If you are HIV positive but do not yet have AIDS, you are probably eligible for Medi-Cal
Earlier this month, the court ruled that the health department “arbitrarily failed to meet its statutory duties” in implementing the 2002 legislation. The ruling came in a case filed by AIDS Healthcare Foundation (AHF) which sought to compel DHCS to comply with legislation intended to extend Medi-Cal coverage to HIV-positive, non-disabled people who would otherwise qualify for Medi-Cal. Prior to the passage and signing of the legislation, Assembly Bill 2197, only those who had advanced to a diagnosis of AIDS were considered eligible for Medi-Cal enrollment and coverage.
“Despite an excellent record on AIDS issues, Gov. Schwarzenegger has been ill-served by his administration, which for six years has failed to enact this crucial – and ultimately cost-saving – health care legislation,” said Michael Weinstein, president of AIDS Healthcare Foundation, the U.S.’ largest HIV/AIDS organization, which operates AIDS treatment clinics in the U.S., Africa, Latin America and the Caribbean and Asia, including 12 clinics in California. “We thank the court for this judgment which compels the state to do its job by implementing this important legislation passed by the state’s representative government and signed into law by the governor.”
In the judgment, the court orders the state to:
“1. Conduct all outreach and awareness activities necessary to encourage the voluntary enrollment into Medi-Cal managed care of persons who are disabled as a result of AIDS pursuant to Welfare and Institutions Code 14149.3, subdivision (g);
“2. Determine the savings generated by the increased voluntary enrollment into Medi-Cal managed care of persons who are disabled as a result of AIDS pursuant to Welfare and Institutions Code 14149.3, subdivision (f) (1);
“3. Establish capitation rates to be paid to Medi-Cal managed care plans for services provided pursuant to Welfare and Institutions Code 14149.3, subdivision (e);
“4. Seek the appropriate federal waiver under Section 1115 of the Social Security Act (42 U.S.C. Sec. 1315) to implement the expansion of eligibility provided for pursuant to Welfare and Institutions Code 14149.3, subdivision (j); and
“5. Take any further action specially enjoined on them by the law. Nothing in this judgment or in that writ shall limit of control in any way the discretion legally vested in respondents.”
The need for care for HIV-infected people in the early stages of the disease
AB 2197 came about in part in response to a call by the federal Centers for Medicare and Medicaid Services for states to seek waivers to extend healthcare services to low-income individuals in the early stages of HIV. As written and signed into law back in 2002, AB 2197 directs California’s Department of Health Services to, among other things:
• Determine whether, under applicable federal law, the federal government will contribute financially for the enrollment and maintenance of these beneficiaries in the Medi-Cal program;
• Seek from the federal government a waiver of requirements for the Medi-Cal program, such that California may implement this program;
• Actively encourage Medi-Cal recipients with AIDS to voluntarily enroll in Medi-Cal managed care programs;
• Utilize the savings generated by such enrolments to fund the coverage of otherwise eligible persons with HIV into the Medi-Cal program.
History of California Assembly Bill 2197
In 2002, California Gov. Gray Davis signed Assembly Bill 2197. The bill, which had been introduced twice before in the California legislature in various versions as far back as 1997, honored a campaign pledge Davis made during his first California gubernatorial campaign.
At the time of its passage, AB 2197′s author, Assembly Member Paul Koretz, D – West Hollywood – now retired, said: “This bill is a win-win for the state and for persons living with HIV. It will provide access to more reliable, stable health care for these individuals at no additional cost to the state. The strong bi-partisan support this bill has received is testament to the fact that it is a very sensible, cost-effective approach to improving access to health care.”
AB 2197 had been the highest priority that legislative year for California’s leading AIDS organizations – including the Southern California HIV Advocacy Coalition (SCHAC), the sponsor of the bill, representing 10,000 individuals throughout the Southland, and AIDS Healthcare Foundation, the nation’s largest specialty provider of HIV/AIDS medical care with clinics in Southern and Northern California.
AB 2197 extends Medi-Cal eligibility to Californians who are HIV positive but do not yet have an AIDS defining illness. Previously, only Californians with an AIDS diagnosis – those who have progressed clinically from being HIV positive to having an AIDS defining illness – could be considered for Medi-Cal eligibility.
As a result, many HIV-positive Californians had to progress to an AIDS diagnosis – in essence get sicker – in order to then access care, via Medi-Cal. Sadly, because of the state’s failure to comply with AB 2197 almost five years after its passage, this still largely remains the case today.
AIDS Healthcare Foundation currently provides medical care and/or services to more than 93,000 people in 21 countries. Contact them at AIDS Healthcare Foundation, 6255 W. Sunset Blvd, 21st Floor, Los Angeles, CA 90028-7422, (877) 844-4243 (toll free), www.aidshealth.org.