California: Legislative Changes Concern People With AIDS, Advocates

California HIV/AIDS patients and advocates are concerned about impending changes in health care resulting from legislation at the state and federal levels. In 2014, most people will be required to have insurance coverage under the federal Affordable Care Act. And advocates say AB 97, signed into law this year by Gov. Jerry Brown would, if given federal approval, mandate co-payments for prescription drugs and physician visits for patients of Medi-Cal, the state's Medicaid program.

In August, San Francisco-based Project Inform and other groups wrote the federal Centers for Medicare and Medicaid Services (CMS), urging the agency "to decline the state's request to impose any mandatory cost-sharing provisions or caps on essential services" for HIV/AIDS patients and others. The law would "impose untenable cost-sharing on the sickest and poorest Californians," the letter said.

Project Inform has not received a reply, and it is not clear when any co-pays would go into effect if approved, said Anne Donnelly, its health care policy director.

"We're working with the state to give them the flexibility they need to administer their Medicaid program, while protecting Californians' access to care," said CMS spokesperson Brian Cook.

Advocates maintain that even a $5 co-pay would be out of reach for people in poverty. More than 46 million people in the United States live in poverty, according to recent census estimates.

Advocates expected that in 2014 about 70 percent of California's uninsured HIV/AIDS patients now dependent on Ryan White will move to Medi-Cal, said Donnelly. While she feels the expansion of insurance will be a good for people with HIV, Donnelly worries that Medicaid reimbursement rates are insufficient to "deliver the kind of care now offered under Ryan White."

Fragmenting the Ryan White system's network of HIV expertise and support "could really have devastating consequences," warned Dr. Joel Gallant of Johns Hopkins University in Baltimore.

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