Fifty-three percent of HIV positive Americans rely on Medicaid for meds and treatment. In February, President George W. Bush signed a bill letting states drastically hike the cost of their coverage. The Congressional Budget Office says the legislation will save nearly $5 billion—approximately $1 billion of which will come from forcing patients to ditch essential services they can no longer afford. Before the change, which took effect in March, states were required to guarantee care to everyone on Medicaid, even those who couldn’t cover the $3 copay. But copays may jump to as much as 20% of the total prescription and medical services. What’s more, states can deny services to anyone lacking funds. “This bill should trouble anyone who cares about people with HIV,” says Jeffrey Crowley, a Medicaid specialist at Georgetown’s Health Policy Institute. “Depending on your annual income, a $50 copay could mean the difference between getting and not getting your drugs.”

States needn’t implement the law. But Medicaid costs consume roughly 17% of state general-fund budgets, and some cash-strapped legislatures have knocked thousands of patients off benefit lists or limited their drug options. Crowley hopes that many states will resist. “State economies are improving,” he adds. “Then again, an economic downturn could impose harsh cost-sharing measures.” Bush’s 2007 budget proposal, meanwhile, will cut an additional $5 billion from Medicaid, making states foot the difference. “If that budget passes, states that would have held off on severe copay raises or denying services will have to use these mechanisms,” says Michael Kink of New York AIDS organization Housing Works. Bush himself has said the cuts are necessary to curtail the soaring national deficit. “It’s slowing down the rate of growth. It’s the difference between slowing your car down to go the speed limit or putting your car in reverse,” says Bush.     

“Right now, the fight to keep benefits is all about advocacy,” says Crowley. And folks in Mississippi are leading the brawl. A state law passed in 2004 imposed a cap of five drugs for Medicaid recipients, only two of which could be brand-name. Last June, weeks before the bill kicked in, activists from AIDS Action in Mississippi (AAIM) rallied on the state capitol’s steps. They proclaimed that the governor had signed a death sentence for people with HIV, since HAART usually requires three brand-name drugs. Shortly afterward, Republican Governor Haley Barbour announced that he wouldn’t apply the two-drug policy to people with HIV. “I was a little shocked,” recalls AAIM’s Shannon Reaze. But the waiver doesn’t help people who are negative. In December, AAIM signed on to support a lawsuit brought by Medicaid recipients in Mississippi with the help of a coalition of local and national advocacy organizations to overturn the cap. A ruling was pending as POZ went to press. “State legislatures need to hear from people with HIV,” says Kink. So contact your representative and your local AIDS group. “Testimony like that can swing even the Feds around,” he says. Get busy.    

Shout-Out
To take action, contact:

AIDS Action
202.530.8030
www.aidsaction.org

Campaign to End AIDS
877.363.2437
www.c2ea.org

Housing Works
212.645.8111
www.housingworks.org

Treatment Access Expansion Project
240.247.1012
www.taepusa.org