More than half of the people living with AIDS use health care services provided by State Medicaid health insurance programs for the poor. Because of their condition, people with AIDS are at increased risk of hospitalization or nursing home placement. During the 1990s, several Medicaid programs initiated waivers for home and community-based services for people with AIDS in an attempt to reduce hospital costs.
Besides traditional Medicaid services, people with waivers are eligible to receive 15 other services such as case management, personal care services, and home-delivered meals. A recent study of Florida's Medicaid AIDS waiver program, Project AIDS Care, from 1993-1997 found that adult AIDS patients who did not participate in the waiver program had significantly higher hospital costs than program participants, after controlling for age and ethnicity.
Florida adults enrolled in the waiver program tended to have more education and have higher incomes but were more seriously ill than those not enrolled. The waiver services they used most frequently were medical supplies, skilled care, meals, homemaker services, personal care, and help with household chores.
Total monthly Medicaid expenditures for AIDS patients without waiver services were about 10 percent higher than those for patients with waiver services, and average monthly spending, excluding drugs, was almost 78 percent higher. Those without waiver services also incurred about $882 or 335 percent higher inpatient costs but spent about 61 percent less per month on drugs than waiver program participants did. Thus, the higher drug spending of waiver participants was only a fraction of the inpatient costs of nonparticipants.
Those with waivers had regular contact with a case manager who could ensure both regularity of care and help with complex medication compliance, reducing the need for expensive hospital care. Because Florida's Project AIDS Care provided people with AIDS with valuable services not otherwise available under Medicaid, it was a success, conclude Jean M. Mitchell, Ph.D., of Georgetown University, and Kathryn H. Anderson, Ph.D., of Vanderbilt University. In the study supported by the Agency for Healthcare Research and Quality (HS09560), they analyzed Florida Medicaid eligibility records and Medicaid claims between 1993 and 1997.
See "Effects of case management and new drugs on Medicaid AIDS spending," by Drs. Mitchell and Anderson, in the July 2000 Health Affairs 19(4), pp. 233-243.
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