NEW YORK, NY August 22, 2008 —The state's Medicaid director wants New York City residents with HIV/AIDS to get treated through health maintenance organizations.

Currently, the Medicaid system pays hospitals and clinics per visit, unlike HMO's that pay a monthly fee. The state has slowly been moving some Medicaid patients with chronic conditions into managed care.

Medicaid is the single largest expenditure by New York State, which spends far more on the program than any other state.

Officials say the proposed change is to improve quality of care not to save money. But advocates fear the change will result in lower quality medical treatment and cause some patients to get lost in the transition.

The Health Department is expected to issue a final decision in the next few weeks.