Speaker Pelosi praises H.R. 3962 that will improve Medicaid access to HIV/AIDS-affected people

Nov 10 2009

Speaker Nancy Pelosi released the following statement praising provisions in the Affordable Health Care for America Act (H.R. 3962) that will improve access to Medicaid and reduce Medicare Part D costs for people living with HIV/AIDS. H.R. 3962 passed the House on Saturday by a vote of 220 to 215:

"Effective drug treatments have improved both health and quality of life for thousands of Americans living with HIV/AIDS. However, many uninsured, low-income HIV-positive individuals still do not have access to these life-saving medications because they generally do not meet Medicaid requirements until becoming disabled by full-blown AIDS.

"Forcing people with HIV to wait for health care until their immune system is compromised by AIDS is bad health policy. The House health insurance reform bill dramatically increases access to Medicaid for all low-income Americans, including people living with HIV, by covering everyone up to 150 percent of the federal poverty level.

"For more than a decade, I have worked to expand access to Medicaid for people living with HIV through the Early Treatment for HIV Act. With Saturday's passage of the Affordable Health Care for America Act, the House has moved a step closer to not just achieving this goal, but exceeding it."

Background:

Currently, childless adults without a disability typically do not qualify for Medicaid at any income level. But even for parents and disabled adults eligibility is generally limited to those with incomes below 100 percent of the poverty level, and in many states the threshold is much lower.

The bill's expanded access to Medicaid begins in January 2013, when the new Health Insurance Exchange begins operation. In the interim, H.R. 3962 further ensures early access to care and treatment for people living with HIV by giving states the option of an enhanced federal match if they choose to cover people with HIV in their existing Medicaid programs. In participating states, people with HIV infection would qualify for coverage using the same eligibility standards that currently apply for disabled adults.

In addition, H.R. 3962 also finally allows medications provided through the AIDS Drug Assistance Program (ADAP) to count toward out-of-pocket costs in the Medicare Part D 'donut hole'. Prior to this change, ADAP beneficiaries would enter the "donut hole" coverage gap and then never leave it because their drug costs weren't being counted.

Now, ADAP beneficiaries will exit the "donut hole" more quickly, giving them access to the full range of medications covered under Medicare Part D. This is important because ADAP programs generally have a more limited formulary than the typical Medicare Part D plan.