Why Does Medicaid Matter to the AIDS Community?

Medicaid provides health coverage for 36 million poor Americans who do not have private health insurance. Medicaid covers a range of health care services which vary by state, but generally includes outpatient services, hospitalization and nursing home care, diagnostic and laboratory tests, prescription drugs, and home health services.

Medicaid is important to you because it is the only safety net in place around the country in case you or a loved one ever gets sick with an illness like AIDS that can leave you unemployed, or too sick to work. Medicaid guarantees you medical care.

Medicaid pays nearly one-half (46%) of all AIDS-related medical costs for all people with AIDS; and 90% of costs for all children with AIDS. Without adequate Medicaid coverage, people with AIDS and their caregivers will be financially devastated.

Why Should I Be Concerned Now?

The current Congressional leadership made a promise to balance the federal budget in seven years, while significantly increasing military spending and offering large tax cuts for wealthy Americans.

To balance the budget, the Republican leadership has decided to cut basic health and social programs. One of those programs up for complete dismantling is Medicaid. All these changes to Medicaid are happening very FAST without input from people or medical providers who will be most affected by drastic changes in the current program.

How Will Congress Make These Changes?

Congress will try to meet its budget goals in two ways:

1. They will try to make deep cuts in health, social services, education, and housing programs through the appropriations process. (As you know, this process is already underway, with deep cuts proposed in pending VA-HUD and Labor-HHS-Education appropriations bills.)
   
   
2. They will try to pass a "Budget Reconciliation bill" which will make major changes in programs that "entitle" eligible persons to certain benefits. The programs addressed in the "Budget Reconciliation bill" will include Medicaid, Medicare, farm support programs, and student loan programs, among others. The House and Senate are both expected to vote on the Reconciliation bill the week of October 23, 1995. OUR JOB IS TO STOP THE "BUDGET RECONCILIATION BILL" FROM BEING PASSED.

If the bill is passed by Congress, it will be sent to President Clinton. If he signs the legislation, this could eliminate the Medicaid program; giving full authority and drastically limited resources to the states to provide medical care for the sick and needy. This is unacceptable. Medicaid and the 36 million poor people it serves must not be sacrificed to balance the budget.

Time is short. Congress is acting quickly. Make yourself and your concerns known to members of congress and to President Clinton.

What Do People with HIV/AIDS Need to Know About Medicaid?

Q: Are people with HIV/AIDS guaranteed coverage?

Current Medicaid Program: YES. People who meet eligibility criteria are covered.

Republican leadership says: NO. There are no guarantees of coverage. Your state decides who is covered.

Q: Does Medicaid provide basic health coverage for services needed by people with HIV/AIDS?

Current Medicaid Program: YES. States are required to offer a comprehensive set of services. Some services like prescription drugs and home and community-based care are optional. (offered in some states but not others)

Republican leadership says: NO. States decide what to provide. They do not have to offer the same services to all people. The states can decide to cut back on medical care to PWAs.

Q: Are medical services affordable to people with HIV/AIDS under Medicaid?

Current Medicaid Program: YES. States are not allowed to charge premiums but are allowed to charge very low co-payments.

Republican leadership says: NO. States may charge any premiums and co-payments they like. There are no federal guidelines for payment structure.

Q: Are there quality assurances and protections for people?

Current Medicaid Program: YES. Medicaid provides extensive protections, including the right to sue the state if people are not receiving the care they need.

Republican leadership says: NO. States set and enforce their own quality standards. No one can sue the state on behalf of people with Medicaid.

Q: Does the federal government provide enough money to the states for these services?

Current Medicaid Program: Medicaid is a federal-state matching program. The federal government matches from 50% to 83% of the cost to individual states. The federal government pays its share of the states costs without limits so that the poor and disabled are protected.

Republican leadership says: NO. Each state will receive a fixed amount (a block grant) to use at its discretion. Spending is capped to about 20% to 30% less than current spending, regardless of changes in health service needs.

Q: Do states have to include specific providers in their Medicaid program?

Current Medicaid Program: YES. States must include any licensed hospital, clinic, or provider who wants to participate.

Republican leadership says: NO. States may limit providers. States are not required to include any category of provider, or to reimburse that provider at reasonable rates.

Q: Are people on Medicaid allowed to have choice of providers?

Current Medicaid Program: YES, although states may get a special waiver to enroll people in managed care plans and use the savings to insure more people. The federal government has strict oversight of these waivers.

Republican leadership says: NO. States may enroll people in any plan the state selects without any federal review or minimun standards.

What do People with HIV/AIDS Need From Medicaid?

1. Health care for all people who are too poor to afford care AND all people who become poor because they suffer from serious disabilities, life-threatening illnesses, or infectious diseases, like HIV/AIDS and tuberculosis;
   
2. The specific kinds of health care services that keep people with HIV/AIDS alive. This must include full coverage for prescription drugs, home health and community-based services, and specialty medical care;
   
3. Quality care by providers, including managed care providers, who are educated about and experienced in treating HIV-disease;
   
4. Free or low-cost services that limit out of pocket costs to poor people with HIV/AIDS;
   
5. Fair reimbursement to providers, including reasonable capitation rates for managed care providers, so that providers are not discouraged from offering comprehensive care to persons with serious illnesses like HIV/AIDS;
   
6. Requirements that states continue to pay their fair share of the costs of the Medicaid program and that federal funds not be used to replace state funds for programs the state already operates;
   
7. Health care for all people living in America whether they are citizens or non-citizens, so that poor communities will not continue to be overwhelmed by diseases like HIV/AIDS and tuberculosis;
   
8. Protections from all types of discrimination including racial and HIV/AIDS discrimination by protecting a patient's right to sue the state if Medicaid providers refuse to provide care or provide sub-standard care; and
   
9. Adequate funding to the states to meet changing health needs if more people get sick or new, serious epidemics arise.

What Do I Need To Do?
Take AIDS Action.

1. Call and write your Senator and House members - tell them Medicaid is an AIDS issue. Tell them to Vote "NO" on the Budget Reconciliation Bill.
   
2. Call and write President Clinton, tell him "if the reconciliation bill passes Congress, VETO the bill."
   
3. Get your AIDS Medicaid story out to the media. Send letters to the editor, Op-ed pieces, and get your local paper to cover your agency's Medicaid needs, and the impending financial losses to your state.
   
4. Share this information with everyone you know. Have them call and write the president, their senators and representatives in Congress.

Senate Switchboard: 202-224-3121
House Switchboard: 202-225-3121
The White House: 202-456-1414

E-mail addresses for your Representatives, Senators and the White House can be found posted in HandsNet at Resources/Congressional Contacts.

Quick Update:

VA-HUD Appropriations: House conferees have not been appointed.

Labor-HHS Appropriations: Action stalled in the Senate.

Ryan White Reauthorization: Senate conferees appointed today are: Kassebaum (R-KS); Kennedy (D-MA); Jeffords (R-VT); Frist (R-TN); Dodd (D-CT). The House has not appointed its conferees. House and Senate staff have begun to meet.

For more information, contact:

Anthony Rios
AIDS Action Council
1875 Connecticut Avenue NW #700
Washington DC 20009
202-986-1300
202-986-1345 (fax)
202-332-9614 (tty)
E-Mail: aidsaction@aidsaction.org

AIDS HIV Issues/AIDS Alerts
10/13/95--HandsNet Public Forums--HN3384