California Fails To Implement Program Providing Care to HIV-Positive People, Court Says
California's Department of Health Care Services has failed to enact a six-year-old state law (AB 2197) that calls for the implementation of a program to provide medical care to low-income California residents living with HIV, according to a ruling announced Thursday by the Los Angeles County Superior Court, the Los Angeles Times reports (Rau, Los Angeles Times, 12/5). The ruling comes in response to a lawsuit filed last year by the AIDS Healthcare Foundation claiming that DHCS failed to expand coverage under Medi-Cal, the state's Medicaid program, to HIV-positive Californians who had not developed AIDS (AP/San Francisco Chronicle, 12/5).
The law, signed by former Gov. Gray Davis (D) in September 2002, calls for the state to provide 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." Before the law was passed, only people with an AIDS diagnosis who were considered disabled were eligible for benefits under Medi-Cal. To fund the program's expansion, the law suggested 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, 4/4/07).
Judge James Chalfant, who issued the ruling, wrote that California "has not fulfilled its statutory obligation" by failing to enact some measures required by the legislature and insufficiently completing others. According to the ruling, DHCS outreach efforts to encourage AIDS patients to switch to managed care were limited to meetings with advocates and medical providers, as well as flier distribution in three counties on one occasion. Chalfant wrote that it is "clear" that the department "simply has not done the necessary outreach and awareness activity to encourage AIDS patients on Medi-Cal to adopt managed care." In addition, the department decided against contacting patients directly because it assumed, without evidence, that federal medical privacy laws would prohibit such action, Chalfant wrote. In addition, Chalfant ruled that DHCS did not comply with the law's requirement to determine how much it would pay Medi-Cal providers to treat HIV-positive people or calculate how much would be saved when people living with AIDS moved into managed care. The department also did not attempt to find other methods to pay for care for HIV patients, did not seek additional revenue sources and rejected potential revenue sources brought to its attention, Chalfant ruled (Los Angeles Times, 12/5). Chalfant ordered AHF to develop a plan for helping DHCS comply with the law, and the foundation is scheduled to submit the plan on Dec. 17.
Ged Kenslea, spokesperson for AHF, said the court's ruling "is a scathing indictment of the state for not doing anything to comply" with AB 2197, adding that "DHCS can't pick and choose which laws they follow" (AP/San Francisco Chronicle, 12/5). Michael Weinstein, president of AHF, said the department "never had any intention of enforcing this law because they thought they had a right to determine which laws they enforce or don't," adding that hundreds or thousands of HIV-positive people might have lost out on health services because the state resisted enacting the law. DHCS officials said they had not fully reviewed the ruling or determined their next steps but added that they had acted appropriately. Norman Williams, a spokesperson for DHCS, said the department believes the law will not work because California's managed care programs for AIDS patients -- which currently enroll 1,800 people -- cost the state more than fee-for-service programs. According to the Times, the law explicitly says that the state can not incur additional costs by extending Medi-Cal to people living with HIV (Los Angeles Times, 12/5). Williams said the state had performed a cost analysis demonstrating that the law would not work without additional funding (AP/San Francisco Chronicle, 12/5).