HIV 101














"Ask Anne"

Should I be concerned about my health care
if I move to another state?


The answer is YES.

Because the American health care system is so fragmented how you get your doctor visits, prescriptions, blood work and medical procedures covered can greatly vary from state to state. There probably will be fewer issues for people who have insurance provided by their employers. There could be more problems for those who rely on public programs like local Ryan White services or Medicaid.

In either case, it’s important to investigate ahead of time to make sure you have a smooth transition in your health care. Keep the following in mind before you move:

- Plan ahead as early as possible before your actual move. Many people underestimate the amount of time that’s necessary to apply for programs in the new state. If you try to catch up after you move, you may actually risk not seeing a doctor or not getting your meds for a period of time.

- Get in touch with a local AIDS service organization in the new city, area or state.

- Speak with a knowledgeable benefits case manager who knows what programs are available to you. See if you can handle some of the work over the phone before you get there. Otherwise, schedule an appointment ahead of time.

- Know and document your current health benefits. This is important because many state programs differ and may not offer the same coverage. You’ll need to know what you have now, including your eligibility requirements. This way, you or your case manager can compare what you currently have to what’s available in your new state of residence.

- Get a 3-6 month supply of your current meds before you move to cover you in case of a lapse in coverage. Hopefully your transition will be smooth, but an adequate supply of medications will make any lapses easier to handle.

Ryan White coverage

If you currently rely upon Ryan White services for your health care, including getting drugs through your state ADAP, then there are a few things to plan ahead for.

Ryan White clinic services

If you currently see your doctor at a Ryan White clinic, check to see: 1) if you are eligible in your new state, and 2) if any of the local clinics are taking new patients and/or have waiting lists. Other types of Ryan White support services, like HIV treatment adherence or substance abuse services, may or may not be available to you after you move. Check ahead of time to see what is offered.

ADAP (AIDS Drug Assistance Program)

If you currently get your prescription drugs through your state ADAP, check ahead to see: 1) if you are eligible for ADAP in your new state, and 2) if the new ADAP has a waiting list. (Check www.welvista.org/adap_states.php") for a list of those states.) If no, you’ll still have to apply to that ADAP which may take some time. (Check to find out how you apply and what is necessary in terms of establishing residency in your new state.) If yes, consult a local case manager to find another way to get your meds paid for.

Also, check your new state’s ADAP formulary. Although all states cover HIV meds, not all will cover the same list of non-HIV meds. To find your state formulary, Google search by typing “your new state ADAP formulary”, or go to www.hab.hrsa.gov/gethelp/statehotlines.html") for a list of state hotlines to call for information, or talk to a local case manager.>

PCIPs (Pre-existing Conditions Insurance Program)

Many people who are eligible for Ryan White may also qualify for state PCIP if they can’t get their health care through Ryan White. PCIPs are state programs where you can purchase or continue insurance at a somewhat reasonable cost. (Go to www.pcip.gov") or contact your state Office of AIDS.) Your new state may also use Ryan White funds to help you cover the expenses of the PCIP. Check to find out if that service is offered and if you’re eligible.

Medicaid coverage

The federal Medicaid program can vary quite a bit from state to state. If some or all of your health care is covered by Medicaid, then it’s wise to plan well ahead of your move to make sure you can find ways to maintain all your current benefits.

The length of time to apply for Medicaid in your new state may be longer than you expect. So the sooner you start asking questions, the better your results. Also, there may be a required length of time you have to live in the new state before you start Medicaid. In this case, Ryan White services or other sources may help cover your health care during this time.

Plan for services you need now and may need in the near future, and check the benefits offered in your new state. Ryan White services may “wrap around” Medicaid services, or offer benefits that Medicaid doesn’t cover. It is always best to talk to a qualified benefits counselor or a case manager, if possible, to ensure you get the most coverage possible.

Medicare coverage

The federal Medicare program is basically the same from state to state; therefore, you may not have many if any changes in your coverage. However, some states have more Medicare managed care plans with HIV experience that may offer more coverage than traditional Medicare. Look closely at the plans before making any decisions and, if possible, talk to other HIV-positive people who use those plans before making a final decision.

Also, some state health care programs that assist with Medicare costs may be very different, so investigate these before you move. There are two main programs that you should keep in mind before you move. The first is if you currently get assistance from the state that helps pay your Medicare premiums or helps pay for your prescription drugs. The second is if you’re enrolled in ADAP to help cover costs during the coverage gap in Medicare Part D. In both of these cases, you may be able to get similar coverage depending on the state. Also, make sure that, in the case of ADAP, the drugs you need are on the formulary.

Employer and individual insurance plans

Group employer and individual insurance plans may not be the same when you move to another state. It is very important not to allow your insurance coverage to lapse for more than 63 days. During this 63-day period, you are protected by federal HIPAA regulations (for details, go to www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html") that require insurance companies to issue you a new policy. However, they do not regulate the cost of the policy.

Moving with same employer insurance.

If you’re moving to a new state with your current employer, you probably don’t have much to worry about. However, it’s still wise to check with your plan to make sure you’ll have the same benefits. Check the plan for a list of doctors who say they treat HIV. If the plan doesn’t provide that, then you may want to find doctors who serve patients with HIV through the physician locators found on these websites: www.aahivm.org"), www.hivma.org"), or www.glma.org"). You can compare those doctors with the ones listed in your insurance plan.

Moving with new employer insurance.

If you’re moving for a new job, when possible you should check with the new plan ahead of time on two types of possible waiting periods: a general one for all new employees and another one for pre-existing conditions.

First, for new employees in some companies, there may be a short general waiting period of 30, 60 or other number of days before coverage starts. If this is the case, then you’ll need to find other coverage in the meantime, which could include a COBRA policy from your old employer or buying a minimal insurance plan for the time you won’t have insurance. A local case manager should be able to help you figure out your best options.

Second, if there’s a pre-existing conditions waiting period, federal law limits the maximum for this to 12 months. Some states have passed their own laws to reduce this even further; for example, in CA it is limited to 6 months. However, if you have “credible coverage” before starting your new job (such as private insurance, Medicaid, COBRA, etc.), then every month you have held that credible coverage reduces your waiting period equally by one month.

New employer insurance can have both general and pre-existing waiting periods. If this is the case, then they must start at the same time. They cannot be added onto each other consecutively to stretch out the waiting time.

However, small companies and small group plans often are not subject to federal and state laws and may get waivers from having to provide coverage to people with pre-existing conditions. Waiting periods and HIV meds coverage may greatly vary. They can also offer plans with a much smaller scope of benefits or extremely high deductibles. Therefore, if you are moving to a small employer, less than 50 employees, ask questions about your scope of coverage and how they work with pre-existing conditions.

Moving with individual insurance.

If you’re moving to a new state with private individual insurance, check to see if your current insurance plan will cover you after you move. If not, then you’re faced with finding new insurance, and it may take some time to figure out which is best for you and your health needs. Remember, it’s important not to let your insurance lapse for more than 63 days so that you can take advantage of your HIPPA protections.

This article hasn’t covered all the possible problems that people face when moving from one state to another. Hopefully it provides some basic information that you can build upon if you find yourself having to move out of state. Because state insurance regulations vary, we always recommend that you check with a qualified health benefits counselor in your new location or at a minimum a knowledgeable case manager.

Contact Project Inform’s HIV Health InfoLine if you have a question about health care benefits by calling toll-free at 1-800-822-7422.

Copyright 2018, Positive Health Publications, Inc.

This magazine is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!