Eligibility


Eligibility for Project Access Services

There are 5 main eligibility criteria which are considered when determining a Patient’s Eligibility for Project Access Services.  All 5 must be met.

 

Number One Medical Need

Project Access looks at three categories of Medical Need as defined below.

Urgent Medical Need – requires immediate (or prompt) intervention in order to preserve life or maintain functionality; needs to be done NOW

Emergent Medical Need – requires intervention in order to sustain or improve the quality of life or to prevent further debilitation or dependence; needs to be done AS SOON AS POSSIBLE
Unstable Medical Need – a chronic condition which resists stabilization, or a chronic condition which has become actively problematic, and through a compounding effect could become emergent in nature; needs to be done

Number Two Uninsured

To be eligible for donated services through the Project Access program, the Patient must not be covered by a health insurance plan (whether employer-based, private, or public such as Medicaid or Medicare).  Also, Patients who have access to health insurance options must be able to show that the options are unaffordable for them.  Patients CANNOT drop their insurance coverage in order to be eligible for Project Access.

Patients who have been approved for disability, but must wait for their medical benefits to “kick-in”, would be considered for enrollment in Project Access (up until the first day when their benefits start).

Number Three

Financial

Project Access connects charitable medical Providers with Patients who are unable to pay for medical services.  The Patient has the responsibility for gathering and submitting appropriate financial information and documentation to their Project Access Case Manager (at the initial eligibility appointment and thereafter as necessary).

Income – A Patient’s income (or benefits) cannot exceed 200% of the Federal Poverty Level.  Please refer to the FPL Guidelines listed below.

2013-2014 FPL Guidelines
Household Size                                 Monthly Limit                                        Yearly Limit

1                                                              $1,915                                                        $22,980

2                                                              $2,585                                                       $31,020

3                                                              $3,255                                                       $39,060

4                                                              $3,925                                                       $47,100

5                                                              $4,595                                                       $55,140

6                                                              $5,265                                                       $63,180

7                                                              $5,860                                                       $70,320

8                                                              $6,605                                                       $79,260

9                                                              $7,812                                                       $93,740

10                                                             $8,472                                                       $101,660

Following the Office of Management and Budget’s (OMB) Statistical Policy Directive 14, the Census Bureau uses a set of money income thresholds that vary by family size and composition to determine who is in poverty. If a family’s total income is less than the family’s threshold, then that family and every individual in it is considered in poverty. The official poverty thresholds do not vary geographically, but they are updated for inflation using Consumer Price Index (CPI-U). The official poverty definition uses money income before taxes and does not include capital gains or noncash benefits (such as public housing, Medicaid, and food stamps).
Taken from http://www.census.gov/hhes/www/poverty/methods/definitions.html

Definition of Gross Income – An individual’s total personal income before taking taxes or deductions into account.  Project Access looks at Gross rather than Net Income.
http://www.investopedia.com/terms/g/grossincome.asp#ixzz2AiBWrDmA

Definition of Household – Any person or group of persons who have a shared experience (together at least 6 consecutive months), drawing from or contributing to a mutual pool of resources.  The determination of any Patient’s particular household (whether one or more) depends on Project Access’s policies and the interpretation of the information submitted by the Patient to his/her Case Manager.

Those who are Self-Employed must be able to show how often and how much they are paid.
Those who are Business Owners must be able to show the difference between personal and business income.
Project Access also reviews the Value of Household Assets [IRA, Stocks, Bonds, Inheritance, Property, Equity, Vehicles].

Number Four

Residency

8 County Region

Project Access serves the Tennessee Department of Health’s Northeast Region, displayed in the picture above.  This region consists of eight (8) counties, including Carter, Greene, Hancock, Hawkins, Johnson, Sullivan, Unicoi, Washington.  These counties are further broken down into our Immediate Service Area and our Extended Service Area.

Immediate Service Area – Sullivan and Washington Counties, TN; Patients who are residents of these two counties automatically qualify under Residency

Extended Service Area – Carter, Green, Hancock, Hawkins, Johnson, and Unicoi Counties, TN; Patients  who are residents of these counties may qualify under Residency IF they have been established with a medical Provider in Washington or Sullivan County for at least 1 yr and have been seen by that Provider withinthe last 6 months.

Number Five

Age

Project Access seeks to serve those who are not eligible for public health insurance programs such as Medicaid and Medicare. Special circumstances may be considered.

Medicaid Cartoon

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                  Medicare Cartoon