those drugs are available in managed care formularies. Medicaid covers the provision of ZDV to HIV-positive pregnant women and their infants to prevent the transmission of HIV. Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program provides services to children and adolescents (under 21) that are ''medically reasonable and necessary," whether they are identified in the plan or not.
The dramatic growth in Medicaid's use of managed care over the last decade has moved many of those with HIV into the managed care setting and placed increased demands on states to monitor and assure access to the full range of quality services needed for management of HIV within managed care organizations (see the discussion of Medicaid issues in the section Important Issues Affecting Services).
Social Security has two programs that can offer benefits to eligible persons with HIV/AIDS. For persons who work, Social Security Disability Insurance (SSDI) provides monthly benefits to persons disabled by a medical condition that is expected to last at least a year or end in death and is serious enough to prevent them from doing substantial work. The amount of the monthly benefit depends upon how much was earned while working. After 24 months on SSDI, the recipient becomes eligible for Medicare, which helps pay for hospital and hospice care, lab tests, home health care, and other medical services.
Supplemental Security Income (SSI) is intended for those who have not worked enough to qualify for Social Security or whose benefits are low and resources limited. Children with disabilities who live in low-income families may qualify for the SSI Disabled Children's Program (SSIDCP). In most states, eligibility for SSI makes one eligible for Medicaid coverage.
Recently enacted, Child Health Insurance Program (Title XXI-Social Security Act) (CHIP) is intended to enable states to expand health insurance coverage to low-income children up to age 19. About $40 billion in federal funds will be provided over the next 10 years with a requirement for matching state funds. States may expand the Medicaid program and/or create or expand a separate state health insurance program. States must submit a state plan (17 states had filed plans as of February 1998) that includes standards and methods for establishing and continuing eligibility and for finding and enrolling eligible children. Eligibility is limited to children whose families have incomes at or below 200% of the poverty level or 50% above the state's current Medicaid eligibility limit and who are not eligible for Medicaid or covered by other health insurance. States may choose how to determine family income.