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Ask A Policy Wonk: What Does the California Budget Proposal Mean for People with HIV?

, by Reilly O'Neal

This morning, California Governor Jerry Brown released his 2013–14 state budget proposal. BETA asked Courtney Mulhern-Pearson, San Francisco AIDS Foundation’s director of state and local affairs, for her initial take on the proposed budget.

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BETA: What does the budget proposal mean for the estimated 41,000 uninsured or underinsured people living with HIV in California?

Courtney Mulhern-Pearson: One piece of good news is that the state has indicated in this budget proposal its willingness to move forward with the optional Medicaid expansion through the Affordable Care Act. The governor’s proposal does include the expansion of Medi-Cal (the name for Medicaid here in California) for childless adults, which means the state is accepting federal funds for expanding the program to people with incomes up to 138% of the federal poverty level.

The complication is that the administration presents two options for how to go about it: as either a state-based expansion or a county-based expansion.

A state-based Medi-Cal expansion would build on the existing state-administered program and managed-care delivery system. California would offer a standardized, statewide benefit package comparable to what is currently available through Medi-Cal, but long-term care coverage would be excluded. (Long-term care will still be offered by traditional Medi-Cal.)

This approach would allow the state to “capture” some of the savings that California’s counties will experience from the expansion. The Brown administration suggests that if the state assumes health care coverage for low-income adults, counties would then take responsibility for some other program, such as subsidized child care.

County-based expansion, on the other hand, would build on the existing LIHPs—Low-Income Health Programs—with statewide eligibility requirements and benefit levels (a minimum of the Essential Health Benefits offered in the Exchange created by the Affordable Care Act). Counties could offer additional benefits (except for long-term care). Going the county-based route would require a federal waiver.

BETA: Is one approach is better than the other for Californians with HIV?

Mulhern-Pearson: There are a lot of details still left to be worked out. It’s not clear at this time which of the two options is better, but advocates will continue to work with the state and counties to further explore both options. HIV advocates will be pushing for as expansive a program as possible in order to ensure that it meets the needs of people living with HIV/AIDS—including an adequate formulary of covered medications and solid provider networks, as well as patient protections.

BETA: What else can you tell us about today’s budget proposal?

Mulhern-Pearson: The budget for ADAP—the AIDS Drug Assistance Program—was decreased (from $16.9 million to $12.7 million), but this is due to a projected caseload decrease of about 8% thanks to the transition of clients to the county LIHPs; as people shift from using ADAP to using LIHPs, ADAP costs go down. For people currently receiving medications through ADAP, their coverage should not be impacted by this budget. We will, however, continue to monitor this number and will work with the State Office of AIDS to ensure that the funding level is sufficient to meet client needs. ADAP is a lifeline for thousands of people, and it’s essential that it continues to be funded at a level that meets the needs of people living with HIV/AIDS in California.

Another piece of promising news is the administration’s proposal to take up the “bridge plan” in California, which means that people with incomes between 138% and 200% of the federal poverty level will have access to a coverage option that looks very much like Medi-Cal expansion in terms of benefits, with nominal cost sharing, and with access to Medi-Cal provider networks. This option, if enacted, means that there should be less trouble with people “churning” or moving from Medi-Cal to Exchange plans and potentially losing coverage or experiencing disruptions in care. This is good news!

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Stay tuned for more news relevant to HIV-positive Californians as the state budget process unfolds.

Reilly O’Neal is a freelance writer and former editor of BETA.


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