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FOR IMMEDIATE RELEASEJune 17 Today, Health Resources and Services Administration (HRSA) is announcing that the HRSA erectile dysfunction treatment Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and treatment Administration for the Uninsured (Uninsured Program) has paid over 5 million claims to kamagra jelly price in canada health care providers for administering erectile dysfunction treatments to uninsured individuals."We know that Black, Latino, and Native American people are more likely to be uninsured. The Uninsured Program is a key tool for ensuring everyone has access to erectile dysfunction treatments kamagra jelly price in canada and that cost is not a barrier for individuals or health care providers," said Acting HRSA Administrator Diana Espinosa. "Regardless of insurance or citizenship status, we want everyone living in the United States to be able to get vaccinated as soon as possible so we can defeat this kamagra."This important milestone reflects the Biden-Harris Administration's commitment kamagra jelly price in canada to ensuring equitable access to erectile dysfunction treatments. There are approximately 29 million uninsured individuals living in the United States. Communities of color have been especially hard-hit by both the erectile dysfunction treatment kamagra and the associated economic downturn.The Uninsured Program allows anyone kamagra jelly price in canada without health insurance, no matter their immigration status, to receive their erectile dysfunction treatments for free by reimbursing providers for the cost of administering the treatment.

The program also covers kamagra jelly price in canada erectile dysfunction treatment testing and treatment claims for individuals without health insurance. HRSA also recently launched the erectile dysfunction treatment Coverage Assistance Fund, which covers the costs of administering erectile dysfunction treatments to underinsured patients – those enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing.Learn more about the HRSA erectile dysfunction treatment Uninsured Program.Full-page version of the map. Rural counties completed an additional 425,000 erectile dysfunction treatment vaccinations last week, bringing the total number of rural vaccinations to about 15 million, or about a kamagra jelly price in canada third of the nonmetropolitan population. The percentage of rural residents who are completely vaccinated grew by about a percentage point last week, reaching 32.6% of the nation’s 46 million kamagra jelly price in canada nonmetropolitan residents. The metropolitan rate of completed vaccinations grew by 1.6 percentage points during the same period and now stands at 41.7%.

The means the gap between the rural and metropolitan vaccinations rates expanded last week kamagra jelly price in canada and now stands at a 9.1 percentage point difference. The gap narrowed slightly two weeks ago after the Daily Yonder added state kamagra jelly price in canada data from Hawaii, Massachusetts, and Texas to our weekly analysis. This week’s analysis, based on data from the Centers from Disease Control and Prevention and kamagra jelly price in canada selected state health departments (Hawaii, Massachusetts, and Texas), covers June 8-14. Rural vaccination rates varied broadly across the U.S.. New England remains the best performing region in rural vaccinations, according to the Daily Yonder’s kamagra jelly price in canada analysis.

Like this story? kamagra jelly price in canada. Sign up for our newsletter. Massachusetts had kamagra jelly price in canada the highest rate of completed rural vaccinations, at 61%, a 2.4 point increase from two weeks ago. Nonmetropolitan residents number only 99,000, only 1.4% of the statewide population.Connecticut, where only 5% of the population is nonmetropolitan, had the next highest rural vaccination rate, at kamagra jelly price in canada 57.1%. That’s an increase of 2.4 percentage points from last week.New Hampshire reported that 53.7% of its rural population was fully vaccinated, an increase of 1.9 percentage points from two weeks ago.

Rural residents constitute more than a third of the state’s population.Maine had the next highest rural kamagra jelly price in canada vaccination rate, with 51.7% of the state’s half million residents fully vaccinated. That’s also a 1.9 percentage point increase from two weeks ago.Hawaii ranked fifth in rural vaccinations, with 47.9%, an increase kamagra jelly price in canada of 1.6 percentage points from two weeks ago. The 10 worst performing states for rural vaccinations were all in the South. Georgia, which has the nation’s lowest rural vaccination rate, has fully kamagra jelly price in canada vaccinated only 11.7% of its rural residents. That rate is up only 0.1 percentage points kamagra jelly price in canada from two weeks ago.

Some of that poor performance may be mitigated by “unallocated” vaccinations, which are recorded at the state level but not assigned to specific counties.Virginia has fully vaccinated only 17.2% of rural residents, although a quarter of the state’s population has been vaccinated but not allocated to specific counties.West Virginia recorded a rural vaccination rate of only 18%, but that figure does not include the 16% of the state’s population that has been vaccinated kamagra jelly price in canada but is unallocated to specific counties.Other states in the bottom 10 for rural vaccinations were Alabama (24.3%), Louisiana (24.6%), Missouri (25.4%), Mississippi (26.6%), Tennessee (27.1%), Arkansas (27.2%), and Florida (28.1%). The percentage of unallocated vaccinations were relatively low in these states, meaning the actual rural vaccination isn’t likely to be much higher than the recorded levels. CORRECTION. An earlier version of this article contained incorrect data because we mismatched Texas health department vaccination reports from four Texas counties, Deaf Smith, Delta, Denton, and DeWitt. A total of 424,783 additional people in rural counties completed their vaccinations from June 8-14, not 450,000.

The rural completed vaccination rate was 32.6%, not 33.2%. The metropolitan vaccination rate was 41.7%, not 41.5%. The gap between the rural and metro vaccination rates was 9.1 percentage points, not 8.1. The maps and graphs have been corrected to reflect these changes. The Daily Yonder regrets the errors.

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[embedded content] Yolanda Coar kamagra blog was 40 when she died of erectile dysfunction treatment in August 2020 in Augusta, Georgia. She was also a nurse manager, and one of nearly 3,000 front-line workers who have died in the U.S. Fighting this kamagra, according to an exclusive investigation by The Guardian kamagra blog and KHN. Read more of the health workers’ stories behind the statistics — their personalities, passions and quirks. €œLost on the Frontline” examines.

Did they kamagra blog have to die?. Related Topics Contact Us Submit a Story TipERIE, Colo. €” Whenever Larry Kelderman looks up from the car he’s fixing and peers across the street, he’s looking across a border. His town of 28,000 straddles two counties, separated kamagra blog by County Line Road. Kelderman’s auto repair business is in Boulder County, whose officials are sticklers for public health and have topped the county website with instructions on how to report erectile dysfunction treatment violations.

Kelderman lives in Weld County, where officials refuse to enforce public health rules. Weld County’s test positivity rate is twice that of its neighbor, but Kelderman is pretty clear which side kamagra blog he backs. €œWhich is worse, the person gets the kamagra and survives and they still have a business, or they don’t get the kamagra and they lose their livelihood?. € he said. Boulder boasts kamagra blog one of the most highly educated populations in the nation.

Weld boasts about its sugar beets, cattle and thousands of oil and gas wells. Summer in Boulder County means concerts featuring former members of the Grateful Dead. In Weld kamagra blog County, it’s rodeo time. Boulder voted for Biden, Weld for Trump. Per capita income in Boulder is nearly 50% higher than in Weld.

Even their erectile dysfunction treatment outbreaks kamagra blog are different. In Boulder County, the kamagra swirls around the University of Colorado. In Weld County, some of the worst outbreaks have swept through meatpacking plants. The town of Erie, Colorado, straddles two counties with opposite views on kamagra blog how to approach erectile dysfunction treatment. (Rae Ellen Bichell/KHN) It’s not the first time County Line Road has been a fault line.

€œI’ve been in politics seven years and there’s always been a conflict between the two counties,” said Jennifer Carroll, mayor of Erie, once a coal mining town and now billed as a good place to raise a kamagra blog family, about 30 minutes north of Denver. Shortly before the erectile dysfunction hit Colorado, Erie’s board of trustees extended a moratorium on new oil and gas operations in the town. Weld County was not pleased. €œThey got really angry at us for kamagra blog doing that, because oil and gas is their thing,” Carroll said. Most of the town’s businesses are on the Weld side.

To avoid public health whiplash, Carroll and other town leaders have asked residents to comply with the more restrictive stance of the Boulder side. The feud got ugly in a dispute kamagra blog over hospital beds. At one point, the state said Weld County had only three intensive care beds, while Weld County claimed it had 43. €œIt made my job harder, because people were doubting what I was saying,” said Carroll. €œNobody trusted kamagra blog anyone because they were hearing conflicting information.” Weld’s number, it turned out, included not just the beds in its two hospitals, but also those in 10 other hospitals across the county line, including in the city of Longmont.

Longmont sits primarily in Boulder County but spills into Weld, where its suburbs taper into fields pockmarked with prairie dog holes. Its residents say they can tell snow is coming when the winds deliver a pungent smell of livestock from next door. Longmont Mayor Brian Bagley worried that Weld’s behavior would deliver more than a kamagra blog stench. It might also deliver patients requiring precious resources. €œThey were basically encouraging their citizens to violate the emergency health orders … with this cowboy-esque, you know, ‘Yippee-ki-yay, freedom, Constitution forever, damn the consequences,’” said Bagley.

€œTheir statement is, ‘Our hospitals are full, but don’t worry, we’re just going to use yours.’” So, “for 48 hours, I trolled Weld County,” he said kamagra blog. Bagley asked the city council to consider an ordinance that could have restricted Weld County residents’ ability to receive care at Longmont hospitals. Bagley, who retracted his proposal the next day, said he knew it was never going to come to fruition — after all, it was probably illegal — but he wanted to prove a point. €œThey’re going kamagra blog to be irresponsible?. Fine.

Let me propose a question,” he said. €œIf there is only one ICU bed left and there are two grandparents there — one from Weld, one from Boulder — and they kamagra blog both need that bed, who should get it?. € Weld County commissioners volleyed back, calling Bagley a “simple mayor.” They wrote that the answer to the kamagra was “not to continually punish working-class families or the individuals who bag your groceries, wait on you in restaurants, deliver food to your home while you watch Netflix and chill.” “I know we’re all trying to get along, but people are starting to do stupid and mean things and so I’ll be stupid and mean back,” Bagley said during a Dec. 8 council meeting. In another Longmont City Council meeting, Bagley (who suspects the commissioners don’t know what “Netflix and chill” typically means) often referred to Weld simply as “our neighbors to the East,” declining kamagra blog to name his foe.

The council shrugged off his statement about withholding medical treatment but demanded that Weld County step up to fight the kamagra. €œWe would not deny medical care kamagra blog to anybody. It’s illegal and it’s immoral,” said council member Polly Christensen. €œBut it is wrong for people to expect us to bear the burden of what they’ve been irresponsible enough to let loose.” “They’re the reason why I can’t be in the classroom in front of my kids,” said council member and teacher Susie Hidalgo-Fahring, whose school district straddles the counties. €œI’m done with that kamagra blog.

Everybody needs to be a good neighbor.” County Line Road is not just a street cutting through Erie, Colorado. It represents a fault line between local governments with very different views on the kamagra. (Rae Ellen Bichell/KHN) Josh Kelderman works with kamagra blog his father, Larry, at the family’s auto repair business, Integrity Products, on the Boulder County side of Erie, Colorado. Weld County is just across the street. (Rae Ellen Bichell/KHN) The council decided Dec.

15 to send a letter to Weld County’s commissioners encouraging them to enforce state restrictions and to make a public statement about the benefits of wearing masks and practicing kamagra blog physical distancing. They’ve also backed a law allowing Democratic Gov. Jared Polisto withhold relief money from counties that don’t comply with restrictions. Weld County Commissioner Scott James said his county doesn’t have the authority to kamagra blog enforce public health orders any more than a citizen has the authority to give a speeding ticket. €œIf you want me as an elected official to assume authority that I don’t have and arbitrarily exert it over you, I dare you to look that up in the dictionary,” said James, who is a rancher turned country radio host.

€œIt’s called tyranny.” James doesn’t deny that erectile dysfunction treatment is ravaging his community. €œWe’re on fire, and we need to put kamagra blog that fire out,” he said. But he believes that individuals will make the right decisions to protect others, and demands the right of his constituents to use the hospital nearest them. €œTo look at Weld County like it has walls around it is shortsighted and not the way our health care system is designed to work,” James said. €œTo use kamagra blog a crudity, because I am, after all, just a ranch kid turned radio guy, there’s no ‘non-peeing’ section in the pool.

Everybody’s gonna get a little on ’em. And that’s what’s going on right now with erectile dysfunction treatment.” The dispute is not just liberal and conservative politics clashing. Bagley, the Longmont mayor, grew kamagra blog up in Weld County and “was a Republican up until Trump,” he said. But it is an example of how the kamagra is tapping into long-standing Western strife. €œThere’s decades of reasons for resentment at people from a distance — usually from a metropolis and from a state or federal governmental office — telling rural people what to do,” said Patty Limerick, faculty kamagra blog director at the Center of the American West at the University of Colorado-Boulder, and previously state historian.

In the ’90s, she toured several states performing a mock divorce trial between the rural and urban West. She played Urbana Asphalt West, married to Sandy Greenhills West. Their child, Suburbia, was indulged and clueless and had a habit of drinking kamagra blog everyone else’s water. A rural health care shortage was one of many fuels of their marital strife. Limerick and her colleagues are reviving the play now and adding erectile dysfunction treatment references.

This time around, she said, it’ll be a last-ditch marriage counseling session for high school classes and communities to adopt and perform kamagra blog. It likely won’t have a scripted ending. She’s leaving that up to each community. Rae Ellen Bichell kamagra blog. rbichell@kff.org, @raelnb Related Topics Contact Us Submit a Story TipNine months into the kamagra that has killed more than 320,000 people in the U.S., Kim Larson is still trying to convince others in her northern Montana county that erectile dysfunction treatment is dangerous.

As Hill County Health Department director and county health officer, Larson continues to hear people say the erectile dysfunction is just like a bad case of the flu. Around the time Montana’s governor mandated face coverings in July, her staffers saw notices taped in several businesses’ windows spurning the state’s right kamagra blog to issue such emergency orders. For a while, the county with a population of 16,000 along the Canadian border didn’t see much evidence of the kamagra. It had only one known erectile dysfunction treatment case until July. But that changed as the nation moved into its third surge of the kamagra kamagra blog this fall.

By mid-December, Hill County had recorded more than 1,500 cases — the vast majority since Oct. 1 — and 33 people there had died. When Larson hears people say kamagra safety rules should end, she talks about kamagra blog how contagious the erectile dysfunction treatment kamagra is, how some people experience lasting effects and how hospitals are so full that care for any ailment could face delays. €œIn public health, we’ve seen the battle before, but you typically have the time to build your evidence, research showing that this really does save lives,” Larson said. €œIn the middle of a kamagra, you have no time.” Public health laws typically come long after social norms shift, affirming a widespread acceptance that a change in habits is worth the public good and that it’s time for stragglers to fall in line.

But even when decades of evidence show a rule can save lives — such as wearing seat belts or not smoking indoors — the debate continues in kamagra blog some places with the familiar argument that public restraints violate personal freedoms. This fast-moving kamagra, however, doesn’t afford society the luxury of time. State mandates have put local officials in charge kamagra blog of changing behavior while general understanding catches up. Earlier this month, U.S. Surgeon General Jerome Adams stood next to Montana’s governor in Helena and said he hopes people wear masks because it’s the right thing to do — especially as erectile dysfunction treatment hospitalizations rise.

€œYou don’t kamagra blog want to be the reason that a woman in labor can’t get a hospital bed,” Adams said, adding a treatment is on the way. €œIt’s just for a little bit longer.” He spoke days after state lawmakers clashed over masks as a majority of Republican lawmakers arrived for a committee meeting barefaced and at least one touted false information on the dangers of masks. As of Dec. 15, the kamagra blog Republican majority hadn’t required masks for the upcoming legislative session, set to begin Jan. 4.

And now a group opposed to masks from Gallatin and Flathead counties has filed a lawsuit asking a Montana judge to block the state’s kamagra-related safety rules. Public health kamagra blog laws typically spark political battles. Changing people’s habits is hard, said Lindsay Wiley, director of the health law and policy program at American University in Washington, D.C. Despite the misconception that there was universal buy-in for masks during the 1918 kamagra, Wiley said, some protesters intentionally built rap sheets of arrests for going maskless in the name of liberty. She said health officials realize any health restrictions amid a kamagra require the public’s trust and cooperation kamagra blog for success.

€œWe don’t have enough police to walk around and force everyone to wear a mask,” she said. €œAnd I’m not sure we want them to do it.” Local officials have the best chance to win over that support, Wiley said. And seeing elected leaders such as President kamagra blog Donald Trump rebuff his own federal health guidelines makes that harder. Meanwhile, public shaming like calling unmasked people selfish or stupid can backfire, Wiley said, because if they were to give in to mask-wearing, they would essentially be accepting those labels. In the history of public health laws, even rules that have had time to build widely accepted evidence weren’t guaranteed support.

It’s illegal in Montana to kamagra blog go without a seat belt in a moving car. But, as in 13 other states, authorities aren’t allowed to pull people over for being unbuckled. Every few years, a Montana lawmaker, backed by a collection of public health and law enforcement organizations, proposes a law to allow seat belt traffic stops, arguing it would save lives. In 2019, that request didn’t even make it out of committee, squelched by the arguments kamagra blog of personal choice and not giving too much power to the government. Main opposition points against public health laws — whether it’s masks, seat belts, motorcycle helmets or smoking — can sound alike.

When Missoula County became the first place in Montana to ban indoor smoking in public spaces in 1999, opponents said the change would destroy businesses, be impossible to enforce and violate people’s freedom of choice. €œThey are kamagra blog the same arguments in a lot of ways,” said Ellen Leahy, director of the Missoula City-County Health Department. €œPublic health was right at that intersection between what’s good for the whole community and the rights and responsibilities of the individual.” Montana adopted an indoor smoking ban in 2005, but many bars and taverns were given until 2009 to fall in line. And, in some places, debate and court kamagra blog battles continued for a decade more on how the ban could be enforced. Amid the erectile dysfunction treatment kamagra, Missoula County was again ahead of much of the state when it passed its own mask ordinance.

The county has two hospitals and a university that swells its population with students and commuters. €œIf you have to see it to believe it, you’re going to kamagra blog see the impact of a kamagra first in a city, most likely,” Leahy said. Compliance hasn’t been perfect and she said the need for strict enforcement has been limited. As of early December, out of the more than 1,500 complaints the Missoula health department followed up on since July, it sent closure notices to four businesses that flouted the rules. In Hill County, kamagra blog when the health department gets complaints that a business is violating kamagra mandates, two part-time health sanitarians, who perform health inspections of businesses, talk with the owners about why the rules exist and how to live by them.

Often it works. Other times the complaints keep coming. County attorney Karen Alley said the local health officials have reached out to her office with complaints of noncompliance on kamagra blog erectile dysfunction treatment safety measures, but she has not seen enough evidence to bring a civil case against a business. Unlike other health laws, she said, mask rules have no case studies yet to offer a framework for enforcing them through the Montana courts. (A handful of cases against businesses skirting erectile dysfunction treatment rules were still playing out as of mid-December.) “Somebody has to be the test case, but you never want to be the test case,” said Alley, who is part of a team of three.

€œIt’s a lot of resources, kamagra blog a lot of time.” Larson, with the Hill County Health Department, said her focus is still on winning over the community. And she’s excited about some progress. The town’s annual live Nativity scene, which typically draws crowds with hot cocoa, turned into a drive-by event this year. She doesn’t expect everyone to follow the rules — that’s never the case in public kamagra blog health. But Larson hopes enough people will to slow down the kamagra.

That could be happening. By mid-December, the county’s tally kamagra blog of daily active cases was declining for the first time since its spike began in October. €œYou just try to figure out the best way for your community and to get their input,” Larson said. €œBecause we need the community’s help to stop it.” Katheryn Houghton. khoughton@kff.org, @K_Hought Related Topics Contact Us Submit a Story TipWASHINGTON — Even before there was a treatment, some seasoned doctors and public health experts warned, Cassandra-like, that its distribution would be “a logistical nightmare.” After Week 1 of the rollout, “nightmare” sounds kamagra blog like an apt description.

Dozens of states say they didn’t receive nearly the number of promised doses. Pfizer says millions of doses sat in its storerooms, because kamagra blog no one from President Donald Trump’s Operation Warp Speed task force told them where to ship them. A number of states have few sites that can handle the ultra-cold storage required for the Pfizer product, so, for example, front-line workers in Georgia have had to travel 40 minutes to get a shot. At some hospitals, residents treating erectile dysfunction treatment patients protested that they had not received the treatment while administrators did, even though they work from home and don’t treat patients. The potential kamagra blog for more chaos is high.

Dr. Vivek Murthy, named as the next surgeon general under President-elect Joe Biden, said this week that the Trump administration’s prediction — that the general population would get the treatment in April — was realistic only if everything went smoothly. He instead predicted kamagra blog wide distribution by summer or fall. The Trump administration had expressed confidence that the rollout would be smooth, because it was being overseen by a four-star general, Gustave Perna, an expert in logistics. But it turns out that getting fuel, tanks and tents into war-torn mountainous Afghanistan is in many ways simpler than passing out a treatment in our privatized, profit-focused and highly fragmented medical system.

Gen. Perna apologized this week, saying he wanted to “take personal responsibility.” It’s really mostly not his fault. Throughout the erectile dysfunction treatment kamagra, the U.S. Health care system has shown that it is not built for a coordinated kamagra response (among many other things). States took wildly different erectile dysfunction treatment prevention measures.

Individual hospitals varied in their ability to face this kind of national disaster. And there were huge regional disparities in test availability — with a slow ramp-up in availability due, at least in some part, because no payment or billing mechanism was established. Why should treatment distribution be any different?. In World War II, toymakers were conscripted to make needed military hardware airplane parts, and commercial shipyards to make military transport vessels. The Trump administration has been averse to invoking the Defense Production Act, which could help speed and coordinate the process of treatment manufacture and distribution.

On Tuesday, it indicated it might do so, but only to help Pfizer obtain raw materials that are in short supply, so that the drugmaker could produce — and sell — more treatments in the United States. Instead of a central health-directed strategy, we have multiple companies competing to capture their financial piece of the kamagra health care pie, each with its patent-protected product as well as its own supply chain and shipping methods. Add to this bedlam the current decision-tree governing distribution. The Centers for Disease Control and Prevention has made official recommendations about who should get the treatment first — but throughout the kamagra, many states have felt free to ignore the agency’s suggestions. Instead, Operation Warp Speed allocated initial doses to the states, depending on population.

From there, an inscrutable mix of state officials, public health agencies and lobbyists seem to be determining where the treatment should go. In some states, counties requested an allotment from the state, and then they tried to accommodate requests from hospitals, which made their individual algorithms for how to dole out the precious cargo. Once it became clear there wasn’t enough treatment to go around, each entity made its own adjustments. Some doses are being shipped by FedEx or UPS. But Pfizer — which did not fully participate in Operation Warp Speed — is shipping much of the treatment itself.

In nursing homes, some treatments will be delivered and administered by employees of CVS and Walgreens, though issues of staffing and consent remain there. The Moderna treatment, rolling out this week, will be packaged by the “pharmaceutical services provider” Catalent in Bloomington, Indiana, and then sent to McKesson, a large pharmaceutical logistics and distribution outfit. It has offices in places like Memphis, Tennessee, and Louisville, which are near air hubs for FedEx and UPS, which will ship them out. Is your head spinning yet?. Looking forward, basic questions remain for 2021.

How will essential workers at some risk (transit workers, teachers, grocery store employees) know when it’s their turn?. (And it will matter which city you work in.) What about people with chronic illness — and then everyone else?. And who administers the treatment — doctors or the local drugstore?. In Belgium, where many hospitals and doctors are private but work within a significant central organization, residents will get an invitation letter “when it’s their turn.” In Britain, the National Joint Committee on Vaccination has settled on a priority list for vaccinations — those over 80, those who live or work in nursing homes, and health care workers at high risk. The National Health Service will let everyone else “know when it’s your turn to get the treatment ” from the government-run health system.

In the United States, I dread a mad scramble — as in, “Did you hear the CVS on P Street got a shipment?. € But this time, it’s not toilet paper. Combine this vision of disorder with the nation’s high death toll, and it’s not surprising that there is intense jockeying and lobbying — by schools, unions, even people with different types of preexisting diseases — over who should get the treatment first, second and third. It’s hard to “wait your turn” in a country where there are 200,000 new cases and as many as 2,000 new daily erectile dysfunction treatment deaths — a tragic per capita order of magnitude higher than in many other developed countries. So kudos and thanks to the science and the scientists who made the treatment in record time.

I’ll eagerly hold out my arm — so I can see the family and friends and colleagues I’ve missed all these months. If only I can figure out when I’m eligible, and where to go to get it. Elisabeth Rosenthal. erosenthal@kff.org, @rosenthalhealth Related Topics Contact Us Submit a Story TipMore than 2,900 U.S. Health care workers have died in the erectile dysfunction treatment kamagra since March, a far higher number than that reported by the government, according to a new analysis by KHN and The Guardian.

Fatalities from the erectile dysfunction have skewed young, with the majority of victims under age 60 in the cases for which there is age data. People of color have been disproportionately affected, accounting for about 65% of deaths in cases in which there is race and ethnicity data. After conducting interviews with relatives and friends of around 300 victims, KHN and The Guardian learned that one-third of the fatalities involved concerns over inadequate personal protective equipment. Many of the deaths — about 680 — occurred in New York and New Jersey, which were hit hard early in the kamagra. Significant numbers also died in Southern and Western states in the ensuing months.

The findings are part of “Lost on the Frontline,” a nine-month data and investigative project by KHN and The Guardian to track every health care worker who dies of erectile dysfunction treatment. One of those lost, Vincent DeJesus, 39, told his brother Neil that he’d be in deep trouble if he spent much time with a erectile dysfunction treatment-positive patient while wearing the surgical mask provided to him by the Las Vegas hospital where he worked. DeJesus died on Aug. 15. Another fatality was Sue Williams-Ward, a 68-year-old home health aide who earned $13 an hour in Indianapolis, and bathed, dressed and fed clients without wearing any PPE, her husband said.

She was intubated for six weeks before she died May 2. €œLost on the Frontline” is prompting new government action to explore the root cause of health care worker deaths and take steps to track them better. Officials at the Department of Health and Human Services recently asked the National Academy of Sciences for a “rapid expert consultation” on why so many health care workers are dying in the U.S., citing the count of fallen workers by The Guardian and KHN. €œThe question is, where are they becoming infected?. € asked Michael Osterholm, a member of President-elect Joe Biden’s erectile dysfunction treatment advisory team and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

€œThat is clearly a critical issue we need to answer and we don’t have that.” [embedded content] The Dec. 10 report by the national academies suggests a new federal tracking system and specially trained contact tracers who would take PPE policies and availability into consideration. Doing so would add critical knowledge that could inform generations to come and give meaning to the lives lost. €œThose [health care workers] are people who walked into places of work every day because they cared about patients, putting food on the table for families, and every single one of those lives matter,” said Sue Anne Bell, a University of Michigan assistant professor of nursing and co-author of the national academies report. The recommendations come at a fraught moment for health care workers, as some are getting the erectile dysfunction treatment while others are fighting for their lives amid the highest levels of the nation has seen.

The toll continues to mount. In Indianapolis, for example, 41-year-old nurse practitioner Kindra Irons died Dec. 1. She saw seven or eight home health patients per week while wearing full PPE, including an N95 mask and a face shield, according to her husband, Marcus Irons. The kamagra destroyed her lungs so badly that six weeks on the most aggressive life support equipment, ECMO, couldn’t save her, he said.

Marcus Irons said he is now struggling financially to support their two youngest children, ages 12 and 15. €œNobody should have to go through what we’re going through,” he said. In Massachusetts, 43-year-old Mike “Flynnie” Flynn oversaw transportation and laundry services at North Shore Medical Center, a hospital in Salem, Massachusetts. He and his wife were also raising young children, ages 8, 10 and 11. Flynn, who shone at father-daughter dances, fell ill in late November and died Dec.

8. He had a heart attack at home on the couch, according to his father, Paul Flynn. A hospital spokesperson said he had full access to PPE and free testing on-site. Since the first months of the kamagra, more than 70 reporters at The Guardian and KHN have scrutinized numerous governmental and public data sources, interviewed the bereaved and spoken with health care experts to build a count. The total number includes fatalities identified by labor unions, obituaries and news outlets and in online postings by the bereaved, as well as by relatives of the deceased.

The previous total announced by The Guardian and KHN was approximately 1,450 health care worker deaths. The new number reflects the inclusion of data reported by nursing homes and health facilities to the federal and state governments. These deaths include the facility names but not worker names. Reporters cross-checked each record to ensure fatalities did not appear in the database twice. The tally has been widely cited by other media as well as by members of Congress.

Rep. Norma Torres (D-Calif.) referenced the data citing the need for a pending bill that would provide compensation to the families of health care workers who died or sustained long-term disabilities from erectile dysfunction treatment. Sen. Ron Wyden (D-Ore.) mentioned the tally in a Senate Finance Committee hearing about the medical supply chain. €œThe fact is,” he said, “the shortages of PPE have put our doctors and nurses and caregivers in grave danger.” This story is part of “Lost on the Frontline,” an ongoing project from The Guardian and Kaiser Health News that aims to document the lives of health care workers in the U.S.

Who die from erectile dysfunction treatment, and to investigate why so many are victims of the disease. If you have a colleague or loved one we should include, please share their story. Christina Jewett. ChristinaJ@kff.org, @by_cjewett Melissa Bailey. @mmbaily Related Topics Contact Us Submit a Story Tip.

[embedded content] Yolanda kamagra jelly price in canada Coar was 40 a fantastic read when she died of erectile dysfunction treatment in August 2020 in Augusta, Georgia. She was also a nurse manager, and one of nearly 3,000 front-line workers who have died in the U.S. Fighting this kamagra, according to an exclusive investigation by The Guardian kamagra jelly price in canada and KHN. Read more of the health workers’ stories behind the statistics — their personalities, passions and quirks. €œLost on the Frontline” examines.

Did they have to die? kamagra jelly price in canada. Related Topics Contact Us Submit a Story TipERIE, Colo. €” Whenever Larry Kelderman looks up from the car he’s fixing and peers across the street, he’s looking across a border. His town of 28,000 straddles two kamagra jelly price in canada counties, separated by County Line Road. Kelderman’s auto repair business is in Boulder County, whose officials are sticklers for public health and have topped the county website with instructions on how to report erectile dysfunction treatment violations.

Kelderman lives in Weld County, where officials refuse to enforce public health rules. Weld County’s test kamagra jelly price in canada positivity rate is twice that of its neighbor, but Kelderman is pretty clear which side he backs. €œWhich is worse, the person gets the kamagra and survives and they still have a business, or they don’t get the kamagra and they lose their livelihood?. € he said. Boulder boasts kamagra jelly price in canada one of the most highly educated populations in the nation.

Weld boasts about its sugar beets, cattle and thousands of oil and gas wells. Summer in Boulder County means concerts featuring former members of the Grateful Dead. In Weld kamagra jelly price in canada County, it’s rodeo time. Boulder voted for Biden, Weld for Trump. Per capita income in Boulder is nearly 50% higher than in Weld.

Even their erectile dysfunction treatment kamagra jelly price in canada outbreaks are different. In Boulder County, the kamagra swirls around the University of Colorado. In Weld County, some of the worst outbreaks have swept through meatpacking plants. The town of Erie, Colorado, straddles kamagra jelly price in canada two counties with opposite views on how to approach erectile dysfunction treatment. (Rae Ellen Bichell/KHN) It’s not the first time County Line Road has been a fault line.

€œI’ve been in politics seven years and there’s always been a conflict between the two counties,” said Jennifer Carroll, kamagra jelly price in canada mayor of Erie, once a coal mining town and now billed as a good place to raise a family, about 30 minutes north of Denver. Shortly before the erectile dysfunction hit Colorado, Erie’s board of trustees extended a moratorium on new oil and gas operations in the town. Weld County was not pleased. €œThey got really angry at us for doing that, because oil and gas is kamagra jelly price in canada their thing,” Carroll said. Most of the town’s businesses are on the Weld side.

To avoid public health whiplash, Carroll and other town leaders have asked residents to comply with the more restrictive stance of the Boulder side. The feud got ugly in a kamagra jelly price in canada dispute over hospital beds. At one point, the state said Weld County had only three intensive care beds, while Weld County claimed it had 43. €œIt made my job harder, because people were doubting what I was saying,” said Carroll. €œNobody trusted anyone because they were hearing conflicting information.” Weld’s number, it kamagra jelly price in canada turned out, included not just the beds in its two hospitals, but also those in 10 other hospitals across the county line, including in the city of Longmont.

Longmont sits primarily in Boulder County but spills into Weld, where its suburbs taper into fields pockmarked with prairie dog holes. Its residents say they can tell snow is coming when the winds deliver a pungent smell of livestock from next door. Longmont Mayor kamagra jelly price in canada Brian Bagley worried that Weld’s behavior would deliver more than a stench. It might also deliver patients requiring precious resources. €œThey were basically encouraging their citizens to violate the emergency health orders … with this cowboy-esque, you know, ‘Yippee-ki-yay, freedom, Constitution forever, damn the consequences,’” said Bagley.

€œTheir statement is, ‘Our hospitals are full, but don’t worry, we’re just going to use yours.’” So, “for 48 hours, I trolled Weld kamagra jelly price in canada County,” he said. Bagley asked the city council to consider an ordinance that could have restricted Weld County residents’ ability to receive care at Longmont hospitals. Bagley, who retracted his proposal the next day, said he knew it was never going to come to fruition — after all, it was probably illegal — but he wanted to prove a point. €œThey’re going to be kamagra jelly price in canada irresponsible?. Fine.

Let me propose a question,” he said. €œIf there is only one ICU bed left and there are two grandparents there — one from Weld, one from Boulder — and they kamagra jelly price in canada both need that bed, who should get it?. € Weld County commissioners volleyed back, calling Bagley a “simple mayor.” They wrote that the answer to the kamagra was “not to continually punish working-class families or the individuals who bag your groceries, wait on you in restaurants, deliver food to your home while you watch Netflix and chill.” “I know we’re all trying to get along, but people are starting to do stupid and mean things and so I’ll be stupid and mean back,” Bagley said during a Dec. 8 council meeting. In another Longmont kamagra jelly price in canada City Council meeting, Bagley (who suspects the commissioners don’t know what “Netflix and chill” typically means) often referred to Weld simply as “our neighbors to the East,” declining to name his foe.

The council shrugged off his statement about withholding medical treatment but demanded that Weld County step up to fight the kamagra. €œWe would not deny medical kamagra jelly price in canada care to anybody. It’s illegal and it’s immoral,” said council member Polly Christensen. €œBut it is wrong for people to expect us to bear the burden of what they’ve been irresponsible enough to let loose.” “They’re the reason why I can’t be in the classroom in front of my kids,” said council member and teacher Susie Hidalgo-Fahring, whose school district straddles the counties. €œI’m done kamagra jelly price in canada with that.

Everybody needs to be a good neighbor.” County Line Road is not just a street cutting through Erie, Colorado. It represents a fault line between local governments with very different views on the kamagra. (Rae Ellen Bichell/KHN) Josh Kelderman works with his father, Larry, at the family’s auto repair business, kamagra jelly price in canada Integrity Products, on the Boulder County side of Erie, Colorado. Weld County is just across the street. (Rae Ellen Bichell/KHN) The council decided Dec.

15 to send a letter to Weld County’s commissioners encouraging them to enforce state restrictions and to kamagra jelly price in canada make a public statement about the benefits of wearing masks and practicing physical distancing. They’ve also backed a law allowing Democratic Gov. Jared Polisto withhold relief money from counties that don’t comply with restrictions. Weld County Commissioner Scott James said his county doesn’t have the authority to enforce public health orders any kamagra jelly price in canada more than a citizen has the authority to give a speeding ticket. €œIf you want me as an elected official to assume authority that I don’t have and arbitrarily exert it over you, I dare you to look that up in the dictionary,” said James, who is a rancher turned country radio host.

€œIt’s called tyranny.” James doesn’t deny that erectile dysfunction treatment is ravaging his community. €œWe’re on fire, and we need to put that fire out,” he kamagra jelly price in canada said. But he believes that individuals will make the right decisions to protect others, and demands the right of his constituents to use the hospital nearest them. €œTo look at Weld County like it has walls around it is shortsighted and not the way our health care system is designed to work,” James said. €œTo use a crudity, because I am, after all, just a ranch kid turned radio guy, there’s kamagra jelly price in canada no ‘non-peeing’ section in the pool.

Everybody’s gonna get a little on ’em. And that’s what’s going on right now with erectile dysfunction treatment.” The dispute is not just liberal and conservative politics clashing. Bagley, the Longmont mayor, grew up in Weld County and “was a Republican kamagra jelly price in canada up until Trump,” he said. But it is an example of how the kamagra is tapping into long-standing Western strife. €œThere’s decades of reasons for resentment at people from a distance — usually from a metropolis and from a state or federal governmental office — telling rural people what to do,” said Patty Limerick, faculty director at the Center of the American West at the University of Colorado-Boulder, and previously state historian kamagra jelly price in canada.

In the ’90s, she toured several states performing a mock divorce trial between the rural and urban West. She played Urbana Asphalt West, married to Sandy Greenhills West. Their child, Suburbia, was indulged and clueless and had a habit of kamagra jelly price in canada drinking everyone else’s water. A rural health care shortage was one of many fuels of their marital strife. Limerick and her colleagues are reviving the play now and adding erectile dysfunction treatment references.

This time around, she said, it’ll be a last-ditch marriage kamagra jelly price in canada counseling session for high school classes and communities to adopt and perform. It likely won’t have a scripted ending. She’s leaving that up to each community. Rae Ellen Bichell kamagra jelly price in canada. rbichell@kff.org, @raelnb Related Topics Contact Us Submit a Story TipNine months into the kamagra that has killed more than 320,000 people in the U.S., Kim Larson is still trying to convince others in her northern Montana county that erectile dysfunction treatment is dangerous.

As Hill County Health Department director and county health officer, Larson continues to hear people say the erectile dysfunction is just like a bad case of the flu. Around the time Montana’s governor mandated face coverings in July, her staffers saw notices taped in several businesses’ kamagra jelly price in canada windows spurning the state’s right to issue such emergency orders. For a while, the county with a population of 16,000 along the Canadian border didn’t see much evidence of the kamagra. It had only one known erectile dysfunction treatment case until July. But that changed as the nation moved into its kamagra jelly price in canada third surge of the kamagra this fall.

By mid-December, Hill County had recorded more than 1,500 cases — the vast majority since Oct. 1 — and 33 people there had died. When Larson hears people say kamagra safety rules should end, kamagra jelly price in canada she talks about how contagious the erectile dysfunction treatment kamagra is, how some people experience lasting effects and how hospitals are so full that care for any ailment could face delays. €œIn public health, we’ve seen the battle before, but you typically have the time to build your evidence, research showing that this really does save lives,” Larson said. €œIn the middle of a kamagra, you have no time.” Public health laws typically come long after social norms shift, affirming a widespread acceptance that a change in habits is worth the public good and that it’s time for stragglers to fall in line.

But even when decades of kamagra jelly price in canada evidence show a rule can save lives — such as wearing seat belts or not smoking indoors — the debate continues in some places with the familiar argument that public restraints violate personal freedoms. This fast-moving kamagra, however, doesn’t afford society the luxury of time. State mandates have put local officials in charge of changing behavior while general kamagra jelly price in canada understanding catches up. Earlier this month, U.S. Surgeon General Jerome Adams stood next to Montana’s governor in Helena and said he hopes people wear masks because it’s the right thing to do — especially as erectile dysfunction treatment hospitalizations rise.

€œYou don’t want to be the reason that a woman in labor can’t get a hospital bed,” Adams said, adding a treatment is on the way kamagra jelly price in canada. €œIt’s just for a little bit longer.” He spoke days after state lawmakers clashed over masks as a majority of Republican lawmakers arrived for a committee meeting barefaced and at least one touted false information on the dangers of masks. As of Dec. 15, the Republican majority hadn’t required masks for the upcoming legislative kamagra jelly price in canada session, set to begin Jan. 4.

And now a group opposed to masks from Gallatin and Flathead counties has filed a lawsuit asking a Montana judge to block the state’s kamagra-related safety rules. Public health kamagra jelly price in canada laws typically spark political battles. Changing people’s habits is hard, said Lindsay Wiley, director of the health law and policy program at American University in Washington, D.C. Despite the misconception that there was universal buy-in for masks during the 1918 kamagra, Wiley said, some protesters intentionally built rap sheets of arrests for going maskless in the name of liberty. She said health officials realize any health restrictions amid a kamagra require the public’s trust and kamagra jelly price in canada cooperation for success.

€œWe don’t have enough police to walk around and force everyone to wear a mask,” she said. €œAnd I’m not sure we want them to do it.” Local officials have the best chance to win over that support, Wiley said. And seeing elected leaders such as President Donald Trump rebuff his own federal health guidelines makes that kamagra jelly price in canada harder. Meanwhile, public shaming like calling unmasked people selfish or stupid can backfire, Wiley said, because if they were to give in to mask-wearing, they would essentially be accepting those labels. In the history of public health laws, even rules that have had time to build widely accepted evidence weren’t guaranteed support.

It’s illegal kamagra jelly price in canada in Montana to go without a seat belt in a moving car. But, as in 13 other states, authorities aren’t allowed to pull people over for being unbuckled. Every few years, a Montana lawmaker, backed by a collection of public health and law enforcement organizations, proposes a law to allow seat belt traffic stops, arguing it would save lives. In 2019, that request didn’t even make it out of committee, kamagra jelly price in canada squelched by the arguments of personal choice and not giving too much power to the government. Main opposition points against public health laws — whether it’s masks, seat belts, motorcycle helmets or smoking — can sound alike.

When Missoula County became the first place in Montana to ban indoor smoking in public spaces in 1999, opponents said the change would destroy businesses, be impossible to enforce and violate people’s freedom of choice. €œThey are kamagra jelly price in canada the same arguments in a lot of ways,” said Ellen Leahy, director of the Missoula City-County Health Department. €œPublic health was right at that intersection between what’s good for the whole community and the rights and responsibilities of the individual.” Montana adopted an indoor smoking ban in 2005, but many bars and taverns were given until 2009 to fall in line. And, in some places, debate and court battles continued for a decade more on how the ban could be kamagra jelly price in canada enforced. Amid the erectile dysfunction treatment kamagra, Missoula County was again ahead of much of the state when it passed its own mask ordinance.

The county has two hospitals and a university that swells its population with students and commuters. €œIf you have kamagra jelly price in canada to see it to believe it, you’re going to see the impact of a kamagra first in a city, most likely,” Leahy said. Compliance hasn’t been perfect and she said the need for strict enforcement has been limited. As of early December, out of the more than 1,500 complaints the Missoula health department followed up on since July, it sent closure notices to four businesses that flouted the rules. In Hill County, when the health department gets complaints that a business is violating kamagra mandates, two part-time health sanitarians, who perform health inspections of businesses, talk with the owners about why the rules kamagra jelly price in canada exist and how to live by them.

Often it works. Other times the complaints keep coming. County attorney kamagra jelly price in canada Karen Alley said the local health officials have reached out to her office with complaints of noncompliance on erectile dysfunction treatment safety measures, but she has not seen enough evidence to bring a civil case against a business. Unlike other health laws, she said, mask rules have no case studies yet to offer a framework for enforcing them through the Montana courts. (A handful of cases against businesses skirting erectile dysfunction treatment rules were still playing out as of mid-December.) “Somebody has to be the test case, but you never want to be the test case,” said Alley, who is part of a team of three.

€œIt’s a lot of resources, a lot of time.” Larson, with the Hill County Health Department, said kamagra jelly price in canada her focus is still on winning over the community. And she’s excited about some progress. The town’s annual live Nativity scene, which typically draws crowds with hot cocoa, turned into a drive-by event this year. She doesn’t expect everyone to follow the rules — that’s never the case in public health kamagra jelly price in canada. But Larson hopes enough people will to slow down the kamagra.

That could be happening. By mid-December, the county’s tally of daily active cases was declining for the first time kamagra jelly price in canada since its spike began in October. €œYou just try to figure out the best way for your community and to get their input,” Larson said. €œBecause we need the community’s help to stop it.” Katheryn Houghton. khoughton@kff.org, @K_Hought Related Topics Contact Us Submit a Story TipWASHINGTON — Even before there was a treatment, some seasoned doctors and public kamagra jelly price in canada health experts warned, Cassandra-like, that its distribution would be “a logistical nightmare.” After Week 1 of the rollout, “nightmare” sounds like an apt description.

Dozens of states say they didn’t receive nearly the number of promised doses. Pfizer says millions of doses sat in its storerooms, because no one from President Donald Trump’s kamagra jelly price in canada Operation Warp Speed task force told them where to ship them. A number of states have few sites that can handle the ultra-cold storage required for the Pfizer product, so, for example, front-line workers in Georgia have had to travel 40 minutes to get a shot. At some hospitals, residents treating erectile dysfunction treatment patients protested that they had not received the treatment while administrators did, even though they work from home and don’t treat patients. The potential for more chaos is high kamagra jelly price in canada.

Dr. Vivek Murthy, named as the next surgeon general under President-elect Joe Biden, said this week that the Trump administration’s prediction — that the general population would get the treatment in April — was realistic only if everything went smoothly. He instead predicted kamagra jelly price in canada wide distribution by summer or fall. The Trump administration had expressed confidence that the rollout would be smooth, because it was being overseen by a four-star general, Gustave Perna, an expert in logistics. But it turns out that getting fuel, tanks and tents into war-torn mountainous Afghanistan is in many ways simpler than passing out a treatment in our privatized, profit-focused and highly fragmented medical system.

Gen. Perna apologized this week, saying he wanted to “take personal responsibility.” It’s really mostly not his fault. Throughout the erectile dysfunction treatment kamagra, the U.S. Health care system has shown that it is not built for a coordinated kamagra response (among many other things). States took wildly different erectile dysfunction treatment prevention measures.

Individual hospitals varied in their ability to face this kind of national disaster. And there were huge regional disparities in test availability — with a slow ramp-up in availability due, at least in some part, because no payment or billing mechanism was established. Why should treatment distribution be any different?. In World War II, toymakers were conscripted to make needed military hardware airplane parts, and commercial shipyards to make military transport vessels. The Trump administration has been averse to invoking the Defense Production Act, which could help speed and coordinate the process of treatment manufacture and distribution.

On Tuesday, it indicated it might do so, but only to help Pfizer obtain raw materials that are in short supply, so that the drugmaker could produce — and sell — more treatments in the United States. Instead of a central health-directed strategy, we have multiple companies competing to capture their financial piece of the kamagra health care pie, each with its patent-protected product as well as its own supply chain and shipping methods. Add to this bedlam the current decision-tree governing distribution. The Centers for Disease Control and Prevention has made official recommendations about who should get the treatment first — but throughout the kamagra, many states have felt free to ignore the agency’s suggestions. Instead, Operation Warp Speed allocated initial doses to the states, depending on population.

From there, an inscrutable mix of state officials, public health agencies and lobbyists seem to be determining where the treatment should go. In some states, counties requested an allotment from the state, and then they tried to accommodate requests from hospitals, which made their individual algorithms for how to dole out the precious cargo. Once it became clear there wasn’t enough treatment to go around, each entity made its own adjustments. Some doses are being shipped by FedEx or UPS. But Pfizer — which did not fully participate in Operation Warp Speed — is shipping much of the treatment itself.

In nursing homes, some treatments will be delivered and administered by employees of CVS and Walgreens, though issues of staffing and consent remain there. The Moderna treatment, rolling out this week, will be packaged by the “pharmaceutical services provider” Catalent in Bloomington, Indiana, and then sent to McKesson, a large pharmaceutical logistics and distribution outfit. It has offices in places like Memphis, Tennessee, and Louisville, which are near air hubs for FedEx and UPS, which will ship them out. Is your head spinning yet?. Looking forward, basic questions remain for 2021.

How will essential workers at some risk (transit workers, teachers, grocery store employees) know when it’s their turn?. (And it will matter which city you work in.) What about people with chronic illness — and then everyone else?. And who administers the treatment — doctors or the local drugstore?. In Belgium, where many hospitals and doctors are private but work within a significant central organization, residents will get an invitation letter “when it’s their turn.” In Britain, the National Joint Committee on Vaccination has settled on a priority list for vaccinations — those over 80, those who live or work in nursing homes, and health care workers at high risk. The National Health Service will let everyone else “know when it’s your turn to get the treatment ” from the government-run health system.

In the United States, I dread a mad scramble — as in, “Did you hear the CVS on P Street got a shipment?. € But this time, it’s not toilet paper. Combine this vision of disorder with the nation’s high death toll, and it’s not surprising that there is intense jockeying and lobbying — by schools, unions, even people with different types of preexisting diseases — over who should get the treatment first, second and third. It’s hard to “wait your turn” in a country where there are 200,000 new cases and as many as 2,000 new daily erectile dysfunction treatment deaths — a tragic per capita order of magnitude higher than in many other developed countries. So kudos and thanks to the science and the scientists who made the treatment in record time.

I’ll eagerly hold out my arm — so I can see the family and friends and colleagues I’ve missed all these months. If only I can figure out when I’m eligible, and where to go to get it. Elisabeth Rosenthal. erosenthal@kff.org, @rosenthalhealth Related Topics Contact Us Submit a Story TipMore than 2,900 U.S. Health care workers have died in the erectile dysfunction treatment kamagra since March, a far higher number than that reported by the government, according to a new analysis by KHN and The Guardian.

Fatalities from the erectile dysfunction have skewed young, with the majority of victims under age 60 in the cases for which there is age data. People of color have been disproportionately affected, accounting for about 65% of deaths in cases in which there is race and ethnicity data. After conducting interviews with relatives and friends of around 300 victims, KHN and The Guardian learned that one-third of the fatalities involved concerns over inadequate personal protective equipment. Many of the deaths — about 680 — occurred in New York and New Jersey, which were hit hard early in the kamagra. Significant numbers also died in Southern and Western states in the ensuing months.

The findings are part of “Lost on the Frontline,” a nine-month data and investigative project by KHN and The Guardian to track every health care worker who dies of erectile dysfunction treatment. One of those lost, Vincent DeJesus, 39, told his brother Neil that he’d be in deep trouble if he spent much time with a erectile dysfunction treatment-positive patient while wearing the surgical mask provided to him by the Las Vegas hospital where he worked. DeJesus died on Aug. 15. Another fatality was Sue Williams-Ward, a 68-year-old home health aide who earned $13 an hour in Indianapolis, and bathed, dressed and fed clients without wearing any PPE, her husband said.

She was intubated for six weeks before she died May 2. €œLost on the Frontline” is prompting new government action to explore the root cause of health care worker deaths and take steps to track them better. Officials at the Department of Health and Human Services recently asked the National Academy of Sciences for a “rapid expert consultation” on why so many health care workers are dying in the U.S., citing the count of fallen workers by The Guardian and KHN. €œThe question is, where are they becoming infected?. € asked Michael Osterholm, a member of President-elect Joe Biden’s erectile dysfunction treatment advisory team and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

€œThat is clearly a critical issue we need to answer and we don’t have that.” [embedded content] The Dec. 10 report by the national academies suggests a new federal tracking system and specially trained contact tracers who would take PPE policies and availability into consideration. Doing so would add critical knowledge that could inform generations to come and give meaning to the lives lost. €œThose [health care workers] are people who walked into places of work every day because they cared about patients, putting food on the table for families, and every single one of those lives matter,” said Sue Anne Bell, a University of Michigan assistant professor of nursing and co-author of the national academies report. The recommendations come at a fraught moment for health care workers, as some are getting the erectile dysfunction treatment while others are fighting for their lives amid the highest levels of the nation has seen.

The toll continues to mount. In Indianapolis, for example, 41-year-old nurse practitioner Kindra Irons died Dec. 1. She saw seven or eight home health patients per week while wearing full PPE, including an N95 mask and a face shield, according to her husband, Marcus Irons. The kamagra destroyed her lungs so badly that six weeks on the most aggressive life support equipment, ECMO, couldn’t save her, he said.

Marcus Irons said he is now struggling financially to support their two youngest children, ages 12 and 15. €œNobody should have to go through what we’re going through,” he said. In Massachusetts, 43-year-old Mike “Flynnie” Flynn oversaw transportation and laundry services at North Shore Medical Center, a hospital in Salem, Massachusetts. He and his wife were also raising young children, ages 8, 10 and 11. Flynn, who shone at father-daughter dances, fell ill in late November and died Dec.

8. He had a heart attack at home on the couch, according to his father, Paul Flynn. A hospital spokesperson said he had full access to PPE and free testing on-site. Since the first months of the kamagra, more than 70 reporters at The Guardian and KHN have scrutinized numerous governmental and public data sources, interviewed the bereaved and spoken with health care experts to build a count. The total number includes fatalities identified by labor unions, obituaries and news outlets and in online postings by the bereaved, as well as by relatives of the deceased.

The previous total announced by The Guardian and KHN was approximately 1,450 health care worker deaths. The new number reflects the inclusion of data reported by nursing homes and health facilities to the federal and state governments. These deaths include the facility names but not worker names. Reporters cross-checked each record to ensure fatalities did not appear in the database twice. The tally has been widely cited by other media as well as by members of Congress.

Rep. Norma Torres (D-Calif.) referenced the data citing the need for a pending bill that would provide compensation to the families of health care workers who died or sustained long-term disabilities from erectile dysfunction treatment. Sen. Ron Wyden (D-Ore.) mentioned the tally in a Senate Finance Committee hearing about the medical supply chain. €œThe fact is,” he said, “the shortages of PPE have put our doctors and nurses and caregivers in grave danger.” This story is part of “Lost on the Frontline,” an ongoing project from The Guardian and Kaiser Health News that aims to document the lives of health care workers in the U.S.

Who die from erectile dysfunction treatment, and to investigate why so many are victims of the disease. If you have a colleague or loved one we should include, please share their story. Christina Jewett. ChristinaJ@kff.org, @by_cjewett Melissa Bailey. @mmbaily Related Topics Contact Us Submit a Story Tip.

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Kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.President Trump and Democratic nominee Joe Biden hold widely divergent views on health issues, with the president’s record and response to the erectile dysfunction kamagra how does kamagra work likely to play a central role in November’s elections.A new KFF side-by-side comparison examines President Trump’s record and former Vice President Biden’s positions across a wide range of key health issues, including the response to the kamagra, the Affordable Care Act marketplace, Medicaid, Medicare, drug prices, reproductive health, HIV, mental health and opioids, immigration and health coverage, and health costs.The resource provides a concise overview of the candidates’ positions on a range of health policy issues. While the Biden campaign has put forward many specific proposals, the Trump campaign has offered few new proposals for addressing health care in a second term and is instead running on his record in office.It is part of KFF’s ongoing efforts to provide useful information related to the health policy issues how does kamagra work relevant for the 2020 elections, including policy analysis, polling, and journalism. Find more on our Election 2020 resource page..

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€œEvery single year our health staff go above and beyond to save lives and provide patients with top level care. This year the challenges ramped right up – topped off with a one-in-one hundred year kamagra – and our staff showed remarkable resilience, meeting these challenges every buy super kamagra online uk step of the way.” Among this year’s winners is an elite team of NSW Health Pathology researchers who established highly specialised erectile dysfunction treatment testing capabilities at the onset of the kamagra. The team of experts at the Institute of Clinical Pathology and Medical Research Westmead successfully grew the kamagra from NSW patients, a much needed step in understanding and containing the kamagra.

€œThanks to their efforts, we’ve now conducted more than three million erectile dysfunction treatment tests – an unprecedented effort that has placed NSW among the highest testing buy super kamagra online uk rates per capita in the world, and helped us fight this deadly kamagra,” Mr Hazzard said. Minister for Mental Health Bronnie Taylor congratulated all of the healthcare workers across NSW and thanked the Excellence in Provision of Mental Health Services finalists for their ongoing commitment to protecting and caring for their communities. €œThis award shines a spotlight on just a few buy super kamagra online uk of the dedicated teams promoting recovery and positive change and making life better for people living with mental illness, their families and loved ones every day,” Mrs Taylor said.

This year’s finalists and winners were celebrated for the first time on digital and social channels rather than at an awards ceremony – in keeping with erectile dysfunction treatment safety. There were 19 finalists from 14 statewide health buy super kamagra online uk entities competing for 10 award categories. The NSW Health Awards recognise innovative and sustainable health programs that deliver better outcomes for patients and invest in the wellness of the NSW community.

The NSW Government has committed buy super kamagra online uk $800 million extra funding over two years on top of the 2019-20 Health Budget of $26.7 billion to help boost ICU capacity and purchase additional services and medical equipment, to respond to erectile dysfunction treatment. For the complete list of winners and to watch the video of the ceremony, please visit 2020 NSW Health Awards.​​Restrictions for religious gatherings and gyms will be eased under relaxed erectile dysfunction treatment safety rules announced today. From Friday 23 buy super kamagra online uk October.

Religious gatherings/places of worship (excluding weddings and funerals) can have up to 300 people, subject to a erectile dysfunction treatment safety plan gyms will only be required to have a erectile dysfunction treatment safety marshal if there are more than 20 people in the gym at one time.Treasurer Dominic Perrottet said as the NSW Government eases restrictions the community should continue to be erectile dysfunction treatment Safe.“Our aim is to provide as many opportunities as we can for organisations and the community to carry on with their work and lives as much as possible,” Mr Perrottet said.“We want to keep moving forward but for that strategy to be successful we need everyone to follow the erectile dysfunction treatment Safety Plans.”Minister for Health Brad Hazzard thanked religious leaders and the community for their ongoing support of the efforts to control erectile dysfunction treatment. €œThe impact of erectile dysfunction treatment is being felt right across the community but the further easing of restrictions to allow 300 people at religious gatherings is another cautious step towards a ‘erectile dysfunction treatment-normal’ life,” Mr Hazzard buy super kamagra online uk said.“erectile dysfunction treatment is still lurking amongst us so I urge all leaders to continue encouraging everyone at their religious gatherings and places of worship to comply with the health advice to keep themselves and others safe.”Religious gatherings exclude weddings and funerals. However, from 1 December, the number of people who can attend weddings will be lifted to 300 people subject to the four square metre rule indoors and two square metre rule outdoors.

People attending a religious service will be required to provide their name and buy super kamagra online uk contact details when they enter so they can be used for contact tracing. They are also being urged to wear a mask when attending places of worship.NSW Health Chief Health Officer Dr Kerry Chant said NSW Health continues to work closely with the gym sector to develop further guidance to ensure every measure is taken to keep people safe when they visit the gym.“People can help stop the spread of erectile dysfunction treatment in gyms by visiting at less busy times, practising good hand hygiene before, during and after workouts, maintaining physical distancing especially when working out, and wiping down equipment with detergent and disinfectant each time it is used,” Dr Chant said. Each gym facility is required to have a erectile dysfunction treatment Safe plan..

€‹â€‹The heroic efforts of NSW healthcare workers who this year faced the challenges of bushfires, drought, floods and the ongoing erectile dysfunction treatment kamagra kamagra jelly price in canada have been recognised at the 2020 NSW Health Awards. Minister for Health Brad Hazzard said the extraordinary circumstances of the past year made it more important than ever to acknowledge the achievements of healthcare workers in NSW. €œI extend my wholehearted gratitude to all of our health staff for their ongoing efforts during kamagra jelly price in canada this immensely challenging time,” Mr Hazzard said. €œEvery single year our health staff go above and beyond to save lives and provide patients with top level care. This year the challenges ramped right up – topped off with a one-in-one hundred year kamagra – and our staff showed remarkable resilience, meeting these challenges every step of the way.” Among this year’s winners is an elite team of NSW Health Pathology researchers who established kamagra jelly price in canada highly specialised erectile dysfunction treatment testing capabilities at the onset of the kamagra.

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There were 19 kamagra jelly price in canada finalists from 14 statewide health entities competing for 10 award categories. The NSW Health Awards recognise innovative and sustainable health programs that deliver better outcomes for patients and invest in the wellness of the NSW community. The NSW Government has kamagra jelly price in canada committed $800 million extra funding over two years on top of the 2019-20 Health Budget of $26.7 billion to help boost ICU capacity and purchase additional services and medical equipment, to respond to erectile dysfunction treatment. For the complete list of winners and to watch the video of the ceremony, please visit 2020 NSW Health Awards.​​Restrictions for religious gatherings and gyms will be eased under relaxed erectile dysfunction treatment safety rules announced today. From Friday kamagra jelly price in canada 23 October.

Religious gatherings/places of worship (excluding weddings and funerals) can have up to 300 people, subject to a erectile dysfunction treatment safety plan gyms will only be required to have a erectile dysfunction treatment safety marshal if there are more than 20 people in the gym at one time.Treasurer Dominic Perrottet said as the NSW Government eases restrictions the community should continue to be erectile dysfunction treatment Safe.“Our aim is to provide as many opportunities as we can for organisations and the community to carry on with their work and lives as much as possible,” Mr Perrottet said.“We want to keep moving forward but for that strategy to be successful we need everyone to follow the erectile dysfunction treatment Safety Plans.”Minister for Health Brad Hazzard thanked religious leaders and the community for their ongoing support of the efforts to control erectile dysfunction treatment. €œThe impact of erectile dysfunction treatment is being felt right across the community but the further easing of restrictions to allow 300 people at religious gatherings is another cautious step towards a ‘erectile dysfunction treatment-normal’ life,” Mr Hazzard said.“erectile dysfunction treatment is still lurking amongst us so I urge all leaders to continue encouraging everyone kamagra jelly price in canada at their religious gatherings and places of worship to comply with the health advice to keep themselves and others safe.”Religious gatherings exclude weddings and funerals. However, from 1 December, the number of people who can attend weddings will be lifted to 300 people subject to the four square metre rule indoors and two square metre rule outdoors. People attending a religious service will be required to provide their name and contact details when they enter so kamagra jelly price in canada they can be used for contact tracing. They are also being urged to wear a mask when attending places of worship.NSW Health Chief Health Officer Dr Kerry Chant said NSW Health continues to work closely with the gym sector to develop further guidance to ensure every measure is taken to keep people safe when they visit the gym.“People can help stop the spread of erectile dysfunction treatment in gyms by visiting at less busy times, practising good hand hygiene before, during and after workouts, maintaining physical distancing especially when working out, and wiping down equipment with detergent and disinfectant each time it is used,” Dr Chant said.

Each gym facility is required to have a erectile dysfunction treatment Safe plan..

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Therefore, many MBI WPD consumers have incomes buy kamagra fast delivery higher than what MSP normally allows, but you could try here still have full Medicaid with no spend down. Those consumers can qualify for MIPP and have their Part B premiums reimbursed. Here is an example. Sam is age 50 and has Medicare and MBI-WPD buy kamagra fast delivery. She gets $1500/mo gross from Social Security Disability and also makes $400/month through work activity.

$ 167.50 -- EARNED INCOME - Because she is disabled, the DAB earned income disregard applies. $400 - $65 buy kamagra fast delivery = $335. Her countable earned income is 1/2 of $335 = $167.50 + $1500.00 -- UNEARNED INCOME from Social Security Disability = $1,667.50 --TOTAL income. This is above the SLIMB limit of $1,288 (2021) but she can still qualify for MIPP. 2 buy kamagra fast delivery.

Parent/Caretaker Relatives with MAGI-like Budgeting - Including Medicare Beneficiaries. Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time. This is referred to as “MAGI-like budgeting.” Under buy kamagra fast delivery MAGI rules income can be up to 138% of the FPL—again, higher than the limit for DAB budgeting, which is equivalent to only 83% FPL. MAGI-like consumers can be enrolled in either MSP or MIPP, depending on if their income is higher or lower than 120% of the FPL. If their income is under 120% FPL, they are eligible for MSP as a SLIMB.

If income is above buy kamagra fast delivery 120% FPL, then they can enroll in MIPP. (See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4) 3. New Medicare Enrollees who are Not Yet in a Medicare Savings Program When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, her Medicaid case is normally** transferred to the local department of social services (LDSS)(HRA in NYC) to be rebudgeted under non-MAGI budgeting. During the transition process, she should buy kamagra fast delivery be reimbursed for the Part B premiums via MIPP. However, the transition time can vary based on age.

AGE 65+ For those who enroll in Medicare at age 65+, the Medicaid case takes about four months to be rebudgeted and approved by the LDSS. The consumer is entitled to MIPP payments for at least three months buy kamagra fast delivery during the transition. Once the case is with the LDSS she should automatically be re-evaluated for MSP. Consumers UNDER 65 who receive Medicare due to disability status are entitled to keep MAGI Medicaid through NYSoH for up to 12 months (also known as continuous coverage, See NY Social Services Law 366, subd. 4(c).

These consumers should receive MIPP payments for as long as their cases remain with NYSoH and throughout the transition to the LDSS. NOTE during erectile dysfunction treatment emergency their case may remain with NYSoH for more than 12 months. See here. See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4 for an explanation of this process. Note.

During the erectile dysfunction treatment emergency, those who have Medicaid through the NYSOH marketplace and enroll in Medicare should NOT have their cases transitioned to the LDSS. They should keep the same MAGI budgeting and automatically receive MIPP payments. See GIS 20 MA/04 or this article on erectile dysfunction treatment eligibility changes 4. Those with Special Budgeting after Losing SSI (DAC, Pickle, 1619b) Disabled Adult Child (DAC). Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an increase in the amount of their benefit).

Consumer must have become disabled or blind before age 22 to receive the benefit. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN. See this article. Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down. Therefore, they are eligible for payment of their Part B premiums.

See page 96 of the Medicaid Reference Guide (Categorical Factors). If their income is lower than the MSP SLIMB threshold, they can be added to MSP. If higher than the threshold, they can be reimbursed via MIPP. See also 95-ADM-11. Medical Assistance Eligibility for Disabled Adult Children, Section C (pg 8).

Pickle &. 1619B. 5. When the Part B Premium Reduces Countable Income to Below the Medicaid Limit Since the Part B premium can be used as a deduction from gross income, it may reduce someone's countable income to below the Medicaid limit. The consumer should be paid the difference to bring her up to the Medicaid level ($904/month in 2021).

They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium. See GIS 02-MA-019. Reimbursement of Health Insurance Premiums MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences. MIPP structures the payments as reimbursement -- beneficiaries must continue to pay their premium (via a monthly deduction from their Social Security check or quarterly billing, if they do not receive Social Security) and then are reimbursed via check. In contrast, MSP enrollees are not charged for their premium.

Their Social Security check usually increases because the Part B premium is no longer withheld from their check. MIPP only provides reimbursement for Part B. It does not have any of the other benefits MSPs can provide, such as. A consumer cannot have MIPP without also having Medicaid, whereas MSP enrollees can have MSP only. Of the above benefits, Medicaid also provides Part D Extra Help automatic eligibility.

There is no application process for MIPP because consumers should be screened and enrolled automatically (00 OMM/ADM-7). Either the state or the LDSS is responsible for screening &. Distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V). If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment. Unfortunately, since there is no formal process for applying, it may require some advocacy.

If Medicaid case is at New York State of Health they should call 1-855-355-5777. Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP. If Medicaid case is with HRA in New York City, they should email mipp@hra.nyc.gov. If Medicaid case is with other local districts in NYS, call your local county DSS. Once enrolled, it make take a few months for payments to begin.

Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program. The check itself comes attached to a remittance notice from Medicaid Management Information Systems (MMIS). Unfortunately, the notice is not consumer-friendly and may be confusing. See attached sample for what to look for. Health Insurance Premium Payment Program (HIPP) HIPP is a sister program to MIPP and will reimburse consumers for private third party health insurance when deemed “cost effective.” Directives:Medicare Savings Programs (MSPs) pay for the monthly Medicare Part B premium for low-income Medicare beneficiaries and qualify enrollees for the "Extra Help" subsidy for Part D prescription drugs.

There are three separate MSP programs, the Qualified Medicare Beneficiary (QMB) Program, the Specified Low Income Medicare Beneficiary (SLMB) Program and the Qualified Individual (QI) Program, each of which is discussed below. Those in QMB receive additional subsidies for Medicare costs. See 2021 Fact Sheet on MSP in NYS by Medicare Rights Center ENGLISH SPANISH State law. N.Y. Soc.

Serv. L. § 367-a(3)(a), (b), and (d). 2020 Medicare 101 Basics for New York State - 1.5 hour webinar by Eric Hausman, sponsored by NYS Office of the Aging Note. Some consumers may be eligible for the Medicare Insurance Premium Payment (MIPP) Program, instead of MSP.

See this article for more info. TOPICS COVERED IN THIS ARTICLE 1. No Asset Limit 1A. Summary Chart of MSP Programs 2. Income Limits &.

Rules and Household Size 3. The Three MSP Programs - What are they and how are they Different?. 4. FOUR Special Benefits of MSP Programs. Back Door to Extra Help with Part D MSPs Automatically Waive Late Enrollment Penalties for Part B - and allow enrollment in Part B year-round outside of the short Annual Enrollment Period No Medicaid Lien on Estate to Recover Payment of Expenses Paid by MSP Food Stamps/SNAP not reduced by Decreased Medical Expenses when Enroll in MSP - at least temporarily 5.

Enrolling in an MSP - Automatic Enrollment &. Applications for People who Have Medicare What is Application Process?. 6. Enrolling in an MSP for People age 65+ who Do Not Qualify for Free Medicare Part A - the "Part A Buy-In Program" 7. What Happens After MSP Approved - How Part B Premium is Paid 8 Special Rules for QMBs - How Medicare Cost-Sharing Works 1.

NO ASSET LIMIT!. Since April 1, 2008, none of the three MSP programs have resource limits in New York -- which means many Medicare beneficiaries who might not qualify for Medicaid because of excess resources can qualify for an MSP. 1.A. SUMMARY CHART OF MSP BENEFITS QMB SLIMB QI-1 Eligibility ASSET LIMIT NO LIMIT IN NEW YORK STATE INCOME LIMIT (2021) Single Couple Single Couple Single Couple $1,094 $1,472 $1,308 $1,762 $1,469 $1,980 Federal Poverty Level 100% FPL 100 – 120% FPL 120 – 135% FPL Benefits Pays Monthly Part B premium?. YES, and also Part A premium if did not have enough work quarters and meets citizenship requirement.

See “Part A Buy-In” YES YES Pays Part A &. B deductibles &. Co-insurance YES - with limitations NO NO Retroactive to Filing of Application?. Yes - Benefits begin the month after the month of the MSP application. 18 NYCRR §360-7.8(b)(5) Yes – Retroactive to 3rd month before month of application, if eligible in prior months Yes – may be retroactive to 3rd month before month of applica-tion, but only within the current calendar year.

(No retro for January application). See GIS 07 MA 027. Can Enroll in MSP and Medicaid at Same Time?. YES YES NO!. Must choose between QI-1 and Medicaid.

Cannot have both, not even Medicaid with a spend-down. 2. INCOME LIMITS and RULES Each of the three MSP programs has different income eligibility requirements and provides different benefits. The income limits are tied to the Federal Poverty Level (FPL). 2021 FPL levels were released by NYS DOH in GIS 21 MA/06 - 2021 Federal Poverty Levels Attachment II NOTE.

There is usually a lag in time of several weeks, or even months, from January 1st of each year until the new FPLs are release, and then before the new MSP income limits are officially implemented. During this lag period, local Medicaid offices should continue to use the previous year's FPLs AND count the person's Social Security benefit amount from the previous year - do NOT factor in the Social Security COLA (cost of living adjustment). Once the updated guidelines are released, districts will use the new FPLs and go ahead and factor in any COLA. See 2021 Fact Sheet on MSP in NYS by Medicare Rights Center ENGLISH SPANISH Income is determined by the same methodology as is used for determining in eligibility for SSI The rules for counting income for SSI-related (Aged 65+, Blind, or Disabled) Medicaid recipients, borrowed from the SSI program, apply to the MSP program, except for the new rules about counting household size for married couples. N.Y.

Soc. Serv. L. 367-a(3)(c)(2), NYS DOH 2000-ADM-7, 89-ADM-7 p.7. Gross income is counted, although there are certain types of income that are disregarded.

The most common income disregards, also known as deductions, include. (a) The first $20 of your &. Your spouse's monthly income, earned or unearned ($20 per couple max). (b) SSI EARNED INCOME DISREGARDS. * The first $65 of monthly wages of you and your spouse, * One-half of the remaining monthly wages (after the $65 is deducted).

* Other work incentives including PASS plans, impairment related work expenses (IRWEs), blind work expenses, etc. For information on these deductions, see The Medicaid Buy-In for Working People with Disabilities (MBI-WPD) and other guides in this article -- though written for the MBI-WPD, the work incentives apply to all Medicaid programs, including MSP, for people age 65+, disabled or blind. (c) monthly cost of any health insurance premiums but NOT the Part B premium, since Medicaid will now pay this premium (may deduct Medigap supplemental policies, vision, dental, or long term care insurance premiums, and the Part D premium but only to the extent the premium exceeds the Extra Help benchmark amount) (d) Food stamps not counted. You can get a more comprehensive listing of the SSI-related income disregards on the Medicaid income disregards chart. As for all benefit programs based on financial need, it is usually advantageous to be considered a larger household, because the income limit is higher.

The above chart shows that Households of TWO have a higher income limit than households of ONE. The MSP programs use the same rules as Medicaid does for the Disabled, Aged and Blind (DAB) which are borrowed from the SSI program for Medicaid recipients in the “SSI-related category.” Under these rules, a household can be only ONE or TWO. 18 NYCRR 360-4.2. See DAB Household Size Chart. Married persons can sometimes be ONE or TWO depending on arcane rules, which can force a Medicare beneficiary to be limited to the income limit for ONE person even though his spouse who is under 65 and not disabled has no income, and is supported by the client applying for an MSP.

EXAMPLE. Bob's Social Security is $1300/month. He is age 67 and has Medicare. His wife, Nancy, is age 62 and is not disabled and does not work. Under the old rule, Bob was not eligible for an MSP because his income was above the Income limit for One, even though it was well under the Couple limit.

In 2010, NYS DOH modified its rules so that all married individuals will be considered a household size of TWO. DOH GIS 10 MA 10 Medicare Savings Program Household Size, June 4, 2010. This rule for household size is an exception to the rule applying SSI budgeting rules to the MSP program. Under these rules, Bob is now eligible for an MSP. When is One Better than Two?.

Of course, there may be couples where the non-applying spouse's income is too high, and disqualifies the applying spouse from an MSP. In such cases, "spousal refusal" may be used SSL 366.3(a). (Link is to NYC HRA form, can be adapted for other counties). In NYC, if you have a Medicaid case with HRA, instead of submitting an MSP application, you only need to complete and submit MAP-751W (check off "Medicare Savings Program Evaluation") and fax to (917) 639-0837. (The MAP-751W is also posted in languages other than English in this link.

(Updated 4/14/2021.)) 3. The Three Medicare Savings Programs - what are they and how are they different?. 1. Qualified Medicare Beneficiary (QMB). The QMB program provides the most comprehensive benefits.

Available to those with incomes at or below 100% of the Federal Poverty Level (FPL), the QMB program covers virtually all Medicare cost-sharing obligations. Part B premiums, Part A premiums, if there are any, and any and all deductibles and co-insurance. QMB coverage is not retroactive. The program’s benefits will begin the month after the month in which your client is found eligible. ** See special rules about cost-sharing for QMBs below - updated with new CMS directive issued January 2012 ** See NYC HRA QMB Recertification form ** Even if you do not have Part A automatically, because you did not have enough wages, you may be able to enroll in the Part A Buy-In Program, in which people eligible for QMB who do not otherwise have Medicare Part A may enroll, with Medicaid paying the Part A premium (Materials by the Medicare Rights Center).

2. Specifiedl Low-Income Medicare Beneficiary (SLMB). For those with incomes between 100% and 120% FPL, the SLMB program will cover Part B premiums only. SLMB is retroactive, however, providing coverage for three months prior to the month of application, as long as your client was eligible during those months. 3.

Qualified Individual (QI-1). For those with incomes between 120% and 135% FPL, and not receiving Medicaid, the QI-1 program will cover Medicare Part B premiums only. QI-1 is also retroactive, providing coverage for three months prior to the month of application, as long as your client was eligible during those months. However, QI-1 retroactive coverage can only be provided within the current calendar year. (GIS 07 MA 027) So if you apply in January, you get no retroactive coverage.

Q-I-1 recipients would be eligible for Medicaid with a spend-down, but if they want the Part B premium paid, they must choose between enrolling in QI-1 or Medicaid. They cannot be in both. It is their choice. DOH MRG p. 19.

In contrast, one may receive Medicaid and either QMB or SLIMB. 4. Four Special Benefits of MSPs (in addition to NO ASSET TEST). Benefit 1. Back Door to Medicare Part D "Extra Help" or Low Income Subsidy -- All MSP recipients are automatically enrolled in Extra Help, the subsidy that makes Part D affordable.

They have no Part D deductible or doughnut hole, the premium is subsidized, and they pay very low copayments. Once they are enrolled in Extra Help by virtue of enrollment in an MSP, they retain Extra Help for the entire calendar year, even if they lose MSP eligibility during that year. The "Full" Extra Help subsidy has the same income limit as QI-1 - 135% FPL. However, many people may be eligible for QI-1 but not Extra Help because QI-1 and the other MSPs have no asset limit. People applying to the Social Security Administration for Extra Help might be rejected for this reason.

Recent (2009-10) changes to federal law called "MIPPA" requires the Social Security Administration (SSA) to share eligibility data with NYSDOH on all persons who apply for Extra Help/ the Low Income Subsidy. Data sent to NYSDOH from SSA will enable NYSDOH to open MSP cases on many clients. The effective date of the MSP application must be the same date as the Extra Help application. Signatures will not be required from clients. In cases where the SSA data is incomplete, NYSDOH will forward what is collected to the local district for completion of an MSP application.

The State implementing procedures are in DOH 2010 ADM-03. Also see CMS "Dear State Medicaid Director" letter dated Feb. 18, 2010 Benefit 2. MSPs Automatically Waive Late Enrollment Penalties for Part B Generally one must enroll in Part B within the strict enrollment periods after turning age 65 or after 24 months of Social Security Disability. An exception is if you or your spouse are still working and insured under an employer sponsored group health plan, or if you have End Stage Renal Disease, and other factors, see this from Medicare Rights Center.

If you fail to enroll within those short periods, you might have to pay higher Part B premiums for life as a Late Enrollment Penalty (LEP). Also, you may only enroll in Part B during the Annual Enrollment Period from January 1 - March 31st each year, with Part B not effective until the following July. Enrollment in an MSP automatically eliminates such penalties... For life.. Even if one later ceases to be eligible for the MSP.

AND enrolling in an MSP will automatically result in becoming enrolled in Part B if you didn't already have it and only had Part A. See Medicare Rights Center flyer. Benefit 3. No Medicaid Lien on Estate to Recover MSP Benefits Paid Generally speaking, states may place liens on the Estates of deceased Medicaid recipients to recover the cost of Medicaid services that were provided after the recipient reached the age of 55. Since 2002, states have not been allowed to recover the cost of Medicare premiums paid under MSPs.

In 2010, Congress expanded protection for MSP benefits. Beginning on January 1, 2010, states may not place liens on the Estates of Medicaid recipients who died after January 1, 2010 to recover costs for co-insurance paid under the QMB MSP program for services rendered after January 1, 2010. The federal government made this change in order to eliminate barriers to enrollment in MSPs. See NYS DOH GIS 10-MA-008 - Medicare Savings Program Changes in Estate Recovery The GIS clarifies that a client who receives both QMB and full Medicaid is exempt from estate recovery for these Medicare cost-sharing expenses. Benefit 4.

SNAP (Food Stamp) benefits not reduced despite increased income from MSP - at least temporarily Many people receive both SNAP (Food Stamp) benefits and MSP. Income for purposes of SNAP/Food Stamps is reduced by a deduction for medical expenses, which includes payment of the Part B premium. Since approval for an MSP means that the client no longer pays for the Part B premium, his/her SNAP/Food Stamps income goes up, so their SNAP/Food Stamps go down. Here are some protections. Do these individuals have to report to their SNAP worker that their out of pocket medical costs have decreased?.

And will the household see a reduction in their SNAP benefits, since the decrease in medical expenses will increase their countable income?. The good news is that MSP households do NOT have to report the decrease in their medical expenses to the SNAP/Food Stamp office until their next SNAP/Food Stamp recertification. Even if they do report the change, or the local district finds out because the same worker is handling both the MSP and SNAP case, there should be no reduction in the household’s benefit until the next recertification. New York’s SNAP policy per administrative directive 02 ADM-07 is to “freeze” the deduction for medical expenses between certification periods. Increases in medical expenses can be budgeted at the household’s request, but NYS never decreases a household’s medical expense deduction until the next recertification.

Most elderly and disabled households have 24-month SNAP certification periods. Eventually, though, the decrease in medical expenses will need to be reported when the household recertifies for SNAP, and the household should expect to see a decrease in their monthly SNAP benefit. It is really important to stress that the loss in SNAP benefits is NOT dollar for dollar. A $100 decrease in out of pocket medical expenses would translate roughly into a $30 drop in SNAP benefits. See more info on SNAP/Food Stamp benefits by the Empire Justice Center, and on the State OTDA website.

Some clients will be automatically enrolled in an MSP by the New York State Department of Health (NYSDOH) shortly after attaining eligibility for Medicare. Others need to apply. The 2010 "MIPPA" law introduced some improvements to increase MSP enrollment. See 3rd bullet below. Also, some people who had Medicaid through the Affordable Care Act before they became eligible for Medicare have special procedures to have their Part B premium paid before they enroll in an MSP.

See below. WHO IS AUTOMATICALLY ENROLLED IN AN MSP. Clients receiving even $1.00 of Supplemental Security Income should be automatically enrolled into a Medicare Savings Program (most often QMB) under New York State’s Medicare Savings Program Buy-in Agreement with the federal government once they become eligible for Medicare. They should receive Medicare Parts A and B. Clients who are already eligible for Medicare when they apply for Medicaid should be automatically assessed for MSP eligibility when they apply for Medicaid.

(NYS DOH 2000-ADM-7 and GIS 05 MA 033). Clients who apply to the Social Security Administration for Extra Help, but are rejected, should be contacted &. Enrolled into an MSP by the Medicaid program directly under new MIPPA procedures that require data sharing. Strategy TIP. Since the Extra Help filing date will be assigned to the MSP application, it may help the client to apply online for Extra Help with the SSA, even knowing that this application will be rejected because of excess assets or other reason.

SSA processes these requests quickly, and it will be routed to the State for MSP processing. Since MSP applications take a while, at least the filing date will be retroactive. Note. The above strategy does not work as well for QMB, because the effective date of QMB is the month after the month of application. As a result, the retroactive effective date of Extra Help will be the month after the failed Extra Help application for those with QMB rather than SLMB/QI-1.

Applying for MSP Directly with Local Medicaid Program. Those who do not have Medicaid already must apply for an MSP through their local social services district. (See more in Section D. Below re those who already have Medicaid through the Affordable Care Act before they became eligible for Medicare. If you are applying for MSP only (not also Medicaid), you can use the simplified MSP application form (theDOH-4328(Rev.

8/2017-- English) (2017 Spanish version not yet available). Either application form can be mailed in -- there is no interview requirement anymore for MSP or Medicaid. See 10 ADM-04. Applicants will need to submit proof of income, a copy of their Medicare card (front &. Back), and proof of residency/address.

See the application form for other instructions. One who is only eligible for QI-1 because of higher income may ONLY apply for an MSP, not for Medicaid too. One may not receive Medicaid and QI-1 at the same time. If someone only eligible for QI-1 wants Medicaid, s/he may enroll in and deposit excess income into a pooled Supplemental Needs Trust, to bring her countable income down to the Medicaid level, which also qualifies him or her for SLIMB or QMB instead of QI-1. Advocates in NYC can sign up for a half-day "Deputization Training" conducted by the Medicare Rights Center, at which you'll be trained and authorized to complete an MSP application and to submit it via the Medicare Rights Center, which submits it to HRA without the client having to apply in person.

Enrolling in an MSP if you already have Medicaid, but just become eligible for Medicare Those who, prior to becoming enrolled in Medicare, had Medicaid through Affordable Care Act are eligible to have their Part B premiums paid by Medicaid (or the cost reimbursed) during the time it takes for them to transition to a Medicare Savings Program. In 2018, DOH clarified that reimbursement of the Part B premium will be made regardless of whether the individual is still in a Medicaid managed care (MMC) plan. GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare ( PDF) provides, "Due to efforts to transition individuals who gain Medicare eligibility and who require LTSS, individuals may not be disenrolled from MMC upon receipt of Medicare. To facilitate the transition and not disadvantage the recipient, the Medicaid program is approving reimbursement of Part B premiums for enrollees in MMC." The procedure for getting the Part B premium paid is different for those whose Medicaid was administered by the NYS of Health Exchange (Marketplace), as opposed to their local social services district. The procedure is also different for those who obtain Medicare because they turn 65, as opposed to obtaining Medicare based on disability.

Either way, Medicaid recipients who transition onto Medicare should be automatically evaluated for MSP eligibility at their next Medicaid recertification. NYS DOH 2000-ADM-7 Individuals can also affirmatively ask to be enrolled in MSP in between recertification periods. IF CLIENT HAD MEDICAID ON THE MARKETPLACE (NYS of Health Exchange) before obtaining Medicare. IF they obtain Medicare because they turn age 65, they will receive a letter from their local district asking them to "renew" Medicaid through their local district. See 2014 LCM-02.

Now, their Medicaid income limit will be lower than the MAGI limits ($842/ mo reduced from $1387/month) and they now will have an asset test. For this reason, some individuals may lose full Medicaid eligibility when they begin receiving Medicare. People over age 65 who obtain Medicare do NOT keep "Marketplace Medicaid" for 12 months (continuous eligibility) See GIS 15 MA/022 - Continuous Coverage for MAGI Individuals. Since MSP has NO ASSET limit. Some individuals may be enrolled in the MSP even if they lose Medicaid, or if they now have a Medicaid spend-down.

If a Medicare/Medicaid recipient reports income that exceeds the Medicaid level, districts must evaluate the person’s eligibility for MSP. 08 OHIP/ADM-4 ​If you became eligible for Medicare based on disability and you are UNDER AGE 65, you are entitled to keep MAGI Medicaid for 12 months from the month it was last authorized, even if you now have income normally above the MAGI limit, and even though you now have Medicare. This is called Continuous Eligibility. EXAMPLE. Sam, age 60, was last authorized for Medicaid on the Marketplace in June 2016.

He became enrolled in Medicare based on disability in August 2016, and started receiving Social Security in the same month (he won a hearing approving Social Security disability benefits retroactively, after first being denied disability). Even though his Social Security is too high, he can keep Medicaid for 12 months beginning June 2016. Sam has to pay for his Part B premium - it is deducted from his Social Security check. He may call the Marketplace and request a refund. This will continue until the end of his 12 months of continues MAGI Medicaid eligibility.

He will be reimbursed regardless of whether he is in a Medicaid managed care plan. See GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare (PDF) When that ends, he will renew Medicaid and apply for MSP with his local district. Individuals who are eligible for Medicaid with a spenddown can opt whether or not to receive MSP. (Medicaid Reference Guide (MRG) p. 19).

Obtaining MSP may increase their spenddown. MIPPA - Outreach by Social Security Administration -- Under MIPPA, the SSA sends a form letter to people who may be eligible for a Medicare Savings Program or Extra Help (Low Income Subsidy - LIS) that they may apply. The letters are. · Beneficiary has Extra Help (LIS), but not MSP · Beneficiary has no Extra Help (LIS) or MSP 6. Enrolling in MSP for People Age 65+ who do Not have Free Medicare Part A - the "Part A Buy-In Program" Seniors WITHOUT MEDICARE PART A or B -- They may be able to enroll in the Part A Buy-In program, in which people eligible for QMB who are age 65+ who do not otherwise have Medicare Part A may enroll in Part A, with Medicaid paying the Part A premium.

See Step-by-Step Guide by the Medicare Rights Center). This guide explains the various steps in "conditionally enrolling" in Part A at the SSA office, which must be done before applying for QMB at the Medicaid office, which will then pay the Part A premium. See also GIS 04 MA/013. In June, 2018, the SSA revised the POMS manual procedures for the Part A Buy-In to to address inconsistencies and confusion in SSA field offices and help smooth the path for QMB enrollment. The procedures are in the POMS Section HI 00801.140 "Premium-Free Part A Enrollments for Qualified Medicare BenefiIaries." It includes important clarifications, such as.

SSA Field Offices should explain the QMB program and conditional enrollment process if an individual lacks premium-free Part A and appears to meet QMB requirements. SSA field offices can add notes to the “Remarks” section of the application and provide a screen shot to the individual so the individual can provide proof of conditional Part A enrollment when applying for QMB through the state Medicaid program. Beneficiaries are allowed to complete the conditional application even if they owe Medicare premiums. In Part A Buy-in states like NYS, SSA should process conditional applications on a rolling basis (without regard to enrollment periods), even if the application coincides with the General Enrollment Period. (The General Enrollment Period is from Jan 1 to March 31st every year, in which anyone eligible may enroll in Medicare Part A or Part B to be effective on July 1st).

7. What happens after the MSP approval - How is Part B premium paid For all three MSP programs, the Medicaid program is now responsible for paying the Part B premiums, even though the MSP enrollee is not necessarily a recipient of Medicaid. The local Medicaid office (DSS/HRA) transmits the MSP approval to the NYS Department of Health – that information gets shared w/ SSA and CMS SSA stops deducting the Part B premiums out of the beneficiary’s Social Security check. SSA also refunds any amounts owed to the recipient. (Note.

Instead, these consumers can have their Part B premium reimbursed kamagra jelly price in canada through the MIPP http://hannahshands.org/how-can-i-get-kamagra/ program. In this article. The MIPP program was established because the State determined that those who have full Medicaid and Medicare Part B should be reimbursed for their Part B premium, even if they do not qualify for MSP, because Medicare is considered cost effective third party health insurance, and because consumers must enroll in Medicare as a condition of eligibility for Medicaid (See 89 ADM 7).

There are generally four groups of dual-eligible consumers that are eligible for kamagra jelly price in canada MIPP. Therefore, many MBI WPD consumers have incomes higher than what MSP normally allows, but still have full Medicaid with no spend down. Those consumers can qualify for MIPP and have their Part B premiums reimbursed.

Here is an kamagra jelly price in canada example. Sam is age 50 and has Medicare and MBI-WPD. She gets $1500/mo gross from Social Security Disability and also makes $400/month through work activity.

$ 167.50 -- EARNED INCOME - kamagra jelly price in canada Because she is disabled, the DAB earned income disregard applies. $400 - $65 = $335. Her countable earned income is 1/2 of $335 = $167.50 + $1500.00 -- UNEARNED INCOME from Social Security Disability = $1,667.50 --TOTAL income.

This is kamagra jelly price in canada above the SLIMB limit of $1,288 (2021) but she can still qualify for MIPP. 2. Parent/Caretaker Relatives with MAGI-like Budgeting - Including Medicare Beneficiaries.

Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to kamagra jelly price in canada use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time. This is referred to as “MAGI-like budgeting.” Under MAGI rules income can be up to 138% of the FPL—again, higher than the limit for DAB budgeting, which is equivalent to only 83% FPL. MAGI-like consumers can be enrolled in either MSP or MIPP, depending on if their income is higher or lower than 120% of the FPL.

If their income is under 120% FPL, they are kamagra jelly price in canada eligible for MSP as a SLIMB. If income is above 120% FPL, then they can enroll in MIPP. (See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4) 3.

New Medicare Enrollees who are Not Yet in kamagra jelly price in canada a Medicare Savings Program When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, her Medicaid case is normally** transferred to the local department of social services (LDSS)(HRA in NYC) to be rebudgeted under non-MAGI budgeting. During the transition process, she should be reimbursed for the Part B premiums via MIPP. However, the transition time can vary based on age.

AGE 65+ For those who enroll in Medicare at age 65+, the Medicaid case takes about four months to be kamagra jelly price in canada rebudgeted and approved by the LDSS. The consumer is entitled to MIPP payments for at least three months during the transition. Once the case is with the LDSS she should automatically be re-evaluated for MSP.

Consumers UNDER 65 who receive Medicare due to disability status are entitled kamagra jelly price in canada to keep MAGI Medicaid through NYSoH for up to 12 months (also known as continuous coverage, See NY Social Services Law 366, subd. 4(c). These consumers should receive MIPP payments for as long as their cases remain with NYSoH and throughout the transition to the LDSS.

NOTE during erectile dysfunction treatment emergency their case may remain with NYSoH for more than kamagra jelly price in canada 12 months. See here. See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4 for an explanation of this process.

Note kamagra jelly price in canada. During the erectile dysfunction treatment emergency, those who have Medicaid through the NYSOH marketplace and enroll in Medicare should NOT have their cases transitioned to the LDSS. They should keep the same MAGI budgeting and automatically receive MIPP payments.

See GIS 20 MA/04 kamagra jelly price in canada or this article on erectile dysfunction treatment eligibility changes 4. Those with Special Budgeting after Losing SSI (DAC, Pickle, 1619b) Disabled Adult Child (DAC). Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an increase in the amount of their benefit).

Consumer must have become disabled or blind before age 22 to receive the benefit kamagra jelly price in canada. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN. See this article.

Consumers may have income higher than MSP limits, but keep full Medicaid kamagra jelly price in canada with no spend down. Therefore, they are eligible for payment of their Part B premiums. See page 96 of the Medicaid Reference Guide (Categorical Factors).

If their income is lower kamagra jelly price in canada than the MSP SLIMB threshold, they can be added to MSP. If higher than the threshold, they can be reimbursed via MIPP. See also 95-ADM-11.

Medical Assistance Eligibility for Disabled Adult kamagra jelly price in canada Children, Section C (pg 8). Pickle &. 1619B.

5. When the Part B Premium Reduces Countable Income to Below the Medicaid Limit Since the Part B premium can be used as a deduction from gross income, it may reduce someone's countable income to below the Medicaid limit. The consumer should be paid the difference to bring her up to the Medicaid level ($904/month in 2021).

They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium. See GIS 02-MA-019. Reimbursement of Health Insurance Premiums MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences.

MIPP structures the payments as reimbursement -- beneficiaries must continue to pay their premium (via a monthly deduction from their Social Security check or quarterly billing, if they do not receive Social Security) and then are reimbursed via check. In contrast, MSP enrollees are not charged for their premium. Their Social Security check usually increases because the Part B premium is no longer withheld from their check.

MIPP only provides reimbursement for Part B. It does not have any of the other benefits MSPs can provide, such as. A consumer cannot have MIPP without also having Medicaid, whereas MSP enrollees can have MSP only.

Of the above benefits, Medicaid also provides Part D Extra Help automatic eligibility. There is no application process for MIPP because consumers should be screened and enrolled automatically (00 OMM/ADM-7). Either the state or the LDSS is responsible for screening &.

Distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V). If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment. Unfortunately, since there is no formal process for applying, it may require some advocacy.

If Medicaid case is at New York State of Health they should call 1-855-355-5777. Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP. If Medicaid case is with HRA in New York City, they should email mipp@hra.nyc.gov.

If Medicaid case is with other local districts in NYS, call your local county DSS. Once enrolled, it make take a few months for payments to begin. Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program.

The check itself comes attached to a remittance notice from Medicaid Management Information Systems (MMIS). Unfortunately, the notice is not consumer-friendly and may be confusing. See attached sample for what to look for.

Health Insurance Premium Payment Program (HIPP) HIPP is a sister program to MIPP and will reimburse consumers for private third party health insurance when deemed “cost effective.” Directives:Medicare Savings Programs (MSPs) pay for the monthly Medicare Part B premium for low-income Medicare beneficiaries and qualify enrollees for the "Extra Help" subsidy for Part D prescription drugs. There are three separate MSP programs, the Qualified Medicare Beneficiary (QMB) Program, the Specified Low Income Medicare Beneficiary (SLMB) Program and the Qualified Individual (QI) Program, each of which is discussed below. Those in QMB receive additional subsidies for Medicare costs.

See 2021 Fact Sheet on MSP in NYS by Medicare Rights Center ENGLISH SPANISH State law. N.Y. Soc.

2020 Medicare 101 Basics for New York State - 1.5 hour webinar by Eric Hausman, sponsored by NYS Office of the Aging Note. Some consumers may be eligible for the Medicare Insurance Premium Payment (MIPP) Program, instead of MSP. See this article for more info.

TOPICS COVERED IN THIS ARTICLE 1. No Asset Limit 1A. Summary Chart of MSP Programs 2.

Income Limits &. Rules and Household Size 3. The Three MSP Programs - What are they and how are they Different?.

4. FOUR Special Benefits of MSP Programs. Back Door to Extra Help with Part D MSPs Automatically Waive Late Enrollment Penalties for Part B - and allow enrollment in Part B year-round outside of the short Annual Enrollment Period No Medicaid Lien on Estate to Recover Payment of Expenses Paid by MSP Food Stamps/SNAP not reduced by Decreased Medical Expenses when Enroll in MSP - at least temporarily 5.

Enrolling in an MSP - Automatic Enrollment &. Applications for People who Have Medicare What is Application Process?. 6.

Enrolling in an MSP for People age 65+ who Do Not Qualify for Free Medicare Part A - the "Part A Buy-In Program" 7. What Happens After MSP Approved - How Part B Premium is Paid 8 Special Rules for QMBs - How Medicare Cost-Sharing Works 1. NO ASSET LIMIT!.

Since April 1, 2008, none of the three MSP programs have resource limits in New York -- which means many Medicare beneficiaries who might not qualify for Medicaid because of excess resources can qualify for an MSP. 1.A. SUMMARY CHART OF MSP BENEFITS QMB SLIMB QI-1 Eligibility ASSET LIMIT NO LIMIT IN NEW YORK STATE INCOME LIMIT (2021) Single Couple Single Couple Single Couple $1,094 $1,472 $1,308 $1,762 $1,469 $1,980 Federal Poverty Level 100% FPL 100 – 120% FPL 120 – 135% FPL Benefits Pays Monthly Part B premium?.

YES, and also Part A premium if did not have enough work quarters and meets citizenship requirement. See “Part A Buy-In” YES YES Pays Part A &. B deductibles &.

Co-insurance YES - with limitations NO NO Retroactive to Filing of Application?. Yes - Benefits begin the month after the month of the MSP application. 18 NYCRR §360-7.8(b)(5) Yes – Retroactive to 3rd month before month of application, if eligible in prior months Yes – may be retroactive to 3rd month before month of applica-tion, but only within the current calendar year.

(No retro for January application). See GIS 07 MA 027. Can Enroll in MSP and Medicaid at Same Time?.

YES YES NO!. Must choose between QI-1 and Medicaid. Cannot have both, not even Medicaid with a spend-down.

2. INCOME LIMITS and RULES Each of the three MSP programs has different income eligibility requirements and provides different benefits. The income limits are tied to the Federal Poverty Level (FPL).

2021 FPL levels were released by NYS DOH in GIS 21 MA/06 - 2021 Federal Poverty Levels Attachment II NOTE. There is usually a lag in time of several weeks, or even months, from January 1st of each year until the new FPLs are release, and then before the new MSP income limits are officially implemented. During this lag period, local Medicaid offices should continue to use the previous year's FPLs AND count the person's Social Security benefit amount from the previous year - do NOT factor in the Social Security COLA (cost of living adjustment).

Once the updated guidelines are released, districts will use the new FPLs and go ahead and factor in any COLA. See 2021 Fact Sheet on MSP in NYS by Medicare Rights Center ENGLISH SPANISH Income is determined by the same methodology as is used for determining in eligibility for SSI The rules for counting income for SSI-related (Aged 65+, Blind, or Disabled) Medicaid recipients, borrowed from the SSI program, apply to the MSP program, except for the new rules about counting household size for married couples. N.Y.

367-a(3)(c)(2), NYS DOH 2000-ADM-7, 89-ADM-7 p.7. Gross income is counted, although there are certain types of income that are disregarded. The most common income disregards, also known as deductions, include.

(a) The first $20 of your &. Your spouse's monthly income, earned or unearned ($20 per couple max). (b) SSI EARNED INCOME DISREGARDS.

* The first $65 of monthly wages of you and your spouse, * One-half of the remaining monthly wages (after the $65 is deducted). * Other work incentives including PASS plans, impairment related work expenses (IRWEs), blind work expenses, etc. For information on these deductions, see The Medicaid Buy-In for Working People with Disabilities (MBI-WPD) and other guides in this article -- though written for the MBI-WPD, the work incentives apply to all Medicaid programs, including MSP, for people age 65+, disabled or blind.

(c) monthly cost of any health insurance premiums but NOT the Part B premium, since Medicaid will now pay this premium (may deduct Medigap supplemental policies, vision, dental, or long term care insurance premiums, and the Part D premium but only to the extent the premium exceeds the Extra Help benchmark amount) (d) Food stamps not counted. You can get a more comprehensive listing of the SSI-related income disregards on the Medicaid income disregards chart. As for all benefit programs based on financial need, it is usually advantageous to be considered a larger household, because the income limit is higher.

The above chart shows that Households of TWO have a higher income limit than households of ONE. The MSP programs use the same rules as Medicaid does for the Disabled, Aged and Blind (DAB) which are borrowed from the SSI program for Medicaid recipients in the “SSI-related category.” Under these rules, a household can be only ONE or TWO. 18 NYCRR 360-4.2.

See DAB Household Size Chart. Married persons can sometimes be ONE or TWO depending on arcane rules, which can force a Medicare beneficiary to be limited to the income limit for ONE person even though his spouse who is under 65 and not disabled has no income, and is supported by the client applying for an MSP. EXAMPLE.

Bob's Social Security is $1300/month. He is age 67 and has Medicare. His wife, Nancy, is age 62 and is not disabled and does not work.

Under the old rule, Bob was not eligible for an MSP because his income was above the Income limit for One, even though it was well under the Couple limit. In 2010, NYS DOH modified its rules so that all married individuals will be considered a household size of TWO. DOH GIS 10 MA 10 Medicare Savings Program Household Size, June 4, 2010.

This rule for household size is an exception to the rule applying SSI budgeting rules to the MSP program. Under these rules, Bob is now eligible for an MSP. When is One Better than Two?.

Of course, there may be couples where the non-applying spouse's income is too high, and disqualifies the applying spouse from an MSP. In such cases, "spousal refusal" may be used SSL 366.3(a). (Link is to NYC HRA form, can be adapted for other counties).

In NYC, if you have a Medicaid case with HRA, instead of submitting an MSP application, you only need to complete and submit MAP-751W (check off "Medicare Savings Program Evaluation") and fax to (917) 639-0837. (The MAP-751W is also posted in languages other than English in this link. (Updated 4/14/2021.)) 3.

The Three Medicare Savings Programs - what are they and how are they different?. 1. Qualified Medicare Beneficiary (QMB).

The QMB program provides the most comprehensive benefits. Available to those with incomes at or below 100% of the Federal Poverty Level (FPL), the QMB program covers virtually all Medicare cost-sharing obligations. Part B premiums, Part A premiums, if there are any, and any and all deductibles and co-insurance.

QMB coverage is not retroactive. The program’s benefits will begin the month after the month in which your client is found eligible. ** See special rules about cost-sharing for QMBs below - updated with new CMS directive issued January 2012 ** See NYC HRA QMB Recertification form ** Even if you do not have Part A automatically, because you did not have enough wages, you may be able to enroll in the Part A Buy-In Program, in which people eligible for QMB who do not otherwise have Medicare Part A may enroll, with Medicaid paying the Part A premium (Materials by the Medicare Rights Center).

2. Specifiedl Low-Income Medicare Beneficiary (SLMB). For those with incomes between 100% and 120% FPL, the SLMB program will cover Part B premiums only.

SLMB is retroactive, however, providing coverage for three months prior to the month of application, as long as your client was eligible during those months. 3. Qualified Individual (QI-1).

For those with incomes between 120% and 135% FPL, and not receiving Medicaid, the QI-1 program will cover Medicare Part B premiums only. QI-1 is also retroactive, providing coverage for three months prior to the month of application, as long as your client was eligible during those months. However, QI-1 retroactive coverage can only be provided within the current calendar year.

(GIS 07 MA 027) So if you apply in January, you get no retroactive coverage. Q-I-1 recipients would be eligible for Medicaid with a spend-down, but if they want the Part B premium paid, they must choose between enrolling in QI-1 or Medicaid. They cannot be in both.

In contrast, one may receive Medicaid and either QMB or SLIMB. 4. Four Special Benefits of MSPs (in addition to NO ASSET TEST).

Benefit 1. Back Door to Medicare Part D "Extra Help" or Low Income Subsidy -- All MSP recipients are automatically enrolled in Extra Help, the subsidy that makes Part D affordable. They have no Part D deductible or doughnut hole, the premium is subsidized, and they pay very low copayments.

Once they are enrolled in Extra Help by virtue of enrollment in an MSP, they retain Extra Help for the entire calendar year, even if they lose MSP eligibility during that year. The "Full" Extra Help subsidy has the same income limit as QI-1 - 135% FPL. However, many people may be eligible for QI-1 but not Extra Help because QI-1 and the other MSPs have no asset limit.

People applying to the Social Security Administration for Extra Help might be rejected for this reason. Recent (2009-10) changes to federal law called "MIPPA" requires the Social Security Administration (SSA) to share eligibility data with NYSDOH on all persons who apply for Extra Help/ the Low Income Subsidy. Data sent to NYSDOH from SSA will enable NYSDOH to open MSP cases on many clients.

The effective date of the MSP application must be the same date as the Extra Help application. Signatures will not be required from clients. In cases where the SSA data is incomplete, NYSDOH will forward what is collected to the local district for completion of an MSP application.

The State implementing procedures are in DOH 2010 ADM-03. Also see CMS "Dear State Medicaid Director" letter dated Feb. 18, 2010 Benefit 2.

MSPs Automatically Waive Late Enrollment Penalties for Part B Generally one must enroll in Part B within the strict enrollment periods after turning age 65 or after 24 months of Social Security Disability. An exception is if you or your spouse are still working and insured under an employer sponsored group health plan, or if you have End Stage Renal Disease, and other factors, see this from Medicare Rights Center. If you fail to enroll within those short periods, you might have to pay higher Part B premiums for life as a Late Enrollment Penalty (LEP).

Also, you may only enroll in Part B during the Annual Enrollment Period from January 1 - March 31st each year, with Part B not effective until the following July. Enrollment in an MSP automatically eliminates such penalties... For life..

Even if one later ceases to be eligible for the MSP. AND enrolling in an MSP will automatically result in becoming enrolled in Part B if you didn't already have it and only had Part A. See Medicare Rights Center flyer.

Benefit 3. No Medicaid Lien on Estate to Recover MSP Benefits Paid Generally speaking, states may place liens on the Estates of deceased Medicaid recipients to recover the cost of Medicaid services that were provided after the recipient reached the age of 55. Since 2002, states have not been allowed to recover the cost of Medicare premiums paid under MSPs.

In 2010, Congress expanded protection for MSP benefits. Beginning on January 1, 2010, states may not place liens on the Estates of Medicaid recipients who died after January 1, 2010 to recover costs for co-insurance paid under the QMB MSP program for services rendered after January 1, 2010. The federal government made this change in order to eliminate barriers to enrollment in MSPs.

See NYS DOH GIS 10-MA-008 - Medicare Savings Program Changes in Estate Recovery The GIS clarifies that a client who receives both QMB and full Medicaid is exempt from estate recovery for these Medicare cost-sharing expenses. Benefit 4. SNAP (Food Stamp) benefits not reduced despite increased income from MSP - at least temporarily Many people receive both SNAP (Food Stamp) benefits and MSP.

Income for purposes of SNAP/Food Stamps is reduced by a deduction for medical expenses, which includes payment of the Part B premium. Since approval for an MSP means that the client no longer pays for the Part B premium, his/her SNAP/Food Stamps income goes up, so their SNAP/Food Stamps go down. Here are some protections.

Do these individuals have to report to their SNAP worker that their out of pocket medical costs have decreased?. And will the household see a reduction in their SNAP benefits, since the decrease in medical expenses will increase their countable income?. The good news is that MSP households do NOT have to report the decrease in their medical expenses to the SNAP/Food Stamp office until their next SNAP/Food Stamp recertification.

Even if they do report the change, or the local district finds out because the same worker is handling both the MSP and SNAP case, there should be no reduction in the household’s benefit until the next recertification. New York’s SNAP policy per administrative directive 02 ADM-07 is to “freeze” the deduction for medical expenses between certification periods. Increases in medical expenses can be budgeted at the household’s request, but NYS never decreases a household’s medical expense deduction until the next recertification.

Most elderly and disabled households have 24-month SNAP certification periods. Eventually, though, the decrease in medical expenses will need to be reported when the household recertifies for SNAP, and the household should expect to see a decrease in their monthly SNAP benefit. It is really important to stress that the loss in SNAP benefits is NOT dollar for dollar.

A $100 decrease in out of pocket medical expenses would translate roughly into a $30 drop in SNAP benefits. See more info on SNAP/Food Stamp benefits by the Empire Justice Center, and on the State OTDA website. Some clients will be automatically enrolled in an MSP by the New York State Department of Health (NYSDOH) shortly after attaining eligibility for Medicare.

Others need to apply. The 2010 "MIPPA" law introduced some improvements to increase MSP enrollment. See 3rd bullet below.

Also, some people who had Medicaid through the Affordable Care Act before they became eligible for Medicare have special procedures to have their Part B premium paid before they enroll in an MSP. See below. WHO IS AUTOMATICALLY ENROLLED IN AN MSP.

Clients receiving even $1.00 of Supplemental Security Income should be automatically enrolled into a Medicare Savings Program (most often QMB) under New York State’s Medicare Savings Program Buy-in Agreement with the federal government once they become eligible for Medicare. They should receive Medicare Parts A and B. Clients who are already eligible for Medicare when they apply for Medicaid should be automatically assessed for MSP eligibility when they apply for Medicaid.

(NYS DOH 2000-ADM-7 and GIS 05 MA 033). Clients who apply to the Social Security Administration for Extra Help, but are rejected, should be contacted &. Enrolled into an MSP by the Medicaid program directly under new MIPPA procedures that require data sharing.

Strategy TIP. Since the Extra Help filing date will be assigned to the MSP application, it may help the client to apply online for Extra Help with the SSA, even knowing that this application will be rejected because of excess assets or other reason. SSA processes these requests quickly, and it will be routed to the State for MSP processing.

Since MSP applications take a while, at least the filing date will be retroactive. Note. The above strategy does not work as well for QMB, because the effective date of QMB is the month after the month of application.

As a result, the retroactive effective date of Extra Help will be the month after the failed Extra Help application for those with QMB rather than SLMB/QI-1. Applying for MSP Directly with Local Medicaid Program. Those who do not have Medicaid already must apply for an MSP through their local social services district.

(See more in Section D. Below re those who already have Medicaid through the Affordable Care Act before they became eligible for Medicare. If you are applying for MSP only (not also Medicaid), you can use the simplified MSP application form (theDOH-4328(Rev.

8/2017-- English) (2017 Spanish version not yet available). Either application form can be mailed in -- there is no interview requirement anymore for MSP or Medicaid. See 10 ADM-04.

Applicants will need to submit proof of income, a copy of their Medicare card (front &. Back), and proof of residency/address. See the application form for other instructions.

One who is only eligible for QI-1 because of higher income may ONLY apply for an MSP, not for Medicaid too. One may not receive Medicaid and QI-1 at the same time. If someone only eligible for QI-1 wants Medicaid, s/he may enroll in and deposit excess income into a pooled Supplemental Needs Trust, to bring her countable income down to the Medicaid level, which also qualifies him or her for SLIMB or QMB instead of QI-1.

Advocates in NYC can sign up for a half-day "Deputization Training" conducted by the Medicare Rights Center, at which you'll be trained and authorized to complete an MSP application and to submit it via the Medicare Rights Center, which submits it to HRA without the client having to apply in person. Enrolling in an MSP if you already have Medicaid, but just become eligible for Medicare Those who, prior to becoming enrolled in Medicare, had Medicaid through Affordable Care Act are eligible to have their Part B premiums paid by Medicaid (or the cost reimbursed) during the time it takes for them to transition to a Medicare Savings Program. In 2018, DOH clarified that reimbursement of the Part B premium will be made regardless of whether the individual is still in a Medicaid managed care (MMC) plan.

GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare ( PDF) provides, "Due to efforts to transition individuals who gain Medicare eligibility and who require LTSS, individuals may not be disenrolled from MMC upon receipt of Medicare. To facilitate the transition and not disadvantage the recipient, the Medicaid program is approving reimbursement of Part B premiums for enrollees in MMC." The procedure for getting the Part B premium paid is different for those whose Medicaid was administered by the NYS of Health Exchange (Marketplace), as opposed to their local social services district. The procedure is also different for those who obtain Medicare because they turn 65, as opposed to obtaining Medicare based on disability.

Either way, Medicaid recipients who transition onto Medicare should be automatically evaluated for MSP eligibility at their next Medicaid recertification. NYS DOH 2000-ADM-7 Individuals can also affirmatively ask to be enrolled in MSP in between recertification periods. IF CLIENT HAD MEDICAID ON THE MARKETPLACE (NYS of Health Exchange) before obtaining Medicare.

IF they obtain Medicare because they turn age 65, they will receive a letter from their local district asking them to "renew" Medicaid through their local district. See 2014 LCM-02. Now, their Medicaid income limit will be lower than the MAGI limits ($842/ mo reduced from $1387/month) and they now will have an asset test.

For this reason, some individuals may lose full Medicaid eligibility when they begin receiving Medicare. People over age 65 who obtain Medicare do NOT keep "Marketplace Medicaid" for 12 months (continuous eligibility) See GIS 15 MA/022 - Continuous Coverage for MAGI Individuals. Since MSP has NO ASSET limit.

Some individuals may be enrolled in the MSP even if they lose Medicaid, or if they now have a Medicaid spend-down. If a Medicare/Medicaid recipient reports income that exceeds the Medicaid level, districts must evaluate the person’s eligibility for MSP. 08 OHIP/ADM-4 ​If you became eligible for Medicare based on disability and you are UNDER AGE 65, you are entitled to keep MAGI Medicaid for 12 months from the month it was last authorized, even if you now have income normally above the MAGI limit, and even though you now have Medicare.

This is called Continuous Eligibility. EXAMPLE. Sam, age 60, was last authorized for Medicaid on the Marketplace in June 2016.

He became enrolled in Medicare based on disability in August 2016, and started receiving Social Security in the same month (he won a hearing approving Social Security disability benefits retroactively, after first being denied disability). Even though his Social Security is too high, he can keep Medicaid for 12 months beginning June 2016. Sam has to pay for his Part B premium - it is deducted from his Social Security check.

He may call the Marketplace and request a refund. This will continue until the end of his 12 months of continues MAGI Medicaid eligibility. He will be reimbursed regardless of whether he is in a Medicaid managed care plan.

See GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare (PDF) When that ends, he will renew Medicaid and apply for MSP with his local district. Individuals who are eligible for Medicaid with a spenddown can opt whether or not to receive MSP. (Medicaid Reference Guide (MRG) p.

19). Obtaining MSP may increase their spenddown. MIPPA - Outreach by Social Security Administration -- Under MIPPA, the SSA sends a form letter to people who may be eligible for a Medicare Savings Program or Extra Help (Low Income Subsidy - LIS) that they may apply.

The letters are. · Beneficiary has Extra Help (LIS), but not MSP · Beneficiary has no Extra Help (LIS) or MSP 6. Enrolling in MSP for People Age 65+ who do Not have Free Medicare Part A - the "Part A Buy-In Program" Seniors WITHOUT MEDICARE PART A or B -- They may be able to enroll in the Part A Buy-In program, in which people eligible for QMB who are age 65+ who do not otherwise have Medicare Part A may enroll in Part A, with Medicaid paying the Part A premium.

See Step-by-Step Guide by the Medicare Rights Center). This guide explains the various steps in "conditionally enrolling" in Part A at the SSA office, which must be done before applying for QMB at the Medicaid office, which will then pay the Part A premium. See also GIS 04 MA/013.

In June, 2018, the SSA revised the POMS manual procedures for the Part A Buy-In to to address inconsistencies and confusion in SSA field offices and help smooth the path for QMB enrollment. The procedures are in the POMS Section HI 00801.140 "Premium-Free Part A Enrollments for Qualified Medicare BenefiIaries." It includes important clarifications, such as. SSA Field Offices should explain the QMB program and conditional enrollment process if an individual lacks premium-free Part A and appears to meet QMB requirements.

SSA field offices can add notes to the “Remarks” section of the application and provide a screen shot to the individual so the individual can provide proof of conditional Part A enrollment when applying for QMB through the state Medicaid program. Beneficiaries are allowed to complete the conditional application even if they owe Medicare premiums. In Part A Buy-in states like NYS, SSA should process conditional applications on a rolling basis (without regard to enrollment periods), even if the application coincides with the General Enrollment Period.

(The General Enrollment Period is from Jan 1 to March 31st every year, in which anyone eligible may enroll in Medicare Part A or Part B to be effective on July 1st). 7. What happens after the MSP approval - How is Part B premium paid For all three MSP programs, the Medicaid program is now responsible for paying the Part B premiums, even though the MSP enrollee is not necessarily a recipient of Medicaid.

The local Medicaid office (DSS/HRA) transmits the MSP approval to the NYS Department of Health – that information gets shared w/ SSA and CMS SSA stops deducting the Part B premiums out of the beneficiary’s Social Security check. SSA also refunds any amounts owed to the recipient.