James “Tiger” Morton Catastrophic Illness Commission Providing Assistance During Catastrophic...

James “Tiger” Morton Catastrophic Illness

Commission

Providing Assistance During

Catastrophic Illness

Julie C. Palas, J.D., Executive Director


Commission

The Commission

The James “Tiger” Morton Catastrophic Illness Commission (JTMCIC) was created during the 1999 regular session of the West Virginia Legislature as a last resort for West Virginia citizens where

death is imminent and no other resources exists.

• Commission members are Governor-appointed citizens from across the state.

• The Commission is administered through the Office of the Cabinet Secretary of WVDHHR.

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(A nurse, doctor, social worker, lawyer and two citizen members at-large)


Commission

James “Tiger” Morton

The Catastrophic Illness Commission is lovingly dedicated to the memory of James “Tiger” Morton who was a:

•Helper of countless people in dire need of medical and personal assistance

•Respected ombudsman and legislative liaison, and a

•Compassionate and caring friend 3

August 22, 1937 -December 27, 2000


Commission

The Need

You may wonder, “Is the JTMCIC is still essential to assist West Virginians who have a life threatening illnesses after they have exhausted all other resources now that the Affordable

Health Care Act is in effect and requires mandatory insurance coverage?”

Well, According to the 2015 County Health Rankings Report by the James Wood Johnson Foundation and the University of Wisconsin . . . 4


Commission

The Need (cont’d)

. . . WV counties have between 14% - 23% of its citizens that are still uninsured, averaging 18% statewide, or 333,538 individuals of our state’s population.

Also, many West Virginians live just above poverty and cannot afford insurance, but are not eligible for state assistance benefits.

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Commission

The Need (cont’d)

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


Commission

How to Apply

The first step in applying for assistance is to call 304-558-9027.

An application will be taken over the phone. We ask for the applicant’s demographics, source of income, assets, social security number, physician’s name, diagnosis, cost of treatment, etc. All information is confidential and protected.

A decision will usually be made within one week.7


Commission

Eligibility

To be eligible for JTMCIC funds, a client must meet the following guidelines:

•Be a West Virginia citizen.•Have a condition that meets the definition of Catastrophic Illness, which means there is an imminent risk of death if assistance does not occur.•Have exhausted all other resources, including Medicaid and Hill-Burton Funds (now known as Charity Care at hospitals, but 3 remain at the Eglon Clinic in Elgon, WV, Marshall in Huntington, and WVU in Morgantown).

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Commission

DENIED

Eligibility (cont’d)

In fact, before receiving assistance from the Commission – •an eligible applicant must apply for and be denied coverage by Medicaid, and •apply for insurance coverage through the Marketplace Exchange program of the Affordable Care Act.

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Commission

Covered Expenses

There are specific parameters for distribution of funds from the JTMCIC. A few examples are:

•Proven and accepted medical procedures•Transportation costs for the approved medical procedure to medical facilities for patient and one family member•Medicine that prevents rejection and/or reoccurrence of a life threatening illness

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Commission

Non-covered Expenses

There are specific expenses that are not covered by the Commission. A few examples are:

•Maintenance of acute prescriptions•Durable medical equipment•Experimental treatments and procedures•Home modifications or remodeling •Co-pays for those insured •Medical bills more than one month old prior to application.

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Commission

Additional Information

•Applications are accepted directly from a patient; however, involvement from the medical facility is preferred.

•The Commission makes direct payment to the provider of the service through the West Virginia Medicaid program.

•All services must be preauthorized through the Executive Director.

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Commission

The Clients

Paid Medicaid rate for medical treatment 64 year old female with colorectal cancer52 year old male colon cancer patient who lost his insurance after losing his

job due to cancer, covered 3 weeks until he was covered under his wife’s

insurance. 31 year old female with heart disease

75 year old male requiring by-pass surgery64 year old female with fallopian/uterine cancer

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Commission

The Clients

Paid transportation related expenses4 year old male undergoing a bone marrow transplant, covered parent’s lodging and meals out of state

49 year old female lymphoma patient undergoing a bone marrow transplant, provided lodging post-surgery

Over 1,000 in all -- also connecting clients to other entities’ services by providing referral assistance information, such as co-pay assistance nonprofits and local health providers.

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Commission

The Client Survey

Ages QofL before JTMCIC help? After?10-19 1 # said 10 (highest) 12 2820-29 3 JTMCIC helpful getting medical help?30-39 1 # said 10 (highest) 5040-49 4 Recommend JTMCIC to others?50-59 19 57 (all who answered)60-69 30 Medicaid?Male 28 Yes 15 No 38Female 30 15


Commission

The Client Survey

Client Quote

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


Commission

The Funding

• Funds are allocated each year from the WV Legislature.

• Initially received $1,000,000 a year and now the allocation is just over $100,000 a year.

• The Commission can accept contributions, gifts, property and grants from both private and corporate donors.

• As a 170(c) government entity providing for a public purpose, donations are tax-deductible.

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Commission

The Hope

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

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Commission

Contact Information

QUESTIONS?

Julie C. Palas, J.D.State Capitol ComplexBldg. 6, Ste. 850, Rm. 8DCharleston, WV 25305Phone: 304-558-6073Fax: [email protected]

www.wvdhhr.org/cic19

Each of our lives weave together

to make the fabric of our

State stronger. Every life matters.

James “Tiger” Morton Catastrophic Illness Commission Providing Assistance During Catastrophic...

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