The Dudley T. Dougherty Foundation

Premium, Deductible, Copayment Assistance for People Living with HIV

Grant Information
Categories Healthcare
Location United States
Cycle Year 2018
Organization Information
Organization Name (provided by applicant) RAIN, Inc.
Organization Name (provided by automatic EIN validation)
Contact Information
Contact Name Joyce Brooks, mha
Phone 704-973-9819
601 E. 5th Street
Suite 470
Additional Information
Used for Grant funds will be used to help 40 individuals living with HIV in obtaining and keeping health insurance that addresses their unique medical needs by providing an annual maximum of $125 per person for health insurance premiums and deductibles, physician visit and prescription copayments.
Benefits Access to health insurance has enabled many individuals living with HIV to have access to medical care including life-saving anti-retroviral medications. However, people living in poverty - even those with subsidies from the Affordable Care Act - are sometime unable to pay premiums, copayments, and deductibles. Funds granted to RAIN for this purpose can help people living with HIV maintain health insurance coverage, access to physicians and medications. Access to medical service is essential for the health of the individual as well as the health of the community since viral suppression is directly related to regular and continued medication compliance.
Proposal Description RAIN ensures access to quality, personalized care in a nurturing environment for individuals and their families who are living with HIV and associated chronic conditions so they may live healthier fulfilled lives. Through education and advocacy, RAIN promotes disease prevention, understanding and dignity for those affected by HIV and for those who are at risk.

In 2016, RAIN began providing health insurance premium assistance to clients living with HIV, and spent $18,609, an increase over the $11,500 provided in 2015. Because of high demand for premium assistance, all of the resources were used for premiums, though the program may also assist with co-payments and deductibles. In 2017, RAIN provided over $85,000 in health insurance premiums, deductibles and copayments assistance to individuals who quality for the program. Only about $35,000 of these expenses were reimbursed to RAIN by Ryan White Part A.

RAIN does not turn anyone away who is seeking help in enrolling in health insurance through the ACA Marketplace. However, we are limited in the number of individuals who can be helped with premium and copayment assistance by the amount of funding we have available. Your support will be vital in helping us continue to provide this service to LGBTQ individuals living with HIV individuals.

In 2018, we expect the amount needed for health insurance premiums and deductibles, physician visits and prescription copayments assistance to nearly double, budgeted at $150,000. As a result, RAIN’s need for additional support for this program will reach an estimated $88,500 this year.

A debt to income ratio scale is used to assess clients’ financial needs to ensure the funds are being utilized to fill the largest gaps. Each client receiving assistance is contacted monthly to ensure they are not experiencing barriers and are still actively engaged in medical care.

Number of Clients to be Served in 2018 with insurance premium assistance and deductibles, and/or physician visits and prescription medication copayments: 40 unduplicated clients
Qualification measures: RAIN will document that individuals served by this program (1) have an HIV diagnosis, (2) live in Mecklenburg County, and (3) have incomes between 100% and 300% of the Federal Poverty Level.
Outcome Measures: (1) 100% of individuals served will gain comprehensive health care coverage. (2) 80% of individuals served will achieve viral suppression.

RAIN is uniquely qualified to deliver this program because of our long history of providing services for the LGBTQ community and people living with HIV in the Charlotte/Mecklenburg County. RAIN is recognized for expertise in assisting people living with HIV in navigating the Affordable Care Act (ACA) insurance marketplace. Since 2014, RAIN has been helping people living with HIV access health insurance that was appropriate for their unique needs. Our evaluation processes show that people who have access to health insurance through this program have better clinical outcomes.