Hiv Listing In 2016 And Earlier
The old listing listed more infections that could qualify a claimant for disability automatically:
- bacterial infections
- fungal infection
- parasitic and protozoan infections
- viral infections
- respiratory conditions caused by frequent infections
- HIV wasting syndrome , and
- other resistant infections .
Learn How You Can Get Disability Benefits From Social Security On The Basis Of Hiv Or Aids
By Lorraine Netter, Contributing Author
Human immunodeficiency virus is a virus that causes progressive failure of your immune system. The failure of the immune system can lead to life-threatening opportunistic infections and cancer. In almost all cases, HIV will develop into autoimmune deficiency syndrome . This progression from HIV to AIDS generally takes about ten years. Patients with HIV infections that haven’t progressed into AIDs, and even some patients with AIDs in its early stages, won’t be found disabled.
Ssdi Benefits For Hiv Positive Americans
SSDI is for those who work and pay Social Security taxes. These taxes earn you Social Security credits, and enough credits qualify you for benefits. Most people earn the maximum of four per year, but its possible to earn more or less. Generally, you need five years of work in the 10 years before the year you became disabled. You must also meet the SSAs definition of disabled.
For HIV positive Americans, your condition must last at least a year. You will also qualify if it should result in death. The condition must prevent you from doing what the SSA calls substantial gainful work. See the current COLA and SGA limits.
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Getting Help With Your Disability Application
You can get help with your claim from a friend, family member, disability advocate, or Social Security attorney. You can even have someone else attend an application appointment with you or complete an online application on your behalf.
To find out more about your case, you can fill out this free evaluation form. Use all of the resources at your disposal for the best chances of winning.
Medicaid Eligibility For People With Hiv
Most Medicaid beneficiaries with HIV qualify for coverage through a disability pathway, compared to just 15% of the Medicaid population overall.15 The remaining share qualify through multiple other mandatory and optional pathways .
Prior to the ACA, to qualify for Medicaid an enrollee had to be both low income and âcategorically eligible,â such as being a person with a disability or pregnant. This presented a âcatch-22â for many low-income people with HIV who could not qualify for Medicaid until they were already quite sick and disabled, despite the fact that early access to treatment could help stave off disability and significantly improve health outcomes.
The ACA sought to fundamentally change this by requiring states to expand their Medicaid programs to nearly all individuals with incomes at or below 138 percent of poverty .16 However, a 2012 Supreme Court ruling on the constitutionality of the ACA effectively made expansion a state option.17 As of July 2019, 36 states and Washington, D.C. have adopted the ACA Medicaid expansion, where two thirds of people with HIV live. Fourteen states have not expanded their programs, where 36% of people with HIV live, most of whom are in Florida and Texas.18
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Aids Drug Assistance Program
ADAP provides US Food and Drug Administration -approved HIV-related prescription medications for uninsured or underinsured individuals. You may have no health insurance, be on Medicare, or have private insurance with co-pays for your medication. Each state has its own requirements and list of covered HIV-related drugs, so requirements and medications provided vary by state. All states want proof that you are living with HIV, but not all require that you be at a certain stage of the disease. States also vary in whether they look at income only or income plus assets when they decide whether you qualify for ADAP.
If you are unable to get medications through your state’s ADAP program, you may be able to get them through a State Pharmaceutical Assistance Program . Contact your county or an AIDS service organization for more information.
Getting Disability For Hiv/aids
The HIV listing in Social Security’s “blue book” is complex. The listing was changed significantly in early 2017 and it is now under section 14.11 of the listings rather than 14.08. To meet the requirements of the new listing, you must first show that you have been diagnosed with HIV or AIDS through proper medical evidence. Next you must show that you have one of the following:
- Castleman disease affecting multiple groups of lymph nodes or organs containing lymphoid tissue
- central nervous system lymphoma
- pulmonary Kaposi sarcoma
- absolute CD4 count of 50 cells/mm3 or less
- absolute CD4 count of less than 200 cells/mm3 or CD4 percentage of less than 14 percent, and one of the following:
- BMI measurement of less than 18.5, or
- Hemoglobin measurement of less than 8.0 grams per deciliter .
- HIV complications requiring at least three hospitalizations within a 12-month period. Each hospitalization must last at least 48 hours and be at least 30 days apart.
- repeated HIV infections, including the conditions listed above that don’t meet the criteria above, with one of the following:
- severe limitation of activities of daily living
- severe limitation in social functioning, or
- severe limitation in completing tasks due to problems concentrating, keeping up with the pace, or endurance.
Social Security’s HIV listing gives much more detail on what’s required to show that you meet the above criteria you may want to go over the listing with your doctor to see if you meet the criteria.
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Qualifying For Benefits Without Meeting A Disability Listing
For HIV to qualify for benefits without meeting a disability listing, you must:
- Have thorough medical records
- Have a doctor that can issue a strong summary statement on your behalf
- Be able to complete function report forms that make a compelling argument that you are disabled despite not qualifying through the Blue Book
Functional report forms are a standard part of the residual functional capacity analysis the SSA completes when an applicant doesnt qualify under a disability listing. An RFC looks at your physical and mental limitations caused by your HIV symptoms, complications, and treatments. The SSA examines your activities of daily living or ADLs to determine how severely youre limited by your health issues.
ADLs included in the RFC are things like shopping for groceries, traveling to doctor visits, cleaning your home, preparing food, and staying in touch with friends and family, among others. Severe nausea, weakness, persistent diarrhea, muddled thinking, and other common complications of HIV treatment alone can make it impossible for you to keep up with everyday tasks. For the SSA to see the full extent of your limitations, you and your doctor must both provide detailed information on the manner in which your HIV and required treatments affect your everyday life.
Hiv Can Be Transmitted From Person To Person
Because HIV is a virus, it can be transmitted between people just like many other viruses. AIDS, on the other hand, is a condition a person acquires only after theyve contracted HIV.
The virus is transmitted from one person to another through the exchange of bodily fluids. Most commonly, HIV is transmitted through sex without condoms or shared needles. Less so, a mother can transmit the virus to their child during pregnancy.
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What Are Counted As Resources
Lets start by whats NOT counted. The following items are NOT counted when SSA computes your resources:
- Any back benefits you will receive as a result of your favorable decision
- The home you live in and the land it is on, if its your primary residence
- Your household goods and personal effects
- One vehicle, regardless of its value, if it is used as transportation
- Grants, scholarships, fellowships, or gifts set aside to pay educational expenses, for a limited period of time after receipt
- Burial spaces and burial funds, up to a certain limit
- Life insurance policies, up to a certain limit
- Property thats essential to supporting yourself
WHAT DOES COUNT:
There are additional items that are NOT counted these are the most common.
It means that if you stopped using drugs or alcohol for three months or more and you were therefore no longer disabled, its a material component of your disability. On the other hand, if you stopped using drugs or alcohol for a period of three months or more, and you were still disabled due to other impairments, drug or alcohol is not a material component.
If you are actively using drugs or alcohol and your only impairment is mental, you are likely to have difficulty being approved for benefits.
If drug or alcohol addiction is found to be a material component of your disability, you cannot receive benefits.
Is Hiv Considered A Disability
The SSA definition of a disability might differ from some other generally accepted definitions. The SSA definition is specific and being HIV positive is not automatically considered disability.
For any condition to be considered a disability by the SSA, it must make it impossible for you to earn enough money through a job to support yourself. This monthly income level is called substantial gainful activity.
In 2020, the substantial gainful activity amount is $1260 for non-blind individuals. This number is $2110 for blind individuals. Therefore, in order for HIV to be considered a disability by the SSA, the symptoms that you have must leave you unable to earn substantial gainful activity.
Another condition that must be met in order for HIV to be considered a disability is that it is not possible to earn money by learning a new skill or changing jobs. This will take into consideration things like age and employment history.
For example, if you have worked the same job for 20 years before you became disabled, it would be more difficult to learn the skills required to change jobs at that point in your life. For someone who becomes disabled at a younger age, or has worked in multiple fields it will be easier to make a transition.
Although there is very specific criteria that must be met in order to qualify for disability benefits, the SSA provides clear definitions of those guidelines.
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Talk To A Disability Lawyer
Need a lawyer? Start here.
Hiv Doesnt Always Progress To Stage 3
HIV is a virus, and AIDS is the condition the virus may cause. An HIV infection doesnt necessarily progress to stage 3. In fact, many people with HIV live for years without developing AIDS. Thanks to advances in treatment, a person living with HIV can expect to live a near-normal life span.
While a person can have an HIV infection without having AIDS, anyone diagnosed with AIDS has already contracted HIV. Because there is no cure, the HIV infection never goes away, even if AIDS never develops.
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Public Benefits And Hiv In The Us
Submitted on May 18, 2021
One of the most stressful problems faced by many people living with HIV is trying to support themselves and cover their bills. Fortunately, in the US, there are benefit programs that can help.
Note: During the COVID-19 pandemic, eligibility requirements for some benefits have been temporarily expanded. Check the website for the specific program in which you are interested to find out about any changes and when they expire.
Medically Qualifying For Benefits For Hiv
As a viral infection that compromises the immune system, youll find the Social Security Administrations listing for HIV in the Immune System Disorders section of the Blue Book. The Blue Book is a technical manual, written for doctors and others with the expertise to understand complex medical terminology. This means youll likely need your doctors help to fully understand HIV disability listing.
Your doctor can help decipher the qualification requirements and the medical evidence necessary to be approved for benefits. To qualify through the Blue Book, your HIV must be advanced and cause significant and frequent symptoms and complications despite treatment.
Specifically, the SSA needs to see through your medical records that at least one of the following is true:
- You experience frequent or persistent bacterial, fungal, viral, or parasitic infections
- Youve developed cancer and that the cancer is advanced or terminal
- There is fluid collecting on the brain or brain swelling that causes severe disruption in your ability to think or move effectively
- Youve had severe weight loss
- Uncontrolled and persistent diarrhea has required you to have IV fluids and nutrition via a feed tube for a month or longer
- You experience other types of infections that require hospitalization, IV therapy, or which are resistant to treatment
- Your frequent infections and other complications have severely compromised your activities of daily living , also called ADLs.
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What To Do If Youve Been Subjected To Discrimination
In the event youve been discriminated against in the workplace as a result of HIV, contact your nearest Equal Employment Opportunity Commission . Charges must be laid within 180 days of the alleged infraction. Upon investigation, the EEOC may either act to correct the infringement or issue a right to sue letter to the employee. To learn more or to find the EEOC office nearest you, telephone 800-669-4000 or visit the EEOC website.
The Job Accommodation Network , a service provided by the U.S. Department of Labor, can offer free advice to employers and people with disabilities on reasonable accommodation in the workplace. Telephone 800-526-7234, or visit the for accommodation advice for people with HIV.
Medication And Effects Of Treatment
If you do not meet the criteria of the HIV-AIDs disability listing, you may still be able to receive disability benefits if the medications you are taking severely affect your ability to function. Two main things Social Security looks at with regards to medications is the effectiveness of the medication at improving your symptoms and the side effects of those medications. Specifically, they will look at any adverse reactions you have, the time and difficulty it takes to follow your treatment plan, the length of your treatment, and the effects of your treatment on your mental functioning.
Common side effects of HIV/AIDS medication include hypersensitivity, diarrhea, abdominal pain, nausea and vomiting, anemia, numbness, tingling, and burning sensations, dizziness, fatigue, difficulty sleeping, headaches, depression, anxiety, general weakness, and joint pain. Some individuals may also suffer from more severe side effects, including a build up of acid, sugar, or fat in their blood, or liver damage.
Lack of concentration is the most common of mental impairments caused by HIV/AIDS medications. Headaches, fatigue, insomnia, and confusion can all contribute to difficulty with concentrating and being able to complete tasks.
It is important for you and your doctor to note the medications you are taking and any difficulties that you are having due to your medication and treatment in your disability application.
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Hiv Medical Requirements For Ssd Benefits
The SSA requires a thorough medical evaluation to determine whether or not an HIV positive patient is disabled. This includes a definitive diagnosis along with signs, symptoms, and lab findings. They also want to know how your HIV diagnosis affects your ability to work. Health professionals should review Providing Medical Evidence for Individuals with Human Immunodeficiency Virus Infection for health professionals who submit these records to the SSA. It details what is required to receive benefits.
Symptoms And Treatment Of Hiv
There are three stages of HIV for individuals. During the period after when you are first infected, individuals can experience symptoms such as fever, swelling of the lymph nodes, sore throat, rash, muscle pain, and mouth and throat sores. Symptoms that are less common include headache, nausea, vomiting, an enlarged spleen or liver, weight loss, thrush , and neurological symptoms. There are also individuals who experience no symptoms during this time.
As the immune system begins to fail, the HIV infection progresses into early symptomatic HIV infection. Mild symptoms include chronic rashes, fatigue, diarrhea, weight loss, cough, and shortness of breath. As the immune system’s ability to function declines, more serious symptoms will arise. In the first two stages of HIV, there are usually few symptoms that would rise to the level of affecting your ability to work for any amount of time.
HIV develops into AIDS when certain blood tests are met and illnesses are present. Serious opportunistic infections, severe weight loss, and a decline in mental function are some of the symptoms that are associated with AIDS.
Treatment for HIV and AIDS involves multiple pills at multiple times throughout the day. Side effects can make the treatment cumbersome. Possible side effects of treatment include nausea, vomiting, diarrhea, irregular heartbeat, shortness of breath, skin rashes, and weakening of your bones.
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