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

INTRODUCTION
<strong>Medicaid</strong> is the
largest form of
public support
for people iluing
with HID.
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Roughly half of all adults living with advanced HIV disease (commonly known as AIDS) and more than
ninety percent of children living with HIV depend on <strong>Medicaid</strong> during some stage of their illness. Until
recently, however, the AIDS community did not devote much attention to advocating for <strong>Medicaid</strong>. In
some regards, <strong>Medicaid</strong> is a program that people living with HIV 'love to hate' The eligibility requiremenu
are such that most adults living with HIV do not qualify for benefits until they have been impoverished
by AIDS-related costs and have met the SociaLSectuity Administration's criteria for being considered
disabled. Although a significant number of people qualify for <strong>Medicaid</strong> on the basis of receiving
cash assistance benefits, thousands of people living with HIV are left without access to health care early
in the course of their illness when they do not yet meet the Social Security disability requirements. Some
people living with HIV, and their advocates, have suggested that <strong>Medicaid</strong> is a program that did not need
the concerted support of the AIDS community because of its size and the wide range of persons who
benefit from the program.
Over the past two years, people living with HIV, and their advocates, have received a wake-up call. Reforms
have been proposed (but not yet enacted) at the federal level with the potential to fundamentally
alter the structure of the <strong>Medicaid</strong> program. Some reforms would remove the cumnt federally
defined individual entitlement to services for all who meet the program's eligibility requirements. This
would be replaced by a fixed federal block grant payment to the states. States would then be given broad
new flexibility to operate their <strong>Medicaid</strong> programs as they choose. Other refotms would redefine eligibility
standards in such a way that even fewer people living with HIV would qualify for <strong>Medicaid</strong>. Still other
reforms would undermine existing consumer protections within the federal <strong>Medicaid</strong> law. Without these
protections, beneficiaries would lose access to vital services. Concurrentiy, state <strong>Medicaid</strong> programs have
been racing to catch up with the private sector in embracing managed care as a cost-containment strategy.
NATIONAL ASSOCIATION OF PEOPLE WITH AIDS