AIDS service agencies say new requirements delay care, scare clients and work against getting people with HIV into treatment
The Department of State Health Services has implemented new requirements for anyone accessing AIDS services from local agencies under federal or state grants administered by the county. That includes Ryan White money and the AIDS Drug Assistance Program or ADAP.
Those new requirements, according to some local service providers, are creating even more roadblocks for those with HIV seeking healthcare. (Several area agencies provided information for this story, but all asked for anonymity out of fear of retribution from the county or the state.)
In this new program, called Modified Adjusted Gross Income or MAGI, clients must show their federal income tax returns, which limits how an agency can qualify someone. Previously, agencies could deduct expenses like child care, out-of-pocket medical expenses, dependents, assistance for handicapped family members and more. Now, only if those items were deducted on a tax form can they be considered in qualifying new or existing clients.
If a client comes into an agency to apply for services and doesn’t have the necessary tax forms or didn’t file taxes, the agency must request the form from the IRS.
One person responsible for that at one agency said if something is different on the form, such as the address, it’s rejected and returned.
The rejection goes to the client. That client must contact the agency again and re-apply. For clients that are homeless, these rules can be especially problematic.
Taxes aren’t due until April 15 each year, and returns aren’t available for the agency to order for another few months. That means that agencies currently are receiving 2014 tax returns. A person’s income and health can change dramatically during that period of time.
Any information not given exactly as it appeared on the tax form might cause a rejection. One agency’s client manager said he’s seen an application rejected because one form listed the applicant’s address as Cedar Springs, and another form listed it as Cedar Springs Road.
He said names can also cause problems, especially for Hispanics that often use their mother’s and father’s last names, but don’t always use both. And since many of the people accessing services are homeless or couch surfing, remembering which address they were at two years ago on the date they filed their tax return, if any, is problematic.
The new regulations also create new barriers for people with mental health issues. The IRS simply intimidates most people. One case manager said after receiving rejections for technical reasons on the application, those with mental illness can be so frightened they don’t return to re-apply and so receive no health care.
Sometimes a client is applying with an agency to receive certain services. The agency has unrestricted money to cover the client until their documentation can be completed. But those applying for medication through ADAP (AIDS Drug Assistance Program) may have to wait until they qualify. That means that person becomes sicker and is more likely to infect someone else, because the longer someone remains off medication, the more damage is done to their immune system.
And until their viral load count becomes undetectable, he or she is more likely to infect other people, which multiplies the costs in HIV care.
Some agencies are paid to enroll clients. Under MAGI, every agency must verify information. Smaller agencies are hit harder by this requirement, because they get no funds reimbursed to pay the person collecting the information.
One agency director was more optimistic about the program, saying MAGI was rolled out before it was ready but that changes will be made to make it more effective.
The state surveyed agencies using the system in 21 markets around the state. Of those responding to the survey, 60 percent found the system difficult or very difficult to use, while just 1 percent found it very easy. The survey showed 90 percent had difficulty obtaining paperwork.
Most agreed the process hasn’t gotten any easier since implementation.
“Too many steps needed to complete financial eligibility when a simpler process was used before,” one agency wrote on the survey to the state.
Asked how easy has it been to obtain tax transcripts, 77 percent said difficult or very difficult. For those clients who didn’t file tax returns, receiving a statement of non-filing was equally difficult.
One agency director compared MAGI to the trans bathroom issue, calling it a solution in search of a problem. He said in all his years working with people with HIV, he’s never seen clients fraudulently obtaining services from his agency.
This article appeared in the Dallas Voice print edition May 13, 2016.