Conversation with Mr. Joe Razes, CMS


Mr. Gomez: Welcome to Conversations on My name is Miguel Gomez, the Director of Each month on we have conversations with government officials about HIV/AIDS issues. Today we're speaking with Mr. Joe Razes from the Center for Medicare and Medicaid Services.

Joe, welcome, and thank you for joining us today.

Mr. Razes: Hey, thanks, Miguel. I'm really glad to be here.

Mr. Gomez: Joe, what is CMS?

Mr. Razes: CMS is an abbreviation for the Centers for Medicare and Medicaid Services. Even though it's CMS, one "m", it actually represents both Medicare and Medicaid Programs. CMS is comprised of about 4,000 individuals. About 2,000 of them work in our ten regional offices across the United States and there are about 2,000 people here at our headquarters staff.

Basically, as its name would imply, Medicare and Medicaid, this is the agency that is responsible for administering both the Medicare and the Medicaid program.

Mr. Gomez: Actually, sir, then what is the distinction between Medicare and Medicaid?

Mr. Razes: Good question. Sometimes my mother doesn't even get it right. Basically what we're talking about when we talk about Medicare, it's a Federal program and it provides health insurance for individuals who are sixty-five years of age or older or who are disabled, according to the Social Security definitions of disability, or individuals who have renal dialysis. It basically covers the whole gamut of services including hospital in-patient, out-patient, physician services, skilled nursing facility services, and also includes the full range of diagnostic services and treatment and it also provides for prescription drugs.

Now, on the other hand, Medicaid is a state/Federal relationship in this program and it's administered by the state. This program really provides medical benefits to low-income people who have no medical insurance or have limited medical insurance; and, as I say, it's a state/Federal partnership and while the Federal government establishes certain standards and certain basic minimum requirements in terms of the provision of services the states are free to design their programs in the ways that they see fit. So every state is a bit different in terms of the types of services it provides and sometimes even the eligibility groups that they cover. There are basic eligibility groups under Medicaid, and these are pregnant women, families with children, aged, blind, and disabled. However, states may provide services to other groups. For example, there's a medically-needy group; and, again, that could cover individuals that don't meet the other groups that I've just mentioned, but have a medical need but are unable to pay, either fully or in part, their medical costs.

Mr. Gomez: What is your role at CMS?

Mr. Razes: Miguel, I'm the Federal focal point for AIDS-related issues here at CMS.

Mr. Gomez: Perfect, then you can help me understand this. Medicare and Medicaid services cover medical costs for people living with HIV/AIDS. Can you give me two examples?

Mr. Razes: Sure, I'll give you an example that covers both programs. Take myself, for example. Say I'm HIV-positive and I meet one of the eligibility categories, poor Medicaid and I'm disabled. So, therefore, I not only am eligible for Medicaid, I'm also eligible for Medicare. And so referred to as dually-eligible individual. So my medical benefits, most of my medical benefits, because I'm low income would be covered through the state Medicaid agency. However, because I'm dually eligible my prescription drugs would be covered through Medicare because, as you may know, in 2006 the Medicare Part D prescription drug program kicked in and dual-eligible individuals receive their benefit, their pharmaceuticals through the Medicare program.

Mr. Gomez: For people living with HIV/AIDS or their caregivers how can they navigate the system to learn about these programs?

Mr. Razes: Navigating the system is not easy because as you know we don't have a national health care program. So we've cobbled together a number of Federal programs, state programs, private insurance, and local- or community-based programs. And so you've got to look through what's available and go through each of those various programs.

On the Medicare side, we've tried to make it as easy as possible by creating a web page, the, and that will give you a sense of the assistance available. It's got a lot of tutorials, it's got a search engine, and it provides quite a bit of information that a person that is HIV-positive or has AIDS, that would be of benefit to them.

On the Medicaid side it's a bit different. It's totally different than the Medicare side of the shop because, as I say, it's really administered by the states. And so if an individual is wanting information about Medicaid they really need to go to the state agency to get that information. All state agencies have websites. Some of those agencies have online applications. But they really need to check with their individual state agencies to see what is covered and the eligibility groups that would be covered.

Mr. Gomez: I want to put you on the spot. Let’s say I put you on the phone right now with a person who just learned they are HIV-positive. They are low income and they want to know how these programs can help them. What would you tell them?

Mr. Razes: First of all, the provision of healthcare services in America is a patchwork of Federal programs, state programs, private insurance, and local endeavors. So, I would recommend that he start locally. One, if he has a computer, or if he doesn’t, go to the library and access a computer, to see what the Medicaid program eligibility requirements are in the state that he resides. Secondly, I wouldn’t just rely on the computer, I would actually go to the state Medicaid office, talk to an eligibility intake worker to find out if he were eligible and what types of services were covered in that particular state.

Mr. Gomez: What kind of benefits could this person potentially anticipate?

Mr. Razes: It is complicated. It depends upon the severity of his illness, where he is in that process as well as where he lives in the state. Basically, these programs provide for all healthcare services both in-patient and out-patient, physician services, x-rays, pharmaceuticals, the whole gamut of services. Again, it would depend in part where he is in the process in terms of what types of services he’d be receiving.

Mr. Gomez: So, it’s doing the homework. It’s learning. It’s reaching out to officials who are responsible for the program at the state level or working with their local health department or a local AIDS service provider.

What actions would you like to see public health officials take or continue to take to help people living with HIV aids?

Mr. Razes: That’s easy for me to answer. There are three basic issues that I would like to see continue to be addressed. One is an anti-stigma campaign. There are a lot of feelings and a lot of emotion about AIDS in general and about individuals who get it and I think that needs to be worked on. Secondly, I believe that we need to get the word out that people can still get AIDS and if you don’t take the precautions, you can get it. It is not something that we should take lightly and I think that we need to be ever vigilant about this. Third and lastly, people need to be tested for AIDS if they think they have the virus because of individuals who get the virus on an annual basis, twenty-five percent of them don’t even know that they have it and that poses a risk not only to them, but to their loved ones.

Mr. Gomez: Thank you for speaking with today about the important work CMS is doing to help people living with HIV/AIDS.

To learn more about CMS and its programs please visit Please visit to view the transcript of this podcast. This podcast was created in partnership with the HHS, Office of HIV AIDS Policy, the managing entity of

Last revised: 08/18/2008