MEDICAID EXPANSION

Medicaid provides access to health care coverage for low-income, uninsured, disabled people. HIV positive individuals who have not yet developed full blown AIDS, however, are not eligible for Medicaid because they do not meet the disability standards. These standards are based on the federal Supplemental Security Income (SSI) program. For someone with HIV disease to qualify for Medicaid they must have AIDS (as defined by the CDC), along with evidence of functional impairment. Therefore, people with HIV who could benefit from early intervention, cannot access those treatments until they become sick.

AIDS Drug Assistance Programs (ADAPs), part of Title II of the Ryan White CARE Act, are designed to provide HIV drug therapies for uninsured or underinsured people. But ADAPs do not provide comprehensive primary care services which are necessary to keep people on the complicated drug regimens. Further, many state ADAP programs are financially constrained and often must limit the number of drugs available and the number of people eligible for the program.

The other CARE Act programs pay for primary care services and additional reimbursement for HIV drug therapies. However, these programs are not designed to provide comprehensive health care services. They fill gaps in that system, but do not provide all the services necessary.

Need for Early Intervention

The HIV treatment guidelines released by the National Institutes of Health last December recommend that comprehensive care and treatment for HIV disease begin at the earliest stages of disease progression. While complete eradication of the virus from the body has not yet been demonstrated, combination therapies have proven to be very effective for many people. Viral loads (the amount of virus in the body) have been dramatically reduced and the onset of opportunistic infections has been delayed. As a result, for the first time since the epidemic began, we are seeing declines in the number of AIDS deaths occurring each year.

Early Intervention is Cost Effective

New research released at the 12th World AIDS Conference in Geneva provides additional evidence that early therapy for individuals with HIV saves lives and is cost effective. One study on cost found that a New England hospital providing highly active retroviral therapy (HAART) to patients with HIV disease experienced an increase in the total number of patients in care but no increase in overall cost and a decrease in cost per patient per year.

In a study of Veterans Administration (VA) hospitals which provide comprehensive services to people with HIV, including broad access to all approved HIV therapies, the number of clinic visits increased between 1996 and 197 by 38%. However, hospital admissions decreased by 37% and total number of hospital days decreased by 41%. Decreased hospital utilization resulted in an $18million net savings in 1997.

Medicaid Expansion

An AIDS-specific expansion of the Medicaid program would allow states to enroll people who are HIV positive, who would otherwise be eligible for the program once they developed AIDS. Such an expansion will save resources because the high costs of hospitalization and treating opportunistic infections will be reduced. Vice President Gore announced his support for such a Medicaid expansion in April and called on the Health Care Finance Administration to issue a report on such an initiative.