The Advocate July/Aug 2022
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Court: Many HIV
Patients Wrongly Deprived of Medi-Cal Coverage

California has
failed to implement a six-year-old law designed to provide
impoverished HIV-positive residents with medical care, a Los
Angeles superior court judge ruled in a decision made
public on Thursday.

Before the law
was passed in 2002, only those with an AIDS diagnosis
could qualify for Medi-Cal, a health care program for the
poor. The legislation was designed to allow enrollment
in Medi-Cal for people who have HIV but not AIDS and
would not otherwise qualify for the program.

While the
legislation, signed by former governor Gray Davis, was to be
effective in 2002, Judge James C. Chalfant ruled November 25
that the Department of Health Care Services made
mediocre attempts to take all of the steps required by
the law, such as encouraging AIDS patients to leave
Medi-Cal's fee-for-service program and use its less
expensive managed care option, with the goal of
freeing funds to treat patients with HIV. Chalfant
ordered the department to make all the moves necessary to
put the program for HIV patients into place.

Possibly
thousands of people have lost out on health care, Michael
Weinstein, president of AIDS Healthcare Foundation in Los
Angeles, told the Los Angles Times. The
nonprofit organization filed the lawsuit, claiming
that the department "never had any intention of
enforcing this law because they thought they had a
right to determine which law they enforce or don't." The
foundation will submit a plan to the DHCS on December
17.

DHCS spokesman
Norman Williams said department officials do not believe
the law can work because the managed care program, which
treats 1,800 residents with AIDS, actually costs
the state more than the fee-for-service program.
Because the law says the state cannot spend more to
extend Medi-Cal to HIV patients, an analysis of the bill
showed the changes were "not possible in a
cost-neutral environment," Williams told the Times.

Chalfant said
DHCS did not do enough to make the program work -- it
failed to determine how much it would pay Medi-Cal providers
to treat HIV-positive people, and it didn't project
savings associated with moving people with AIDS
to managed care, both required by the 2002 law. He
also said the department made no suggestions or plans to
find other funding for the program. (Michelle Garcia,
Advocate.com)

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