Bay Windows - Local News, November 18, 1999
Beth Berlo, Bay Windows staff

According to the AIDS Action Committee of Massachusetts (AAC), the move will make nearly 2,000 low-income people with HIV newly eligible for comprehensive health care benefits under the Massachusetts Medicaid plan, making the Bay State the first in the nation to extend the benefits to under-privileged populations with HIV. Gov. Paul Cellucci is expected to sign the referendum into law.

"As far as I'm concerned, this is probably one of the most significant new programs that we have ever accomplished in addressing the needs of people living with HIV," said Robert Greenwald, AAC's director of public policy and legal affairs. The expansion, he said, will provide $50 million for resources over the next five years for the care of people living with HIV.

"Under the current system, [people] with HIV must be so sick that they are unable to work in order to be eligible for Medicaid," Greenwald explained. "So basically, you have to have AIDS in order to get Medicaid. The governor and the Legislature have recognized that this is a life-threatening situation that goes against the government's own stated standard of care for the treatment of HIV which calls for early intervention."

Recent clinical studies have demonstrated the difference between people with HIV who were treated early in the course of their infection and those who weren't. In addition, studies have shown the cost-effectiveness of early HIV treatment.

"This is a win-win for everybody," said Larry Kessler, AAC executive director. "Poor people with HIV can now get the treatment they need before becoming seriously ill, and the Commonwealth will save millions in unnecessary treatment costs."

According to Greenwald, numerous studies have proven that a reduction in overall care costs associated with HIV has occurred with the introduction of early intervention health care and combination therapies. Some of the more costly expenses linked with uninsured or under-insured HIV-positive people (which would be reduced dramatically under the new plan) are lengthy and repeated hospital stays and home nursing care.

Under the present system, most applicants must have incomes of 133 percent of poverty level or less before they are eligible to receive health care through Medicaid. The proposed expansion would permit people who test positive for HIV and have incomes at or below 200 percent of the federal poverty level ($16,000 a year for a single individual and $32,000 a year for a family of four) immediate access to comprehensive health care through Medicaid.

"That would include access to primary care, diagnostic services, prescription drugs, mental health and substance abuse services," Greenwald said. "It is as good as almost any private plan."

While effective medications continue to be developed, it is critical for people with HIV to have access to the treatments as early as possible, he said.

"With this new program, Massachusetts will remain number one at reducing AIDS mortality and progression toward AIDS," said Greenwald. "We will be able to keep people living with HIV disease, healthier longer, until ultimately there's a vaccine or cure."

Greenwald recently presented a paper in Denver at the U.S. Conference on AIDS on Medicaid expansion defending the proposition. In addition to being a sound investment for everyone, earlier access to care can serve as an incentive for people to learn their serostatus for the first time, he said, so they can take steps to avoid contracting or transmitting HIV. He added that an expansion program would gather large numbers of poor and low-income people with the disease into care, and provide the opportunity to conduct further research to end the epidemic.

How will the state pay for a Medicaid expansion? "In Massachusetts, we will amend our existing Section 1115 Waiver and fund increased costs in initial years out of Tobacco Settlement Funds," Greenwald said. He also underscored long-term savings which will occur after the numbers of hospital stays and skilled nursing care needs, begin to drop off.

Governor Cellucci and Lt. Gov. Jane Swift also have recommended earmarking $10 million from Massachusetts' settlement with the tobacco companies to fund Medicaid expansion.

"We think it's critically important," Felipe Rocha, deputy director of the state Department of Public Health's AIDS Bureau, said of the expansion proposal. "We've been working collaboratively with the Division of Medical Assistance on this project. We're optimistic that the [Health Care Financing Administration] will approve it, but that's their call. They could send it back and say they need more information."

A similar waiver has been going back and forth in the state of Maine, Rocha said. "But I think the difference is that we have been working collaboratively." The collaboration involves the Health Care Financing Administration, Division of Medical Assistance; Department of Public Health; health care advocates and providers, and assistance from the Kaiser Family Foundation and Lewin Group.

"I think the expansion will have huge implications of HIV intervention," said Greenwald. "For the first time ever, we can say, 'We guarantee you access to health care.'
991118
BY991103

Always watch for outdated information. This article first appeared in 1999. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1999. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .