Better health care for individuals living with HIV

By Don Berwick, M.D., Administrator of the Centers for Medicare & Medicaid Services

In 1981, when AIDS first emerged in the US, the disease was equivalent to a death sentence. At present, this epidemic has claimed the lives of 600,000 Americans and has deeply hurt many more, including family members and friends of those it has struck. Now, thirty years later, through major advances in science and medicine, people with HIV who receive medication and proper care live longer, healthier lives — just as they could with any other chronic illness, such as diabetes or hypertension.

Changing that prognosis has been an ongoing battle, and one where each day individuals living with HIV, health care professionals, advocates, scientists and many others wake up to fight the disease with every weapon we have: research, treatment, quality medical care and education. Although we have made tremendous progress and slowed the transmission of the disease through using these advancements, more than 56,000 people continue to become infected with HIV in the U.S. each year.

And despite the powerful arsenal at our disposal, some of our best defenses remain out of reach for a significant proportion of the more than 1.1 million Americans living with HIV. An estimated 30 percent of this group does not have health coverage of any kind. As a result, they have no way to cover the cost of medications and treatment that we know are life-preserving.

Today, we are taking an important step to remove this barrier. The Centers for Medicare and Medicaid Services, in collaboration with the White House, HRSA, and the CDC, is releasing new guidance that encourages States to take advantage of six important Medicaid options that will help improve care for individuals living with HIV. These options can make it easier for States to prevent or delay the institutionalization of people with HIV and can help people living in nursing homes or other institutions transition back home when they are able. States can expand Medicaid access to individuals with HIV, enabling them to become eligible for services without having to be considered permanently disabled due to an AIDS diagnosis. States can provide more effective, earlier treatment of HIV by making available a limited or comprehensive package of services, which may include anti-retroviral therapies or case management to ensure adherence to treatment. Early treatment and case management services are not only cost-effective but promote better health outcomes for people with HIV, helping them lead longer and healthier lives. I am hopeful of the positive quality of life effects that these options will make for the countless Medicaid beneficiaries living with and fighting through HIV/AIDS everyday.

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