Search Frequenty Asked Questions

Serving approximately 55 percent of all persons living with AIDS (PLWA) and up to 90 percent of all children with AIDS, Medicaid is the largest single payer of direct medical services for PLWAs in the United States. CMS estimates that 231,079 persons living with AIDS will be served by the Medicaid program nationwide in Federal fiscal year (FY) 2003. Combined Federal and State Medicaid expenditures for serving this population are estimated to be $8.5 billion in FY 2003.

• Most adults with HIV disease who qualify for Medicaid do so because they are disabled, have low income, and limited assets. Others in families with dependent children may become eligible for Medicaid by meeting certain income and resource standards. In many States others who would be otherwise eligible except for having too much income or resources may become Medicaid eligible based on their medical expenses. Individuals should contact their State Medicaid agency for State-specific criteria.
  
  
• Special Medicaid income limits exist for pregnant women and their babies. These income limits are higher than the State's regular Medicaid income limits for families, and are designed to assure that pregnant women receive optimal prenatal care. The income limits in your State for pregnant women can be seen here http://www.cms.hhs.gov/hiv/maternal4.asp
  
  
• States must provide the full range of Medicaid services covered in the State plan to eligible persons with HIV disease, and they may also provide optional services that are often appropriate for people with HIV/AIDS, such as targeted case management, prevention services, and hospice care.
  
  
• Currently, all States cover FDA-approved prescribed drugs, including various drugs for prophylactic treatment of AIDS-related opportunistic infections, and drugs for treatment of primary HIV disease, such as protease inhibitors and nucleoside and nonnucleoside reverse transcriptase inhibitors including zidovudine (ZDV). ZDV (widely known as AZT) can be provided to HIV-positive pregnant women and their infants to help prevent the transmission of HIV to those infants. In several studies, other drugs have also been shown to be effective in reducing the risk of mother-to-child infection.
  
  
• CMS's Maternal HIV Consumer Information Project is designed to inform women of childbearing age about the benefits of being tested for HIV. Without proper care, HIV may be transmitted from the mother to the baby during pregnancy, childbirth or breast feeding. More information about what every women should know about mother to child HIV infection can be seen here http://www.cms.hhs.gov/hiv/default.asp
  
  
• Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program and managed care options can offer health care systems to persons with AIDS and HIV infection.
  
  
• EPSDT offers Medicaid-eligible individuals under age 21 access to Medicaid services that are medically reasonable and necessary whether or not they are covered under the States' Medicaid plan.
  
  
• Managed care plans are offering people living with AIDS (PLWAs) the opportunity to coordinate their health care through various services such as access to specialists, case management, home health services, social services, and effective implementation of new treatment protocols.
  
  
• The States of Maine, Massachusetts, and the District of Columbia have been granted a demonstration waiver by CMS to extend Medicaid benefits to non-disabled persons living with HIV disease. The purpose of the demonstrations is to evaluate the cost effectiveness of expanding Medicaid eligibility to this group. Other States are expected to apply for similar waivers.
  
  
• Sixteen States have elected to provide PLWAs cost-effective alternatives to confinement to a medical facility and expanded services through home and community-based services waiver programs as optional services.
  
  
• The Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) gave States the option to expand Medicaid coverage of persons with disabilities who wish to work by increasing the amount of income they may earn. For more information on this option.
  
  
• TWWIIA also contained provisions which permit States to apply for grants that provide Medicaid benefits and services to workers that have physical or mental impairments that without medical assistance will result in disability. The District of Columbia has been approved to provide such services for persons with HIV disease.
  
  
• States work with CMS and other Federal agencies to assure that persons with HIV infection and AIDS are not subject to discrimination in seeking access to Medicaid and Medicare services.
  
  
• For more information, please contact CMS's Regional Office HIV/AIDS Coordinator who serves your State.

Contact: Joseph Razes at (410) 786-6126 or E-Mail, JRazes@cms.hhs.gov