General Eligibility:

  • HIV Positive
  • Income between 100% & 250% FPL (exceptions noted below for <100% & up to 350% FPL)
  • County residency must be in, Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis or Williamson
  • Must have been previously denied or found ineligible for ADAP/SPAP assistance
  • HIA funds are considered ‘payor of last resort’ funds, therefore, patient/client income and expenses must demonstrate an inability to afford the assistance amount requested
  • Copay or deductible must be for HIV-related medications or related conditions. (Diagnosis and/or treatment of said condition(s) or illness(s) or provision of the medication should aim to maintain or improve positive health outcomes, and should easily illustrate the connection of a continuum of care in the ongoing management of HIV disease the patient’s HIV)
  • Medication must be prescribed by a doctor or other medical provider
  • Copy of premium statement
  • Copy of insurance policy(s) or statement of benefits (premium only)
  • Copy of requested medication receipts (turned in after payment is made)

 

What is Covered:

  • Co-pays and deductibles for medications and services that are HIV-related
  • Health insurance premiums (including ACA Silver Plans, Medicare supplemental plans, and other costs effective private insurance plans)
  • COBRA premiums may be covered on a case-by-case basis through the next ACA enrollment period

 

What is Not Covered:

  • Prescription costs associated with Medicare Part D “donut hole” (LIS, SPAP)
  • Medication not covered by the insurance plan
  • Medicare premiums that are automatically deducted from client’s social security award (must receive a separate invoice or premium statement)
  • Non-Silver level ACA insurance plans
  • Premiums for vision, life insurance or EAP benefits
  • Emergency services
  • Inpatient services

 

Additional Information: Assistance may not be guaranteed and is based on funding availability.  Eligibility and assistance guidelines are subject to change without notice.  Assistance for clients with income between 250% -350% FPL may be provided on a sliding scale basis.

 

Potential clients should contact HIA program staff listed below to be screened for program eligibility.

 

Sheira Gentle, Health Insurance Coordinator, (512) 406-6121                

Vanessa Ricones, Programs Specialist, (512) 406-6152

Maria Esquivel, Health Insurance Specialist, (512) 406-6129