drugs for people on Medicaid who participate in Medicaid's drug rebate contract, many states have imposed limitations by restricting the number of prescriptions a patient can purchase in a month, the number and terms of refills, a requirement for prior authorization, and a determination of "medical necessity." In June 1996, in response to reports that some managed care organizations did not include all FDA-approved drugs for HIV in their formulary, the Medicaid program issued a directive to states requiring that those which include drugs and cover the HIV population in managed care assure that those drugs are available in managed care formularies.
The federal Social Security program offers two types of benefits for which women and children with HIV/AIDS may be eligible. For persons with an employment history, Social Security Disability Insurance (SSDI) provides monthly benefits to those disabled with a medical condition that is expected to last a year or end in death and is serious enough to prevent them from doing substantial work. The monthly benefit depends upon how much was earned while working. After 24 months on SSDI, the recipient becomes eligible for Medicare. The Supplemental Security Income (SSI) program is intended for those with a disability who have not worked long enough to qualify for Social Security or whose benefits are low and resources limited. Children with disabilities who live in low-income families may qualify for the SSI Disabled Children's Program (SSIDCP). In most states, eligibility for SSI makes one eligible for Medicaid coverage.
The range of funding mechanisms for primary and specialty care that existed prior to the HIV/AIDS epidemic has been supplemented by funding specifically for HIV/AIDS patients.
Federal funds for primary and specialty care are authorized and appropriated by Congress and distributed primarily from the Department of Health and Human Services (DHHS) through the Maternal and Child Health Bureau (MCHB) and the Bureau of Primary Health Care (BPHC) of the Health Resources and Services Administration (HRSA); the Office of Population Affairs (OPA); the Centers for Disease Control and Prevention (CDC); and Substance Abuse and Mental Health Services Administration (SAMHSA). Federal money flows into the community either directly through grants to public and private providers in the community, or indirectly through state agencies, which then allocate funds in a manner specific to their mandate. State funding consists of matching contributions required by specific programs, shared funding, or supplemental funds used to expand service support. Local health agencies, especially ones serving large populations, may also fund primary and secondary health services. State and local health agencies frequently receive grants from private foundations for special initiatives.