California Bill Extending Government-Funded Health Care Benefits to HIV-Positive People Not Being Implemented, Los Angeles Times Reports
A California law (AB 2197) signed by former Gov. Gray Davis (D) in September 2002 that aims to extend government-funded health care benefits to HIV-positive residents who have not developed AIDS has yet to be implemented by Gov. Arnold Schwarzenegger's (R) administration, the Los Angeles Times reports (Rau, Los Angeles Times, 4/4). Before the law was signed, only people with an AIDS diagnosis who were considered disabled were eligible for benefits under Medi-Cal, the state's Medicaid program. The law provides full Medi-Cal benefits to HIV-positive people who already are enrolled in the state's AIDS Drug Assistance Program, "who are not disabled and who would otherwise qualify for benefits under the Medi-Cal program." Medi-Cal will not cover prescription drug costs. To fund the program's expansion, the law suggests moving Medi-Cal beneficiaries with AIDS from the current fee-for-service system to a less expensive managed care program. The money saved would go toward financing the expansion of Medi-Cal benefits to people with HIV (Kaiser Daily HIV/AIDS Report, 9/19/02). The shift is voluntary, and the California 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, the Times reports. According to state estimates, about 8,000 HIV-positive Californians would qualify for Medi-Cal coverage if the program were implemented. The AIDS Healthcare Foundation, which sponsored the law as part of the Southern California HIV Advocacy Coalition, has announced that it plans to file a lawsuit Wednesday to compel the state to start providing coverage.
"It's not optional which laws to implement," AHF President Michael Weinstein said, adding, "It's just a turgid bureaucracy, and they don't know how to do this, or they haven't been interested in doing this." State officials have said that the law's constraints make it impossible to implement. The federal government required that the program's costs be offset, and the law stated that California could not launch the program until it demonstrated how it would do that. Some lawmakers and advocates anticipated that California would begin enrolling HIV-positive people into the program as money became available, according to the Times. Stan Rosenstein, deputy director of medical care services in the health department, said the state annually informs people with AIDS enrolled in Medi-Cal about their option to switch to managed care plans, but state and federal laws bar California from advertising the benefits of switching or offering people enticements to do so. "It's really regretful we've not been able to demonstrate budget neutrality," Rosenstein said, adding, "We've tried to outreach to people, we've sent notices. It's a choice people make." According to Rosenstein, the state has stopped attempting to gain federal approval for the program until it can demonstrate increased savings. The Times reports another reason for the law's delayed implementation is some Democratic lawmakers' "aversion" to managed care for disabled patients. In addition, Marcus Conant, chair of the San Francisco-based Conant Foundation, said another issue hampering the law's implementation is that many people with AIDS enrolled in fee-for-service Medi-Cal may be wary of abandoning the personal relationship they have created with their physicians. According to Rosenstein, the Schwarzenegger administration's focus on improving its Medi-Cal fee-for-service program for people with AIDS in an attempt to increase savings also might have diminished efforts to ask AIDS patients to switch to managed care (Los Angeles Times, 4/4).