California: Extension of Medi-Cal to Bolster Help to HIV Patients

In September, California Gov. Gray Davis signed legislation extending Medi-Cal coverage to all uninsured Californians who have HIV but have not progressed to AIDS. Previously, only those with AIDS were covered by the state medical insurance program. "It's high time that our Medi-Cal system met the needs of those living with HIV," Davis said in a statement.

Proponents said the measure would be cost-neutral, extending services to potentially tens of thousands of new patients without costing the state any more money. Patients who receive fee-for-service Medi-Cal coverage and choose their own physicians will be "strongly encouraged" to move to a health maintenance organization, which is cheaper for the state. But some AIDS advocates question whether HMOs are equipped to handle such specialized care and complicated drug regimens.

"Conceptually, putting people into managed care makes a lot of sense, but the devil is in the details," said Marty Keale, executive director of CARES, the Center for AIDS Research, Education and Services, a regional collaboration of health care organizations that pool resources to provide quality AIDS care. Uninsured HIV patients, typically the working poor, already receive medical care on demand in Sacramento thanks to a combination of federal funding and private support to CARES, Keale sad.

The new bill will remove the cost of caring for HIV patients from the federal Ryan White Fund. Those funds typically run out by the end of the fiscal year, while Medi-Cal coverage is on- demand and cannot be limited, said fund administrator Adrienne Rogers. While federal funding was cut by about 6 percent last year, she said, the number of clients receiving services climbed to 1,465. The physician oversight required by antiretroviral regimens has increased the number of annual doctor visits from about 3 five years ago to 10 per client in the first six months of 2002.

Rogers and others noted that the increased medical coverage will not necessarily result in medical care for what may be tens of thousands of untreated people with HIV, since 40-60 percent of patients statewide have not sought treatment after testing HIV- positive.

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