Richard H. Hughes, IV, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in AIS Health, in “Federal Watchdog: One Quarter of HIV-Positive Medicaid Enrollees Missed Care,” by Peter Johnson. (Read the full version – subscription required.)
Following is an excerpt:
More than a quarter of HIV-positive Medicaid enrollees did not receive at least one of three necessary services for viral suppression in 2021, according to a new report from the HHS Office of Inspector General (OIG). According to one expert, that missed care is certain to rebound to Medicaid managed care organizations (MCOs) in the form of a heavy cost burden: If HIV isn’t continually treated with antiretroviral therapy (ART) drugs and patients are not monitored by practitioners, the virus will cause a patient to develop AIDS — and patients are more likely to transmit the virus to others.
Medicaid covers a notable portion — 40% — of people in the U.S. who contracted HIV in 2018, per OIG. In the report, OIG reviewed 2021 claims data for 265,493 enrollees with HIV across the country. …
To Prevent High Costs, Plans Must Be Proactive
Richard Hughes IV, an attorney and partner at Epstein Becker Green, tells AIS Health, a division of MMIT, that Medicaid MCOs should react to the OIG report with a sense of urgency. The cohort studied in the OIG report, already being HIV positive, will require high-touch care one way or another, Hughes emphasizes.
“There could be persons who are living with HIV and don’t know it — maybe they’re asymptomatic….That’s a different can of worms — these are people that started the patient journey,” Hughes says. “They’ve learned that they have acquired HIV. It’s a question of, do they start ART? Do they maintain this regimen?
“Making sure the patient is receiving timely access to care and follow-up care is going to yield huge cost savings for the plan,” Hughes explains. That can only happen if the plan “maintain[s] the ART regimen” and is able “to do the testing and address potential issues or comorbidities as early as possible.”
