America Living With AIDS

erage of the disease by private insurance; probably both factors contribute
to this dramatic trend.
Evidence of such "Medicaidization"
is abundant. Whereas Medicaid pays
for approximately 11 percent of total
health care costs in the United States,
it funds approximately 25 percent of
AIDS care. There is an unfortunate
side to this trend, for although Medicaid is designed to cover low-income
people, it falls short of serving the
needs of many poor individuals
because of the stringent criteria defining "low-income" and the prerequisite
that assets be below a certain minimum. In addition to poverty restrictions, an individual must meet one of
the categorical eligibility criteria by
being over 65, a member of a family
with dependent children, or totally
disabled. For most people with HIV
disease, eligibility for Medicaid is
through disability, which requires a
clinical diagnosis of AIDS. As a result,
Medicaid is generally available only to
very poor individuals and during the
later stages of HIV disease.
Eligibility criteria and types of benefits covered vary considerably from
state to state, and coverage is almost
nonexistent in the Commonwealth of
Puerto Rico and the U.S. territories.
While some states provide coverage
for the complete range of benefits
needed, others provide a more
restricted range of benefits including
only partial and selective coverage of
costly prescription drugs. The low
provider-payment rates under Medi
caid raise other concerns, specifically
the reluctance of physicians to serve
Medicaid patients and the financial
burden placed on hospitals serving
Medicaid patients. Green and Arno
found that "physicians are reimbursed
by Medicaid an average of 33 percent
of the rates paid by private insurance
in San Francisco and 15 percent in
New York. In New York, an intermediate care office visit is compensated at
$84 by private insurance compared
with $11 by Medicaid." They also
found a "disproportionate number of
hospitalizations of AIDS patients with
Medicaid beginning in an emergency
room, unmediated by a physician
responsible for continuing care."
Clearly, this situation does not serve
anyone well. Patients are poorly
served because of late intervention
and limited services. The health care
system is poorly served because of
high overhead costs and the use of
expensive inpatient services when
early intervention might have prevented the need for them.
Medicare
Medicare provides coverage for
approximately 2 percent of people
with AIDS (HCFA, 1990). This is
largely as a result of the limiting effect
of eligibility criteria. Before qualifying
for Medicare, individuals who are not
elderly must qualify for Social Security
Disability Insurance (SSDI). Before
obtaining Medicare they must wait
five months from diagnosis of a disabling condition to receive SSDI payments and then survive a two-year
waiting period-a total of 29 months.
It is also important to note that eligi
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