Recent Health Care Developments - new Medicaid options for HIV, breast and cervical cancer treatment; help for paying Medicare Part B premium; Pennsylvania State Children's Health Program expansion approved; environmental causes of disease researched

Health Care Financing Review, Spring, 2000

Maine Medicaid Early HIV Treatment Plan Approved

Health and Human Services (HHS) Secretary Donna E. Shalala recently approved Maine's demonstration plan to launch an early intervention and treatment program for individuals in need who are human immunodeficiency virus (HIV)-positive, but do not yet have acquired immunodeficiency syndrome (AIDS) and are not already eligible for Medicaid. Maine is the first State to offer a plan to enroll low-income HIV-positive individuals in the Medicaid program before they become disabled or impoverished.

Recent research has shown that early intervention with AIDS-fighting drugs, including anti-retroviral therapies, can slow the progress of the disease and increase life expectancy for many HIV-positive individuals. However, many people with HIV generally do not qualify for Medicaid--the State/Federal partnership that provides health insurance to low-income young, aged, blind, and disabled Americans--until they are considered disabled. This demonstration program will make drug therapies and treatment services available to HIV-positive people earlier in the course of their disease, delaying the onset of disability for many of these individuals.

"Since 1993, we have made unprecedented progress in the baffle against HIV and AIDS," Secretary Shalala said. "Better research, prevention, and treatment is helping people with this-disease live longer, healthier lives, even as we continue our search for a cure. I'm especially pleased today to approve a new approach in Maine which can give more people living with HIV access to promising therapies."

Early intervention is also expected to reduce the need for costly hospitalization and to prevent the onset of opportunistic infections. HHS will closely monitor the Maine demonstration to identify any cost savings to Medicaid during the 5 years of the demonstration.

"By making treatment available early to people with HIV, we can vastly improve the quality of their lives," said Nancy-Ann DeParle, administrator of the Health Care Financing Administration (HCFA), which oversees the Medicaid program. "I'm pleased to be able to work with Maine to promote early treatment of HIV-positive individuals to help them cope with this devastating disease."

Since 1993, HHS has approved 18 comprehensive Medicaid demonstrations and several sub-State demonstrations, which have expanded health insurance coverage to more than 2 million people. And last year, President Clinton signed the Ticket to Work and Work Improvement Incentives Act, which creates an option for States to let Americans with disabilities buy in to the Medicaid program; extends Medicare coverage for people receiving disability insurance payments who return to work; and creates an expanded Medicaid demonstration program to help expand coverage to people with serious illnesses before they become disabled, to allow them to keep working.

Maine's Medicaid agency plans to begin the 5-year demonstration project this September. To be eligible,-a participant must be HIV-positive and have an income of less than 300 percent of the Federal poverty level (the Federal poverty level is $8,350 for a person under age 65). The benefit package will include highly active anti-retroviral therapy, office visits, lab services, case management, hospitalizations, and mental health and substance abuse services.

New Insurance Option to Cover Breast and Cervical Cancer

President Clinton recently announced a new health initiative to cover more uninsured women who have breast and cervical cancer. Specifically, his fiscal year (FY) 2001 budget will include a new Medicaid option to provide insurance to the thousands of uninsured women whose breast and cervical cancer was detected through federally supported screening programs.

This investment of $220 million over 5 years will help bring down current and frequently overwhelming financial barriers to treatment. The Vice President and the First Lady, as well as national leaders in the prevention, diagnosis, and treatment of breast cancer, have been strong advocates for this initiative. Similar legislation has received broad bipartisan support under the leadership of the late Senator Chafee, Senator Mikulski, Senator Snowe, and Representatives Eshoo and Lazio.

For low-income women diagnosed with breast or cervical cancer, treatment options are limited. The National Breast and Cervical Cancer Early Detection Program provides breast and cervical cancer screening to over 360,000 women without access to these services annually. Typically, Federal Government-sponsored screening programs make every effort to assist individuals diagnosed with disease to access treatment. However, thousands of women still face financial barriers to care, and those that receive some help frequently do not receive comprehensive coverage for services they need.

An estimated 2 million American women will be diagnosed with breast or cervical cancer in this decade, and half a million women will lose their lives to these diseases. According to the Centers for Disease Control, approximately 15 to 30 percent of all deaths from breast cancer among women over the age of 40 and virtually all deaths from cervical cancer could have been prevented with early screening. When breast cancer is diagnosed early, the 5-year survival rate is 97 percent; but when it is diagnosed after it has spread, the 5-year survival rate is only 21 percent.