CMS Says States Can Withhold Medicaid Reimbursement of Viagra for Sex Offenders

Main Category: Medicare / Medicaid / SCHIP
Article Date: 25 May 2005 - 11:00 PST

email to a friend   printer friendly   opinions  

CMS on Monday clarified that states have the ability to block Medicaid coverage of erectile dysfunction drugs such as Viagra for convicted sex offenders,... USA Today reports (Jones, USA Today, 5/24). New York state Comptroller Alan Hevesi on Friday said a state audit found that nearly 200 convicted Level 3 sex offenders in the state received Medicaid coverage for Viagra. Hevesi sent a letter urging HHS Secretary Mike Leavitt "to take immediate action to ensure that sex offenders do not receive erectile dysfunction medication paid for by the taxpayers." People designated as Level 3 sex offenders have been convicted of crimes such as rape, sexual abuse and sexual conduct against a child and are classified by courts as likely to re-offend. The auditors did not review whether Medicaid pays for Viagra for sex offenders in other states, but a spokesperson for the comptroller said there was no indication that policies are different elsewhere (Kaiser Daily Health Policy Report, 5/23). CMS spokesperson Gary Karr said, "The Medicaid program should not be paying for erectile dysfunction drugs for sex offenders" (AP/New York Times, 5/24). Karr said the confusion stemmed from an apparent misunderstanding of a 1998 federal Medicaid policy that requires the program to cover any drug that is medically necessary, including ED drugs. Karr said, "States have big leeway," adding, "A state can determine (that) a drug is medically not appropriate for a certain patient or class of patients, and the state can exclude that group from coverage" (USA Today, 5/24). CMS on Monday began sending notices to states to clarify the 1998 rule (Mahoney, New York Daily News, 5/24).

Reaction
Sen. Charles Schumer (D-N.Y.) said he plans to introduce legislation that would ban Medicaid coverage of ED drugs for convicted sex offenders. He said, "It's like paying for a convicted bank robber to get a gun when he gets out of prison" (Taylor, Long Island Newsday, 5/24). Sen. Hillary Rodham Clinton (D-N.Y.) said she would support Schumer's bill (Dicker/Orin, New York Post, 5/24). Laura Ahearn, executive director of Parents for Megan's Law -- an advocacy group for the law requiring that communities be notified of sex offenders living in the area -- said, "Now that we know the states have the power ... we are going to lobby the states to make sure this is stopped." Karen Terry, a professor at John Jay College of Criminal Justice in New York who studies sex offenders, said, "I think it's probably better not to give [convicted sex offenders] Viagra. But you can't generalize with a group like that" (USA Today, 5/24). Meanwhile, New York Gov. George Pataki (R) on Monday ordered a total ban on sales of ED treatments to local and state sex offenders on parole, regardless of the method of payment (New York Post, 5/24). Florida Attorney General Charlie Crist (R) said Medicaid in his state has provided Viagra to 218 sex offenders over the last four years, at a cost of $93,000 (Farrington, AP/Tallahassee Democrat, 5/24).

"Reprinted with permission from kaisernetwork.org kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

• Additional
• References
• Citations