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Public Financing and Delivery of Hiv/Aids Care: Securing the Legacy of Ryan White
The Ticket to Work/Work Incentives Improvement Act (TWWIIA) included an option for states to launch demonstration projects to provide Medicaid to workers with potentially severe disabilities, including HIV/AIDS, who are not yet disabled but whose health conditions could be expected to cause disability. This demonstration is funded at a total of $250 million over the FY 2001–2006 period. Mississippi and the District of Columbia have been awarded approval for HIV-related demonstrations under the Act.62
The Early Treatment for HIV Act. Because of the many barriers faced by states through the 1115 process and the limited nature of the TWWIIA demonstration, Congress is considering the Early Treatment for HIV Act (ETHA). ETHA would create a new state option to expand Medicaid coverage to low-income people living with HIV who are not disabled, similar to legislation passed in 2000 by Congress that gave states the option to provide Medicaid coverage to women diagnosed with breast and cervical cancer.63
Returning to/Entering the Workforce
While new treatments are enabling more Medicaid beneficiaries with HIV to enter or return to the workforce, the continuation of their Medicaid coverage is uncertain. Current Medicaid rules do not allow beneficiaries to keep their health coverage when they earn income above the eligibility level. This may present a barrier to working since the cost of treatments that allow people with HIV to enter the workforce may be prohibitive without Medicaid coverage. In addition, people with HIV/AIDS who re-enter or enter the workforce for the first time may not be able to get insurance through the workplace. The Balanced Budget Act of 1997 gave states the option to allow low-income disabled individuals to keep their Medicaid coverage while working and earning income up to 250 percent of poverty. The TWWIIA also made several changes designed to encourage low-income individuals with disabilities to work while allowing them to keep their Medicaid coverage.64 In both these cases, however, relatively few states have exercised these options.65
Variation in state Medicaid programs resulting in different levels of access across the states
In states with less generous Medicaid programs (e.g., states with limits on the number of prescriptions filled per month or states with lower income eligibility thresholds), low-income people with HIV may have to rely on other programs to fill the gaps or may not have access to needed services.66