Volume IX, Issue XII - May 2016

From:  Maria Bruni, Acting Director
Division of Alcoholism and Substance Abuse


Starting October 1, 2016 (Federal Fiscal Year 2017), DASA will no longer set aside 5 percent of the Block Grant for HIV Early Intervention Services (EIS). The purpose of this Smart Alert is to provide some basic information about the impact of these changes to current HIV EIS providers. In State Fiscal Year 2017, current HIV EIS providers will receive three month (July 1 through September 30, 2016) contracts.

Section 1924 of the Public Health Service (PHS) Act defines "designated State" as any State whose AIDS case rate is 10 or more such cases per 100,000 individuals as reported to and confirmed by the Director of Centers for Disease Control and Prevention (CDC). Based on data from CDC, the State of Illinois' AIDS case rates dropped from 10.1 to 9.3 cases per 100,000 individuals in 2010 (the year which Federal Fiscal Year 2016 determinations are made), below the designated State threshold.

When the State of Illinois was informed of the 2011 change in policy, the choice was made to maintain its designation status and set aside 5 percent of the Block Grant for HIV early intervention services at that time. With the Affordable Care Act working to make health care more affordable, accessible, and high quality for the people of Illinois and Medicaid managed care for over 65 percent of those enrolled in Medicaid, there is evidence that HIV counseling and testing is a covered service for an increasingly large percentage of the population and a large number of those receiving substance abuse treatment services.

Illinois Medicaid HIV Testing Policies

  • Women: HIV testing is covered as a family planning - related Reproductive Health Service for all women enrolled in Medicaid. HIV testing is also covered for women enrolled in the Illinois Healthy Women Program. Illinois law mandates that all pregnant women be counseled and offered an HIV test to prevent mother-to-child transmission. If the mother's HIV status is not known at the time of birth, the mother will be offered a rapid HIV test. If she declines, the infant must be tested for HIV as soon as possible after birth. Medicaid will pay for such testing.
  • Children: Under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, Medicaid-eligible children under the age of 21 are covered for HIV testing. This includes routine testing for Medicaid-eligible children at state-specified intervals as part of the child's well-child exam, and otherwise medically necessary HIV testing. Routine HIV testing for such children is covered by states under the preventive or screening benefit in Section 1905(a)(13) of the Social Security Act, and otherwise medically necessary HIV testing is covered under the benefit for laboratory services in Section 1905(a)(3) of the Act.
  • Men: Medicaid-eligible adults are covered for medically necessary HIV testing through the mandatory laboratory benefit under Section 1905(a)(3) of the Social Security Act. http://www.hfs.illinois.gov/html/062712n2.html.