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Financial Concerns
Several government entitlement programs are available to people with symptomatic HIV or AIDS. The rules and regulations for applying may seem overwhelming, but once you have a basic understanding of the programs you can make the system work for you. It is important to seek advice and information so that you will receive the maximum benefits available.
The best time to plan for disability and other entitlement programs is before you leave work. Although you cannot apply for benefits until you have stopped working, start to educate yourself now.
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New York State Disability (NYSD)
NYSD is a short-term benefit for people who have left, or must leave, their jobs due to illness or disability. If you are currently working but need to leave your job because of your health, or if you have recently left your job, or if you are receiving Unemployment Insurance Benefits, you may qualify for NYSD.
Eligibility
- You are probably eligible if:
You worked for a covered employer for four (4) weeks or more before your disability or illness began;
and
The first day you were disabled occurred within 28 days of the last day you worked;
and
A doctor will sign a statement that you are unable to work because you are sick and verifies the date your disability began;
and
You file a claim within four (4) weeks after you quit working;
or
You have a valid excuse for missing the deadline, such as being in the hospital.
You are probably not eligible if:
You are self-employed;
or
You work for the government, the railroads, the maritime industry, or religious and certain nonprofit organizations.
If you are on unemployment, you are probably eligible if:
Your disability began during the 26-week period in which you were receiving benefits;
and
You file a claim within twenty days after your disability began;
or
You have a valid excuse for missing the deadline, such as being in the hospital.
You cannot collect unemployment and NYSD at the same time. You must stop unemployment before NYSD begins. You must file for NYSD within 26 weeks of your last day of employment.
- Deadlines for Applying
- You should apply for NYSD within four (4) weeks of the last day you worked. If you are in the hospital or are physically unable to apply during this period, you may still apply after the fourth week, but you will have to fill out a different application and explain why you were unable to apply in time.
- Benefits
- The amount you receive is based on your average weekly wage during the last eight (8) weeks of your employment. Payments are calculated starting from the eighth day you are continually disabled. Your benefit is 50 percent of your weekly earnings, up to a maximum of $170 per week. You will usually receive a check by mail every two weeks. You may receive benefits for up to 26 weeks. NYSD does not include any medical benefits. Your first check should arrive three to four weeks after you submit your application.
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Social Security Disability (SSD)
SSD pays monthly checks to people who have worked and paid into the Social Security program and are now disabled. If you have worked on the books or paid FICA taxes most of your working life, you should apply for SSD. You should apply at the same time you apply for NYSD.
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Eligibility
- You are probably eligible if:
You are disabled and unable to work;
and
You are over 31 and you worked on the books for five of the last ten years;
or
You are between 24 and 31 years old and worked one-half of the time between turning 21 and the date you became disabled;
or
You are under 24 and have worked at least a year and a half.
You are probably not eligible if:
You have not paid enough FICA taxes;
or
You worked for the government, the railroads, the maritime industry, or religious and certain nonprofit organizations.
- Deadline for Applying
There is no filing deadline for SSD. Try to file within six months after you become disabled. Payments begin five months after the date on which medical records show you became disabled. The easiest way to file for SSD is to apply by phone using the SSA Teleclaim Number, (800) 772-1213.
It is very important that you indicate on your application the very first date you were unable to work because of HIV-related illness. Even if your employer paid you after this date, your eligibility begins the first day you physically could not work or your normal working pattern became disrupted. Social Security will then base the five-month waiting period on that date rather than on the date you stopped working or receiving a salary.
- Required Documents
- Certified birth certificate;
Green Card or Naturalization Papers;
W-2 forms or tax statements from last two (2) years you filed taxes;
Social Security Card;
Last (most recent) paycheck stub.
- Benefits
- Your SSD benefits are determined by a formula based on the amount of money you paid in FICA taxes during certain periods of on-the-books work.
If you receive SSD payments for more than two (2) years, you automatically become eligible for Medicare benefits. Benefits last as long as you are disabled.
If your application is denied, or your benefit amount is lower than you think it should be, you can appeal. Once you receive your award letter stating when your checks will begin and how much you will receive, you may be eligible for Food Stamps, the Medicaid Surplus Spend-Down Program, or benefits from the Division of AIDS Services.
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Supplemental Security Income (SSI)
SSI is a Federal program run by Social Security. It pays monthly checks to people who are disabled and who have few assets and low income. If you do not have more money and/or assets than allowed, you should apply for SSI benefits at the same time you apply for SSD benefits. Even if you do not qualify for SSD benefits, you may qualify for SSI.
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Eligibility
- To be eligible for SSI, you must not be working. You are probably eligible if:
You are disabled and unable to work. It doesn't matter how long you worked or if you have ever worked at all;
and
You don't have more money, financial assets, or property than is listed below (for a single person living alone):
$2,000 as cash, money in any bank or money market fund, or investments in stocks, bonds, IRAs, etc.;
Any life insurance policy with a maximum cash-in value of $1,500;
$1,500 in a special burial fund account at a bank;
A car worth a maximum of $4,500 in blue book value;
A house, condo, or co-op that you live in, and its adjacent land, no matter what it is worth. The home you live in is considered your primary residence, and it is not considered an asset.
- If you are married or live with your family, the allowances are different.
Deadline for Applying
- There is no deadline, but the sooner you file a claim the better. SSI claims are based on the date you file -- your 'protective filing date.' This date affects the amount of money you will get. Be well informed before filing in order to get the maximum benefit you are entitled to.
The easiest way to file for SSI is to apply by phone using the SSA Teleclaim number, (800) 772-1213. Later, you will receive a computer printout confirming your application and the assets you have reported. You will have to sign this paper verifying that it is correct.
- Required Documents
- All those documents described under Social Security Disability and
Original copies of your three (3) most recent checking/banking statements;
All passbooks of any savings accounts you own or share;
Original copy of your apartment lease or a letter from your roommate;
Diagnosis letter from your doctor;
Rent receipt or canceled check;
Con Ed and other utilities bills.
- Benefits
- You will receive money, medical benefits, and possibly Food Stamps. The amount of money you get is based on your living arrangements and other sources of monthly income. The maximum benefit paid in 1993 was $520 per month for a single person in New York State. You will automatically get Medicaid benefits without applying for them separately. You will be eligible for Food Stamps, but you must send in a separate application for them. You may also be eligible for money from the Division of AIDS Services.
SSI benefits will continue for as long as you are disabled and your assets remain below the allowance listed. SSI benefits will stop when SSD or other benefits begin (if these benefits are higher than your SSI award). Your SSI benefits may also be adjusted to account for any other benefits you receive. Benefits are paid monthly.
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Income Support (IS)
Also called "Public Assistance" or "Welfare," Income Support is issued as an intermediary program for individuals who have no other source of income and who have applied for SSI and/or SSD. You may also be eligible if you owe back rent and are facing possible eviction. Most often, your "IS" benefit will continue only until SSI/SSD starts.
Eligibility
- You are probably eligible if:
You are in a severe financial crisis, facing eviction or a utilities cut-off;
and
Your maximum resources do not exceed:
$1,000 in cash, the bank, or any other "cashable" form;
A car worth more than $1,800 in blue book value;
Your home (provided you don't sell it).
- Required Documents
- All those documents described under SSD and SSI, plus any SSI, SSD, or other benefit award letter you may have.
- Benefits
- Income Support creates a monthly budge -- usually $354 for a single person -- plus a Medicaid card and $60-$80 in Food Stamps. Of this amount, $215 is considered as a rent allotment; the remaining $139 is for utilities and other expenses.
As a person with symptomatic HIV or AIDS, you may be eligible for an "enhanced shelter allowance." Instead of the standard $215.00 for rent you may be able to get up to $480.00 for rent from IS.
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Medicaid
Medicaid is a program that pays medical bills for eligible individuals and families who cannot afford medical care. Medicaid pays for hospital inpatient and outpatient services, laboratory tests and x rays, some physician's services, home nursing services, and private health insurance premiums.
- You can obtain Medicaid in any one of three ways:
- A hospital may arrange for it:
You get it automatically with SSI or Income Support;
You can apply directly for Medicaid.
- Medicaid is a complex program. As with other benefits programs, educating yourself in advance will save much time and energy.
Required Documents
- Birth certificate or other proof of age;
Eight (8) weeks of wage stubs (if you were/are working);
Social Security card;
Documentation of your income from SSI, VA, retirement funds, etc.;
Insurance policies (especially health insurance);
Three recent bank statements/savings account passbook;
Lease, letter from landlord, rent receipt, or canceled check;
Heat/utility receipts.
- Eligibility
- You are probably eligible if your maximum assets (money and property) do not exceed:
Your home (primary residence only -- not a second or vacation home);
Your automobile (if valued at under $4,500);
Your clothing, personal effects, furniture, and appliances;
Home, term, group, or other insurance with no face (cash) value;
A burial fund not exceeding $1,500.
Medicaid Income/Resource Levels
Monthly Family-Size Net-Income Resources (effective January 1, 1993)
Family size | Minimum income | Maximum income |
1 | $525 | $3,150
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2 | $759 | $4,550
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3 | $767 | $4,600
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4 | $850 | $5,100
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5 | $992 | $5,950
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6 | $1,134 | $6,800
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7 | $1,275 | $7,650
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8 | $1,417 | $8,500
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- Benefits
- Once you are eligible, you will receive a temporary paper Medicaid card; within thirty (30) days you will receive a permanent plastic card. It can be used to cover 100 percent of medical expenses at clinics, hospitals, drugstores, and laboratories, provided these agencies/suppliers accept Medicaid. Important: Not all doctors, drugstores, etc. accept Medicaid payments. If your doctor or drugstore, etc. does not accept Medicaid, you will not be able to submit that bill to Medicaid.
- Expenses Covered by Medicaid
- Hospital inpatient and outpatient services;
Laboratory tests and x rays;
Care in a skilled nursing facility or intermediate care facility;
Home health care (with approval);
Treatment and preventative health care by physicians and dentists;
Podiatrists;
Eye care;
Hearing aids;
Treatment in psychiatric hospitals and mental health facilities;
Family planning services;
Drugs, supplies, equipment, and appliances (such as wheelchairs);
Physical, occupational, and speech therapy;
Private duty nursing;
Clinic psychological services;
Transportation to Medicaid-participating facilities.
Medicaid will pay for medical bills incurred up to three months prior to your application. When you apply, submit bills for this period with all supporting financial records substantiating that you were eligible for Medicaid during this period.
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Food Stamps
Food Stamps provide additional buying power to low-income households in order to increase their food budget.
Eligibility
- Eligibility for Food Stamps is determined by a complicated system that takes into account your household income and your monthly household expenses including rent, utilities, and phone costs. If you qualify for SSI or IS (Public Assistance), you may get Food Stamps through these programs. If you do not get SSI or IS and you want Food Stamps, you will have to apply directly.
- Required Documents
- All those documents described under Supplemental Security Income, plus any SSI, SSD, or other benefit award letters.
- Benefits
- A monthly allotment of coupons to buy food (or to eat in a very few restaurants). If you live alone, you may receive as little as $10 or more than $100 in Food Stamps each month.
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Division of AIDS Services
The Division of AIDS Services (DAS) provides supplemental funds to those whose primary income is from SSI/SSD. Money from DAS is sometimes called a rent supplement.
Eligibility
- To qualify you must meet eligibility criteria for Income Support
and
have a CDC-defined AIDS diagnosis or symptomatic HIV;
and
need home care services.
To apply, have your doctor complete a Medical Request for Home Care Form (M11Q). This form is used by DAS to verify your diagnosis. Most doctors have these forms; if yours doesn't, contact GMHC Financial Advocacy at 212/807-7519 and we will mail one to you.
Not everyone is eligible for DAS funds even if they meet IS income/asset criteria. You can call the GMHC Financial Advocacy Hotline or another AIDS service organization to find out if you are eligible.
- Some Suggestions on Government Applications:
- Dealing with the various government agencies that control benefits involves miles of red tape and seemingly endless requests for documents and appointments. Don't let the systems intimidate you. You are entitled to certain benefits. You have the right to ask questions. If you are confused about something or are asked to do something you don't understand, ask for an explanation.
As you have seen, each entitlement program has a long list of documents you are required to submit with your applications. Although the list for each program varies (as noted above), some basics to locate right away are:
your birth certificate, passport, or baptismal certificate;
your Social Security card;
lease and rent receipts;
your W-2 or income tax return for last year; and
your three most recent bank statements.
When you call an agency to apply for benefits, follow up, or ask for information, keep a log of all the information you receive, particularly the date and the name and title of each person you speak with.
When you submit applications or other documents to any agency, make photocopies for your own file.
When you mail applications or documents to an agency, it's a good idea to send them by certified or registered mail with a return receipt requested.
Regarding your benefits:
If you share an apartment, you must be able to show that you and your roommate(s) share all costs (rent, utilities) equally and that you purchase and prepare food separately.
If you are no longer working, you must show some means of current support. This may be savings or loans from family or friends. You will be asked to provide letters from those loaning you money stating the amounts of the loans and that they expect to be repaid when your benefits are in place.
Do not transfer assets. Some people believe they can protect their assets and property by selling, giving away, or otherwise transferring their assets. They may do this to qualify for benefits based on income/assets. If the government finds out, benefits may be denied or reduced.
Generally, your benefit payments begin to arrive in one to two months for Income Support, Medicaid, Food Stamps, and New York State Disability; two months for Supplemental Security Income; five months for Social Security Disability.
Applying for benefits can be confusing and frustrating. Whenever you run into problems, have questions, or feel you are not receiving the right service, speak out. Don't hesitate to contact the benefits agency or an advocacy group. These are your benefits, and you're entitled to them!
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