Optional Medicaid Benefit for Sickle Cell Disease

A new optional Medicaid benefit for Sickle Cell Disease (SCD) was included in Section 712 of Public Law 108-357 (the American Jobs Creation Act), which was signed by President Bush on October 22, 2004.  The American Jobs Creation Act amends Title XIX of the Social Security Act to provide a new optional benefit in the Medicaid program and to make available federal matching funds for education and outreach to Medicaid eligible adults and children with SCD. Specifically, Section 712 does the following: 

1. Amends §1905(a) of the Act, which contains the definition of medical assistance, to include primary and secondary medical benefits for individuals with SCD.  These benefits include the following:

• chronic blood transfusion (with deferoxamine chelation),  
• genetic counseling and testing, and
• other treatment and services to prevent SCD individuals who have had a stroke from having another stroke. 

States may already cover most of the services included in the law under §1905(a) of the Act such as physician services, prescribed drugs, or hospital services.  However, the new provision offers additional flexibility to states.

• Cover additional services as part of the SCD benefit that might not otherwise be covered in the state plan;
• Reimburse for SCD services at a different rate than they pay for similar services provided to individuals without the disease; and
• Establish different coverage limits for SCD services under Federal amount, duration, and scope provisions. 

2. Amends §1903(a)(3) of the Act to permit states to receive a 50% federal match for education and other services related to the prevention and treatment of SCD.  The covered services include those that identify Medicaid individuals with SCD and educate those individuals about the risks and prevention of stroke and other complications.

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Page Last Modified: 12/14/2005 12:00:00 AM
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