How to Qualify for Social Security Disability Benefits With HIV/AIDS

Posted on November 25, 2019September 23, 2020 by [email protected]

If you have HIV or AIDS, and your symptoms have advanced and made it impossible for you to work and earn a living, you may qualify for Social Security Disability benefits. The Social Security Administration (SSA) oversees two different disability programs that offer monthly benefits to disabled workers. A medical guide, which is called the Blue Book, is used to determine if an individual meets the medical criteria to qualify for disability benefits. There are several listings in the Blue Book that may apply to an HIV or AIDS diagnosis, but there is a specific listing that focuses on the condition itself. Meeting the Medical Criteria Section 14.00 of the Blue Book applies to adult immune system disorders. Listing 14.11 itself applies to HIV infection itself. To qualify using this listing, you must provide documentation to confirm your diagnosis, and you must also be able to prove one of the following:

Multicentric Castleman disease that affects multiple groups of organs containing lymphoid tissue or lymph nodes OR
Primary effusion lymphoma OR
Progressive multifocal leukoencephalolopathy OR
Primary central nervous system lymphoma OR
Pulmonary Kaposi sarcoma OR
Absolute CD4 count of 50 cells/mm3 or less OR
Absolute CD4 count of less than 200 cells/mm3 or CD4 percentage of less than 14 percent, and one of the following – BMI measurement of less than 18.5, hemoglobin measurement of less than 8.0 grams per deciliter, or complications of HIV infection requiring a minimum of three hospitalizations within a 12-month period at least 30 days apart with each hospitalization lasting no less than 48 hours.

For your claim to be successful, you must provide hard medical evidence that includes test results and different laboratory tests that confirm your diagnosis and that support your claim. Any opportunistic diseases that you have been diagnosed with should have indications of a cell-mediated immunity and should have been diagnosed by the proper testing. As an example, provide biopsy results for any cancer diagnosis and biopsy results for toxoplasmosis of the brain. You should provide detailed records that confirm any systems, restrictions, and limitations, such as headaches, fever, brain lesions, and seizures. Even if your diagnosis does not meet any of the specific Listings set out above, you can still be found disabled if you can show that your impairment prevents you from being able to perform the functions of your past relevant work or other full time work. Medical tests, including positive serology tests, should be provided to help confirm the diagnosis and its severity. Some blood tests, including CD4 tests, aren’t adequate for confirming a diagnosis of HIV or AIDS. Remember, hard medical evidence and supporting documentation are essential for a disability claim to be successful. Applying for Disability Benefits If you are unable to work because of HIV or AIDS, or because of an opportunistic disease resulting from either of those conditions, you should apply for Social Security Disability benefits. You can start your application process online at the SSA’s website or by calling 1-800-772-1213 and talking with a representative or by scheduling an appointment at your local SSA field office. While it sometimes takes months for a claim to be approved, the more documentation that you provide to support your claim, the more likely you are to get an approval and be awarded disability benefits. Resources: https://www.disability-benefits-help.org/social-security-disability-locations/ https://www.ssa.gov/disability/ https://www.ssa.gov/disability/professionals/bluebook/14.00-Immune-Adult.htm https://www.ssa.gov/disability/professionals/bluebook/14.00-Immune-Adult.htm#14_11 https://www.disability-benefits-help.org/glossary/social-security-disability-medical-sources https://www.ssa.gov/applyfordisability/

Check out the new ADAP Client Portal!

Posted on October 31, 2019September 23, 2020 by [email protected]

On September 3, 2019, the California Department of Public Health, Office of AIDS released the AIDS Drug Assistance Program (ADAP) Client portal.

Using the portal, clients enrolled in ADAP can:

View their client ID, enrollment site, enrollment worker contact information, eligibility status, and eligibility end date
View the Insurance Assistance Program information if enrolled, including program type (OA-HIPP, EB-HIPP, or MDPP), insurance carrier, eligibility status, and eligibility end date
Elect to receive automatic notifications about eligibility and re-enrollment
Recertify if there are no changes to residency or health insurance and annual household income is within program limits

To request access to the Client Portal, contact the ADAP Call Center at 1-844-421-7050, Monday-Friday, 8:00 AM – 5:00 PM. After requesting access, the client will receive an email with a URL to the client portal. Using the link, the client will enter their email address as the username and a temporary password, and then be prompted to create a new password. Contact the ADAP Call Center, with any issues accessing the Client Portal.

For more information about ADAP, go to California Department of Health Office of AIDS webpage.

If you are interested in ADAP and not yet enrolled, contact an ADAP Enrollment Worker to apply. To find an Enrollment Worker in your area, go to ADAP Enrollment Site Locator.

Lift UP SF: A win-win-win for San Francisco

Posted on October 2, 2019September 23, 2020 by Katharine Berg

We’re proud to introduce a new pathway to personal and economic growth for the thousands of people overcoming mental health, HIV or substance use challenges each year in San Francisco. One of five California programs selected, the Office of Statewide Health Planning will invest nearly $500,000 over two years in PRC’s award winning workforce development model. The result? We’re scaling up a peer-to-peer occupational training pathway recently launched in partnership with San Francisco’s Department of Public Health. Lifting Up Peers for a Brighter Tomorrow or Lift UP SF is a win for consumers, a win for behavioral health services providers, and a win for San Francisco.

Lift UP SF readies consumers—people in and exiting mental health and substance use treatment programs, family members, and caregivers—to put their lived experience to use on a competitive career path. It spans a 64-hour comprehensive training curriculum designed by advocates and consumers, individualized placement support, and peer group services to prepare graduates for volunteer, part-time, and full-time peer positions in the most common health settings: Social and Human Service Assistants, Case Workers, Case Managers, Client Advocates, Family Self-Sufficiency Specialists, and Independent Living Specialists among others.

Leveraging the experience of people with lived experience in mental health, substance use, and public health systems doesn’t just make sense, it’s proven to result in better outcomes for consumers on both sides of the interaction.

Beyond professional skill delivery, peer specialists in health settings share the same vocabulary as those they help, have credibility, and embody an accessible vision of success. Paid or volunteer employment is also a key component of recovery from mental health and substance use disorders, particularly methamphetamine addiction. The act of going to training, getting placed in employment, and accessing a supportive community support throughout this process dramatically improves an individual’s ability to maintain their recovery.

This pathway is timely, right here and right now. San Francisco has very low unemployment (1.9%) overall, but prosperity and stability are not shared equitably across our community. A high cost of living, driven primarily by housing expenses, strains many long-time residents and the populations PRC serves. African Americans and other communities of color, LGBTQ+ individuals, people with disabilities, people with behavioral health disorders, and people living with HIV are overrepresented among the unemployed and have lower than average salaries, placing them at high risk for displacement and homelessness. People with lower incomes also have higher rates of mental health disorders.

It’s a circular argument Lift UP SF seeks to disrupt.

The training program specifically reaches into these under-employed consumer groups to provide more than a living wage. An increasing economic outlook seeds hope, and a career trajectory positions consumers—people like those exiting PRC’s 30/60/90 day treatment programs or in our co-op living around the city—to progress through the continuum of care and transition successfully to independent living.

As a result, not only do we expect to decrease unemployment among Bay Area residents impacted by mental illness, substance use disorder, and/or HIV/AIDS and to expedite treatment program exits making room for more people to access needed treatment services, Lift UP SF will develop a diverse, representative pool of qualified, culturally competent staff to help alleviate the worker shortage in behavioral health settings across San Francisco and beyond. PRC’s program launches with more than 17 partners—from Castro Country Club and the City of San Francisco Community Behavioral Health Services to Native American Health Center, Mission Neighborhood Health Center, and Alameda and Contra Costa County Behavioral Health Programs—already signed on and seeking to fill already identified peer staffing shortages across public mental health services.

Want to know more? Contact our Workforce Development team.

Want to contribute to support innovate solutions, like Lift UP SF? Donate here.

Keep Reading the Fall 2019 Frontline

Moving People Forward: 2019 Impact Report

Posted on August 10, 2019September 23, 2020 by Katharine Berg

Dear Friend,

It’s been a tremendous year at PRC, and I’m pleased to share PRC’s 2019 Impact Report with you today.

As you’ll learn, PRC’s staff, volunteers, and clients have been hard at work transforming lives and the systems San Francisco has in place to support vulnerable adults. We opened PRC’s new Integrated Service Center in April 2019 to improve the way people affected by mental health issues, substance use, and HIV/AIDS access crisis intervention, stabilizing services, and longer term supports when they’re needed. In 2018, we helped 5,419 adults.

At PRC we’re addressing the nexus of poverty, stigma, discrimination, and isolation head-on to prevent hopelessness and connect people—like John on page 5 or Liliana on page 7—with new and better paths out of poverty and addiction, illness and stigma, homelessness and decline.

Honesty and innovation are key to moving past the status quo. In San Francisco, as across the nation, we are all challenged to reflect on a rising population of homeless adults and redress inequities in health and resource distribution. You and I may have a support network, a safety net, a couch, or access to money for treatment services or prescription medication when it’s needed. For those among us who do not, whether it’s a brief moment of free fall or a life-long health issue to manage and best, PRC is here: a bridge to hope, to health, and to wellness.

I invite you to read on, be inspired, bring your questions, and share with a friend.

In community,

Brett Andrews

Chief Executive Officer

PRC endorses U=U

Posted on June 24, 2019September 23, 2020 by [email protected]

SAN FRANCISCO (June 20, 2019) – PRC, whose nonprofit mission is to provide a variety of legal, social and health services to San Francisco residents affected by HIV/AIDS, substance use or mental health issues, has announced its official endorsement of the Undetectable equals Untransmittable (U=U) campaign. Whether one is affected by HIV or is HIV negative, it is important to know and understand U=U. The U=U campaign was born in New York City and has quickly spread across North America and the global community. The stigma associated with HIV remains one of the greatest barriers for people in accessing HIV prevention, testing, treatment, and support. PRC’s endorsement of U=U sends a clear message that sharing the knowledge regarding U=U with our San Francisco community is an urgent priority to save lives and fight stigma, as well as is a call to take action to help spread the message. U=U (Undectable equals Untransmittable) has unequivocally been supported by scientific evidence. It shows that, when an individual is in HIV Treatment and maintains a suppressed viral load, there is effectively no risk of transmission to their partner during sex. Through its partnership with Getting to Zero San Francisco, PRC is committed to preventing new HIV diagnoses and supporting people living with HIV to stay in treatment so they can live their best lives. Continued support of campaigns like U=U is critical to ending HIV-related stigma. This will help us achieve the goals of preventing new diagnoses, reaching undiagnosed individuals, and ensuring that people living with HIV receive the care, treatment and support they need. About PRC PRC (formerly Positive Resource Center) is a San Francisco-based nonprofit that helps people affected by HIV/AIDS, substance use or mental health issues better realize the opportunities available to them. PRC provides integrated legal, social, and health services to address the broad range of social risk factors that impact wellness and limit potential. In 2017, the organization merged with AIDS Emergency Fund (AEF), an emergency financial assistance provider for low-income residents living with HIV/AIDS, and Baker Places, an agency that provides a comprehensive array of residential treatment services to people with mental health, substance use, and HIV/AIDS-related issues. Combined, the three organizations represent a 115-year history of service and serve approximately 5,000 clients annually. For more information, please visit www.prcsf.org

Covered California: Tax Filing Requirement for Consumers Receiving Premium Assistance

Posted on April 23, 2019September 23, 2020 by [email protected]

Some Californians, individuals, and families enrolled in Covered California (Covered CA) plans are eligible for financial assistance to lower the cost of their health insurance. Anyone who receives financial assistance with Covered CA is required to file a federal tax return as a condition of eligibility.

Covered CA offers two main ways to get assistance with health care coverage costs:

Premium Assistance (formally called the Advanced Premium Tax Credit or APTC) is a tax credit to reduce an individual’s monthly premium.
Cost-Sharing Reductions is a subsidy to reduce an individual’s out-of-pocket costs (their copay’s, coinsurance, deductible and out-of-pocket maximum).

Important Information Regarding Premium Assistance and Tax Filing

All Covered CA consumers who receive Premium Assistance/APTC, must file federal taxes for each calendar year they receive the assistance. If they fail to file their taxes, they will lose their eligibility for Premium Assistance/APTC. The consumer will then be responsible for paying the full premium amount and will have a higher cost-sharing for health care services.

Warning Notices

Covered CA has mailed warning notices to those who are at risk of losing their Premium Assistance/APTC. These notices were sent to consumers who in 2017:

Received Premium Assistance/APTC in the calendar year but did not file a federal tax return for that year;
Filed a federal tax return but did not include IRS Form 8962; or
Requested an extension to file a federal tax return but did not end up filing the return.

Covered CA consumers who fall within any of these categories will have until May 15, 2019, to preserve their Premium Assistance/APTC by reconciling their premium assistance and contacting Covered California to attest to having done so.

If consumers fail to take these steps, they will receive another notice, in a pink envelope, that tells them when their financial assistance will end if no action is taken. Covered CA consumers who fail to take corrective action will lose their current financial help starting July 1, 2019.

Open Enrollment Is Here!

Posted on October 16, 2018September 23, 2020 by [email protected]

This year’s health insurance enrollment cycle began on October 15, 2018, and ends on January 15, 2019. Enrolling is easy and may be done a number of ways:

online at Covered CA
by phone (1-877-453-9198)
in-person with one of San Francisco’s many enrollment workers.

Covered CA Basics

Covered CA is the state’s health insurance marketplace where consumers may purchase new insurance, change insurance plans, or renew existing insurance coverage. Qualified individuals may also receive financial assistance to help pay for health insurance costs.

Health insurance plans available through Covered California are organized by metal tier—Bronze, Silver, Gold, and Platinum. Plans in the higher metal tiers have higher monthly premiums, but smaller co-pays. All plans sold through Covered CA provide essential health benefits including outpatient care, hospitalization, prescription drugs, laboratory tests, mental health care, and emergency services. There are five health carriers who offer a variety of plans in the County of San Francisco: Blue Shield, Chinese Community Health Plan, Health Net, Kaiser, and Oscar.

Sign Up and Renewal Dates

Sign up by December 15, 2018, for coverage starting January 1, 2019
Sign up by January 15, 2019, for coverage starting February 1, 2019

Need Help Paying For Health Insurance Costs?

Californians who are HIV-positive may access health insurance cost-savings programs through the California Office on AIDS. The AIDS Drug Assistance Program (ADAP) and Office of AIDS Health Insurance Premium Payment Program (OA-HIPP) help pay insurance premiums, medication costs, and other out-of-pocket expenses. Enrollment into these programs must be done through a certified enrollment worker.

Get Help

Open enrollment can be a confusing time, regardless of who you are. If you are an HIV-positive San Francisco resident who needs assistance in exploring your options and/or enrolling in healthcare you can contact PRC for additional help and information: 415-777-0333.

Employer-Based Health Insurance Premium Payment (EB-HIPP) Program for ADAP Clients

Posted on June 21, 2018September 23, 2020 by [email protected]

On May 15, 2018, the Office of AIDS (OA) and AIDS Drug Assistance Program (ADAP) announced the implementation of an employer-based health insurance premium payment (EB-HIPP) Program. New and existing ADAP clients who are enrolled in an employer-based health insurance plan are now eligible to receive premium assistance for their portion of their insurance premium.

EB-HIPP will pay medical and dental premiums, and it will also pay for vision premiums that are included in a medical or dental premium. EB-HIPP It will also pay the even pays for medical out of pocket (MOOP) expenses!

Eligibility for EB-HIPP is based on the following requirements:

Be enrolled in ADAP
Be employed and enrolled in an employer-based insurance program
Employment verified with paystub dated within last three months
The employer must agree to participate in the EB-HIPP program

Medicare Part D Premium Payment Program (MDPP) Now Offers Medigap Premium Payment Program for ADAP Clients

Effective June 14, 2018, the Office of AIDS (OA) and AIDS Drug Assistance Program (ADAP) has also expanded their MDPP Program benefits to include payment of Medigap premiums. Medigap insurance is private insurance that helps pay for some of the health care costs that are not covered by traditional Medicare, such as copayments, coinsurance, and deductibles. New and existing MDPP clients will now be eligible to receive assistance with their Medigap insurance premiums, as well as medical out of pocket (MOOP) expenses for Medicare outpatient claims.

Note: EB-HIPP must pay the client’s portion of their premium in order for the client to receive MOOP benefits

Latinx LGBTQ+ Mental Health

Posted on March 16, 2018September 23, 2020 by [email protected]

Each Mind Matters¹(EMM) recently collaborated with a group of LGBTQ+ community leaders and stakeholders to come together and create informational materials on mental health issues faced by Latinx LGBTQ+. The materials focus on three key segments: young adults, older adults, and providers working with Latinx youth.

Latinx LGBTQ+ Youth Mental Health Provider Fact Sheet²

This fact sheet helps providers working with Latinx LGBTQ+ youth address the complex connections that can have an impact on a young person’s life, such as sexual orientation, gender identity, race/ethnicity, and immigration status. The fact sheet provides relevant resources and best practices within a culturally responsive framework.

EMM also created a fully bilingual in Spanish and English resource online, which covers key terms for providers working with Latinx LGBTQ+ youth, things to consider as mental health professionals serving Latinx LGBTQ+ immigrant youth, and seeking benefits. At this time there are no printed copies available; however, the pamphlet is available free to download³.

EMM website is a resource for mental health and LGBTQ+ topics:

Latinx LGBTQ+ Youth Handbook⁴
Be True and Be You: A Basic Mental Health Guide for LGBTQ+ Youth⁵ Discusses caring for mental health as an LGBTQ+ young adult including topics such as sexual orientation, gender identity, coming out, healthy relationships, common mental health challenges, and symptoms.
LGBT Mental Health and Aging Support Guide⁶ Provides information on mental health for older LGBTQ+ adults on topics such as considerations around caregiving, legal affairs, rejection, and discrimination.