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

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E . | CONSENSUS FORACTION
People living with HIV should strive to work with state <strong>Medicaid</strong> programs
and managed care plans to create Incentives that reward the beneficiary,
the provider and the managed care plan for Improved health.
We are crrently living in a time of considerable optimism that our nation's investment in biomedical
research has begun to pay off with a series of new drugs (protease inhibitors and other antiretrovirals)
that show great promise in successfully treating HIV disease. This has caused many people living with
HIV to consider a whole range of new possibilities. Improved health due to these therapies could even
permit some people who were previously disabled to return to work
Due to the nature of our health care system, and the fact that most adults with AIDS only qualified for
<strong>Medicaid</strong> coverage once they were too ill to be 'gainfully employed', the new treatments could be so
effective in restoring health that they make the individual ineligible for <strong>Medicaid</strong>. This could threaten
access to the drugs that are necessaty to maintain their newfound vigor. One of the main features of
managed care is that physicians and other providers who receive a capitated payment are at risk for the
cost of their patient's health care An important advocacy goal must be to ensure that <strong>Medicaid</strong> managed
eare programs are designed such that people living with HIV, their health care providers, and their managed
care organizations all benefit from the individual becoming healthier.
NATIONAL ASSOCIATION OF PEOPLE WITH AIOS I