CMS Offers Guidance to States on Providing Medicaid to Residents Living with HIV

June 6, 2011

CMS Offers Guidance to States on Providing Medicaid to Residents Living with HIV 1115 Waiver Offers Critical Avenue to Provide Care, Improve Health Outcomes

Washington, DC — Today, the Centers for Medicare & Medicaid Services (CMS) released guidance for states who wish to apply for 1115 Medicaid demonstration projects, which would allow states to provide care through Medicaid for residents living with HIV. Currently, a person must be disabled by AIDS before they are eligible for coverage through the program. This inhumane policy leaves low-income individuals living with HIV who would otherwise be eligible for Medicaid, few avenues for accessing their treatment. It also places an ever growing burden on the nation’s Ryan White programs.

“The National Minority AIDS Council (NMAC) applauds efforts by CMS to streamline its application process for 1115 waivers,” said NMAC Deputy Executive Director Daniel C. Montoya. “The release of today’s guidance further demonstrates the agency’s commitment to both health care reform and the National HIV/AIDS Strategy. Communities of color, in general, utilize Medicaid at a higher rates, while also being disproportionately impacted by HIV. These waivers provide an opportunity for states to immediately address health disparities and ensure that all residents have equal access to care.”

Under the Patient Protection and Affordable Care Act, all Americans earning 133 percent of the Federal Poverty Level would be eligible for Medicaid, regardless of their disability status. This would eliminate the catch-22 for low-income individuals living with HIV, who must wait to be disabled by the disease before becoming eligible for the program. Unfortunately, this reform will not go into effect until 2014. 1115 waivers offers an important bridge for states to provide care to their residents until the law takes effect, while providing relief to those states facing funding shortfalls for their AIDS Drug Assistance Programs (ADAP).

“These waivers provide an incredibly important opportunity for states to address the nation’s ADAP crisis,” continued Montoya. “13 states have instituted ADAP wait lists, while 17 others have introduced a variety of ‘cost containment measures.’ Given recent data that shows the importance of antiretroviral treatment in both improving health outcomes and reducing transmission risk, we must ensure that everyone has access to drug therapies. 1115 waivers are an important tool in achieving that goal.”


Contact: Kyle Murphy, (202) 483-6622 ext. 333