Department of Health and Human Services
FACT SHEET
June 1996 Medicaid Bureau (410) 786-4577
MEDICAID AND ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION
Serving at least 50 percent of all persons living with AIDS (PLWA) and up to 90 percent of all children with AIDS, Medicaid is the largest single payer of direct medical services for PLWAs. Estimated combined Federal and State Medicaid expenditures will be $3.5 billion in fiscal year 1996, or about 25 percent of the aggregate cost of AIDS-related medical care.
o States may provide optional services that are often appropriate for people with HIV/AIDS, such as targeted case management and hospice care. All States cover prescribed drugs, including various drugs for prophylactic treatment of AIDS-related opportunistic infections, FDA-approved drugs for treatment of primary HIV disease, such as reverse transcriptase inhibitors, FDA-approved protease inhibitors, and zidovudine (AZT). AZT can be provided to HIV-positive pregnant women and their infants to help prevent the transmission of HIV to those infants.
o When cost-effective, States must pay the cost of premiums to continue employer-based health insurance policies of PLWAs eligible for Medicaid, or with low income and resources.
o Fifteen States have elected to provide PLWAs cost-effective alternatives to confinement to a medical facility and expanded services through home and community-based services waiver programs, as optional services.
o Most adults with AIDS or HIV-related illnesses who qualify for Medicaid do so because they are disabled, have low income, and limited assets. Individuals not considered disaled may qualify for Medicaid as aparent/ caretaker relative or child receiving benefits under Aid to Families with Dependent Children (AFDC) or as a poverty-related pregnant woman orchild.
o HCFA works with the Public Health Service (PHS) to enhance collaboration between State Medicaid programs and grantees funded under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990.
o HCFA monitors developments in national and State health care reform, such as managed care programs, to assess their impact on persons with HIV/AIDS
o States also work with HCFA and other Federal agencies to assure that persons with HIV infection and AIDS are not subject to discrimination in seeking access to Medicaid and Medicare services.
o HCFA seeks to assure appropriate care for PLWAs through the development of national consumer information initiatives for HIV-positive pregnant women, and the issuance of letters to State Medicaid Agencies on priority AIDS issues (e.g., access to protease inhibitors and other prescription drugs, encouragement of HIV counseling and testing, etc.).
Contact:
Violet Baxter at (410) 786-4577 or E-mail, vbaxter@hcfa.gov.
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