Providing Assistance During Catastrophic Illness

1. Providing Assistance During Catastrophic Illness Julie C. Palas, J.D., Executive Director

2. The Commission The James “Tiger” Morton Catastrophic Illness Commission (JTMCIC) was created during the 1999 regular session of the West Virginia Legislature as a last resort for West Virginia citizens where death is imminent and no other resources exists. Commission members are Governor-appointed citizens from across the state. The Commission is administered through the Office of the Cabinet Secretary of WVDHHR. (A nurse, doctor, social worker, lawyer and two citizen members at-large)

3. James “Tiger” Morton The Catastrophic Illness Commission is lovingly dedicated to the memory of James “Tiger” Morton who was a: Helper of countless people in dire need of medical and personal assistance Respected ombudsman and legislative liaison, and a Compassionate and caring friend August 22, 1937 - December 27, 2000

4. The Need You may wonder, “Is the JTMCIC is still essential to assist West Virginians who have a life threatening illnesses after they have exhausted all other resources now that the Affordable Health Care Act is in effect and requires mandatory insurance coverage?” Well . . .

5. The Need (cont’d) . . . there are approximately 10% of our West Virginia citizens that are uninsured – about 116,000 individuals of our state’s population. Also, many West Virginians live just above the poverty level andare not eligible for state assistance benefits, but are struggling to afford insurance.

6. The Need (cont’d) With these facts, the picture becomes clearer that gaps in service still exist in providing treatment and life-saving procedures for those in dire need while facing a catastrophic illness. That is when the JTMCIC can step in to provide assistance to eligible applicants.

7. How to Apply The first step in applying for assistance is to call 304-558-9027. An application will be taken over the phone. We ask for the applicant’s demographics, source of income, assets, social security number, physician’s name, diagnosis, cost of treatment, etc. All information is confidential and protected. A decision will usually be made within one week.

8. Eligibility To be eligible for JTMCIC funds, a client must meet the following guidelines: Be a West Virginia citizen. Have a condition that meets the definition of Catastrophic Illness, which means there is an imminent risk of death if assistance does not occur. Have exhausted all other resources, including Medicaid and Hill-Burton Funds (Charity Care at hospitals - 3 remain at the Elgon Clinic/Elgon; Marshall /Huntington; WVU/Morgantown). Must apply for insurance through ACA

9. Eligibility (cont’d) In fact, before receiving assistance from the Commission – an eligible applicant must apply for and be denied coverage by Medicaid, and apply for insurance coverage through the Marketplace Exchange program of the Affordable Care Act. DENIED

10. Covered Expenses There are specific parameters for distribution of funds from the JTMCIC. A few examples are: Proven and accepted medical procedures Transportation costs for the approved medical procedure to medical facilities for patient and one family member Medicine that prevents rejection and/or reoccurrence of a life threatening illness

11. Non-covered Expenses There are specific expenses that are not covered by the Commission. A few examples are: Maintenance of acute prescriptions Durable medical equipment Experimental treatments and procedures Home modifications or remodeling Co-pays for those insured Medical bills more than one month old prior to application.

12. Additional Information Applications are accepted directly from a patient; however, involvement from the medical facility is preferred. The Commission makes direct payment to the provider of the service through the West Virginia Medicaid program. All services must be preauthorized through the Executive Director.

13. The Clients Paid Medicaid rate for medical treatment 64 year old female with colorectal cancer 52 year old male colon cancer patient who lost his insurance after losing his job due to cancer, covered 3 weeks until he was covered under his wife’s insurance. 31 year old female with heart disease 75 year old male requiring by-pass surgery 64 year old female with fallopian/uterine cancer

14. The Clients Paid transportation related expenses 4 year old male undergoing a bone marrow transplant, covered parent’s lodging and meals out of state 49 year old female lymphoma patient undergoing a bone marrow transplant, provided lodging post-surgery Over 1,000 in all -- also connecting clients to other entities’ services by providing referral assistance information, such as co-pay assistance nonprofits and local health providers.

15. The Client Survey AgesQofL before JTMCIC help? After? 10-19 1 # said 10 (highest) 12 28 20-29 3 JTMCIC helpful getting medical help? 30-39 1 # said 10 (highest) 50 40-49 4 Recommend JTMCIC to others? 50-59 19 57 (all who answered) 60-69 30Medicaid? Male 28 Yes 15 No 38 Female 30

16. The Client Survey Client Quote It would be nice if [the] fund were available to more people . . . The financial burden was extremely hard on my family and without the help [from JTMCIC], I am not sure what we would have done.

17. The Funding Funds are allocated each year from the WV Legislature. Initially received $1,000,000 a year and now the allocation is just over $100,000 a year. The Commission can accept contributions, gifts, property and grants from both private and corporate donors. As a 170(c) government entity providing for a public purpose, donations are tax-deductible.

18. The Hope As a reminder, in many cases before catastrophic illness occurs, there areways we can help ourselves – such as practice preventative behaviors to avoid illness and also to secure insurance through the ACA Marketplace Exchange or Expanded Medicaid coverage to provide the necessary coverage if and when major illness does strike. Learn about what options are available to you!

19. Contact Information QUESTIONS? Julie C. Palas, J.D. State Capitol Complex Bldg. 6, Ste. 850, Rm. 8D Charleston, WV 25305 Phone: 304-558-6073 Fax: 304-558-6640 Julie.C.Palas@wv.govwww.wvdhhr.org/cic Each of our lives weave together to make the fabric of our State stronger. Every life matters.