Financing AIDS Care

There is reassuring news from Sacramento. The state has decided to seek a waiver from the federal government that will allow the use of Medi-Cal funds to provide care for AIDS patients in homes, hospices or places other than acute-care hospitals.

This follows the earlier decision of the state to extend Medi-Cal coverage for AZT, the medication that can prolong the life of some AIDS patients but that, at an annual cost of about $10,000, is beyond the reach of many.

The waiver for alternative care will be filed by Sept. 1, and funding may be available early next year, according to state officials. It is a welcome step. Our only regret is that it has taken so long.

This will be “budget neutral,” according to officials. In fact, there is evidence that there can be significant savings in providing alternatives to in-hospital care while at the same time creating a more amenable and humane situation for patients.

AIDS Project Los Angeles commenced a state-funded study of 131 AIDS patients receiving home care last May. Preliminary data show a cost of $71.65 per day, compared with an average cost of $963 a day for hospital care. The 131 initially enrolled in the survey ranged in age from 1 to 68, including men and women. Of these, 86 have died, the majority at home. Hospital time has been reduced by at least one-third. Most important, however, is the finding of the researchers of significant benefits for the patient in remaining at home with family and friends. However, under present regulation, Medi-Cal funds are not available for home care. And at least a quarter of all AIDS patients depend on Medi-Cal--a percentage expected to increase in the years ahead.

The waiver will make possible a variety of alternatives to in-hospital care in addition to home care. Among the other alternatives under consideration are hospices, skilled-nursing facilities and day-care centers. State officials are now drafting the program for submission to the federal government, which provides half the Medi-Cal funding.