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Davis Signs Bill to Help Patients With HIV

Health: Uninsured people not yet disabled by AIDS will qualify for government-funded care starting in 2003.


SACRAMENTO — Uninsured Californians infected with HIV but not yet disabled by full-blown AIDS will be eligible for government-funded health care under a bill signed by Gov. Gray Davis on Wednesday.

Hailed by AIDS activists as the state's most significant AIDS-related legislation in a decade, the law is expected to fund treatment for hundreds of HIV-positive patients beginning in 2003, at no direct cost to taxpayers.

"This is a momentous day in the long battle for access to quality HIV care," said Michael Weinstein, executive director of the AIDS Healthcare Foundation in Los Angeles.

Weinstein said the law, which awards HIV-positive patients coverage under the federal and state Medi-Cal program for the poor, will improve the lives of the infected and ultimately save money by providing them early care.

In a statement, Davis agreed: "It's high time that our Medi-Cal system met the needs of those living with HIV."

Davis predicted that the law would "extend the lives and productivity of thousands of Californians."

Carried by Assemblyman Paul Koretz (D-West Hollywood), the bill, AB 2197, was approved with bipartisan support and faced no organized opposition. It was the third time in five years that advocates tried to pass such legislation in California.

Koretz said the law would create no new costs for taxpayers--because of an unusual, offsetting funding mechanism--while getting patients treatment early, "rather than just waiting for symptoms to occur."

Though the number of AIDS cases in California continues to decline because of increasingly effective drugs, the number of new HIV infections is rising, in part because AIDS is no longer viewed as an automatic death sentence.

Supporters of the bill said that trend makes early treatment of the virus all the more essential to help break the chain of infection.

If they lack insurance through an employer or other program, people with HIV typically go without health care or struggle to obtain help from a patchwork of community organizations.

HIV-positive patients with annual incomes under $50,000 are eligible for some government-funded medications. But they can only receive care under Medi-Cal if they have full-blown AIDS and are considered disabled under the law. In essence, that means that they must get sicker to win access to regular treatment.

To put the Koretz bill into practice, the state must first win a waiver from the federal government, which jointly funds the Medi-Cal program and specifies that any expansion of beneficiaries must not result in new costs.

To meet that requirement, the bill proposes shifting patients with full-blown AIDS from one category of Medi-Cal coverage--fee-for-service--into the Medi-Cal managed-care program, which costs the state less. Money saved from that shift, which is voluntary, will finance care for the newly eligible HIV patients.

Weinstein said the first HIV-positive patients likely to enroll in the program would come from a group of 10,000 who now receive government-funded medications. He said he expects about 2,500 patients to be phased into the program in the first year, with each case costing Medi-Cal about $6,200. That cost, according to the bill, would be offset by savings accrued from AIDS patients shifting into managed care. A legislative analysis of the bill said it would take 18 or 19 transfers to managed care to offset the cost of enrolling one newly eligible person in Medi-Cal.

Some AIDS activists question whether HIV patients will want to make that shift, because in many cases it would require them to change doctors and receive a lower level of benefits. State officials plan to run an outreach campaign urging patients to join managed care.

"We support the bill, but we don't necessarily believe that the [funding] scheme it contains is the most desirable," said Dana Van Gorder, director of state and local affairs at the San Francisco AIDS Foundation.

Though the governor won widespread praise for signing the Koretz bill, Van Gorder and other AIDS activists said that another important measure remains on his desk. That bill, SB 1785, would permit adults to buy syringes from licensed pharmacies without a prescription.

California is one of only six states that restrict pharmacy access to syringes, and health-care providers said that lifting that ban could help curb the spread of AIDS and hepatitis C among injection drug users.

"We're trying to remind the governor that this is sound public health policy and that we hope he'll make a decision based on that, not on the misbelief that this creates more crime or drug use," said Van Gorder. "It's time for California to enter the modern age."

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