A Guide to Fiscal Year 1991 Federal Funding for HIV Disease: How Dollars are Spent How to Access Them

The Health Care Financing Administration
(HCFA) administers the Medicare and Medicaid programs and related Federal medical care quality control programs. The Medicare program provides basic
health benefits to recipients of Social Security and
is funded through the Social Security Trust. HCFA
is concerned with the development of policies, procedures, and guidance related to the program recipients the providers of services (hospitals, nursing
homes, physicians), and the intermediaries who
adjudicate claims. It also oversees the effective coordination with related department programs, activities, and organizations which are closely related to
the Medicare program. (See Figure 1.10.)
The Medicaid program through grants to States
provides medical services to the needy and the
medically underserved. HCFA is responsible for
developing approaches toward meeting the needs of
those who cannot afford adequate medical care; providing technical assistance to state and local organizations to extend the scope and content to improve the
quality of medical care programs for the needy; and
serves as the clearinghouse for information relating
to such programs.
In Fiscal Year 1991, HCFA will spend approximately $1,050,000,000 for the care and treatment of people with AIDS through its Medicare and
Medicaid programs.
Medicaid
Medicaid is a Federal/state program that pays for
health-care services for eligible low-income individuals. It is the largest single payer of direct
medical care services for people with AIDS, as it pays
about 25 percent of the aggregate cost of their
medical care. Combined Federal and state Medicaid
expenditures for AIDS-related care in FY '91 are
estimated at $1,690,000,000 ($870,000,000 in
Federal funds and $820,000,000 in state funds).
HCFA estimates that nationally Medicaid serves at
least 40% of all AIDS patients and up to 90% of all

children with AIDS (these percentages vary from
state to state). HCFA projects that these outlays will
reach $2,500,000,000 annually by FY '93.
Medicaid covers health care expenses for all recipients of Aid to Families With Dependent Children
(AFDC) and in most states the needy elderly, blind,
and disabled who receive cash assistance under the
Social Security Administration's Supplemental
Security Income (SSI) program. Coverage also extends to some low-income pregnant women and
infants, and, dependent upon state policy, other lowincome individuals with high medical bills who
qualify as medically needy.
Medicaid is administered by the states and
financed jointly with the Federal government.
Federal law requires states to provide a minimum
benefit package for AFDC and SSI recipients that
includes hospital inpatient and outpatient services,
physician services, skilled nursing facility care,
laboratory and x-ray services, health screening and
follow-up services for children under 21, nurse and/or
midwife services, family planning services and supplies, and rural health clinic services. States may also
establish policies whereby they cover a wide variety
of additional benefits.
As designed, the Medicaid program permits states
latitude (within Federal guidelines) in determining
individual criteria for those considered "medically
needy." This flexibility permits states to extend
Medicaid eligibility to specifically prescribed
individuals -including people with AIDS -with high
medical costs relative to their ability to pay. More
than half of the states and the District of Columbia
have provided Medicaid benefits through medically
needy programs. States may provide optional services that are of particular help to people with AIDS
such as targeted case management and hospice services, and access to drug therapies.

~1991 ASAP

Reproduction By Permission Only

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~1991 ASAP Reproduction By Permission Only 79