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Senate OKs HIV Medicaid coverage If House passes, benefits will not be limited to full-blown AIDS
  By LOU CHIBBARO JR. | Nov 7, 1:18 PM
WASHINGTON - In a little noticed action, the U.S. Senate on Nov. 3 approved by unanimous voice vote an amendment that would allow an undetermined number of low-income people with HIV to become eligible for Medicaid, ending an existing rule barring them from receiving Medicaid benefits until they have full-blown AIDS.
Oregon Republican Gordon Smith spearheaded a Senate measure to extend Medicaid to cover anyone who is HIV-positive and not just those with full-blown AIDS.
The amendment calls for a demonstration program that gives states the option of providing Medicaid coverage to low-income people with HIV who otherwise meet Medicaid eligibility requirements. It sets a cap of $450 million for the program over five years.
At the request of Senators Gordon Smith (R-Ore.) and Hillary Rodham Clinton (D-N.Y.), the Senate attached the amendment to a controversial fiscal year 2006 budget reconciliation bill that, among other things, calls for across-the-board cuts in social welfare programs and would allow oil drilling in Alaska's Arctic National Wildlife Refuge.
The House did not include similar language providing Medicaid coverage for people with HIV its version of the budget reconciliation bill, and a House-Senate conference committee must now make the final decision on the proposal.
The Smith-Clinton amendment is a scaled-back version of the Early Treatment for HIV Act, or ETHA, introduced by Smith earlier this year. Similar versions of ETHA had been proposed since the late 1990s, when President Bill Clinton promised to study the legislation. The bills have died in committee each year since that time.
Smith, who has been one of the Senate's leading advocates for Medicaid coverage for people with HIV, said he was forced to reduce the scope of the legislation in the amendment because rules associated with the budget reconciliation bill do not allow new spending measures unless they are offset by spending cuts.
Saving federal dollars
AIDS activists and gay rights groups have said full Medicaid coverage for low income people with HIV - most of whom do not have private health insurance - would save the government millions of dollars because it would delay the onset of AIDS and its related opportunistic infections and diseases, which are more expensive to treat.
Gay rights and AIDS groups have cited a recent study by the consulting firm Price Waterhouse Coopers that shows, over 10 years, the death rate for people with HIV who would become eligible for Medicaid under ETHA could be reduced by 50 percent.
While Smith's original ETHA legislation calls for providing Medicaid benefits for all low-income people with HIV who are otherwise eligible for Medicaid, the Smith-Clinton amendment passed by the Senate on Nov. 3 scales back the program into a "demonstration" project with a $450 million cap on Medicaid expenditures over a five-year period.
Similar to ETHA, the amendment also leaves it up to the states to decide whether to adopt the program.
It could not be determined by press time how many otherwise eligible people with HIV would be excluded from Medicaid coverage under the Smith-Clinton amendment compared to Smith's original bill.
Under existing Medicaid rules, the federal government and the states share of the cost of Medicaid under various funding formulas. The sharp increases in Medicaid costs in recent years have created financial burdens for many states, prompting some to scale back on Medicaid programs.
"This is a major accomplishment," said Carl Schmid, director of federal affairs for the AIDS Institute, a national AIDS advocacy group, in describing the Smith-Clinton amendment.
"It's very good because it will cover a lot of people," Schmid said, even though it isn't as comprehensive as the original bill.
The Human Rights Campaign, a Washington-based gay political group, called the Smith-Clinton amendment a major breakthrough in efforts by gay and AIDS groups to advance the ETHA legislation.
"We firmly believe the demonstration project, in conjunction with the study by Price Waterhouse Cooper on ETHA, will lead to a reversal of a policy that generally requires individuals to develop AIDS before being eligible for Medicaid," said Christopher Labonte, HRC's legislative director.
"Passage of this amendment will provide an impetus to developing a sound HIV/AIDS policy in Medicaid, as well as help alleviate some burden on an already over-extended AIDS Drug Assistance Program through the Ryan White CARE Act," Labonte said.
The federal AIDS Drug Assistance Program, or ADAP, already provides free prescription drugs to low-income people with HIV based on available funds appropriated each year by Congress. But AIDS activists have said funds for the program have not always met the needs of everyone eligible for it in all states. ADAP also does not provide the type of primary care medical services that Medicaid provides, activists have said.
Spokespersons for Smith and Clinton did not return calls by press time.
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