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HIV: PRACTICAL MATTERS-FINANCING MEDICAL CARE: PUBLIC PROGRAMS FOR FINANCING HEALTH CARE-MEDICAID

Saturday, July 2nd, 2011

Help with financing health care is offered by both state and federal governments. One kind of help, called Medicaid, is available to those who are indigent; that is, people who are unable to support themselves. The other kind of help with finances is called Medicare. Medicare is an add-on to Social Security benefits. Therefore, if you are over sixty-five years old, or are disabled by Social Security standards, and if you are eligible for Social Security benefits, you should qualify for Medicare.     Medicaid-Medicaid is a combination of state and federal programs for medical care of those who are indigent. Both state and federal governments therefore dictate the requirements for eligibility and for benefits. Medicaid is the major third-party payer for people with HIV infection. Whether you qualify as indigent, what services are available, and how much money you are eligible to receive, all vary from state to state.     The definition of indigence is, in general, stringent. It ranges from an income that is 23 percent of the poverty level in South Dakota to one that is 97 percent of the poverty level in California; in thirty-four states, the definition is 50 percent of the poverty level. In other words, if the poverty level is around $7,000 per year for one person, then most states will find you eligible for Medicaid if your income is $3,500 per year or less. Some states have a definition of indigence with a higher income level for people with AIDS; that is, people with AIDS can qualify for financial help from public funds and still be relatively able to support themselves. Some states also have definitions of indigence that are substantially higher for women who are pregnant and for children.     In defining indigence, Medicaid also considers resources you have other than income. To be considered indigent, you may have liquid assets (for instance, a savings account), a car, a house, or other property only if their values are below a certain level. What that level is differs in different states.     Medicaid pays for most medical necessities, but pays relatively little for each one, especially for physicians’ fees. It pays for inpatient services, outpatient services, and skilled nursing home services. In some states, Medicaid also pays for home health care, private nursing, and drugs. Some states pay for as few as fourteen days of hospital care; some states have no limit. Some have special programs for people with HIV infection. Professional fees such as physicians’ bills are usually reimbursed at only about 20 percent of the physicians’ customary charges. As a result, unfortunately, many physicians do not accept patients who are on Medicaid. Home care, hospital care, and chronic care are also reimbursed at low rates, and some facilities will reject Medicaid patients on similar grounds.     Medicaid will pay for all drugs, but often restricts payment to drugs that the FDA has approved and sometimes pays only for conditions the drug is specifically approved for. This means that if a clinical trial shows a drug is useful, Medicaid will not pay for the drug until the FDA has approved it. If the FDA has approved the drug but has not approved it specifically for a certain condition, Medicaid may deny payment until the drug is approved for this condition.*207\191\2*

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HIV INFECTION AND ITS EFFECTS ON INTERPERSONAL RELATIONS: RELATIONSHIPS WITH YOUR CHILDREN-PROBLEMS WITH TELLING

Tuesday, April 19th, 2011

Many of the problems people with HIV infection have with their children are, on the surface, the same problems they have with any other relative: how to tell them about the infection, how to deal with their worries, how not to be a burden on them. Under the surface, however, the problems are complicated by the uniqueness of the parent-child relationship. Parents and children are not equal partners in a relationship. Parents take care of children, not the reverse. Young children truly are helpless and cannot care for their parents. Older children may be unable emotionally to care for their parents, or the parents may be unable to accept care.     Problems with Telling-In many ways, telling your children about HIV infection is different from telling most other relatives. People feel responsible for their children; they want to protect them against fear and worry and life’s hard facts. They think of themselves as their children’s safe haven, and they want to avoid bringing uncertainty into their lives. As a result, many people decide to put off telling their children until they have to. They will have to tell, they say, if they get an AIDS-defining illness. “With this virus,” said Helen, “you don’t know anything definite about the future. I have two kids, aged sixteen and seventeen, who live with their father. I will only tell them if I start getting really sick. They would be anxious, a little for themselves even, though they would believe I wouldn’t hurt them. They’d be anxious about my dying.” Dean also has a child by an earlier marriage: “I have a son, who’s pretty well grown now. He knows about me. I told him only when I hit the AIDS stage.”     Sometimes, in spite of their plans, people find that they must tell their children even before their first AIDS-defining illness. People in the stage called ARC are often fatigued and bothered with many minor illnesses. The children, who always see more than they seem to, sense that their parents are unwell and preoccupied. The children worry. Sometimes they suspect the truth; sometimes they come to entirely wrong conclusions.     One mother had two children she wasn’t telling about her diagnosis. The children noticed her frequent sicknesses and doctor appointments, talked to each other about it, and decided she was dying of cancer. The children were upset: one child became a workaholic, going to school and then working into the night until early the next morning; the other got into trouble at school. When their mother finally told them she was infected with HIV and wasn’t dying any time soon, they were almost relieved. At the least, they no longer had to deal with uncertainty.     Telling your children you have HIV infection usually also means telling them how you got the virus. People want their children to respect and look up to them. They don’t want to look vulnerable or fallible. Most people, however, get infected in ways that society judges harshly: through using drugs intravenously or through gay sexual relations. Often people have hidden these behaviors from their children. People worry their children will make the same judgment society makes, and reject them. Drug users especially worry that they have set a bad example. Helen is proud that her children do not use drugs and have never seen her use drugs: “I’d rather die than lose my kids’ respect,” she said. One couple with two children told them that the father (who had HIV infection) had cancer. Several years before, the father had experimented with bisexuality and had become infected. Both parents were ashamed of this. The mother said she didn’t want them to see her as a secret-keeper, but she couldn’t tell them their father is bisexual.     Dean and his eighteen-year-old son managed to resolve the issue of homosexuality the way Dean and his parents resolved it. He talked openly and lovingly about his life and his son’s place in it, and his son’s relation to his partner. “Now my son just accepts it,” Dean said. “He says, ‘Dad is gay and has AIDS.’ He brings his friends to our house. When the kids are around, my partner and I hold back our normal affections and don’t use terms of endearment with each other.” Sometimes children have more trouble with the situation than Dean’s son, and are upset at their father’s bisexuality. Sometimes they dislike their father’s partner.     In general, people find telling the truth works out best. They naturally feel sadness and guilt and regret about the truth, and those feelings will complicate how they talk to their children. They find that the simplest truth works; they say things like, “You know I used to have a drug problem. At that time, I did things I wasn’t proud of, and I got AIDS.” Children in their teens understand this sort of information best.
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