What are various states offering in HIV coverage from Medicaid?

About 20 states either have or are in the process of implementing Section 1115 Medicaid waivers that expand Medicaid coverage for people with AIDS. Some permit those who meet income requirements but are not considered disabled by AIDS or other diseases to receive Medicaid coverage. Massachusetts is the first state to request a waiver solely for the inclusion of people with HIV. State-specific strategies vary widely:

Florida

Florida has a Medicaid demonstration project that pays for comprehensive health services for an estimated 12,500 Medicaid AIDS and HIV patients. The state’s project also includes a new disease management program that will track the continuity of care for about 7,500 Medicaid HIV/AIDS patients.

Originally the state had proposed including only AIDS patients in the project, but ultimately decided to cover eligible people who have symptomatic HIV disease, says Fred Goldstein, president of Specialty Disease Management Services of Jacksonville, FL. Mr. Goldstein is in charge of implementing the disease management program. (See story about Florida’s new HIV disease management program, p. 5.)

Massachusetts

Massachusetts’ Medicaid expansion, approved by the state legislature in November 1999, will provide complete health care coverage for all HIV-positive people with incomes at or below 200% of the federal poverty level, about $16,000 per year for a single individual and $32,000 per year for a family of four. Coverage will include primary care services, diagnostic services, prescription drug coverage, mental health care, and substance abuse treatment.

An estimated 2,000 people will have immediate access to the new expanded program, says Joe Carleo, associate director for public policy with AIDS Action Committee of Massachusetts in Boston.

New York

New York’s Medicaid program is expansive and people infected with HIV, who qualify for the medically needy program, have been receiving AIDS services since 1986, says Ira Feldman, MPS, deputy director for health care for AIDS Institute of the New York State Department of Health in Albany.

New York’s program covers up to 185% of poverty level for HIV-infected patients, equal to $15,448 annual income for an HIV-infected patient or $20,802 per year for a household of two. An estimated 50,000 to 70,000 HIV-infected people receive Medicaid coverage, Mr Feldman says.

"We have a full litany of services," he adds. "We have an extremely generous Medicaid package in the state."

The package includes an infrastructure of providers, outpatient services, and even adherence programs are funded through the state’s Medicaid program.

Oregon

The Oregon Health Plan (OHP), implemented in 1994, expands Medicaid coverage to all Oregonians living in households below 100% of the federal poverty level, including people who are infected with HIV.

"Oregon Health Plan is a truly innovative approach, one that has accomplished its goal of increasing access to health care," says Mark Loveless, MD, director of the HIV/STD/TB programs of the Oregon Health Division in Portland.

Unfortunately, the program also has been threatened by financial problems, Mr. Loveless says. "Because it’s been so successful and because people have accessed it and benefited from its services, it currently is struggling financially."

Elected state officials are aware of how well the program has worked in keeping people healthy, and HIV statistics are the most telling data offering proof, he says.

"The outcomes that we’ve seen in Oregon have been a dramatic decrease in death rates and a dramatic decrease in AIDS cases since the program began," Mr. Loveless says.

OHP’s strategy of allocating resources by disease and medical condition benefits works to the advantage of those with HIV infection, Mr. Loveless says, because HIV treatment is a relatively high priority on the list.

"Originally HIV was placed on the list very low because it was viewed as an incurable disease with only palliative care," Mr. Loveless says. "And we advocated strongly that antiretroviral therapy, which was in its infancy at the time, was likely to improve and change the natural history of the disease."

HIV disease is listed at 172 on the priority list, which currently is funded through the mid-500s.

Tennessee

TennCare, Tennessee’s Section 1115 waiver program, generally provides coverage to anyone who is uninsured and has an income of 300% or less of the federal poverty level.

The state has medical care managers in each of 18 "centers for excellence" across the state. (See "TennCare launches voluntary managed care program for HIV, AIDS patients with Centers of Excellence," State Health Watch, May 1998). The managers serve as a point of entry for TennCare enrollees and help HIV patients receive medical services, antiretroviral drugs, and other health services.

About 2,400 HIV-infected people have been enrolled under TennCare. Funding problems have been a drawback, however, and recent proposed revisions by Gov. Don Sunquist may restrict access for the newly diagnosed.