HIV Screening Reimbursement Faces Roadblocks

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.”

Such definitions could theoretically make HIV testing and counseling eligible for reimbursement, Ms. Lubinski said.

She said she believes the federal government must contribute more to Medicaid to implement the CDC guidelines, noting: “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 [will] be adequate. … Medicaid, with its significant reach into low-income populations and ethnic/racial minorities, must be part of the financing mix. Federal leadership could and should facilitate coverage of routine screening by state Medicaid programs.”

'Yes, we have the capacity to do [routine screening], and yes, we have the will to do it. But it is a lot of money.' DR. HORBERG