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You have to go to extreme lengths to buy amoxil 500mg online find places on Earth that don’t reveal that they’re part of a water-rich planet. Even the highest and driest deserts, like the Atacama Plateau in South America, still get a minimum of a couple of millimeters of annual precipitation on average (although there are places where we don’t yet know what the average is because it’s simply not rained for years). And if you whip out your handy mass spectrometer on a desert walkabout the chances are that you’ll be able to detect at least a few atmospheric water molecules.

Go elsewhere, buy amoxil 500mg online and it’s hard to imagine anything but a water-logged world. More than 70 percent of Earth’s surface is covered in oceans and roughly 97 percent of the surface water is in those oceans, leaving a scant 1 percent as freshwater. Water is also seldom static, whether it’s flowing in ocean currents or being evaporated and precipitated.

Averaged out over the planet there is about 100 centimeters of rainfall a year, but that’s buy amoxil 500mg online across a total surface area of around 5.1x1018 square centimeters. In other words, doing the back-of-the-envelope calculation, some 510 trillion metric tons of water gets evaporated and then re-precipitated every year on Earth. But the catch is that we don’t really know where all of this water came from in the first place.

For a long while our picture of the formation of a rocky planet buy amoxil 500mg online like the Earth has involved a violent, hot assembly some 4.5 billion years ago out of comparatively dry material in the inner solar system. Water would have come along later, with proposals for possible delivery by comets from the chill, frozen outer solar system, or by rocky but still volatile-rich meteoritic infall. But these options have proven tricky to justify completely for a variety of reasons.

Comets, for instance, often (but not always) have a deuterium concentration that doesn’t match what buy amoxil 500mg online we see in Earth’s water—limiting their likely contribution. Similarly, water-rich rocky meteoritic material—so-called carbonaceous chondrites—have isotopic differences that could also limit how much they contributed to a young planet. At the same time, the representative type of material for building the entirety of a rocky Earth (and matching the planet’s overall isotopic composition in elements like oxygen and calcium) seems to closely resemble what’s called enstatite chondrite.

Chunks of enstatite chondrite are still around in the buy amoxil 500mg online solar system, and occasionally fall as meteorites. But they’ve been thought to be too dry to be involved in Earth’s water supply. Now, in a work reported by Piani, et al.

In the journal Science, an analysis of the composition of 13 enstatite chondrite meteorite samples reveals a much buy amoxil 500mg online higher than expected hydrogen content. Extrapolating from these numbers the researchers claim that if this is the type of protoplanetary material that built Earth, it could have resulted in a total, initial water content of at least three times the present mass of water in our oceans. The same material could have also provided a starter mix of atmospheric nitrogen to the young planet.

This possibility is enormously appealing for its relative simplicity buy amoxil 500mg online. Our wet world was simply made this way from the very beginning, with little need to invoke any more complex evolution except for a small drizzling from comets and other outer solar system material. Whether or not this idea holds up to further scientific scrutiny, it’s a beautiful reminder that even the simplest things in our lives, like a glass of water or a shower in the morning, are actually windows into the deepest origins of everything we know..

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€‹The families of four children who were tragically killed by a drunk and drugged driver are launching an annual forgiveness day with the support of the NSW Government.Siblings Antony, Angelina and Sienna Abdallah and their cousin Veronique Sakr were killed in February this year when an out-of-control ute mounted the footpath.The two families have taken the extraordinary step of forgiving the man behind the wheel as an important step in their grieving process.The families want i4give Day to be held every year on the anniversary of the deaths in memory of the children.In launching this day, a where to get amoxil pills memorial service will be held on the eve of the anniversary, Sunday, 31 January 2021, which will be live streamed to the public.Daniel Abdallah said he wants i4give Day to become one when people can remember the four children but it may also help others who have suffered.“We still feel pain Kamagra 100mg gold price and sorrow everyday, but forgiveness has helped to get rid of the anger and bitterness. It’s helped us get through each day and make sure we are there for our other children,” said Mr Abdallah.Both families say this is about honouring their four little saints in heaven.“Our where to get amoxil pills four children are now our four saints and this day is for them. Forgiveness is the greatest gift you can where to get amoxil pills give yourself and others.

The more you where to get amoxil pills practise the better you become at it and it allows you live peacefully and to heal.” Leila Abdallah said.“Christmas Eve is a very hard time for us as it is also Angelina’s birthday. Even though it is where to get amoxil pills tough, we’ll be celebrating Christmas for the rest of our kids.”Veronique’s mother Bridget Sakr, said “Christmas can be a difficult time for many families. I hope where to get amoxil pills people can reflect on what so tragically happened to our beautiful children to mend bridges with estranged family members and move forward, to love each other in peace and harmony.

Life is too precious.”People across the state will be encouraged to reflect where to get amoxil pills on events and relationships in their own lives and look to the example set by the Abdallah and Sakr families.Minister for Mental Health Bronnie Taylor said that while grieving is a normal part of life, when a tragedy such as this occurs the impact on the family is profound.“The grief experienced can take many forms and there is no set timeline. For some people a psychologist or grief and trauma therapist may be of assistance and the where to get amoxil pills need for this may occur months or years after the event,” Mrs Taylor said.“For some people where the loss has occurred through trauma, forgiveness may play a healing role as part of the grieving process.“This day is about honouring Antony, Angelina, Sienna and Veronique. Their families have shown amazing strength through such a terrible tragedy.”A where to get amoxil pills website i4give.com will also be launched where people will be directed to links dealing with grief and trauma counselling..

€‹The families of four children who were tragically killed by a drunk and drugged driver are launching an annual forgiveness day with the support of the NSW Government.Siblings Antony, Angelina and Sienna Abdallah and their cousin Veronique Sakr were killed in February this year when an out-of-control ute mounted the footpath.The two families have taken the extraordinary step of buy amoxil 500mg online forgiving the man behind the wheel as an important step in their grieving process.The families want i4give Day to be held every year on the anniversary of the deaths in memory of the children.In launching this day, a memorial service will be held on the eve of the anniversary, Sunday, 31 January 2021, which will be live streamed to the public.Daniel Abdallah said he wants i4give Day to become one when people can remember the four children but it may also help others who have suffered.“We still feel pain and sorrow everyday, but forgiveness has helped to get rid of the anger and bitterness. It’s helped us get through each day and make sure we are there for our other children,” said Mr Abdallah.Both families say this is about buy amoxil 500mg online honouring their four little saints in heaven.“Our four children are now our four saints and this day is for them. Forgiveness is the buy amoxil 500mg online greatest gift you can give yourself and others. The more you practise the better you become at it and it allows you live peacefully and to heal.” buy amoxil 500mg online Leila Abdallah said.“Christmas Eve is a very hard time for us as it is also Angelina’s birthday. Even though it is tough, buy amoxil 500mg online we’ll be celebrating Christmas for the rest of our kids.”Veronique’s mother Bridget Sakr, said “Christmas can be a difficult time for many families.

I hope people can reflect on buy amoxil 500mg online what so tragically happened to our beautiful children to mend bridges with estranged family members and move forward, to love each other in peace and harmony. Life is too precious.”People across the state will be encouraged to reflect on events and relationships in their own lives and look to the example set by the Abdallah and Sakr buy amoxil 500mg online families.Minister for Mental Health Bronnie Taylor said that while grieving is a normal part of life, when a tragedy such as this occurs the impact on the family is profound.“The grief experienced can take many forms and there is no set timeline. For some people a psychologist or grief and trauma therapist may be of assistance and the need for this may occur months or years after the event,” Mrs Taylor said.“For some people where the loss buy amoxil 500mg online has occurred through trauma, forgiveness may play a healing role as part of the grieving process.“This day is about honouring Antony, Angelina, Sienna and Veronique. Their families have shown amazing strength through such a terrible tragedy.”A website i4give.com will also be launched where people will be directed to buy amoxil 500mg online links dealing with grief and trauma counselling..

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In recognition http://buzz-feed.co.uk/where-can-you-buy-zithromax-over-the-counter/ of May as Mental Health Month, the American buy amoxil over the counter Farm Bureau Federation launched a comprehensive, easy-to-use online directory of resources for farmers, ranchers and their families who are experiencing stress and mental health challenges. The directory, which is on the Farm State of Mind website at farmstateofmind.org, features listings for crisis hotlines and support lines, counseling services, training opportunities, podcasts, videos, buy amoxil over the counter published articles and other resources in every U.S. State and Puerto Rico. Listings for crisis support, counseling and behavioral health buy amoxil over the counter resources that are available nationwide are also included.

€œFor far too long, farmers and ranchers have been trying to cope with increasing levels of stress on their own,” said AFBF President Zippy Duvall. €œOur Farm State of Mind campaign is encouraging buy amoxil over the counter conversations about stress and mental health in farming and ranching communities. It is so important to spread the word that no buy amoxil over the counter one has to go it alone. €œThis new online directory of stress and mental health resources in every state gives farmers, ranchers and rural communities a user-friendly, one-stop shop to find services in their area that can help them manage farm stress and find help for mental health concerns.

Whether you’re looking for information about how to recognize and manage stress, trying to find counseling services in your area or are buy amoxil over the counter in need of crisis support, you can find help here.” National research polls conducted and published by AFBF in 2019 and 2021 showed that a number of factors including financial issues and the impact of the buy antibiotics amoxil are impacting farmers’ mental health, highlighting the need to identify local resources that can help farmers and ranchers cope with chronic stress and mental health concerns. The Farm State of Mind directory lists resources specifically geared toward farmers, ranchers and rural communities in states where these specific services are available, with additional listings for county and statewide mental health and other support services in every state. The listings buy amoxil over the counter can be filtered by state and type of resource, including hotlines, counseling services and published information. AFBF partnered with the University of Georgia School of Social Work to buy amoxil over the counter research available resources across the U.S.

And Puerto Rico and compile the comprehensive information included in the directory. Farmers and ranchers are encouraged to share the directory with their family, friends and community networks to ensure widespread awareness of the buy amoxil over the counter availability of these important resources. Contact. Mike TomkoDirector, Communications(202) 406-3642miket@fb.org buy amoxil over the counter Ray AtkinsonDirector, Communications(202) 406-3717raya@fb.org Return to NewsroomAlicia Lewis has struggled with a binge eating disorder for most her life.

It involves eating large amounts of food in a short period of time.Like others who suffer with the issue, Lewis, who lives in Huntington, often feels a loss of control and guilt.But overeating is how she copes with her depression.When the amoxil hit and she was furloughed from work, she found she was more depressed buy amoxil over the counter. So, she turned to food.“I gained about 30 pounds -- I want to say in probably three or four months just from depression eating,” Lewis said. €œI was so buy amoxil over the counter unsure of what the future was holding, and I was anxious about my husband going to work and bringing buy antibiotics home to me or going out and catching buy antibiotics, and I was worried about my mother and my family.”Lewis is not alone. Mental health across the nation has taken a toll since the amoxil began -- and this includes eating disorders.According to the National Eating Disorders Association, hotline calls are up nearly 80 percent in the past year.Nationally, more than a third of the country’s population dealing with binge eating disorders reported an increase in episodes after the amoxil kicked off.

For those diagnosed with anorexia, more than 60 percent reported an episode, according to buy amoxil over the counter a study last year by the International Journal of Eating Disorders. This trend seems to exist in buy amoxil over the counter West Virginia, as well. Jess Luzier, Charleston Disordered Eating Center clinical director, said she saw dozens more people requiring services when the amoxil first hit.“People who were in early or even sustained remission from eating disorder behaviors, many of them struggled with relapse when the buy antibiotics amoxil hit us,” Luzier said.Eating disorders are complex psychiatric illnesses -- no one chooses to have one, said Luzier. Their severity can depend on a variety of factors.“Dieting history, perfectionism or impulsivity, buy amoxil over the counter self-esteem, body esteem, even things like participation in sports that emphasize weight can affect the development of eating disorders,” Luzier said.For many, these factors have only gotten worse as more people are practicing social distancing and spending time by themselves at home.But there is something else that can make eating disorders even worse, and Luzier said it is especially true to West Virginians -- limited access to affordable food.“I don't know where my next meal is going to come from, or I'm not sure that I can pay for groceries this week, most commonly is going to be loss of control eating episodes, or binge-eating episodes,” she said.Food insecurity has gotten even harder for people living in rural food deserts in the middle of a amoxil, Luzier said.

Food pantries were literally running out of food this time last year.“And that was really scary for a lot of people,” Luzier said. €œIt led buy amoxil over the counter to this hyperfixation on food, and, ‘Will I have food?. €™ Because none of us knew what was going to happen.”As more West Virginians buy amoxil over the counter have access to the buy antibiotics treatment, and the world begins to return to a sense of normalcy, Luzier said eating disorders and poor food access will still be here. This makes treatment crucial.She recommended researching on NEDA’s website and visiting a primary physician first.As for Lewis, she is hopeful and in “recovery” from her eating disorder.In the last year, Lewis received a gastric bypass surgery to limit her appetite.

She lost the 30 pounds she gained at the start of the amoxil, re-entered trauma therapy and is buy amoxil over the counter learning again how to care for herself.Lewis said she takes comfort from this mantra. €œWe are human, you are human. And we're in a amoxil, these are unprecedented buy amoxil over the counter times,” Lewis said. €œâ€˜You are human’ was what I needed to hear after struggling all year with my weight and my eating and my depression because there were so many days where I felt less than human.”If you or someone you know needs help with an eating disorder, call the national helpline at 1-800-931-2237..

In recognition of buy amoxil 500mg online May as Mental Health Month, the American Farm Bureau Federation launched a comprehensive, easy-to-use online directory of resources for farmers, ranchers and their families who are experiencing stress Where can you buy zithromax over the counter and mental health challenges. The directory, which is on the Farm State of Mind website at farmstateofmind.org, buy amoxil 500mg online features listings for crisis hotlines and support lines, counseling services, training opportunities, podcasts, videos, published articles and other resources in every U.S. State and Puerto Rico. Listings for crisis support, counseling and behavioral health buy amoxil 500mg online resources that are available nationwide are also included.

€œFor far too long, farmers and ranchers have been trying to cope with increasing levels of stress on their own,” said AFBF President Zippy Duvall. €œOur Farm State of Mind campaign is encouraging conversations about stress and mental buy amoxil 500mg online health in farming and ranching communities. It is so important to buy amoxil 500mg online spread the word that no one has to go it alone. €œThis new online directory of stress and mental health resources in every state gives farmers, ranchers and rural communities a user-friendly, one-stop shop to find services in their area that can help them manage farm stress and find help for mental health concerns.

Whether you’re looking for information about how to recognize and manage stress, trying to find counseling services in your area or are in need of crisis support, you can find help here.” National research polls conducted and published by AFBF in 2019 and 2021 showed that a number of buy amoxil 500mg online factors including financial issues and the impact of the buy antibiotics amoxil are impacting farmers’ mental health, highlighting the need to identify local resources that can help farmers and ranchers cope with chronic stress and mental health concerns. The Farm State of Mind directory lists resources specifically geared toward farmers, ranchers and rural communities in states where these specific services are available, with additional listings for county and statewide mental health and other support services in every state. The listings can be filtered by buy amoxil 500mg online state and type of resource, including hotlines, counseling services and published information. AFBF partnered with the University of Georgia School of buy amoxil 500mg online Social Work to research available resources across the U.S.

And Puerto Rico and compile the comprehensive information included in the directory. Farmers and ranchers are encouraged to buy amoxil 500mg online share the directory with their family, friends and community networks to ensure widespread awareness of the availability of these important resources. Contact. Mike TomkoDirector, Communications(202) 406-3642miket@fb.org Ray AtkinsonDirector, Communications(202) 406-3717raya@fb.org Return to NewsroomAlicia Lewis has struggled buy amoxil 500mg online with a binge eating disorder for most her life.

It involves eating large amounts of food in buy amoxil 500mg online a short period of time.Like others who suffer with the issue, Lewis, who lives in Huntington, often feels a loss of control and guilt.But overeating is how she copes with her depression.When the amoxil hit and she was furloughed from work, she found she was more depressed. So, she turned to food.“I gained about 30 pounds -- I want to say in probably three or four months just from depression eating,” Lewis said. €œI was so unsure of what the future was holding, and I was anxious about my husband going to work and bringing buy antibiotics home to me or going out and catching buy antibiotics, and I was worried about my mother and my family.”Lewis is buy amoxil 500mg online not alone. Mental health across the nation has taken a toll since the amoxil began -- and this includes eating disorders.According to the National Eating Disorders Association, hotline calls are up nearly 80 percent in the past year.Nationally, more than a third of the country’s population dealing with binge eating disorders reported an increase in episodes after the amoxil kicked off.

For those diagnosed with anorexia, more than 60 percent reported an episode, according to a study last year by the buy amoxil 500mg online International Journal of Eating Disorders. This trend seems to exist buy amoxil 500mg online in West Virginia, as well. Jess Luzier, Charleston Disordered Eating Center clinical director, said she saw dozens more people requiring services when the amoxil first hit.“People who were in early or even sustained remission from eating disorder behaviors, many of them struggled with relapse when the buy antibiotics amoxil hit us,” Luzier said.Eating disorders are complex psychiatric illnesses -- no one chooses to have one, said Luzier. Their severity can depend on a variety of factors.“Dieting history, perfectionism or impulsivity, self-esteem, body esteem, even things like participation in sports that emphasize weight can affect the development of eating disorders,” Luzier said.For many, these factors have only gotten worse as more people are practicing social distancing and spending time by themselves at home.But there is something else that can make eating disorders even worse, and Luzier said it is especially true to West Virginians -- limited access to affordable food.“I don't know where my next meal is going to come from, or I'm not sure that I can pay for groceries this week, most commonly is going to be loss of control eating episodes, or binge-eating buy amoxil 500mg online episodes,” she said.Food insecurity has gotten even harder for people living in rural food deserts in the middle of a amoxil, Luzier said.

Food pantries were literally running out of food this time last year.“And that was really scary for a lot of people,” Luzier said. €œIt led to this hyperfixation on buy amoxil 500mg online food, and, ‘Will I have food?. €™ Because none of us knew what was going to happen.”As more buy amoxil 500mg online West Virginians have access to the buy antibiotics treatment, and the world begins to return to a sense of normalcy, Luzier said eating disorders and poor food access will still be here. This makes treatment crucial.She recommended researching on NEDA’s website and visiting a primary physician first.As for Lewis, she is hopeful and in “recovery” from her eating disorder.In the last year, Lewis received a gastric bypass surgery to limit her appetite.

She lost the 30 pounds she buy amoxil 500mg online gained at the start of the amoxil, re-entered trauma therapy and is learning again how to care for herself.Lewis said she takes comfort from this mantra. €œWe are human, you are human. And we're in a amoxil, these are buy amoxil 500mg online unprecedented times,” Lewis said. €œâ€˜You are human’ was what I needed to hear after struggling all year with my weight and my eating and my depression because there were so many days where I felt less than human.”If you or someone you know needs help with an eating disorder, call the national helpline at 1-800-931-2237..

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Patients, visitors and employees should allow for extra travel time to and from UC Davis Medical Center buy amoxil usa and other buildings on the Sacramento campus for several days, amoxil online canada starting this Friday. State Route 99 will be closed for construction from 8 p.m., Friday, June 11 until 4 a.m., amoxil online canada Wednesday, June 16.Map adapted from Caans graphic. Click here for larger view (PDF).To amoxil online canada replace an aging bridge deck, the California Department of Transportation (Caans) will close northbound and southbound Route 99 from 47th Avenue to the U.S. Highway 50 connector during that time period (see map PDF).Rerouted traffic along Stockton Boulevard is expected to increase congestion amoxil online canada around the UC Davis Medical Center campus, so please plan ahead accordingly. UC Davis Health employees coming from South Sacramento and Elk Grove should allow extra time to get to work.Patients with appointments during this time frame who live south of the Medical Center, Lawrence J.

Ellison Ambulatory Care Center, and Midtown Clinic will receive notifications of the highway closure later this week, via text message and MyUCDavisHealth.The mainline westbound Business 80/Capital City Freeway to southbound Route 99 is also slated to be closed, amoxil online canada as will the westbound and eastbound U.S. 50 connector ramps amoxil online canada to southbound Route 99. Also, the following ramps are scheduled to be amoxil online canada closed:The on-ramp from 16th Street to eastbound U.S. 50The on-ramp from 29th Street/H Street to westbound Business 80/Capital City FreewayThe on-ramp from 29th Street/N Street to westbound Business 80/Capital City FreewayThe on-ramp from 29th Street/T Street to southbound Route 99The on-ramp from Broadway to southbound Route 99The off-ramp from southbound Route 99 to 12th StreetThe off-ramp from northbound Route 99 to 12th StreetThe on-ramp from 14th Avenue/30th Street to southbound Route 99The on-ramp (slip) from Fruitridge Road to northbound Route 99The on-ramp (loop) from Fruitridge Road to northbound Route 99The on-ramp (slip) from East 47th Avenue to northbound Route 99The on-ramp (loop) from West 47th Avenue amoxil online canada to northbound Route 99Caans is encouraging motorists to take public transit. SacRT is providing free light rail service from June 12-15.For more information, including alternate routes, visit FixSac99.com.[embedded content]This video is best viewed in Chrome, Firefox or Safari.Sara Guevara-Plunkett knows what it’s like to rely on handouts during tough times.At the onset of the antibiotics amoxil, the UC Davis pre-med student looked forward to Tuesdays, the day when several families in Davis and Woodland place tables on the sidewalks and stock them with groceries, clothes and toiletries.Resource table co-founder Ana Jazmin Flores Pimentel, center, shown with volunteers Jordan Oler and Abby LeonGuevara-Plunkett could take as much as she wanted.

Free. No questions asked.A year into the amoxil, and with her situation slightly improved, Guevara-Plunkett turned the tables, so to speak. She and two friends from UC Davis, who are also committed to helping the underserved, started their own weekly giveaway table.Guevara-Plunkett, Elyse Kristine Ong and Ana Jazmin Flores Pimentel have set up shop in Knights Landing, a high-need, low resource, heavily Latino immigrant community in rural Yolo County.On a recent Sunday, the clients included an older man maneuvering a walker, mothers with tugging toddlers and a man who rode up on a bicycle with a Bible in hand.“What this is,” Guevara-Plunkett explained to a newcomer, “is a take-what-you-need table. We’re here every Sunday from 12 to 2, grab anything for yourself, your neighbors, your friends. There’s no limit, so take what you need.”The resource table – actually, up to six tables now -- is stocked with fresh fruit and vegetables, dry food, canned goods, feminine hygiene products, pet food and other supplies for animals, diapers, hand-knit scarves and other items.Guevara-Plunkett, Ong and Flores Pimentel constantly scour Facebook Marketplace ads for free goods.

Then they pinball across the Sacramento region and even into the Bay Area to pick them up.“We happily travel for the needed items,” said Guevara-Plunkett, who aspires to be a physician in infectious diseases and preventive medicine, and who works as a research assistant at a UC Davis Health dermatology lab in Sacramento.“The people that come to the resource table each week are like our family. We love them. So all the driving and time is worth it, especially when many of the items we provide are hard for residents to get in Knights Landing.”The unincorporated farming town of about 1,000 people is a 30-minute drive from Davis, and a world away. The town has no stoplights. Its convenience stores sell bait and tackle, and only a limited amount of produce.

Many of the residents work long hours as seasonal, migrant agricultural workers.Public transportation is scarce in Knights Landing, which prevents some residents from traveling to the nearest city, Woodland, for fresh produce. €œDiabetes and hypertension are common medical conditions for Knights Landing residents,” said Flores Pimentel, “and the limited bus hours make it harder for them to access healthy food and thus improve their health.”Access to health care also is inadequate in the community, which is why UC Davis students in 2011 established a branch of their Sacramento-based free clinic, Clinica Tepati, in Knights Landing. The satellite location is called Knights Landing One Health Center and also includes an animal health clinic run by UC Davis School of Veterinary Medicine students.The table’s humble beginningsGuevara-Plunkett, Ong and Flores Pimentel each experienced some degree of financial hardships growing up, and they’re passionate about helping people in need.As the amoxil dragged on, Guevara-Plunkett and Ong, who were housemates at the time, realized that if there’s a need for a Tuesday Table in Davis, then surely there must be a greater need for one in Knights Landing.The resource table every Sunday outside the Knights Landing Resource Center draws dozens of people.“I’ve been wanting to do this for a while,” said Ong, a UC Davis graduate. €œBut if it wasn’t for my housemate, I would have never thought we could have gotten this going.”Last Thanksgiving morning, Guevara-Plunkett and Ong crammed donations into Ong’s compact car generic amoxil online and drove to Knights Landing. They extended their folding table outside the small community center in town.

They displayed a few cans of food and feminine hygiene products.They wondered if anybody had read their fliers or seen their Facebook posts.“We were ecstatic to get one person, let alone five!. € Guevara-Plunkett recalled.Word spread fast. Three weeks later, when Guevara-Plunkett and Ong drove up to unload their table, there were 15 people waiting in line for them.Their operation was growing, and they needed help.Guevara-Plunkett sought volunteers through a Slack message to nearly 90 students connected to the Knights Landing clinic where she is a board member. She received a positive response from Flores-Pimentel, a 2020 UC Davis graduate from Vallejo and future medical school applicant. Flores Pimentel was already part of a buy antibiotics relief effort and was willing to do more.That, plus the challenges in Knights Landing felt familiar to her.“I can relate to many of the struggles that the Knights Landing patients face,” Flores Pimentel said.

€œI come from a similar background growing up and obtained first-hand experience of the extent to which the Latinx population is underserved. I am passionate about giving back to my community, especially my local Latinx community, and I also hope to do as much as I can to reduce any health care disparities.”Table’s popularity grows through word of mouthThe Thursday table was moved to Sundays to serve more clients and increase the pool of volunteers.Some weeks, more than 50 local residents show up. Most of them learn about the table through word of mouth.Regulars like Josefina Pizano arrive early to grab whatever will be the day’s most popular item. €œThis helps us a lot,” said Pizano, who acquired a heavy tub of laundry soap on a recent morning. €œRight now, with the economy the way it is, we don’t have work,” she said, “and what we get here helps us a lot.”Other sought-after items include toilet paper, hand soap and sanitizer.

Toothpaste and deodorant are popular. There’s also demand for rice, beans, pasta, eggs, bread, cereal, and water.Guevara-Plunkett, Ong and Flores Pimentel have a keen sense of the community’s needs. And they’ve become experts at seeking donations, no matter how far they have to drive.They’ve also encountered people and organizations that make regular donations.The UC Davis Student Farm provides produce that is harvested on Fridays. Employees at Yolo County Animal Services collect money for pet food. Louise DeLateur, a local resident, donates weekly knitted garments and homemade pastries.

Period, an organization that advocates for menstrual health, contributes feminine hygiene items.In addition, Purina, the pet food company, is now providing pet toys, food and treats, thanks to a relationship it established with UC Davis veterinary students who volunteer at the One Health Center.Still, Guevara-Plunkett, Ong and Flores Pimentel put their own money into their project – to buy things nobody donates, such as gallon-sized clear zipper bags they fill with the donated dog food.The benefit of knowing they’re helping Knights Landing, they say, outweighs the personal cost.Their work is being noticed by advocates for the disenfranchised.“My hats are off to these ladies, it’s just amazing what they are doing,” said Susie Richter, a volunteer with Empower Yolo, a social service organization housed at the same community center as the resource table. €œKnights Landing is kind of isolated out here and we don’t have retail or anything, so by their figuring out what’s needed – clothing, dog food – it’s really helping people.” Improving the health of the communityWhile there is great need for durable items like diapers, shampoo, men’s clothes and laundry detergent, Knights Landing residents also need access to better and healthier foods.“We’ve heard from a lot of community members that they want to start eating healthy,” Guevara-Plunkett said. €œI know there’s a lot of diabetes, heart problems and other health issues in this specific community.”On weeks when there’s leftover food from the table, the groceries are donated to Empower Yolo, a women’s shelter in Davis, and UC Davis HOPE, a campus club that caters to people experiencing homelessness in Davis.“We make sure nothing goes to waste, and give to other communities in need,” Guevara-Plunkett said.The three friends are passionate about improving health, but they have begun to channel that energy elsewhere. Ong recently moved to attend nursing school in Southern California, and Guevara-Plunkett will soon graduate with a degree in global disease biology and move out of state for a research opportunity.Flores Pimentel, who lives more than 60 miles away, is now overseeing the large task alone.She’s made a few modifications lately to make the job more manageable. The table, which used to be open for two hours, now runs for an hour, from 10 to 11 a.m.Flores Pimentel, who’s also a Knights Landing One Health Clinic volunteer, has been thinking a lot about the table’s future.She is in discussions with clinic leadership about incorporating the table, which could open up volunteer opportunities to dozens of students.“I’d definitely say we are in the process of accomplishing our vision of making the table a sustainable resource for the Knights Landing community,” she said.

Anyone interested in making donations can email SETabledonations@gmail.com..

Patients, visitors and employees should allow for extra travel time to and from UC buy amoxil 500mg online Davis Medical Center and other buildings on the Sacramento campus for several days, starting this Friday. State Route 99 buy amoxil 500mg online will be closed for construction from 8 p.m., Friday, June 11 until 4 a.m., Wednesday, June 16.Map adapted from Caans graphic. Click here for larger view (PDF).To buy amoxil 500mg online replace an aging bridge deck, the California Department of Transportation (Caans) will close northbound and southbound Route 99 from 47th Avenue to the U.S. Highway 50 connector during buy amoxil 500mg online that time period (see map PDF).Rerouted traffic along Stockton Boulevard is expected to increase congestion around the UC Davis Medical Center campus, so please plan ahead accordingly. UC Davis Health employees coming from South Sacramento and Elk Grove should allow extra time to get to work.Patients with appointments during this time frame who live south of the Medical Center, Lawrence J.

Ellison Ambulatory Care Center, and Midtown Clinic will receive notifications of the highway closure later this week, via buy amoxil 500mg online text message and MyUCDavisHealth.The mainline westbound Business 80/Capital City Freeway to southbound Route 99 is also slated to be closed, as will the westbound and eastbound U.S. 50 connector ramps to southbound Route 99 buy amoxil 500mg online. Also, the following ramps are scheduled to be closed:The on-ramp from buy amoxil 500mg online 16th Street to eastbound U.S. 50The on-ramp from 29th Street/H Street to westbound Business 80/Capital City FreewayThe on-ramp from 29th Street/N Street to westbound Business 80/Capital City FreewayThe on-ramp from 29th Street/T Street to southbound Route 99The on-ramp from Broadway to southbound Route 99The off-ramp from southbound Route 99 to 12th StreetThe off-ramp from northbound Route 99 to 12th StreetThe on-ramp from 14th Avenue/30th Street to southbound Route 99The on-ramp (slip) from Fruitridge Road to northbound Route 99The on-ramp buy amoxil 500mg online (loop) from Fruitridge Road to northbound Route 99The on-ramp (slip) from East 47th Avenue to northbound Route 99The on-ramp (loop) from West 47th Avenue to northbound Route 99Caans is encouraging motorists to take public transit. SacRT is providing free light rail service from June 12-15.For more information, including alternate routes, visit FixSac99.com.[embedded content]This video is best viewed in Chrome, Firefox or Safari.Sara Guevara-Plunkett knows what it’s like to rely on handouts during tough times.At the onset of the antibiotics amoxil, the UC Davis pre-med student looked forward to Tuesdays, the day when several families in Davis and Woodland place tables on the sidewalks and stock them with groceries, clothes and toiletries.Resource table co-founder Ana Jazmin Flores Pimentel, center, shown with volunteers Jordan Oler and Abby LeonGuevara-Plunkett could take as much as she wanted.

Free. No questions asked.A year into the amoxil, and with her situation slightly improved, Guevara-Plunkett turned the tables, so to speak. She and two friends from UC Davis, who are also committed to helping the underserved, started their own weekly giveaway table.Guevara-Plunkett, Elyse Kristine Ong and Ana Jazmin Flores Pimentel have set up shop in Knights Landing, a high-need, low resource, heavily Latino immigrant community in rural Yolo County.On a recent Sunday, the clients included an older man maneuvering a walker, mothers with tugging toddlers and a man who rode up on a bicycle with a Bible in hand.“What this is,” Guevara-Plunkett explained to a newcomer, “is a take-what-you-need table. We’re here every Sunday from 12 to 2, grab anything for yourself, your neighbors, your friends. There’s no limit, so take what you need.”The resource table – actually, up to six tables now -- is stocked with fresh fruit and vegetables, dry food, canned goods, feminine hygiene products, pet food and other supplies for animals, diapers, hand-knit scarves and other items.Guevara-Plunkett, Ong and Flores Pimentel constantly scour Facebook Marketplace ads for free goods.

Then they pinball across the Sacramento region and even into the Bay Area to pick them up.“We happily travel for the needed items,” said Guevara-Plunkett, who aspires to be a physician in infectious diseases and preventive medicine, and who works as a research assistant at a UC Davis Health dermatology lab in Sacramento.“The people that come to the resource table each week are like our family. We love them. So all the driving and time is worth it, especially when many of the items we provide are hard for residents to get in Knights Landing.”The unincorporated farming town of about 1,000 people is a 30-minute drive from Davis, and a world away. The town has no stoplights. Its convenience stores sell bait and tackle, and only a limited amount of produce.

Many of the residents work long hours as seasonal, migrant agricultural workers.Public transportation is scarce in Knights Landing, which prevents some residents from traveling to the nearest city, Woodland, for fresh produce. €œDiabetes and hypertension are common medical conditions for Knights Landing residents,” said Flores Pimentel, “and the limited bus hours make it harder for them to access healthy food and thus improve their health.”Access to health care also is inadequate in the community, which is why UC Davis students in 2011 established a branch of their Sacramento-based free clinic, Clinica Tepati, in Knights Landing. The satellite location is called Knights Landing One Health Center and also includes an animal health clinic run by UC Davis School of Veterinary Medicine students.The table’s humble beginningsGuevara-Plunkett, Ong and Flores Pimentel each experienced some degree of financial hardships growing up, and they’re passionate about helping people in need.As the amoxil dragged on, Guevara-Plunkett and Ong, who were housemates at the time, realized that if there’s a need for a Tuesday Table in Davis, then surely there must be a greater need for one in Knights Landing.The resource table every Sunday outside the Knights Landing Resource Center draws dozens of people.“I’ve been wanting to do this for a while,” said Ong, a UC Davis graduate. €œBut if it wasn’t for my housemate, I would have never thought we could have gotten this going.”Last Thanksgiving morning, Guevara-Plunkett and Ong crammed donations into Ong’s compact car and drove to Knights Landing. They extended their folding table outside the small community center in town.

They displayed a few cans of food and feminine hygiene products.They wondered if anybody had read their fliers or seen their Facebook posts.“We were ecstatic to get one person, let alone five!. € Guevara-Plunkett recalled.Word spread fast. Three weeks later, when Guevara-Plunkett and Ong drove up to unload their table, there were 15 people waiting in line for them.Their operation was growing, and they needed help.Guevara-Plunkett sought volunteers through a Slack message to nearly 90 students connected to the Knights Landing clinic where she is a board member. She received a positive response from Flores-Pimentel, a 2020 UC Davis graduate from Vallejo and future medical school applicant. Flores Pimentel was already part of a buy antibiotics relief effort and was willing to do more.That, plus the challenges in Knights Landing felt familiar to her.“I can relate to many of the struggles that the Knights Landing patients face,” Flores Pimentel said.

€œI come from a similar background growing up and obtained first-hand experience of the extent to which the Latinx population is underserved. I am passionate about giving back to my community, especially my local Latinx community, and I also hope to do as much as I can to reduce any health care disparities.”Table’s popularity grows through word of mouthThe Thursday table was moved to Sundays to serve more clients and increase the pool of volunteers.Some weeks, more than 50 local residents show up. Most of them learn about the table through word of mouth.Regulars like Josefina Pizano arrive early to grab whatever will be the day’s most popular item. €œThis helps us a lot,” said Pizano, who acquired a heavy tub of laundry soap on a recent morning. €œRight now, with the economy the way it is, we don’t have work,” she said, “and what we get here helps us a lot.”Other sought-after items include toilet paper, hand soap and sanitizer.

Toothpaste and deodorant are popular. There’s also demand for rice, beans, pasta, eggs, bread, cereal, and water.Guevara-Plunkett, Ong and Flores Pimentel have a keen sense of the community’s needs. And they’ve become experts at seeking donations, no matter how far they have to drive.They’ve also encountered people and organizations that make regular donations.The UC Davis Student Farm provides produce that is harvested on Fridays. Employees at Yolo County Animal Services collect money for pet food. Louise DeLateur, a local resident, donates weekly knitted garments and homemade pastries.

Period, an organization that advocates for menstrual health, contributes feminine hygiene items.In addition, Purina, the pet food company, is now providing pet toys, food and treats, thanks to a relationship it established with UC Davis veterinary students who volunteer at the One Health Center.Still, Guevara-Plunkett, Ong and Flores Pimentel put their own money into their project – to buy things nobody donates, such as gallon-sized clear zipper bags they fill with the donated dog food.The benefit of knowing they’re helping Knights Landing, they say, outweighs the personal cost.Their work is being noticed by advocates for the disenfranchised.“My hats are off to these ladies, it’s just amazing what they are doing,” said Susie Richter, a volunteer with Empower Yolo, a social service organization housed at the same community center as the resource table. €œKnights Landing is kind of isolated out here and we don’t have retail or anything, so by their figuring out what’s needed – clothing, dog food – it’s really helping people.” Improving the health of the communityWhile there is great need for durable items like diapers, shampoo, men’s clothes and laundry detergent, Knights Landing residents also need access to better and healthier foods.“We’ve heard from a lot of community members that they want to start eating healthy,” Guevara-Plunkett said. €œI know there’s a lot of diabetes, heart problems and other health issues in this specific community.”On weeks when there’s leftover food from the table, the groceries are donated to Empower Yolo, a women’s shelter in Davis, and UC Davis HOPE, a campus club that caters to people experiencing homelessness in Davis.“We make sure nothing goes to waste, and give to other communities in need,” Guevara-Plunkett said.The three friends are passionate about improving health, but they have begun to channel that energy elsewhere. Ong recently moved to attend nursing school in Southern California, and Guevara-Plunkett will soon graduate with a degree in global disease biology and move out of state for a research opportunity.Flores Pimentel, who lives more than 60 miles away, is now overseeing the large task alone.She’s made a few modifications lately to make the job more manageable. The table, which used to be open for two hours, now runs for an hour, from 10 to 11 a.m.Flores Pimentel, who’s also a Knights Landing One Health Clinic volunteer, has been thinking a lot about the table’s future.She is in discussions with clinic leadership about incorporating the table, which could open up volunteer opportunities to dozens of students.“I’d definitely say we are in the process of accomplishing our vision of making the table a sustainable resource for the Knights Landing community,” she said.

Anyone interested in making donations can email SETabledonations@gmail.com..

Amoxil for sinus

Medicare Savings Programs (MSPs) pay for the monthly Medicare Part B premium for low-income Medicare beneficiaries and amoxil for sinus qualify enrollees for the "Extra Help" subsidy for Part D prescription check my reference 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 amoxil for sinus . See 2019 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 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 (2020) Single Couple Single Couple Single Couple $1,064 $1,437 $1,276 $1,724 $1,436 $1,940 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). 2019 FPL levels were released by NYS DOH in GIS 20 MA/02 - 2020 Federal Poverty Levels -- Attachment II and have been posted by Medicaid.gov and the National Council on Aging and are in the chart below. 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 2019 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). 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. This process can take awhile!. !. !.

) CMS “deems” the MSP recipient eligible for Part D Extra Help/ Low Income Subsidy (LIS). ​Can the MSP be retroactive like Medicaid, back to 3 months before the application?. ​The answer is different for the 3 MSP programs. QMB -No Retroactive Eligibility – Benefits begin the month after the month of the MSP application. 18 NYCRR § 360-7.8(b)(5) SLIMB - YES - Retroactive Eligibility up to 3 months before the application, if was eligible This means applicant may be reimbursed for the 3 months of Part B benefits prior to the month of application.

QI-1 - YES up to 3 months but only in the same calendar year. No retroactive eligibility to the previous year. 7. QMBs -Special Rules on Cost-Sharing. QMB is the only MSP program which pays not only the Part B premium, but also the Medicare co-insurance.

However, there are limitations. First, co-insurance will only be paid if the provide accepts Medicaid. Not all Medicare provides accept Medicaid. Second, under recent changes in New York law, Medicaid will not always pay the Medicare co-insurance, even to a Medicaid provider. But even if the provider does not accept Medicaid, or if Medicaid does not pay the full co-insurance, the provider is banned from "balance billing" the QMB beneficiary for the co-insurance.

Click here for an article that explains all of these rules. This article was authored by the Empire Justice Center.Dr. Scott Gottlieb on Friday offered a dismal assessment of the U.S. antibiotics outbreak, suggesting the real number of new s per day is more than 500,000 — more than four times the current record of daily new diagnosed buy antibiotics cases.That record came Thursday, when 121,888 new s were reported, according to data from Johns Hopkins University. A day earlier, the country saw its daily case count top 100,000 for the first time ever, part of a trend of record-high daily s as the country's epidemic ascends further into its third peak ahead of the holiday season."Remember 120,000 cases aren't 120,000 cases.

We're probably, at best, diagnosing 1 in 5 cases right now, maybe a little bit less than that, so this is at least half a million cases a day, probably more in terms of actual numbers of ," Gottlieb said on CNBC's "Closing Bell."The situation also is unlikely to improve without targeted interventions to reduce transmission in the hardest-hit states, according to Gottlieb, a former U.S. Food and Drug Administration commissioner under President Donald Trump. "But we're not doing that right now," he said. "We're building up a lot of trouble for the future, and I think that this is going to explode in several weeks.""You have to be really worried what January is going to look like, what December is going to look like right now given the way this is rising," added Gottlieb.The worrisome indicators extend beyond just case counts, Gottlieb said. Hospitalization data is troubling, he said.

The average number of people hospitalized with buy antibiotics is up by at least 5% in 36 states, according to a CNBC analysis of data from the buy antibiotics Tracking Project, which is run by journalists at The Atlantic.Many of the states reporting record levels of hospitalizations are in America's Midwest and West. Iowa, Indiana, Kansas, Minnesota, Missouri, Montana, North Dakota, Nebraska, New Mexico, Ohio, Oklahoma, South Dakota, Utah, Wisconsin and Wyoming.In the U.S. Overall, more than 53,000 people are currently hospitalized with buy antibiotics, according to the buy antibiotics Tracking Project. More than 10,000 people are in intensive care units, Gottlieb said. "That's a lot, and it's growing very quickly."The mortality rate for buy antibiotics patients has improved during the amoxil, as doctors and health-care workers are more experienced at treating the disease, Gottlieb noted.

Additionally, he said more patients are being treated at home, compared with the early days of the outbreak in the spring.The challenge facing the country right now is, simply, the number of people who are infected, he said. More s ultimately will lead to more hospitalizations, which at a certain point strains health-care resources, he said."It's just a fact that, even if we get the death rates down and we manage people in the hospital better, and ... We're discharging people more easily, more quickly, we're infecting a lot more people, so eventually the health-care system is going to get pressed," Gottlieb said. He pointed to places where it's already happened, such as Green Bay, Wisconsin, where a field hospital was set up last month.Earlier in the amoxil, when a particular area such as New York experienced a severe crunch in its health-care system, it was easier to provide it with extra resources from around the country, Gottlieb said. "But if you have very diffuse spread across the country, which is where we're headed, it's going to be hard for the federal government to backstop that much."The U.S.

Has more than 9.6 million confirmed cases of the antibiotics, according to Hopkins data. At least 235,761 people have died.Visitors walk past a sign requiring face masks to stop the spread of the antibiotics disease (buy antibiotics) during Memorial Day weekend at Bethany Beach, Delaware, May 24, 2020.Kevin Lamarque | ReutersDelaware's stay-at-home order and face mask mandate — coupled with other health measures —substantially reduced antibiotics s, hospitalizations and deaths early in the amoxil, a new U.S. Centers for Disease Control and Prevention study published on Friday found.Delaware reported its first case of buy antibiotics on March 11 and subsequently issued a stay-at-home order on March 24 that closed all nonessential businesses and schools until June 1. Some small businesses, including clothing stores, hair salons and bookshops, were allowed to reopen with limited operations on May 8.Gov. John Carney issued a statewide mask mandate on April 28 and began contact tracing efforts in mid-May, according to the study, published in the CDC's Morbidity and Mortality Weekly Reports.Using laboratory data from the Delaware Electronic Reporting and Surveillance System and case investigation data from the Delaware Division of Public Health, researchers found those efforts contributed to an 82% reduction in buy antibiotics s and an 88% reduction in hospitalizations.

They also led to a 100% reduction in deaths in Delaware from late April to June, the study found.However, the decline in buy antibiotics cases, hospitalization and mortality couldn't be attributed to one single mitigation effort, they said. Data on adherence to the state-mandated stay-at-home order and the use of face masks also wasn't available."A stay-at-home order and case investigations instituted weeks before the peak in buy antibiotics cases ... In Delaware likely contributed to the subsequent decline observed in buy antibiotics incidence and associated hospitalization and deaths," researchers wrote."Additional steep declines in reports of new cases occurred after a public mask use mandate was issued in late April. Masks are critical for reducing antibiotics transmission from persons with symptomatic or asymptomatic ," they said.The researchers also identified "several barriers" to Delaware's contact tracing efforts. Among the more than 9,700 laboratory-confirmed cases reported between March 11 and June 25, nearly two-thirds of the patients were interviewed and 83% either refused to name contacts or could not recall contacts, researchers found."Early detection, self-isolation, and investigation of buy antibiotics cases and self-quarantine of close contacts can be effective in preventing community transmission, if contacts are identified and reached soon after exposure," the study said..

Medicare Savings Programs (MSPs) pay for the monthly Medicare Part B premium for low-income Medicare beneficiaries and buy amoxil 500mg online 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 buy amoxil 500mg online costs. See 2019 Fact Sheet on MSP in NYS by Medicare Rights Center ENGLISH SPANISH State law.

§ 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 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 (2020) Single Couple Single Couple Single Couple $1,064 $1,437 $1,276 $1,724 $1,436 $1,940 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). 2019 FPL levels were released by NYS DOH in GIS 20 MA/02 - 2020 Federal Poverty Levels -- Attachment II and have been posted by Medicaid.gov and the National Council on Aging and are in the chart below. 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 2019 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.

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). 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. This process can take awhile!. !.

!. ) CMS “deems” the MSP recipient eligible for Part D Extra Help/ Low Income Subsidy (LIS). ​Can the MSP be retroactive like Medicaid, back to 3 months before the application?. ​The answer is different for the 3 MSP programs.

QMB -No Retroactive Eligibility – Benefits begin the month after the month of the MSP application. 18 NYCRR § 360-7.8(b)(5) SLIMB - YES - Retroactive Eligibility up to 3 months before the application, if was eligible This means applicant may be reimbursed for the 3 months of Part B benefits prior to the month of application. QI-1 - YES up to 3 months but only in the same calendar year. No retroactive eligibility to the previous year.

7. QMBs -Special Rules on Cost-Sharing. QMB is the only MSP program which pays not only the Part B premium, but also the Medicare co-insurance. However, there are limitations.

First, co-insurance will only be paid if the provide accepts Medicaid. Not all Medicare provides accept Medicaid. Second, under recent changes in New York law, Medicaid will not always pay the Medicare co-insurance, even to a Medicaid provider. But even if the provider does not accept Medicaid, or if Medicaid does not pay the full co-insurance, the provider is banned from "balance billing" the QMB beneficiary for the co-insurance.

Click here for an article that explains all of these rules. This article was authored by the Empire Justice Center.Dr. Scott Gottlieb on Friday offered a dismal assessment of the U.S. antibiotics outbreak, suggesting the real number of new s per day is more than 500,000 — more than four times the current record of daily new diagnosed buy antibiotics cases.That record came Thursday, when 121,888 new s were reported, according to data from Johns Hopkins University.

A day earlier, the country saw its daily case count top 100,000 for the first time ever, part of a trend of record-high daily s as the country's epidemic ascends further into its third peak ahead of the holiday season."Remember 120,000 cases aren't 120,000 cases. We're probably, at best, diagnosing 1 in 5 cases right now, maybe a little bit less than that, so this is at least half a million cases a day, probably more in terms of actual numbers of ," Gottlieb said on CNBC's "Closing Bell."The situation also is unlikely to improve without targeted interventions to reduce transmission in the hardest-hit states, according to Gottlieb, a former U.S. Food and Drug Administration commissioner under President Donald Trump. "But we're not doing that right now," he said.

"We're building up a lot of trouble for the future, and I think that this is going to explode in several weeks.""You have to be really worried what January is going to look like, what December is going to look like right now given the way this is rising," added Gottlieb.The worrisome indicators extend beyond just case counts, Gottlieb said. Hospitalization data is troubling, he said. The average number of people hospitalized with buy antibiotics is up by at least 5% in 36 states, according to a CNBC analysis of data from the buy antibiotics Tracking Project, which is run by journalists at The Atlantic.Many of the states reporting record levels of hospitalizations are in America's Midwest and West. Iowa, Indiana, Kansas, Minnesota, Missouri, Montana, North Dakota, Nebraska, New Mexico, Ohio, Oklahoma, South Dakota, Utah, Wisconsin and Wyoming.In the U.S.

Overall, more than 53,000 people are currently hospitalized with buy antibiotics, according to the buy antibiotics Tracking Project. More than 10,000 people are in intensive care units, Gottlieb said. "That's a lot, and it's growing very quickly."The mortality rate for buy antibiotics patients has improved during the amoxil, as doctors and health-care workers are more experienced at treating the disease, Gottlieb noted. Additionally, he said more patients are being treated at home, compared with the early days of the outbreak in the spring.The challenge facing the country right now is, simply, the number of people who are infected, he said.

More s ultimately will lead to more hospitalizations, which at a certain point strains health-care resources, he said."It's just a fact that, even if we get the death rates down and we manage people in the hospital better, and ... We're discharging people more easily, more quickly, we're infecting a lot more people, so eventually the health-care system is going to get pressed," Gottlieb said. He pointed to places where it's already happened, such as Green Bay, Wisconsin, where a field hospital was set up last month.Earlier in the amoxil, when a particular area such as New York experienced a severe crunch in its health-care system, it was easier to provide it with extra resources from around the country, Gottlieb said. "But if you have very diffuse spread across the country, which is where we're headed, it's going to be hard for the federal government to backstop that much."The U.S.

Has more than 9.6 million confirmed cases of the antibiotics, according to Hopkins data. At least 235,761 people have died.Visitors walk past a sign requiring face masks to stop the spread of the antibiotics disease (buy antibiotics) during Memorial Day weekend at Bethany Beach, Delaware, May 24, 2020.Kevin Lamarque | ReutersDelaware's stay-at-home order and face mask mandate — coupled with other health measures —substantially reduced antibiotics s, hospitalizations and deaths early in the amoxil, a new U.S. Centers for Disease Control and Prevention study published on Friday found.Delaware reported its first case of buy antibiotics on March 11 and subsequently issued a stay-at-home order on March 24 that closed all nonessential businesses and schools until June 1. Some small businesses, including clothing stores, hair salons and bookshops, were allowed to reopen with limited operations on May 8.Gov.

John Carney issued a statewide mask mandate on April 28 and began contact tracing efforts in mid-May, according to the study, published in the CDC's Morbidity and Mortality Weekly Reports.Using laboratory data from the Delaware Electronic Reporting and Surveillance System and case investigation data from the Delaware Division of Public Health, researchers found those efforts contributed to an 82% reduction in buy antibiotics s and an 88% reduction in hospitalizations. They also led to a 100% reduction in deaths in Delaware from late April to June, the study found.However, the decline in buy antibiotics cases, hospitalization and mortality couldn't be attributed to one single mitigation effort, they said. Data on adherence to the state-mandated stay-at-home order and the use of face masks also wasn't available."A stay-at-home order and case investigations instituted weeks before the peak in buy antibiotics cases ... In Delaware likely contributed to the subsequent decline observed in buy antibiotics incidence and associated hospitalization and deaths," researchers wrote."Additional steep declines in reports of new cases occurred after a public mask use mandate was issued in late April.

Masks are critical for reducing antibiotics transmission from persons with symptomatic or asymptomatic ," they said.The researchers also identified "several barriers" to Delaware's contact tracing efforts. Among the more than 9,700 laboratory-confirmed cases reported between March 11 and June 25, nearly two-thirds of the patients were interviewed and 83% either refused to name contacts or could not recall contacts, researchers found."Early detection, self-isolation, and investigation of buy antibiotics cases and self-quarantine of close contacts can be effective in preventing community transmission, if contacts are identified and reached soon after exposure," the study said..

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