A recent study by 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, Ms. Lubinski 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, which is what 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 says.
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: “Medicaid, with its significant reach into low-income populations and ethnic/racial minorities, must be part of the financing mix.”
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