accountability for individuals with HIV who rely on public programs. From this goal, the Committee derived five assessment criteria:

  • Eligibility: Does the approach include a minimum, uniform standard for eligibility that ensures that low-income individuals with HIV (i.e., individuals with incomes at or below 250 percent of the federal poverty level, or FPL) have coverage for recommended services regardless of the state in which they reside?

  • Benefits: Does the approach include a benefit package that meets the standard of care for HIV/AIDS and that is uniform for all eligible individuals?

  • Provider reimbursement: Does the approach include payment rates that are adequate to enable providers to furnish services commensurate with the standard of care for HIV/AIDS?

  • Financing: Does the approach include a financing mechanism that is capable of supporting eligibility, benefits, and provider payment elements that meet the Committee’s criteria and that is stable over time?

  • Integrated and coordinated services that foster accountability: Does the approach include the integration and coordination of services that allows for administrative arrangements that are efficient and that support program accountability and evaluation?

The Committee applied these assessment criteria to each of the alternative approaches. The Committee’s findings are summarized in Table 5-1. The remainder of this chapter sets forth the Committee’s analysis of the advantages and disadvantages of these alternative approaches in light of these criteria. The recommendations that flow from this analysis are set forth in Chapter 6.

In the Committee’s judgment, the alternative that best fits the assessment criteria is a new federally funded, state-administered entitlement program for low-income individuals with HIV.

The Committee recognizes that the alternatives examined here do not represent the universe of policy options for financing and delivering HIV care. The Committee selected these particular options as broadly illustrative of the alternatives that federal policy makers are likely to explore given the current configuration of federal and state programs described in Chapter 3. For example, the most recent significant health care eligibility expansion at the federal level was the State Children’s Health Insurance Program (SCHIP), enacted in 1997. Although this program is targeted at a much different population than that to which this report is addressed, the structural features of SCHIP reflect some important policy preferences. The Committee therefore modeled one of its illustrative approaches on SCHIP.

The Committee notes that, in each approach presented (excluding the Medicare option), state participation is optional. In theory, the federal



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