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May 28, 2005

States end Viagra coverage for sex offenders

Predictably, States Ending Payments for Sex Offenders' Erectile Treatments [NYT].

More interesting is the background information towards the end of the article.

Federal regulations have required states to provide erectile dysfunction treatments, including Viagra, Cialis and Levitra, to Medicaid recipients since 1998. Recipients can receive four pills a month.

But in a letter Monday to Medicaid issuers in all 50 states, the federal Centers for Medicare and Medicaid Services ordered state agencies to stop offering the drugs to sex offenders or face sanctions. The letter, signed by Dennis G. Smith, the centers' director, stated that under the federal Medicaid statute, states were obligated to prevent inappropriate or unnecessary medical care. The letter said that the use of the drugs by sex offenders was not appropriate.

The issue became publicized after Alan G. Hevesi, the New York State comptroller, said on Sunday that 198 rapists and other high-risk sex offenders in New York had been reimbursed for the drugs in the past five years. Since then, other states have reported paying for the drugs to sex offenders under the Medicaid statute. The reports have prompted debate about whether Medicaid should pay for the drugs at all.

So, only 198 New York sex offenders have been reimbursed for any ED prescription over the past five years. Pretty thin fodder for a moral panic, if you ask me.

The article fails to dispel the key misperception that fueled this entire controversy. Viagra for sex offenders isn't a program. Medicaid covers ED drugs, some registered sex offenders are on Medicaid, so a few sex offenders got prescriptions

Now New York has issued a temporary ban on all publicly-funded ED drug coverage. Nice going, moral busybodies. Now, a lot of innocent guys won't get their drugs reimbursed because New York hasn't updated its sex offender database.

The new, temporary ban will ensure that no convicted sex offender receives these drugs through Medicaid and other publicly-funded health care programs, until legislation the Governor will propose authorizing the Health and Insurance Departments to obtain the State's complete sex offender registry database is enacted. The legislation must be enacted to allow the State's Division of Criminal Justice Services to provide the complete sex offender registry to the Health and Insurance Departments.

"We're pleased that on Monday the Federal government heeded our call to overturn the misguided Clinton Administration policy that allowed convicted sex offenders to receive Medicaid-funded erectile dysfunction drugs," Governor Pataki said. "This temporary ban will ensure that no sex offender receives these drugs at taxpayer expense while we push to pass legislation that will allow the Health and Insurance Departments to obtain the complete sex offender registry and put a targeted ban in place."

Under current New York State law, full and complete information about all levels of sex offenders is not publicly available. Only information about Level 3 sex offenders is currently available on the sex offender registry website. Due to stringent statutory restrictions on access to and use of sex offender registry information regarding convicted sex offenders, specific information about Level 1 and 2 offenders - most of those listed on the State's sex offender registry -- is not generally available to the public and/or non-law enforcement State and local government agencies.

Notice the widening Orwellian scope of this project. Initially, comptroller Hevesi objected to a handful of high risk (Level 3) offenders getting full Medicaid coverage.

Now, Pataki's ban will extend to all convicted sex offenders, even those at low risk of recidivism. Apparently, the governor wants to deny ED coverage for life to anyone who has been convicted of any sexual offense, even something as minor as patronizing prostitute. The ban will affect not only offenders on parole or probation, but also those who have already done their time. This is staggeringly unfair, especially for designated low risk offenders who have paid their debt to society.


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Are statutory rapists in New York on the sex offenders list? In Texas, you can get put on the list for being 18 and having sex with a 15 year old. Those lists piss me off, since they are wildly misused. Rapists with a high chance of recidivism avoid getting on there by pleading down to mere assault or just getting off scot-free because of the low conviction rate for rape. Meanwhile, a teenager who has sex with his teenage girlfriend only to find that her parents are willing to protect Buffy's precious chastity by going to the police find their most decidely non-criminal selves on the list.

I think that most states do make a distinction between statutory rape and violent sex crimes, but I don't know if there are any Federal standards.

Another is pedophiles, is there a difference between a twelve year old kid who molests a youger child and then doesn't have and repeat offenses for twenty years vs the serial pedophile who continues his offenses into his adult years. Right now both wind up on the lists and databases.

Mental Healthcare professionals did come out strongly against the viagra for sex offenders benefit. They called it "gasoline on the fire."

Well, healthsignals NY says that the way they found this out is illegal

"Hevesi's auditors found the problem by matching the Medicaid claims data they have with the listings of Level 3 Sex Offenders listed on the Division of Criminal Justice Services (DCJS) Sex Offender Registry. Linking Medicaid data with data from other sources is one of the things that's explicitly forbidden by the Department of Health for others who wish to use the Medicaid data."

This is a classic case of taking a worst-case scenario and presenting it out of context in order to prejudice opinion.

I am reminded of welfare queens.

I have not seen this discussed elsewhere: how are these (presumedly) adult male sex offenders getting Medicaid in the state of Texas?

Texas is not exactly a generous state regarding Medicaid eligibility. The only two ways an adult male can get Medicaid is categorically via TANF or SSI eligibility. If via TANF the guy is a caretaker of one or more children. If via SSI the guy is disabled.

I think each of these situations leads to an interesting next question or two.

My bad: forgot a bit of context above. Texas has had the same issue in the news.

And I suspect NY has a general assistance program that would extend Medicaid to a low income adult male who is not disabled or the caretaker of a child.

I did think that viagra for sex offenders who were incarcerated only... could be an interesting concept as long as the guards stayed well out of reach.

Sorry Lindsay... no winky support for the troops either! Santorum has spoken:

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