America Living With AIDS

AM E R I C A Living With A

would be split between the federal
government ($337 million) and state
governments ($323 million).
If the income requirement were
raised to 200 percent of the federal
poverty level, with no asset test, Medicaid would cover 103,200 people
with HIV infection and 22,100 with
AIDS. The total cost to Medicaid
would be $727 million and would be
split between the federal government
($371 million) and state govern
e have had to
pidemic with
urces since the
subsidy for the
icaid, has an
ual cap of $79
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er 1990

ments ($356 million).
Another incremental
step would be to allow
persons whose Social
Security disability benefits
render them ineligible for
Supplemental Security
Insurance (SSI) (because
their disability payments
are larger than the SSI
income level permits) to
keep their Medicaid coverage. In some cases,
once a person becomes
eligible for SSDI, they lose
their eligibility for SSI and
Medicaid and along with
it, many of the health care
services they need, partic
the Medicaid program are serious disincentives for health care providers to
care for people who rely on Medicaid.
Medicaid payment rates for physicians,
which currently average only 64 percent of Medicare rates, should be raised
to Medicare levels.
Low reimbursement rates to hospitals may also contribute to an
inequitable distribution of the HIV
patient caseload. States should ensure
that payment rates are adequate to
cover the cost of efficiently caring for
people with HIV disease.
To expand primary care to Medicaid beneficiaries with HIV disease, all
community health centers and community clinics receiving Ryan White
CARE Act funding, or similar sites
meeting minimal federal standards,
should be entitled to Federally Qualified Health Centers status. As a Federally Qualified Health Center, a
provider would be eligible for reimbursement at 100 percent of reasonable cost under Medicaid. This would
increase the availability of primary
care in areas with large concentrations
of people in need of care.
Special attention should be given to
the concerns of the Commonwealth of
Puerto Rico, where the HIV epidemic
is intense and yet where there is a cap
on total Medicaid expenditures,
regardless of the growing needs of the
population dependent on Medicaid.
Because of the existing cap on Medicaid funds allocated to Puerto Rico,
none of the Medicaid recommenda
ularly prescription drug coverage.
Some states have opted to allow lowincome SSDI recipients to keep their
Medicaid coverage in order to expand
Medicaid to the medically indigent.
The Commission believes all states
should exercise this option.
Medicaid payment rates for
providers should also be increased sufficiently to ensure adequate participation in the Medicaid program. Unrealistically low reimbursement rates under

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