A recent study by researchers at George Washington University's Center for Health Services Research and Policy found that Medicaid programs in 32 of the 48 states surveyed covered targeted HIV testing and counseling, with 19 of those also covering prenatal and perinatal counseling. A few state programs also covered services such as HIV risk assessment and case management.
But as yet, with the exception of New Jersey, most state Medicaid programs have not adopted routine HIV testing. California has employed a special waiver to provide broad family planning services including HIV testing and counseling for men and women of childbearing age up to 200% of the poverty level. However, that type of waiver is unlikely to be granted elsewhere, she noted.
States could opt to cover HIV screening under a “diagnostic, screening, preventive, and rehabilitative” (DSPR) benefit. The state would need to broaden the definition of medical necessity to allow for preventive services such as HIV screening, as Massachusetts has done.
There, a service is “medically necessary if it is reasonably calculated to prevent, diagnose, prevent the worsening of, alleviate, correct, or cure conditions in the member that endanger life, or cause suffering or pain,” the definition states.
Such definitions could theoretically make HIV testing and counseling eligible for reimbursement, Ms. Lubinski said.
She said she believes that the federal government will need to contribute more to Medicaid for the CDC guidelines to be fully implemented.
“It is absolutely unreasonable to think that the modest amount of discretionary funding through the CDC, Ryan White [Comprehensive AIDS Resources Emergency Act], or state and local health departments is going to be adequate to implement population-based HIV screening. Medicaid, with its significant reach into low-income populations and ethnic and racial minorities, must be part of the financing mix. Federal leadership could and should facilitate coverage of routine screening by state Medicaid programs,” Ms. Lubinski noted.
'We have the capacity to do [routine, universal HIV screening], and we have the will to do it. But it is a lot of money.' DR. HORBERG