GMHC Medicaid Priorities for 2005
Medicaid is a lifeline for people with HIV/AIDS and over 65,000
people living with the disease in New York State depend on Medicaid
for their health care. While GMHC agrees that Medicaid reform in
New York State is needed and cost containment is necessary, it
must be achieved by strengthening our state's program and making
prudent reform decisions, not by making Medicaid even more difficult
to access by those in need of health coverage.
(1) GMHC vigorously opposes any proposals that reduce benefits
or impose cost- sharing in Medicaid and Family Health Plus. Numerous
studies have shown that imposing greater cost sharing and reducing
benefits for low-income individuals merely forces people to go
without the services and medications they need to stay healthy.
Specifically, GMHC opposes:
- Eliminating dental and vision benefits in Family Health Plus
and for those not enrolled in Medicaid managed care
- Eliminating several "optional" services for Medicaid beneficiaries,
including podiatry, and those provided by private duty nurses,
and dentists and psychologists in private practice
- Requiring high co-payments for Family Health Plus benefits,
including hospital inpatient ($50), outpatient ($10), emergency
room and ambulance ($25 each), and $3 generic and $5 brand name
prescription drugs
- Increasing fee-for-service beneficiary co-payments for prescription
drugs from $.50 to $1.00 for generics and from $2.00 to $3.00
for brand name drugs
- Establishing co-payments for drugs for individuals enrolled
in Medicaid Managed Care
- Imposing an assets test on Family Health Plus applicants
- Requiring that Family Health Plus enrollees have no coverage
for 12 months prior to enrollment and eliminating the equivalency
standard
- Restricting employees of businesses of more than 50 and government
employees from enrolling in Family Health Plus
(2) GMHC does not support the creation of a Preferred Drug
Program (PDP) in Medicaid. Should one be established in New York
State, GMHC asks that HIV Medicaid beneficiaries be exempt from
the Medicaid PDP. ARV drug class exemption is an insufficient
consumer protection for HIV positive Medicaid beneficiaries.
According to HHS guidelines, drugs that are commonly considered
interchangeable for most healthy individuals, such as cholesterol
lowering drugs Lipitor and Zocor, have unique interactions with
ARVs that can affect the potency of both the HIV and non-HIV
drugs, and therefore impact the health of a person with HIV if
paired incorrectly.
(3) GMHC opposes a change in the proposed budget that will
force staff in nursing homes to seek prior authorization for
drugs not included in the Medicaid rate. People with serious
illnesses and intensive health care needs, especially those with
HIV/AIDS, have complex drug regimens that are likely to contain
medications not factored into the Medicaid nursing home rate.
The proposed change may delay the administration of drugs, prompt
providers to switch to another drug, or in the worst case scenario,
cause the drug not to be administered at all.
(4) GMHC strongly urges you to reject the elimination of 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.
GMHC asks that you oppose these proposed cuts and changes in Medicaid,
which will disproportionately impact those with HIV/AIDS in New
York State.
© 2004 Gay Men's Health Crisis
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