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Medicare/Medicaid and availibility of treatment.
Jun 18, 2006

I live on SS Disability-I have worked hard and piad into Social Securtiy for all my working career. Since I am considered low income, existing on such low andlimited income that having private or group insurance is impossible to afford. I have my every 3 month blood work, yearly physicals etc. at a county/state Aids Action Coalition clinic. My question and concern is that people who are uninsured, who have only Medicare insurance regardless whether they have Medicaid QMB or not is not treated in the same manner as with someone having private "good" insurance. My question is why won't the government pay for thr early treatment of HIV so that the onset of Aids can either be prolonged or avoided all together? FACT: people with good insurance are started on treatment msny times as soon as they are dignosed HIV+ to help keep the progression to Aids a much in the furture occurance and helps to keep them healtheir longer. Myself and others with their only income being from Social Security Disability and only have Medicare QMB and/or full MediCAID are not put on HIV meds until the onset of Aids. Medicare/Medicaid will only fund and pay for HIV meds when the symptoms of Aids is present. Persons with "good" medical insurance are started on treatment as soon as right after an HIV+ diagnosis is made. Why won't Medicare and/or Medicaid pay for medication treatment until the client is considered to have Aids? Why would they want to wait til we are really sick instead of starting treatment right away to improve our chances of staying only HIV+ without aquiring the effects of the late stage of the virus, -Aids?

Response from Dr. Frascino

Hello,

You raise an interesting question. Do folks on government-subsidized programs receive different or suboptimal HIV/AIDS care? In general I do not believe it is true that Medicare and/or Medicaid will not cover HIV treatment until the client develops full-blown AIDS. Current guidelines suggest HAART be started when the CD4 count falls into the 250-350 range. Medicare/Medicaid follows these guidelines. Yes, some HIV specialists (and patients) may decide to begin treatment earlier. Whether this is helpful in the long run balancing long-term drug toxicities, potential for developing resistance, etc. remains to be seen.

My bigger concern centers on folks on ADAP waiting lists. These are people for whom HAART is definitely warranted, but for whom there are insufficient federal or state funds to provide the life-sustaining meds. And perhaps most shameful of all is the fact there are over 45 million Americans who are completely uninsured. If you want to see these policies change, we must change the policy makers, beginning with Dubya and the greedy, scandal-ridden Republican Congress. Don't just be frustrated by the current state of affairs, get involved and help effect a "positive" change!

Dr. Bob



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