Medi-Cal Benefits for HIV-Positive People Spark Suit
The AIDS Healthcare Foundation on Wednesday plans to file a lawsuit to compel the state to start providing Medi-Cal coverage for HIV-positive residents under a 2003 law, the Los Angeles Times reports. Medi-Cal is California's Medicaid program.
Former Gov. Gray Davis (D) signed AB 2197, which was intended to extend government-funded health care benefits to HIV-positive residents who have not developed AIDS.
The federal government required that the costs to Medi-Cal from the policy change be offset, and the law bars California from launching the program until cost-neutrality can be demonstrated.
Officials for the administration of Gov. Arnold Schwarzenegger (R) say these conditions have prevented the program from being launched.
To fund the program's expansion, the law suggests moving Medi-Cal beneficiaries with AIDS from the current fee-for-service system to Medi-Cal managed care plans. The money saved would go toward financing the expansion of Medi-Cal benefits to people with HIV.
The shift is voluntary, and the Department of Health Services said that of the 18,000 Medi-Cal beneficiaries with AIDS, 200 have agreed to switch. The state initially estimated that it would be able to cover the health care costs of one HIV-positive person with savings from 20 people with AIDS who opted to move into managed care.
However, increased reimbursement rates to Medi-Cal managed care providers have reduced the anticipated savings. The state now estimates that it would take 100 people with AIDS to move into managed care to offset the cost of providing treatment for one HIV-positive person.
According to state estimates, about 8,000 HIV-positive Californians would qualify for Medi-Cal coverage if the program were launched.
Stan Rosenstein, deputy director of medical care services for DHS, said the state has stopped attempting to gain federal approval for the program until it can demonstrate increased savings. He said the Schwarzenegger administration now is focusing on improving its Medi-Cal fee-for-service program for people with AIDS in an attempt to increase savings (Rau, Los Angeles Times, 4/4).