Policy Brief

How Will Proposed Medi-Cal Cost Sharing Affect People Living With HIV in California?

March 1, 2011

California Gov. Brown proposed Medicaid co-payments that would impose significant financial barriers on the receipt of medical care by persons living with HIV (PLWH), who require substantial amounts of Medi-Cal care annually. This analysis quantifies those costs based on actual medical utilization experience of PLWH in California in prior years. PLWH average 10.3 outpatient visits a year. Copayments for these visits as well as for emergency room visits, medications, inpatient and dental care would impose cost-sharing on the average PLWH in California of over $312. PLWH who use the most services could face charges of up to $4760. If hard caps initially proposed by the governor were instituted, one quarter of PLWH would have been charged the full cost of all visits over the first ten each year, thereby facing average cost-sharing of $5020. The one third of PLWH who used more than six prescriptions a month would be charged $2200 on average. Charges this high will likely discourage appropriate utilization, undermine health and lead to higher Medi-Cal costs for inpatient care.