Health Care: Q & A

Case Management

Question: My client needs case management and our program doesn’t have funding for a case manager for a Hepatitis B or C mono-infected patient. Is there any resource that can help?

Answer: Most health insurance plans, including Medicaid Managed Care plans, have a ‘Care Management’ service. Call the plan on the plan using the member services phone number on the back of the patient’s membership card and ask if you can enroll the patient in ‘Care Managment.’


Question: The Prior Authorization for Hep C medications is is extremely difficult! Is there any resource that can help reduce the confusion and time?

Answer: Many providers have noted this problem. Try using this service: CoverMyMeds helps physicians and pharmacists complete Prior Authorization and other insurance coverage determination forms for any drug and almost all drug plans.


Question: My client cannot afford to pay Medicare Part D and therefore has no prescription coverage. Is there support available for patients who need help covering the premium for Medicare Part D?  Are there resources they can apply for in NY State?

Answer: They should contact the HIICAP program for assistance.  In NYC they can be reached through 311.  The statewide number is 800-701-0501.  Social Security and the Medicare Rights Center also provide help with this.  There are income limits for the assistance programs offered which would include the “Medicare Savings Program” and “Extra Help” for Part D.


Question: My patient is an undocumented immigrant and needs care for his hepatitis, where can he go to get care he can afford? Is he at risk for deportation if he goes to a government hospital?

Answer: Public Hospitals (HCC) and Federally Qualified Health Centers (FQHC) must provide care regardless of ability to pay. Medical institutions will not report patients to immigration services. Learn more….


Question: A HCV+ patient who has cirhossis and may need a liver transplant was denied Medicaid due to $300 surplus from unemployment insurance. He can not afford to purchase private health insurance, and definitely needs medical care that is more expensive than he can pay out of pocket. What can he do?

Answer: Your patient may be eligigble for the Medicaid Excess Income (“Spenddown” or “Surplus Income”) Program . Take a look at the info on this webpage, and also consider contacting Self Help Legal Services.

Have a question or issue? Ask us! We will try our best to provide you with the answer!

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