Medicaid Expansion for HIV/AIDS
Discrimination, lifetime coverage limits and other practices have served to deny private health care coverage to people with AIDS. As a result, Medicaid is the single largest source of health insurance for people living with AIDS, providing access to physician visits, hospitalization, prescription drugs, home health care and long-term care. Over half of all people with AIDS and 90 percent of children with AIDS rely on Medicaid benefits for their health care.
What is Medicaid?
Authorized under Title XIX of the Social Security Act, Medicaid is a joint federal-state health care program and serves as the nation's primary program for providing health and long-term care coverage to disabled and low-income Americans. The federal share of Medicaid funding varies by state. Poorer states receive a higher federal share, yet no state can receive less than 50 percent or more than 83 percent of their costs from the federal government. Combined federal and state Medicaid expenditures to care for people living with HIV/AIDS were estimated to be $7.7 billion in fiscal year 2002.
To receive federal payments for Medicaid, states are generally required to offer services to individuals who are low income and receive federal income assistance, such as Supplemental Security Income recipients and infants born to women eligible for Medicaid. In addition, states have the option of allowing "categorically needy" individuals to be eligible for Medicaid. Currently, some states are providing coverage to categories of individuals, such as certain aged, blind or disabled adults and recipients of state supplementary payments.
Are HIV-Positive People Eligible for Medicaid?
Currently, childless adults living with HIV typically only qualify for Medicaid coverage once they become eligible for SSI. Because individuals are not eligible for SSI until they become disabled, those with asymptotic HIV infections are not eligible for Medicaid until their conditions have progressed to full-blown AIDS. Since these individuals do not qualify for Medicaid, they lack the critical ability to receive medical care and medicine to help slow the progression of the disease and prevent the onset of opportunistic infections.
Don't Some States Already Offer Medicaid to This Population?
Under a special provision of the Medicaid law, states can apply to the federal government for a waiver to further research and improve the health care delivery for the Medicaid population in their state. Maine, Massachusetts and the District of Columbia have received waivers to extend Medicaid benefits to non-disabled persons living with HIV. The purpose of the demonstrations is to evaluate the cost effectiveness of expanding Medicaid eligibility to this group. Other states are expected to apply for similar waivers and we encourage them to do so until a national policy is in place to provide Medicaid to all HIV-positive individuals.
What Should the National Policy Be for Medicaid?
Treating individuals with HIV early in the progression of the disease provides numerous benefits. By providing therapeutics earlier, costs will decrease and the number of new HIV infections will decline because of lower viral loads. And the AIDS Drug Assistance Program will be able to provide care to more individuals with HIV because of savings. Most importantly, the quality of life for countless HIV-positive individuals will improve. Simply put, providing coverage earlier rather than later is the right thing to do.
The Presidential Advisory Council on HIV/AIDS supports expansion of Medicaid for those living with HIV. In its report, entitled "AIDS — No Time to Spare," the council called on the administration to remove barriers that states encounter in efforts to expand Medicaid eligibility to individuals in the early stages of HIV/AIDS.
Legislation to expand Medicaid to people living with HIV has been introduced in Congress. The Early Treatment for HIV Act would provide states with the option to cover low-income HIV-infected individuals as "categorically needy." HRC supports this legislation and urges members of Congress to co-sponsor this important measure.