Information Regarding HIV Medicaid Qualifications

Medicaid is a program available to many individuals and was created under Title XIX of the Social Security Amendments of 1965. The three primary groups covered are low-income Americans, the elderly, the disabled or women and children. People living with the HIV virus and AIDS who meet the qualifications for coverage under the program can receive Medicaid benefits. The type of condition that a person has is not what determines whether or not a person is eligible for Medicaid but whether the person is low-income or otherwise meets the established guidelines. The specific list of individuals covered under Medicaid includes:

  • Persons aged 65 or older
  • Persons who are blind or disabled
  • Individuals or families receiving Aid to Families with Dependent Children
  • Medically needy, indigent refugees who have been in the U.S. for 18 months or less
  • Women who are pregnant
  • Persons receiving care in a skilled nursing or immediate care facility
  • Children under the age of 21 who are in foster care
  • Persons in need of kidney dialysis

Generally, to be considered low-income for the purposes of Medicaid, an individual must earn at or below 200 percent the federal poverty level (approximately $33,000 in 2009).  Medicaid covers roughly 60 percent of people in the United States who are considered to be poor. In 1997, 104,000 people received Medicaid benefits for HIV and AIDS treatment. This represents 0.3 percent of all Medicaid enrollments for the year.

Federal and State Funded

In addition to meeting the eligibility requirements for Medicaid, it should be noted that the program is not solely a federally based program. Individual states work with the federal government also to fund Medicaid. The Department of Health and Human Services through the Centers for Medicare and Medicaid Services administer the program, but the individual states establish the programs funding. The federal government matches the amount that the state puts into Medicaid on a proportionate basis.

Optional Benefit

HIV and AIDS are considered an optional benefit and only when a person with HIV progresses to AIDS (based on T cell counts) will they be considered disabled for the purpose of receiving benefits.  This is provided of course that the person meet the income and other tests of the federal and state governments for eligibility into the program. The largest portion of money spent on healthcare by the federal government goes to patients who are HIV positive living with AIDS.

Deemed Medically Needy

A person with HIV/AIDS in need of assistance through Medicaid may be defined by a state as being “medically needy.” Under this classification, the individual may incur medical expenses related to treatment in order to spend down their assets to a level sufficient to qualify for Medicaid. In essence, the person is permitted to become poor to meet the federal government’s poverty guideline in order to get the healthcare benefits payable under Medicaid. 34 states offer this option to persons with HIV/AIDS.  The only benefit of this option is that it bypasses the normal income testing performed to determine if a person meets the income requirements for Medicaid.

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