Ruling: California Health Agency Fell Short on HIV Coverage Law
The California Department of Health Care Services has not taken adequate steps to implement a law intended to provide Medi-Cal coverage for HIV-positive Californians, a Los Angeles County Superior Court judge determined in a ruling made public Thursday, the Los Angeles Times reports.
Medi-Cal is California's Medicaid program.
The AIDS Healthcare Foundation filed the lawsuit.
In 2002, former Gov. Gray Davis (D) signed AB 2197, which required DHCS to encourage Californians who have developed AIDS to enroll in Medi-Cal managed care plans rather than higher-cost fee-for-service plans.
The cost savings from the move to managed care was intended to cover the cost of expanding Medi-Cal coverage for HIV-positive Californians whose conditions have not progressed to AIDS.
Medi-Cal already provides coverage to people with AIDS.
In his ruling, Judge James Chalfant faulted DHCS for not working to implement the law.Â The judge concluded that the department:
- Made minimal effort to encourage Medi-Cal beneficiaries with AIDS to enroll in managed care plans;
- Did not assess how much money the move to managed care plans would save;
- Did not calculate reimbursement rates for care providers who treat HIV-positive beneficiaries; and
- Did not pursue other strategies to cover the cost of expanding Medi-Cal to HIV-positive Californians.
DHCS officials said they had not reviewed the ruling completely or determined their next course of action.Â
Department spokesperson Norman Williams said that DHCS leaders believe that it is not feasible to implement the law, in part because the state's managed care programs for AIDS patients cost the state more than fee-for-service programs do (Rau, Los Angeles Times, 12/5).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.