ETHA and Medicaid

Early Treatment for HIV Act Reintroduced in Congress

April 9, 2009

Early Treatment for HIV Act (ETHA), one of Project Inform’s top policy priorities for the past several years, was reintroduced in the House of Representatives on March 19, 2009, and in the Senate on April 20, 2009. ETHA would allow states to extend Medicaid coverage to low-income individuals living with HIV before the disease progresses to AIDS. The bill continues to have strong, bipartisan support. Speaker Nancy Pelosi (D-CA), Congresswoman Ileana Ros-Lehtinen (R-FL) and Congressman Eliot Engel (D-NY) are the lead sponsors of the House bill, and Senators Charles Schumer (D-NY) and Olympia Snowe (R-ME) are the lead sponsors of the Senate bill.

Current Medicaid eligibility rules require most people to become disabled by AIDS before they become eligible for the Medicaid-based care that could have prevented HIV-disease progression to AIDS. ETHA would bring Medicaid eligibility rules in line with federal government guidelines on the standard of care for treating HIV, and help to address growing wait lists for access to life-saving medications and limited access to comprehensive health care in many parts of the country.

According to a study by PricewaterhouseCoopers, ETHA enactment would slow disease progression, increase life expectancy, and be much more cost effective. Specifically, over ten years, ETHA is projected to reduce by 50% the death rate for persons with HIV on Medicaid, result in 35,000 more individuals having CD4 levels above 500, and, according to traditional budget analysis rules, save $31.7 million.

Early access to HIV therapies as provided under ETHA is also an important HIV prevention tool, given that recent studies have found that HIV therapies lower viral load and the potential for HIV transmission by 60%. Securing passage of ETHA is an important remedy to problems with current Medicaid policy, will remove barriers to early intervention, save lives, and generate significant savings for individuals and the healthcare system.

Despite the clear benefits of ETHA, the bill has stalled in Congress over the past several years. Hopefully this will change with the renewed focus on expanding health care. Project Inform, along with our advocacy partners, will push for quick passage of this legislation, potentially as part of broader health care reform. For more information about ETHA and how you can make a difference, contact .