Health Care Access & Meds

Medicaid Buy in Program for Working People with Disabilities

Single person can make up to approximately 56,000 a year and still maintain Medicaid.

Medicaid Excess Income (“Spenddown” or “Surplus Income”) Program

Emergency Medicaid for undocumented immigrants.

Community Health Advocates

NY Statewide program to help people of all ages find insurance and resolve insurance issues with help available in multiple languages from community partners (888) 614-5400.

NYS Office of Health Insurance Programs

Email: omcmail@health.state.ny.us

NYS Department of Financial Services Insurance Department – Consumer Assistance Unit

Toll free: 1-800-342-3736 (NY)
consumers@ins.state.ny.us
www.dfs.ny.gov/complaint

Public Hospitals (HHC) and Federally Qualified Health Centers (FQHC)

provide care regardless of ability to pay. To find hepatitis clinics in these systems, see the online Site Locator.

HHC Options

Through HHC Options, low and moderate-income NYC Public Hospital (HHC) patients can get affordable healthcare. HHC helps patients apply for public health insurance programs for which they may qualify. If a patient is not eligible for public insurance, we reduce the patient’s fee to an affordable amount, based on family size and income. For example, a child in a family of four whose annual income is between $57,626 and $69,150 can be seen at an HHC hospital or clinic for a fee of $15 per visit.

Clinical Trials.gov

Some trials are open to people without health insurance.

Community Health Advocates offers resources to assist providers and patients in filing appeals, fair hearings and grievance or complaints.

Give them a call to get started: 800-614-5400.

1. Appeal: A treatment denial can be appealed. Medical providers and patients can contact the health insurance company using the phone number on the back of the membership card to file an appeal.
2. Fair Hearing: If the treatment is still not approved after the appeal,  a Fair Hearing can be requested. A Fair Hearing is a chance for you to tell an administrative law judge why you think your health insurance should cover your treatment.
3. A grievance or complaint should  be filed if a recommended medication is denied. Filing a grievance or complaint is the only way health insurance regulators will know there is a problem with patient care.
4. Report it to the Health Care Bureau. The NYS Attorney General’s office requests that all patients, their doctors, or their representatives make a call to the Health Care Bureau’s toll-free helpline 1-800-428-9071 or fill out a complaint form if they feel they have been wrongly denied coverage for their Hep C treatment medications.

Other helpful resources

• Legal Aid Society – Health Law Unit and Services Hotline: 888-663-6880
• NY State Department of Health’s Managed Care Hotline: 1-800-206-8125
• NY State Department of Financial Services: 1-800-342-3736
• NY State Attorney General’s Health Care Bureau: 1-800-428-9071
• Contact the New York State Medicaid Pharmacy Benefit (NYRx) for help with coverage issues NYRxEO@magellanhealth.com or call the helplines for members/patients 855-648-1909 and providers 800-343-9000. If issues persist contact NYS Department of Health Medicaid Pharmacy Program at ppno@health.state.ny.us to investigate.

Cover the cost of medications or co-pays

Pharmaceutical Patient Assistance Programs

• Pharmaceutical Assistance Programs: Hepatitis B. Positively Aware.
• Harvoni and Sovaldi Gilead Support Path Program
• Gilead U.S. Patient Access
• Bristol-Myers-Squibb All in One Access Program for Baraclude
• Zepatier Merck Patient Assistance Program
• Asegua Therapeutics (generic for Epclusa and Harvoni): Patient Support
• AbbVie Patient Assistance

Prescription Assistance 360

Partnership for Prescription Assistance Programs

Brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients without prescription drug coverage get free or low-cost medicines through the public or private program that’s right for them.

Patient Access Network (PAN)

Independent non-profit organization that provides assistance to under-insured patients for their out-of-pocket expenses for life-saving medications. Has Hep B & Hep C assistance!

NeedyMeds

Non-profit information resource devoted to helping people in need find assistance programs to help them afford their medications and costs related to health care.

Chronic Disease Fund

Non-profit charitable organization that helps people with chronic disease, cancer and other life-altering conditions obtain the life-savings medications they need. Disease states may open and close throughout the year as funds are diminished or become available.

RxAssist

Comprehensive database of patient assistance programs, as well as news and practical tools.

Patient Advocate Foundation

Case Managers can assist patients and providers with  medication assistance program applications. Program is able to cover hepatitis B medication co-pays up to $4,000 per year and $24,000 per year for hepatitis C medications.

Harbor Path

Provides a single site for all patient assistance program applications for both HIV and HCV medications.

Healthwell Foundation

Their newly formed hepatitis C co-pay assistance program can provide up to $15,000 to eligible patients who are insured and have an annual household income of up to 500% of the federal poverty level.(800) 675-8416