title: Do United States-based Medicaid spend-down programmes make public sense for persons with HIV/AIDS?
abstract: Medicaid is a US government insurance programme designed primarily for poor individuals, with expenditures that rose more than 13% in 2002. Thirty-five states have programmes allowing individuals to incur medical expenses at a rate that would make them poor enough to meet Medicaid eligibility criteria. This paper examines the cost of providing care to those spending-down to Medicaid compared to those eligible without spending-down. This longitudinal cohort study compiled inpatient, outpatient and Medicaid data from three academic Infectious Diseases clinics serving approximately 40% of the reported HIV-positive population in North Carolina. Participants included all HIV-positive patients who received care in one of three clinics and received Medicaid coverage at any time from 1996 to 2000 (1,495 individuals). Overall, those who needed to spend-down to Medicaid incurred higher medical costs, following a distinctive pattern of high costs when initially qualified and when ending coverage, and low costs while on spend-down. US states may wish to consider expanding Medicaid's categorically eligible criteria or significantly reducing the frequency with which persons must spend-down to become eligible for Medicaid.
authors.affiliation: Stanford Institute of Public Policy and Community and Family Medicine, Duke University, NC, USA. kathryn.whetten@duke.edu
authors.forename: K
authors.initials: K
authors.lastname: Whetten
authors.forename: C W
authors.initials: CW
authors.lastname: Zhu
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004608:Eligibility Determination; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000191:economics*; D005102:Health Expenditures / Q000592:standards; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008484:Medicaid / Q000592:standards*