HIV/AIDS and the Republican Medigrant Bill

Does the House Republican MediGrant bill protect coverage for everyone who is currently eligible for Medicaid and for people who might become eligible in the future?

No. The Republican proposal ends the entitlement to Medicaid and guarantees no one health care coverage. Current beneficiaries, whether poor families with children, low-income seniors, or people with disabilities including HIV disease, would not be guaranteed health care services after Medicaid becomes a state-controlled program.

Does Medigrant mandate a benefit package which offers comprehensive medical services?

No. States must submit a plan outlining:

1. the services to be offered to each group of beneficiaries,
2. the setting, and
3. the providers who will provide the care.

But the states have complete discretion about the package of services available to the beneficiaries in the program, including the duration and scope of those services. Under the current Medicaid program, there are federally mandated services and states have the option of providing additional essential services, such as prescription drugs and home- and community-based care, to people with HIV/AIDS (PWAs). All of these services will be jeopardized under the reduced funding of the MediGrant plan.

Does Medigrant protect beneficiaries from being subject to high out-of-pocket costs for health care services?

No. States are offered complete discretion in identifying copayment rates for Medigrant covered services. The bill only requires that copayment rates be kept "nominal" for pregnant women and children whose family income is under 100 percent of federally established poverty levels.

Does the bill protect the ability of Medicaid beneficiaries to choose their own specialty providers with expertise in HIV/AIDS?

No. Medigrant encourages the movement of the Medicaid-eligible population into managed care plans, including disabled populations. States are no longer required to offer "choice" to recipients and, therefore, would not need any federal waiver or special approval to put all beneficiaries into managed care. While states are required to outline the terms of managed care plans which will receive Medigrant funding and report health care charges, there are no federal guidelines or consumer protections guiding the operations of managed care plans.

Does the House Republican Medigrant bill ensure the rights of beneficiaries to challenge states in court if states fail to deliver medically necessary services to all Medicaid beneficiaries?

No. The bill explicitly prohibits MediGrant beneficiaries and their advocates from suing to enforce program provisions in federal courts. The only recourse for aggrieved persons, therefore, would be in some state courts.

Under Medigrant, does the formula for distribution of federal Medicaid funding to states ensure that states with a high incidence of HIV/AIDS have enough money to meet the costly health care needs of persons with HIV/AIDS?

No. In fact the distribution of funding to states under the House formula results in deep federal Medicaid cuts to the majority of states. Many states with high numbers of AIDS cases are particularly hard hit--New York (projected 35% loss in funding for FY 2002), California (27% loss), Florida (33% loss), Texas (20% loss), Illinois (18% loss), and Washington (43% loss).

Does the MediGrant bill require states to continue to make their current expenditures on medical coverage for beneficiaries (state "maintenance of effort" requirement)?

No. The MediGrant bill requires that states spend the federal money on medical care for beneficiaries. In addition, states are required to contribute their own money toward the care of three set aside populations: 1) low-income families, 2) low-income elderly, and 3) low-income disabled. There are neither guarantees that states continue their current level of expenditure nor that specific recipients continue to get care.

Is the MediGrant bill flexible enough to respond to changing circumstances within a state's populations?

No. The MediGrant bill limits federal spending and is not subject to change. States receive their grant based on a complex formula that does not take into account changing circumstances such as a recession or an increase in a beneficiary population, such as long-term care or HIV/AIDS beneficiaries.

Does MediGrant protect hospitals that have historically provided unreimbursed care for expensive populations such as those with chronic diseases like HIV/AIDS?

No. Under the current system, hospitals which have a large number of patients for which they provide unreimbursed care, called Disproportionate Share Hospitals (DSH), receive special, direct federal grants to offset the costs of providing such care. But under Medigrant, they are not guaranteed to receive any money for that care. This change puts the hospitals and care for these populations at risk.

* Data in this summary was compiled by AIDS Action Council and National Alliance of State and Territorial AIDS Directors. Epidemiological data was provided by the state health department. Funding amounts were provided by the appropriate federal agency, and are from the most current fiscal year that state-by-state data is available. May, 1995.