DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland 21244-1850 
 
Center for Medicaid and State Operations 
                       
                     SHO # 09-007 
June 24, 2009     
   
             
Dear State Health Official: 
 
Every year, National HIV Testing Day is held on June 27th.  This is an annual occasion when the 
Department of Health and Human Services, along with the National Association of People with 
AIDS (the original sponsor of National HIV Testing Day), state and local health departments, 
community based organizations and other entities promote HIV testing to encourage knowledge 
of serostatus as a first step to linking people living with HIV into care.  In support of this 
initiative, we would like to make you aware of current recommendations from the Centers for 
Disease Control and Prevention (CDC).  CDC recommends that opt-out HIV screening be a part 
of routine clinical care in all health-care settings for all adults and adolescents aged 13-64.  Opt-
out screening preserves the patient's choice to decline HIV testing and ensures a provider-patient 
relationship conducive to optimal clinical and preventive care.  These recommendations were 
published in the September 22, 2006 issue of the Morbidity and Mortality Weekly Report, and 
may be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm.   
 
We are using this opportunity to explain the policies of the Medicaid and Children's Health 
Insurance Program (CHIP) programs regarding the coverage of HIV testing and HIV screening.  
We also note that such services are subject to the confidentiality protections under the Health 
Insurance Portability and Accountability Act of 1996, including the implementing regulations at 
45 C.F.R. Part 164, Subpart D, and applicable State privacy laws.  
 
We encourage you to post information about Medicaid and CHIP coverage of HIV testing on 
your websites or link to HIVtest.org.  This site provides links to resources and information about 
local National HIV Testing Day events across the nation.  HHS launched the I know I took the 
Test! story widget which profiles individuals sharing their experiences taking an HIV test.  We 
also suggest adding this widget (http://www.aids.gov/national_hiv_testing_day/index.html) to 
your website.   
 
 
Medicaid Coverage of HIV Testing  
 
Under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit described in 
sections 1905(a)(4)(B) and 1905(r) of the Social Security Act (the Act), Medicaid-eligible 
children under the age of 21 are covered for HIV testing.  This includes routine testing/screening 
for Medicaid-eligible children at State-specified intervals as part of the childs well-child exam, 
and otherwise medically necessary HIV testing.  Routine HIV testing/screening for such children    
is covered by States under the preventive or screening benefit in section 1905(a)(13) of the Act, 
    Page 2  State Health Official 
 
and otherwise medically necessary HIV testing is covered  under the benefit for laboratory 
services in section 1905(a)(3) of the Act. 
 
Medicaid-eligible adults are covered for medically necessary HIV testing through the mandatory 
laboratory benefit under section 1905(a)(3) of the Act.  States also have the option of covering 
routine HIV testing of Medicaid-eligible adults as a preventive or screening benefit under section 
1905(a)(13) of the Act.   
 
 
CHIP Coverage of HIV Testing 
 
For States with a CHIP Medicaid expansion, coverage of HIV testing is the same as for other 
Medicaid-eligible children, as described above.   States with a separate child health program are 
required to provide well-baby and well-child care services, which can include HIV testing.    
HIV testing can be covered in a separate child health plan consistent with the States elected 
benefit package under Section 2103 of the Act. 
 
Our goal is to remind people that HIV remains a major health concern, especially among African 
Americans and Latinos, and gay and bisexual men of all races.  We also want to acknowledge 
your efforts to serve this vulnerable population and hope that this letter will encourage States to 
provide routine screening along with that which is medically indicated and necessary by 
clarifying the coverage options that are available for Federal reimbursement. 
 
          Sincerely,  
 
              /s/ 
               
          Cindy Mann 
           Director 
 
 
cc: 
 
CMS Regional Administrators 
 
CMS Associate Regional Administrators 
Division of Medicaid and Childrens Health 
 
Ann C. Kohler          
NASMD Executive Director 
American Public Human Services Association 
 
Joy Wilson 
Director, Health Committee 
National Conference of State Legislatures 
 
 
 
  Page 3  State Health Official 
 
Matt Salo 
Director of Health Legislation 
National Governors Association 
 
Debra Miller 
Director for Health Policy 
Council of State Governments 
 
Christine Evans, MPH 
Director, Government Relations  
Association of State and Territorial Health Officials 
 
Alan R. Weil, J.D., M.P.P. 
Executive Director 
National Academy for State Health Policy