Treatment access emergency: ADAP and Medicaid.

A combination of unrelated events and changes in the last two years is increasingly threatening the ability of thousands of Americans with HIV to get medically necessary care. The national economic slowdown, a crisis in state budgets, the Federal focus on war, and the neglect of treatment-access activism, have combined so that probably thousands of people are being denied necessary treatment for economic reasons alone, when they would have had access a year ago. The problem is likely to get much worse before it gets better. While most of the causes are .beyond the control of readers of AIDS Treatment News, we can work on the activism.

Few patients are immune to these problems. Due to high prices for drugs and tests, very few can pay the full cost of HIV care entirely out of pocket. And private insurance has become increasingly efficient at getting rid of people with expensive illnesses -- especially HIV infection, since it is not officially recognized as a medical specialty like cancer, even though it is one in fact. Therefore HMOs can pay HIV doctors the "healthy adult" rate, less than the cost of providing care, in order to drive good doctors out of the plan and keep patients away.

(1) As this issue goes to press, there may or may not be an emergency mobilization on ADAP (the AIDS Drug Assistance Program, funded by the Ryan White CARE Act), in the coming days or weeks. The growing crisis in ADAP results from flat Federal funding despite increasing needs, rising drug prices, state budget shortfalls, and indirectly from increasing Medicaid problems. Also, the traditional coalition of patient advocates and industry to seek funding for ADAP has not been very active in the last year.

(2) Medicaid is a huge program that has surprisingly little advocacy for it, either in AIDS or otherwise. Many people think of Medicaid as a program only for the poor -- not realizing that it also pays for their own grandparent in a nursing home. Medicaid provides for many more HIV patients than ADAP, and pays for more of their medical care instead of just drugs. After hearing from people who are having more and more serious problems obtaining HIV care under Medicaid in many states, activist Kate Krauss looked into the program and wrote the background article below for AIDS Treatment News. She is also researching the ADAP crisis -- and how people can help with both programs -- for a future article for this newsletter.