N.C. ‘Spend-Down’ Medicaid Program Creates Gap in Care for Some Low-Income HIV/AIDS Patients, Study Says
North Carolina's Medicaid program -- which requires patients to pay some out-of-pocket health care expenses over a six-month period in order to qualify for the program for the subsequent six months -- can create gaps in care for patients with HIV/AIDS and other chronic diseases who cannot afford the expenses, according to a study published in the August issue of the journal AIDS Care, the AP/Charleston Post & Courier reports. North Carolina's Medicaid program has the strictest income eligibility requirement of the 35 similar "spend-down" Medicaid programs in the United States, the AP/Post & Courier reports. The state requires a maximum income of 125% of the poverty level -- $23,512 for a family of four or $15,019 for a couple -- in order to qualify for Medicaid.
Kathryn Whetten, a professor of public policy and director of the health inequalities program at Duke University in North Carolina, and Carolyn Zhu of the Health Policy Resource Center at New School University in New York examined the eligibility status of 1,495 HIV-positive people for the study, which was funded by the Health Resources and Services Administration's Special Projects of National Significance program. The researchers found that the cost of care for HIV-positive people who qualify outright for Medicaid is less than the cost of care for HIV-positive patients whose incomes are higher and have to pay out-of-pocket costs to qualify for Medicaid coverage. According to the study, HIV/AIDS care costs an average of $5,475 more per person for people in the spend-down program compared with people who qualify for coverage immediately. The researchers concluded that expanding Medicaid eligibility would improve health outcomes and be more cost effective because early treatment for HIV saves $11,500 per patient over five years. The current system can cause gaps in accessing medications and treatment and creates a "yo-yo" effect among some people as they fluctuate in and out of Medicaid eligibility, the AP/Post & Courier reports. According to Whetten, the program "should either be amended or scrapped," the AP/Post & Courier reports (AP/Charleston Post & Courier, 9/7).