Raeline Nobles

The Institute of Medicine is recommending new guidelines to determine whether someone with HIV qualifies for Social Security.

The new recommendations reflect new treatments for the virus but in the wrong hands could be used to discriminate against those who need disability payments to survive.

These are the changes that would qualify someone as eligible for Social Security disability payments:

• A CD4 (white blood cell) count at or below 50 cells per microliter of blood, a threshold that indicates an advanced stage of illness
• One of a few rare but fatal or severely disabling HIV-associated conditions, such as dementia or certain types of AIDS-related cancers. The committee advises that benefits for these diseases should be permanent.
• An HIV-associated condition, such as heart disease or hepatitis, that is already covered by another section of SSA’s full Listing of Impairments
• An HIV-associated condition, such as wasting syndrome, that is not already included in another section but that significantly impairs a person’s ability to function.

The biggest change to the regulations would be that people with HIV would qualify for disability for three years and would have to re-apply. That change would apply only to new applications, not to those already receiving disability.

AIDS Arms Executive Directors Raeline Nobles said current regulations allow disability for people with a CD4 count of 200. She said that she sees many people now who can get along OK with a CD4 count of 100.

“But politically, it might be a way to cut some expensive corners,” she said.

She said reassessing over time might be reasonable.

“Over time some do get better,” she said. “But 50 seems awfully low to me.”

Rafael McDonnell, a spokesman for Resource Center Dallas who alerted us to the changes, said the center likely will release a statement about them next week.