| Medicaid Matters to People Living
with HIV/AIDS
Medicaid is the largest payer of healthcare for people
living with HIV/AIDS in the United States and in New York
In the United States, 55% of people living with AIDS, 44% of people
living with HIV, and 90% of children living with HIV/AIDS rely on
Medicaid for their healthcare and medications. In 2002, Medicaid
spent $7.7 billion dollars on HIV/AIDS care, far more than the amounts
spent by Medicare ($2.2 billion) and Ryan White ($1.9 billion).
New York continues to be the epicenter of the HIV/AIDS epidemic
in the United States, and Medicaid is at the front lines, covering
65,000 people living with HIV/AIDS. A majority of the 15,000 clients
that walk through GMHC's doors each year use Medicaid to see a doctor,
for case management and hospital care, as well as for life-saving
prescription drugs. A disproportionate number of Medicaid enrollees
are women and people of color.
The Bush Administration's Medicaid proposal will devastate
people living with HIV/AIDS
Because of continuing budget deficits at the state level, all Governors,
including New York's, are proposing Medicaid cuts in 2004. Instead
of supporting an extension of federal fiscal relief for state Medicaid
programs that would help stave off cuts, the Bush Administration
is continuing to push for radical new changes to Medicaid that would
give states further incentives to drastically cut their programs.
The Bush Medicaid block grant plan would offer states a capped
allotment for Medicaid, limiting federal funds available to New
York for critical health coverage programs for children and adults.
There will be no additional federal funds in times of rising medical
costs, whether due to economic downturns, new treatments like T-20,
or rising epidemics like Hepatitis C. Although this proposal did
not gain traction in Congress or among Governors in 2003, the Administration
is intent on moving forward with this plan by strong-arming states
into accepting a block grant, which will short-change New York and
its HIV+ citizens in years to come.
The Bush Medicaid plan would also allow states to eliminate non-mandatory
"optional" populations and "optional" benefits from Medicaid. In
New York, many HIV+ Medicaid enrollees are in optional categories,
including those who "spend-down" to receive Medicaid coverage and
adults without children. Other optional beneficiaries include:
- 22% of people living with disabilities, including HIV/AIDS
- 43% of parents and 20% of kids, with incomes over 100% of the
federal poverty level
- All pregnant women with incomes above 133% of the federal poverty
level
Many others, including a disproportionate number of people with
HIV/AIDS, could lose life-sustaining optional benefits, such as:
- Prescription drugs
- Home care, nursing home coverage, hospice, and rehabilitative
services
- Case management
- Dental and vision care
Furthermore, recent health care expansions in New York State, such
as Family Health Plus, the Medicaid Buy-in, the Breast and Cervical
Treatment program, and the Family Planning Benefit program could
be eliminated completely by the Administration's block granting
proposal. New York State has benefited from a federal match for
many health care programs that were not originally under Medicaid.
Accepting the Bush Medicaid plan could mean the end of federal funds
for these programs — forcing the state to assume the balance
of these costs. Other states seeking to expand coverage to uninsured
individuals with HIV, through proposals like the Early Treatment
for HIV Act (ETHA), would be hard-pressed to do so under the Bush
proposal.
If the President's goal of dismantling Medicaid becomes a reality,
people losing their Medicaid coverage will be forced to turn to
the Ryan White program and the AIDS Drug Assistance Program (ADAP)
for their medications and healthcare. These programs are already
stretched to their limits, and increases in enrollment will lead
to program closures, waiting lists, and reduced eligibility and
services.
Governor Pataki's 2004 proposals to cut Medicaid will devastate
people living with HIV/AIDS
To offset the state's budget deficit, Governor Pataki has proposed
a combined $1.6 billion in cuts to the state's Medicaid program.
These cuts will harm the over 3 million New Yorkers who rely on
Medicaid for their health care, including the over 65,000 people
living with HIV/AIDS. Men, women and children with HIV/AIDS use
Medicaid to access long and short-term care at home or in an institution,
family planning and reproductive health, primary and preventative
care, and mental health therapies. Most importantly, Medicaid is
a lifeline to prescription drugs for people with HIV/AIDS. Cuts
to Medicaid will weaken New York's health care infrastructure and
put millions of individuals, especially those with HIV/AIDS, in
harm's way.
The Governor wants to dismantle our fragile public health care
system that helps people with HIV/AIDS by:
- Eliminating dental and vision benefits in Family Health Plus,
and imposing an assets test and co-payments in the program. Cutting
Family Health Plus will not only affect access to health care
for people with HIV/AIDS, but will increase the number of people
who turn to the state's already-strapped AIDS Drug Assistance
Program for assistance.
- Eliminating "optional" services in Medicaid, including those
provided by nurses, dentists, and psychologists. These benefits
are essential for people with HIV who need primary, dental, and
mental health care.
- Implementing a preferred drug program for Medicaid without
strong consumer safeguards and without exempting people living
with HIV/AIDS. A preferred drug list will limit access for HIV+
individuals and provide less effective drug therapies. Access
to prescription drugs will also be restricted through increases
in pharmacy co-payments in fee-for-service Medicaid and Medicaid
managed care.
- Eliminating Medicaid coverage of nutritional supplements (enterals),
which are critical to maintain weight among people with HIV and
help counter poor nutrition among HIV+ Medicaid beneficiaries.
- Cutting resources from the Health and Hospitals Corporation
(HHC), which will limit access to care for low income HIV+ New
York City residents, including many immigrants.
© 2003 Gay Men's Health Crisis
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