N.C. Medicaid program creates gap in care for HIV patients

Low-income HIV patients in North Carolina may be facing gaps in care through the state's Medicaid program, which requires some patients to pay some out-of-pocket health expenses over a six-month period to qualify for the program during the subsequent six months, according to a new study. Some HIV patients simply forgo adequate medical care during the six-month "spend-down" period because they are unable to pay for it, causing them to "yo-yo" in and out of the Medicaid system, say researchers Kathryn Whetten of Duke University and Carolyn Zhu of New School University in New York. The "spend-down" plan also ends up costing the state more money in the long run, according to the study. A comparison of HIV patients who qualify for Medicaid immediately and those in spend-down programs shows health costs are about $11,500 less over a five-year period for patients who immediately qualify, because consistent care and anti-HIV therapy helps prevent later serious health problems, including hospitalizations, according to the study. Expanding Medicaid eligibility in North Carolina would improve the health outcomes of low-income HIV-positive people in the state and be more cost-effective, Whetten and Zhu conclude. North Carolina's Medicaid program has one of the strictest income eligibility requirements in the country. The state requires a maximum income of 125% of the federal poverty level to qualify--$23,512 for a family of four or $15,019 for a couple.