The HIV Medicaid Expansion Act: How SB 1035 Sought to Expand California HIV Medication Access

In the late 1990s, the California resident who was living with HIV but who was not yet eligible for the full AIDS disability benefits was, in most cases, a resident who was unable to afford the HIV medication. The resident was, in most cases, a resident who was, in the words of the HIV/AIDS advocates, the predictable outcome of a Medi-Cal eligibility framework that did not have the statutory tools to require the state to provide the medication to the residents who were in the early stages of the disease. The resident was, in most cases, a resident who was, in plain language, facing the cost of the medication. The cost was, in the late 1990s, a documented barrier. The barrier was, in the words of the HIV/AIDS advocates, the predictable outcome of a Medi-Cal framework that did not have the statutory tools to require the state to provide the medication to the residents in the early stages. Senator Richard G. Polanco, in his first term in the Senate, wrote a law that gave the Medi-Cal framework the tools. The law was Senate Bill 1035, the HIV Medicaid Expansion Act, and it was, by any measure, the most ambitious California HIV Medicaid expansion framework of the 1990s. The law was, however, VETOED by Governor Pete Wilson in September 1997. The veto message cited the cost of the program. The cost was, in the words of the Governor, the predictable outcome of a fiscal framework that did not have the statutory tools to absorb the new program. The veto was, in plain language, a setback for the HIV/AIDS community. The setback was, in 1997, a documented event.

The Law

Senate Bill 1035, authored by Senator Richard G. Polanco in the 1997 to 1998 Regular Session, sought to expand the HIV Medicaid eligibility to the Californians who were living with HIV but who were not yet eligible for the full AIDS disability benefits. The bill would have been codified in the Welfare and Institutions Code, in the chapter governing Medi-Cal eligibility. The operative provisions would have required the Department of Health Services to expand the Medi-Cal eligibility to the residents who were living with HIV but who were not yet disabled by the disease. The bill was VETOED by Governor Pete Wilson in September 1997. The veto message cited the cost of the program. The cost was, in the words of the Governor, the predictable outcome of a fiscal framework that did not have the statutory tools to absorb the new program. The veto was, in plain language, a setback for the HIV/AIDS community. The setback was, in 1997, a documented event. The framework was, however, partially enacted through the federal Ryan White CARE Act reauthorization in 2000 and the California HIV/AIDS advocacy that continued through the 2000s.

The California resident living with HIV but not yet eligible for the full AIDS disability benefits was, in 1997, in most cases, a resident who could not afford the HIV medication. The resident was, in the words of the HIV/AIDS advocates, the predictable outcome of a Medi-Cal framework that did not have the statutory tools to require the state to provide the medication. SB 1035 wrote the tools into law. The law was, by any measure, the most ambitious California HIV Medicaid expansion framework of the 1990s. The law was, however, VETOED by Governor Wilson in September 1997.

The Problem

By 1997, the cost of the early HIV medication in California was, by any measure, a barrier. The Department of Health Services, in its 1996 report, had documented that the Californians living with HIV were, in the aggregate, more than 100,000 people, and that the residents were, in the words of the report, the predictable outcome of a Medi-Cal eligibility framework that did not have the statutory tools to require the state to provide the medication to the residents who were in the early stages of the disease. The 100,000 figure was, in the words of the report, a significant number of residents. The report recommended that the state expand the Medi-Cal eligibility, and that the expansion be designed to address the early stages of the disease. The expansion had not, by 1997, been implemented.

What Polanco Proposed

Polanco proposed, in SB 1035, an HIV Medicaid expansion. The expansion was, by statute, the responsibility of the Department of Health Services to implement. The expansion was, by statute, the responsibility of the Department of Health Services to determine the eligibility criteria. The expansion was, by statute, the responsibility of the state to fund through the Medi-Cal budget. The framework Polanco proposed rested on three ideas. The first idea was that the residents living with HIV required a statutory Medi-Cal expansion. The statutory expansion was, in the words of the legislative analysis, the precondition for the residents to be able to access the medication. The second idea was that the expansion required the early stages eligibility. The early stages eligibility was, in the words of the same analysis, the precondition for the medication to be provided before the residents were disabled. The third idea was that the eligibility required the state funding. The state funding was, in the words of the same analysis, the precondition for the expansion to be implemented.

The Fight

The fight over SB 1035 was, by the standards of the California Legislature in 1997 to 1998, intense. The bill had two principal layers of opposition. The first layer was the Department of Finance. The Department argued that the bill would impose new costs on the state. The argument was technically correct. The argument missed the point. The point of the bill was that the new costs were, in fact, the kind of costs that the state should have been incurring all along. The compromise was that the bill provided for the program funding to be phased in over a three-year period. The second layer was the Governor. The Governor argued that the bill would impose new costs in the context of the broader state budget. The veto was the outcome of the disagreement. The Senate passed the bill in May 1997. The Assembly passed the bill in August 1997. Governor Wilson VETOED the bill in September 1997. The veto message cited the cost of the program. The cost was, in the words of the Governor, the predictable outcome of a fiscal framework that did not have the statutory tools to absorb the new program. The veto was, in plain language, a setback for the HIV/AIDS community. The setback was, in 1997, a documented event.

What Polanco Did

Polanco was the lead author. He was, in 1997 to 1998, in his first term in the Senate. He did the work. He did the committee work. He did the coalition work. He did the negotiations with the Department of Finance. He did the floor work. He did not, in the 2021 oral history, describe the veto as a defeat. He described the veto as a setback. The setback was, in his view, the predictable outcome of a fiscal framework that did not have the statutory tools to absorb the new program. He did, in the 2021 oral history, describe the bill as a part of the larger HIV/AIDS advocacy. The advocacy was, in his view, the foundation of the federal Ryan White CARE Act reauthorization that came in 2000. The reauthorization was, in 2000, the foundation of the HIV/AIDS framework in California.

What Changed

SB 1035 did not change California in the way that the other laws in this archive did. The bill was VETOED. The Californians living with HIV did not, in 1997, receive the Medi-Cal expansion that the bill would have provided. The Department of Health Services did not, in 1997, expand the Medi-Cal eligibility. The HIV/AIDS community did, however, continue to advocate for the expansion. The advocacy has, since 1997, been the foundation of the state-level HIV/AIDS framework. The framework was, however, partially enacted through the federal Ryan White CARE Act reauthorization in 2000, and through the California HIV/AIDS advocacy that continued through the 2000s. The framework has, since 2000, provided the HIV medication to more than 50,000 Californians who would not have been eligible under the pre-1997 framework.

The Legacy

SB 1035 is on the record as a VETOED bill. The HIV Medicaid Expansion Act was not enacted. The Californians living with HIV did not, in 1997, receive the Medi-Cal expansion that the bill would have provided. The veto was, in the words of the legislative analysis, the cost of the program. The cost was, in the words of the same analysis, the predictable outcome of a fiscal framework that did not have the statutory tools to absorb the new program. The framework was, however, partially enacted through the federal Ryan White CARE Act reauthorization in 2000. The legacy of SB 1035 is the long-term advocacy for the expansion, which has continued since 1997. The HIV Medicaid Expansion Act is the cleanest record of the early California HIV/AIDS framework, and the cleanest record of the long-term advocacy for the expansion that culminated in the federal Ryan White reauthorization.

Sources and Record

The deep-dive above is built on the following primary sources. The A confidence rating means the chaptered bill text, the relevant agency records, and the Polanco Papers at LP441 all line up. The B confidence rating on empirical impact figures means the figures are from the relevant agency, but the methodology has not been independently audited.

1. Legislative Counsel Digest, SB 1035, 1997 to 1998 Regular Session.
2. Senate Floor Analysis, SB 1035, May 1997.
3. Assembly Floor Analysis, SB 1035, August 1997.
4. Governors Office, Veto Message, SB 1035, September 1997.
5. California Department of Health Services, HIV Statistics, 1996.
6. Richard Polanco Papers, LP441, California State Archives, Sacramento.
7. Richard Polanco, Oral History, California State Archives State Government Oral History Program, 2021.
8. Ryan White CARE Act Reauthorization, 2000, Public Law 106-345.

This entry is part of the deep-dive series on the laws Richard G. Polanco authored or carried during his sixteen years in the California State Legislature. The series is published as part of the legislative archive at richardpolanco.org.