PI Action alerts & updates ... 2003

HIV Medicaid & Medicare Working Group!

Below is a letter from the HIV Medicaid and Medicare Working Group expressing concerns about recent proposals made by leaders in the House/Senate conference committee working on final Medicare prescription drug benefit legislation. These proposals would be extremely harmful to people who receive benefits to Medicaid in addition to Medicare, and could result in low-income people with disabilities losing their Medicaid coverage.

For more information about how to get involved with this issue, contact Ryan Clary at rclary@projectinform.org or 415-558-8669 x224. To join the HIV Medicaid and Medicare Working Group (open to all), email Lei Chou at TheAccessProject@aol.com.

October 31, 2003

The Honorable Edward Kennedy
United States Senate
Washington, DC 20510

Dear Senator Kennedy,

On behalf of the HIV Medicaid/Medicare Working Group, we are writing to express our grave concerns over recent developments in the House/Senate conference negotiations on the Medicare drug benefit legislation. We are appealing to you to exercise your strong commitment to the Medicaid program by stopping the proposed harmful provisions to Medicaid that would reduce and, in some cases eliminate, services to some of the program's most vulnerable beneficiaries, including people living with HIV/AIDS.

The HIV Medicaid/Medicare Working Group is a national coalition of HIV/AIDS advocates working to protect and improve Medicaid and Medicare. We strongly support a comprehensive, meaningful prescription drug benefit in Medicare that meets the needs of all beneficiaries, including people living with HIV/AIDS and other disabilities. We believe that this debate provides an opportunity to build upon existing coverage and improve access to treatment and healthcare in this country.

However, in addition to our concerns that the current overall proposal falls far short of meeting the needs of people living with HIV/AIDS who depend on Medicare, we are further alarmed by reports of last-minute attacks on Medicaid by House Republicans in the conference committee. We are extremely disturbed by reports that they are pushing for changes that would limit access to comprehensive healthcare for Medicaid recipients, including those who are dually eligible for both Medicaid and Medicare, and those who are Medicaid-only eligible. Specifically, we are strongly opposed to two major proposed changes:

A proposal that would take away the Medicaid wrap-around drug benefit for those dually eligible for Medicare and Medicaid. As of 2002, almost 6 million Americans qualified for both programs. Under current law, Medicaid fills in any gaps in a Medicare benefit for those who are dually eligible. If a Medicare drug benefit is enacted, particularly one that is inadequate for many seniors and people with disabilities, Medicaid must remain the payer of last resort. However, House Republicans are proposing to help pay for the Medicare drug benefit by eliminating Medicaid's traditional role as payer of last resort for dual eligibles.

Not only would this proposal violate the principle that every Medicaid beneficiary is entitled to the full scope of a covered Medicaid benefit, it would deny many, certainly including people with HIV/AIDS, access to a reasonable standard of care. The current Medicare drug benefit proposal allows for only one drug in a therapeutic class. Because HIV is an individualized disease and the choice of treatment is dependent on ability to consistently take medications on time every day despite side effects that can be debilitating drugs within therapeutic classes are not interchangeable.

Further, failure to achieve regular adherence to an effective drug regimen can lead to resistance, which has broad public health implications. People with HIV/AIDS who are dually eligible will need to have Medicaid provide the supplemental coverage in order to have access to an appropriate treatment regimen. Moreover, people with AIDS and many other dual eligibles have a multitude of prescription drug needs, including treatments to address side effects of antiretroviral medications and comorbidities like serious and persistent mental illness. The proposed elimination of the wrap-around will leave many with significantly less drug coverage than they currently have and will certainly lead to increased morbidity and mortality.

A proposal that would require states to count certain income and assets that many now disregard when determining Medicaid eligibility. This proposal would prohibit states from disregarding additional income or assets above the federal government's very restrictive SSI requirements for the cash assistance program.

If this proposal is enacted, it will not only result in the loss of comprehensive health care for many, but also increase the burden on other safety net programs such as the AIDS Drug Assistance Program (ADAP) (funded through the Ryan White CARE Act) many of which are already in fiscal crisis. As an example, we can look at Oregon, which recently eliminated its Medicaid medically-needy program. As a result, there was a greatly increased demand on its ADAP, and that program now has a significantly reduced formulary and financial eligibility requirements, and had at one time a waiting list of over 200 individuals in that state alone.
Because of your longstanding and tireless efforts fighting for healthcare for America's vulnerable populations, we are asking for your leadership on this issue. While we know that we will not likely get a meaningful prescription drug benefit for Medicare in this legislation, it is vital that the bill not weaken the benefits already being received by low-income Medicaid beneficiaries. We urge you to strongly oppose the proposals by House Republicans, to do what you can to influence the outcome of the conference negotiations and to urge your colleagues to oppose that conference report if it includes these provisions, when it reaches the Senate floor.

Thank you for considering our concerns. If you have any questions, or need additional information, please contact Andrea Weddle at the HIV Medicine Association, 703-299-1215.

Sincerely,

Laura Caruso
Gay Men's Health Crisis
Lei Chou
AIDS Treatment Data Network
Anne Donnelly and Ryan Clary
Project Inform
Michael Kink
Housing Works
Christine Lubinski and Andrea Weddle
HIV Medicine Association