Jennifer Kates, Kaiser Family Foundation, 1330 G. St., NW, Washington, DC 20005, 202-347-5270, jkates@kff.org

Description: Medicaid is the largest source of public financing for HIV/AIDS care in the U.S., estimated to cover almost half of all people living with HIV/AIDS receiving care. It is a significantly larger program than the Ryan White CARE (CARE) Act; in FY 2004, federal Medicaid spending on people with AIDS is estimated to reach $5.4 billion, compared to $2 billion in funding for the CARE Act. The CARE Act, therefore, acts as a safety net around Medicaid, filling in its gaps in coverage. As such, the CARE Act is particularly sensitive to changes in state Medicaid programs. For the past several years, states have been in fiscal crisis, and have sought ways to control expenditures, including through Medicaid cost containment strategies. In FY 2004, all states implemented or planned such strategies, including prescription drug cost containment, benefit reduction, eligibility restrictions, and increased beneficiary co-payments. These measures are expected to continue, particularly after temporary federal fiscal relief provided to states ends later this year. Such measures will likely impact beneficiaries, including those with HIV/AIDS, and other programs that serve them.

Lessons Learned: Participants will obtain the latest information about Medicaid cost containment and discuss implications for people with HIV/AIDS and the CARE Act.

Recommendations: If states continue to restrict Medicaid programs in response to their fiscal crises, policymakers will have to assess the impact on Ryan White and may have to bolster its role in an effort to ensure access for people with HIV/AIDS.

Learning Objectives: