Medicaid Managed Care - U.S. Senate Special Committee on Aging

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delayed, creating health risks, discharged from the hospital before
my doctor was ready for me to go home and told I could not see
my AIDS and hemophilia specialist until a primary care physician
could work me in-in about 3 months. Simply stated, getting meds
late for me could mean death. Not getting the right meds in the
right combination could and did result in health complications.
Tenn<strong>Care</strong> is now a viable health program, but it still needs improvement
when it comes to dealing with catastrophic diseases like
HIV and AIDS. I can tell you from personal experience that improper
disease state management costs everyone-you the taxpayer,
the managed care organization, and those of us who are living
with these diseases. I have almost died, not from HIV, but from
improper disease management. One particular protease inhibit
drug is great for many HIV-positive people, but for me, will make
me spontaneously bleed internally.
As our Nation transitions our public health care programs into
a new era of cost containment and reduction in services, we must
take a strong look at how these new programs affect care of persons
living with catastrophic diseases. What process helps these
persons stay viable and productive individuals in their communities?
<strong>Medicaid</strong> in particular forms the bedrock of our Nation's response
to caring for people living with HIV. In many States, <strong>Medicaid</strong> has
changed into a managed care program, either through a demonstration
project or a fully operational program. The Health <strong>Care</strong>
Financing Administration estimates that 90 percent of children
with HIVdepend on <strong>Medicaid</strong>, and 50 percent of adults with AIDS
or advanced HIV also rely on <strong>Medicaid</strong>. Medicare is the next largest
resource for these people. With people living longer Medicare
is becoming an even more important program for people living with
HIV. pehigwt
I must tell you that the Ryan White Comprehensive AIDS Resources
Emergency Act or CARE Act is greatly depended on. This
Act has been a life-saver for many. This program provides supplemental
relief to fill in the service gaps left unfilled by <strong>Medicaid</strong>,
Medicare and other programs. It acts as the payer of last resort.
Still, there are many people with HIV who lack regular access to
health care. Just in the last several weeks, several State ADAP
programs have run out of funds, meaning there will be no HIV
medications for many in this country.
No preventive treatments such as protease inhibitors starts a
chain reaction. Simply stated, no treatments leads to opportunistic
infections, opportunistic infections lead to higher-cost treatments,
provided by public health and community-based organizations.
I just mentioned protease inhibitors, a new class of drugs made
available in the last year and a half. These new drug treatments
have given a new lease on life for many, including me. This advance
allows us to attack the virus on a different front than the
older medications such as AZT. Taken in combination with these
other classes of antivirals, this virus has been attacked and limited
to undetectable levels in many.
Please do not let this mislead you. While this has been a tremendous
breakthrough for HIV treatment, it is not a cure. There is not
enough history of this treatment to give us absolute evidence that