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Clinton Per Capita Cap Proposal Threatens Health Care Safety Net For People With AIDS

January 13, 1997

Contact: Joe Zuñiga, AIDS Action
(202) 986-1300 Ext. 3042

WASHINGTON, D.C. - At a time when Americans living with HIV disease are enjoying renewed hope spurred by the advent of promising AIDS therapies, the health care safety-net program that provides them access to health care is in jeopardy. Medicaid provides health care to 53 percent of adults and 90 percent of children living with HIV and AIDS. The program and its 37 million beneficiaries are threatened by a dramatic $30 million funding cut expected to be proposed in the Clinton administration's plan to achieve a balanced federal budget by 2002.

"President Clinton championed the Medicaid program in the 104th Congress, refusing to acquiesce to efforts to dismantle this vital program," said Christine Lubinski, AIDS Action's deputy executive director. "It would be nothing short of tragic if, just when we have the most hope for saving the lives of people living with HIV and AIDS, those very people are deprived access to health care."

Cuts in Medicaid funding would be realized by capping the federal payment per Medicaid beneficiary to a certain dollar amount. The so-called "per capita cap" proposal would have grave implications for people living with HIV and AIDS because the cost for their care, which is significantly higher than that for other Medicaid beneficiaries, will substantially exceed the federal cap. States would then be left with a substantially higher fiscal burden for Medicaid beneficiaries living with HIV and AIDS.

To control costs, states may move to restrict benefits or eligibility categories. States could eliminate or reduce prescription drug coverage, which is currently an optional Medicaid benefit that states are not required to provide. States also are not required to cover "medically needy" individuals, and could eliminate Medicaid coverage for this optional eligibility category. Medically needy Medicaid beneficiaries are people who do not meet Medicaid income eligibility criteria until they "spend down," meaning that they demonstrate that their medical expenses are so significant that they are forced into poverty. Many people living with HIV and AIDS qualify for Medicaid as medically needy. Obviously, the loss of prescription drug coverage could mean the loss of the very health care benefit that keeps people living with HIV and AIDS alive.

The per capita cap proposal will likely be unveiled with the February 6 release of President Clinton's fiscal year 1998 budget plan.

This article was provided by the AIDS Action Council

For more information, contact:
Sara Collins
AIDS Action Council
1875 Connecticut Avenue NW #700
Washington DC 20009
202-986-1300, extension 3053
202-986-1345 (fax)
202-332-9614 (tty)

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This article was provided by AIDS Action Council.
See Also
More on the Economics of HIV Care