2
"Resource Wall" or at
http://www.state.ma.us/dma/hivservices/memberbklt.pdf
for more information.
4/01