Christine Lubinski started by noting the serious concerns that members of the
Medicare and Medicaid Working Group had with the provisions regarding
dual-eligibles in the [now passed] Medicare reform legislation, urging audience
members to join the group in visiting legislators to address those concerns.
Ms. Lubinski continued by gearing her comments to address “the fight to preserve
and enhance the [Medicaid] entitlement.”

Historically, the Medicaid program has been at-risk since the 1980’s when an attempt
to cap spending and shift the program into block-grants was averted, and a second
attempt to do so was fended off in 1997. Eligibility for Medicaid and other public
programs was also eroded in this time-frame by cutting alcohol and substance abuse
from the list of qualifying disabilities and the loss of benefits for legal immigrants
during their first five years in the country.

Lubinski noted that in the mid-1990’s, with the improvement in treatment options for
people with HIV disease, the conceptual framework was laid for the “Early Treatment
for HIV Act” (ETHA), which would expand Medicaid eligibility to non-disabled persons
with HIV infection. Lubinski noted that ETHA is still very high on the agenda. However,
with the states in fiscal crisis, the immediate concern is fending off losses of benefits
including:

Lubinski noted there have been some cost-containment successes, such as Florida’s
AIDS Disease Management program, which has helped reduce the cost of HIV care
and more aggressively monitor the quality of care at the same time, and a temporary
increase from Congress in the federal matching rate for Medicaid funds. Finally,
Lubinski noted the January 2003 White House proposal, which did not make it into
legislative language. The proposal would provide $16 billion in additional funding over
the next seven years and offer states new flexibility over eligibility and benefits. However,
|the proposal was heavily criticized by advocates because it could ultimately result in a
capping or reduction of benefits, of inequity in eligibility standards within states, and in
states running out of Medicaid funding in the midst of a fiscal year. Lubinski noted that
there was great relief in the advocacy community when the National Governors
Association could not reach consensus on the plan, yet she warned that threats to
Medicaid remain, and that those gathered in the audience must continue to work to
preserve and expand the Medicaid benefit for people with HIV infection, and to
preserve and expand Ryan White CARE Act services to ensure that those not covered
|by Medicaid receive needed services.