California Gov. Davis Signs Bill Extending Government-Funded Health Care Benefits to People With HIV Who Have Not Yet Developed AIDS

California Gov. Gray Davis (D) yesterday signed a bill (AB 2197) that will extend government-funded health care benefits to state residents who are HIV-positive but have not yet developed AIDS, the Los Angeles Times reports. Currently, only people with an AIDS diagnosis who are considered disabled are eligible for benefits under Medi-Cal, the state's Medicaid program (Warren, Los Angeles Times, 9/19). The new program will provide full Medi-Cal benefits to HIV-positive people who are already enrolled in the state's AIDS Drug Assistance Program, "who are not disabled and who would otherwise qualify for benefits under the Medi-Cal program" (AB 2197 text, 9/19). Medi-Cal will not cover prescription drug costs. As many as 10,000 HIV-positive people could receive coverage under the program expansion, according to Eric Bauman, a special assistant to Davis (Chu, AP/Contra Costa Times, 9/19). AIDS advocates had unsuccessfully tried to pass similar legislation twice in the previous five years.

Funding Questions
The program -- which must be approved by the federal government, which contributes funding to Medi-Cal -- would not incur any additional expense for the state through an "unusual, offsetting funding mechanism," the Times reports. To fund the expansion, the bill suggests moving Medi-Cal patients with AIDS from the current fee-for-service system to a less expensive managed care program. The money saved would go toward financing the expansion of Medi-Cal benefits to people with HIV. The shift would be voluntary, and according to a legislative analysis, it would take 18 to 19 transfers to fund the cost of covering one newly eligible person. Some AIDS advocates are concerned that the money saved will not be enough to finance the expansion and worry that AIDS patients will see their quality of care diminish. Although the state has developed an outreach program to encourage AIDS patients to switch to managed care, AIDS advocates say many people may be reluctant because the switch would necessitate changing doctors and receiving fewer benefits. "We support the bill, but we don't necessarily believe that the (funding) scheme it contains is the most desirable," Dana Van Gorder, director of state and local affairs for the San Francisco AIDS Foundation, said (Los Angeles Times, 9/19).

Needle Bill Still Awaiting Approval
Van Gorder called the Medi-Cal expansion an "important step" in HIV/AIDS care in California but said that Davis has "another life-saving bill on his desk, which we are also hopeful he will sign." The bill (SB 1785) would allow pharmacies in the state to sell up to 30 needles or syringes at a time without a prescription to people over the age of 18. The bill has the support of many AIDS advocates and public health groups, but is opposed by the California Narcotics Officers Association, the California Police Chiefs Association and the California Peace Officers Association. The groups say that the state's existing needle-exchange programs are "sufficient" for preventing the transmission of HIV and other infectious diseases through needle sharing. Davis has yet to take a position on the bill, but supporters say that he is "reluctant to sign the measure" without the support of law enforcement officials. Forty-four other states have laws permitting the purchase of needles without a prescription (Gledhill, San Francisco Chronicle, 9/19).