Medicaid eligibility patterns of persons with AIDS in California and New York, 1982-1987

Article Abstract:

Individual states set criteria for eligibility for the financing of care and treatment for individuals with AIDS by Medicaid. The criteria include the categories of individuals that are covered and financial limits. How these criteria affect individuals with AIDS was examined in 1,314 individuals with AIDS from California and 6,273 individuals with AIDS in New York between the years 1982 and 1987. Both New York and California do not have strict criteria for eligibility for coverage and the importance of higher financial limit and the availability of an optional coverage, known as medically needy coverage, to the AIDS patients is clear. Medically needy coverage is a type of coverage where individuals become eligible for Medicaid if their medical expenses exceed their incomes. Many individuals' annual incomes are too high to make them eligible for Medicaid, yet too low to pay for private heath care insurance. Medically needy coverage is optional for each state. Two thirds of the individuals with AIDS that are financed by Medicaid in California and one third of the individuals on Medicaid in New York are covered by this option, demonstrating a strong need for this type of coverage among persons with AIDS. Individuals who are enrolled under medically needy coverage generally have other health care coverage and use Medicaid only in the later stages of the disease (such as when they may become unemployed and their health costs rise). The lifetime costs of individuals with this type of coverage are less than for those who are fully covered by Medicaid, as these patients use Medicaid for shorter periods of time. The study also showed that many AIDS patients from both states experience difficulties in obtaining eligibility status for Medicaid, which can be a stressful experience for those who are sick and need financial assistance. Improvements must be made. Some of the costs of care and treatment of persons with low incomes may be covered by the federal government, as well as by the state. Thus states, including New York, may lower their costs by using all options available from the federal government. (Consumer Summary produced by Reliance Medical Information, Inc.)

Finance, New York (State)

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The epidemiology of AIDS in the New York and California medicaid programs

Article Abstract:

The demographics of persons with AIDS being cared for under Medicaid in New York and California from 1983 through 1986 were analyzed. There were approximately three times as many Medicaid cases in New York (7,541) as in California (2,495). The number of persons with AIDS on Medicaid increased tremendously during the four years of the study. The increase was 298 percent in New York and 595 percent in California. The increase occurred primarily in the young adults between 21 and 44 years old. The largest number of cases were in counties containing large cities, such as New York City, Los Angeles and San Francisco. However, the epidemic was spreading to other counties as well. Differences were seen between the two states. The proportion of cases of patients with a history of drug use was greater in New York (40 percent), compared with 12 percent in California. Drug users are generally poor and depend on Medicaid funding for treatment. The proportion of cases among other groups of adult males, e.g. homosexuals, was greater in California. The majority of homosexuals with AIDS have higher incomes and often depend on Medicaid only later in the course of the disease. A much higher proportion of patients with AIDS in New York were women (30 percent of all AIDS patients) than of those in California (5 percent). There were also more cases of AIDS in young children in New York. These data support the evidence that transmission of AIDS occurs in the heterosexual population living in urban areas via sexual encounters with infected drug users. This type of analysis is necessary for determining policies for Medicaid at both the federal and state level. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, New York, New York, New York

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Lifetime Medicaid services utilization and expenditures for AIDS in New York and California

Article Abstract:

The use and total costs of services provided by Medicaid to AIDS patients were examined in individuals on Medicaid in New York and California who died between 1985 and 1986. The average lifetime costs were approximately $30,000 per individual in New York and $20,000 in California. Ninety-three percent of the costs in New York and 86 percent of the costs in California were due to hospital care. Care was more often obtained in the hospital in New York, while it was more often obtained on an outpatient basis in California. The individuals in the study were classified into different risk populations: men who used drugs, men who did not use drugs, women and children. The differences in costs and use of Medicaid services between the states were still present even if risk groups, clinical manifestations of disease, and income levels were taken into consideration. In California, women used more inpatient services and the costs were higher than for men. In New York, women and men who used drugs had a greater use of both inpatient and outpatient services and the costs were higher than for men who did not use drugs. Inpatient care and costs were higher for children in New York than adults, with the average number of days in the hospital for children being 85 compared with 55 days for adults. The differences in costs and use of services among the risk groups were due to differences in clinical manifestations of disease and income level. Thus, the economic impact of AIDS can vary among states and depends on how services are used. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Hospital utilization, Ambulatory medical care, Ambulatory care

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