03 Feb American Academy of HIV Medicine Warns Against the Adoption of Block Grants for State Medicaid Programs
WASHINGTON, DC: The American Academy of HIV Medicine today called the Centers for Medicare & Medicaid Services’ (CMS) recommendation for states to adopt block grants for their Medicaid programs misdirected and warned that the health and welfare of millions – including people living with HIV – will be in jeopardy.
“Ironically named the Healthy Adult Opportunity Initiative, the CMS guidance on block grants threatens the health of the most vulnerable among us,” says Executive Director Bruce Packett. “People with HIV, those with disabilities, children – these people are all at risk to lose access to needed health care and coverage through Medicaid.”
Since its inception, the Medicaid Act has provided for unlimited federal matching dollars for state funds spent under Medicaid’s rules. By switching to a block grant, a state would accept a cap to federal support in exchange for the freedom to disregard Medicaid rules on mandatory benefits, such as prescription drug coverage.
An estimated 42 percent of adults with HIV in care in the United States receive their health care coverage from Medicaid. Critical services that Medicaid beneficiaries rely on like mental health care, prescription drug coverage, transportation assistance, and dental coverage can be indiscriminately cut from the Medicaid program with no oversight and no consequences.
Block grants encourage states to take actions that include restricting enrollment for legally eligible beneficiaries, limiting mandatory and optional benefits, decreasing already low reimbursement rates (which may lead providers to abandon the program), a combination of all three, and more.
“A state that allows prescription drug coverage but severely limits the drug formulary to only a handful of antiretroviral drugs would have a devastating effect on the progress we’ve made in treatment and prevention over the past two decades,” said Academy Board Chair Dr. Margaret Hoffman-Terry. “This practice would limit the ability of the healthcare provider to tailor treatment options for their patients.”
For Americans with HIV, there is a direct link to Medicaid access and the HIV epidemic. Eight of the ten states with the highest rates of HIV diagnoses in the United States are states that have not expanded Medicaid in accordance with the Affordable Care Act, and all eight of those states are in the southern United States. The South currently bears the largest burden of the domestic epidemic and has the least access to medical care.
“If the President is serious about ending the HIV epidemic in 10 years as he stated in his State of the Union Address just last year, then allowing states to block grant Medicaid will be in direct opposition to this goal,” says Bruce Packett. “The administration tried to enact Medicaid block grant legislatively in 2017 and millions of Americans lifted their voices in opposition and that attempt failed. With this guidance, CMS is trying to administratively accomplish what it could not do in Congress. The reality is, we can end this epidemic, but only if we expand access to care, not restrict it.”
Options for HIV treatment and prevention have grown exponentially over the past decade, giving practitioners the tools needed to effectively manage current cases, while reducing HIV incidence. However, access to these clinical options is paramount.
“Continuity of care is essential in HIV treatment in order to keep the patient healthy and the virus untransmittable to others,” stated Dr. Hoffman-Terry. “Block grants will allow states to arbitrarily determine the quality of services and treatment healthcare professionals will be able to provide. This is not in the best interest of the patient or public health overall.”
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About the American Academy of HIV Medicine: The American Academy of HIV Medicine is the nation’s leading independent organization of healthcare professionals dedicated to providing excellence in HIV care and prevention. Our membership of practitioners and credentialed providers manage the health of the majority of people with and at risk for HIV in the United States. The Academy’s mission is to ensure health care professionals have the resources needed to provide prevention, treatment and care for those living with or at risk for HIV and related conditions to achieve optimal health.