5435.01
September 2004
How the AIDS Medi-Cal Waiver Can Help You to Get the Care You Need At Home Instead Of In a Medical Facility
It provides home and community based services to persons with HIV/AIDS in their own home rather than in a hospital or nursing facility.
More people than you
think can qualify for help in the home under this waiver! For instance, the
waiver covers people whose T-cell count at any time was below 500 and where HIV
infection complicates another medical condition’s clinical course or
management. There are special more flexible eligibility criteria for children
under age 13.
You must:
§ Be diagnosed with AIDS or symptomatic HIV. See Attachment A, the Centers for Disease Control Classification for symptomatic HIV and AIDS definitions for Adolescents and Adults. For children under 13 years of age: be mild, moderate or severely symptomatic on the CDC Classification System for HIV Infection (See Attachment B);
§ Require the level of care provided in a hospital, nursing facility, or intermediate care facility and have a rating of 60 or less on the Cognitive and Functional Ability scale. (See Attachment C);
§ Be on outpatient status while receiving waiver services;
§ Be on Medi-Cal;
§ Not be enrolled in the AIDS Case Management Program or Medi-Cal Hospice; and
§ Exhausted other coverage similar to that available under this waiver.
§ Case management
§ Homemaker services such as meal preparation and
routine household care, grocery shopping etc…
§ Minor physical adaptations to your home such as
ramps, grab bars, and widening of doorways
§ Skilled nursing
§ Specialized medical equipment and supplies
§ Attendant care
§ Psychological counseling
§ Financial assistance for children/infants in
foster care
§ Nutritional supplements
§ Non emergency transportation
§ Meals
delivered to your home
§ Nutritional counseling
Fill out an AIDS Waiver application form. The form can be obtained by contact the AIDS Waiver Agency in your area. See Attachment D.
Protection & Advocacy, Inc.
tel. 213/427-8747, fax 213/427-8767, tyy 800/781-4546
toll free 800/776-5746
CD4+ T LYMPHOCYTE CATEGORY 1, 2, OR 3
NOTE: The lowest accurate, but not necessarily the
most recent, CD4+ T-lymphocyte count should be used for classification
purposes. So, If you once had a 500 CD4+ T-lymphocyte
count and it is now above 500, you can still use the 500 reading and qualify
under Category 1. You will still need to qualify under Clinical Category A, B or C.
Category 1:
greater than or equal to 500 cells/mL; OR
Category 2:
200-499 cells/Ul; OR
Category 3:
less than 200 cells/uL
Category A: one
or more of the conditions listed below in someone 13 years or older with
documented HIV infection. Conditions listed in Categories B and C must not have
occurred.
§ Asymptomatic HIV infection
§ Persistent generalized
lymphadenopathy
§ Acute (primary) HIV infection with accompanying
illness or history of acute HIV infection
OR
Category B
consists of symptomatic conditions in an HIV-infected adolescent or adult that
are not included among conditions listed in clinical Category C and that meet
at least one of the following criteria: a) the conditions are attributed to HIV
infection or are indicative of a defect in cell-mediated immunity; or b) the conditions are considered by physicians
to have a clinical course or to require management that is complicated by HIV
infection. Examples of conditions in clinical Category B include, but are
not limited to:
§ Bacillary angiomatosis;
§ Candidiasis, oropharyngeal (thrush);
§ Candidiasis, vulvovaginal; persistent, frequent, or poorly responsive to therapy
§ Cervical dysplasia (moderate or severe)/cervical carcinoma in situ;
§ Constitutional symptoms, such as fever (38.5 C) or diarrhea lasting greater than 1 month;
§ Hairy leukoplakia, oral;
§ Herpes zoster (shingles), involving at least two
distinct episodes or more than one dermatome;
§ Idiopathic thrombocytopenic purpura;
§ Listeriosis;
§ Pelvic inflammatory disease, particularly if
complicated by tubo-ovarian abscess; and
§ Peripheral neuropathy.
For classification purposes, Category B conditions take
precedence over those in Category A. For example, someone previously treated
for oral or persistent vaginal candidiasis (and who
has not developed a Category C disease) but who is now asymptomatic should be
classified in clinical Category B.
OR
Category C: includes the following clinical conditions:
§ Candidiasis of
bronchi, trachea, or lungs;
§ Candidiasis,
esophageal;
§ Cervical cancer, invasive;
§ Cervical cancer, invasive;
§ Coccidioidomycosis, disseminated or extrapulmonary;
§ Cryptococcosis, extrapulmonary;
§ Cryptosporidiosis, chronic intestinal (greater than 1 month's duration);
§ Cytomegalovirus disease (other than liver, spleen, or nodes);
§ Cytomegalovirus retinitis (with loss of vision);
§ Encephalopathy, HIV-related;
§ Herpes simplex: chronic ulcer(s) (greater than 1 month's duration); or bronchitis, pneumonitis, or esophagitis;
§
Histoplasmosis,
disseminated or extrapulmonary;
§ Isosporiasis, chronic
intestinal (greater than 1 month's duration);
§ Kaposi's sarcoma;
§ Lymphoma, Burkitt's
(or equivalent term)
§ Lymphoma, immunoblastic
(or equivalent term);
§ Lymphoma, primary, of brain;
§ Mycobacterium avium
complex or M. kansasii, disseminated or extrapulmonary;
§ Mycobacterium tuberculosis, any site (pulmonary or
extrapulmonary);
§ Mycobacterium, other species or unidentified
species, disseminated or extrapulmonary;
§ Pneumocystis carinii pneumonia;
§ Pneumonia, recurrent ;
§ Progressive multifocal
leukoencephalopathy;
§ Salmonella septicemia, recurrent;
§ Toxoplasmosis of brain; and
§ Wasting syndrome due to HIV.
For classification purposes, once a Category C condition has
occurred, the person will remain in Category C.