Nearly 800 convicted sex offenders in 14 states got Medicaid-funded prescriptions for Viagra (search) and other impotence drugs, according to a survey by The Associated Press.

The majority of the cases were in New York, Florida and Texas.

Medicaid (search), the health insurance program for the poor, is administered differently in every state. Thus, while some states allowed Medicaid payments for prescriptions for the drugs Viagra, Cialis and Levitra, other states did not.

New York, acting on a tip, was the first to uncover that Medicaid had paid for Viagra prescriptions for sex offenders. Its report prompted the federal government, which provides states with funds for Medicaid, to order states to take steps to stop the coverage for these felons.

The states that provided registered sex offenders with subsidized impotence drugs are Florida, 218 cases; New York, 198; Texas, 191; New Jersey, 55; Virginia, 52; Missouri, 26; Kansas, 14; Ohio, 13; Michigan, seven; Maine, five; Georgia, three; Montana, three; Alabama, two; and North Dakota, one. That comes to 788 cases.

In Virginia, the cost came to at least $3,085. Gov. Mark R. Warner issued an emergency order barring Medicaid from continuing to pay for the drugs for these men.

Kyle Smith, a spokesman for the Kansas Bureau of Investigation, put it this way: "Do we have programs giving clubs to wife beaters or drinks for those committing DUI? Weird things happen in this world, and this is one of the weirder."

In Alabama, officials said the federal government previously had mandated that states pay for erectile dysfunction drugs.

"Now that we are armed with new information from the federal government, Alabama can and will deny this coverage for registered sex offenders," Carol Herrmann, the state's Medicaid director, said last week.

Some states had relied on a 1998 letter from the Clinton administration as a basis for providing coverage, said Matt Salo, a staff member of the National Governors Association (search). But that letter also said restrictions could be put in place to curb abuse. For example, the letter said states should limit the number of refills or the quantity of pills per prescription.

That letter, sent to then-Govs. Mike Leavitt of Utah and Lawton Chiles of Florida, said Medicaid must cover all FDA-approved drugs with certain exceptions. Those exceptions included drugs used for weight control, for cosmetic purposes or to promote fertility.

"The law is pretty clear. The letter in 1998 said Medicaid had to cover Viagra," said Salo, the director of the association's health and human services committee. "I don't think there is any dispute about that."

Some states did decline to provide coverage for impotence drugs to any male. South Dakota considers Viagra and similar drugs to be fertility drugs.

"Our rules are specific in that we do not cover agents to promote fertility or to treat impotence," said Larry Iverson, director of South Dakota's Office of Medical Services.

Wisconsin officials simply ignored the directive.

The state's health and human services chief "thought the directive was ill-advised and chose to disregard it," said a department spokeswoman, Stephanie Marquis.

Tennessee took the position that the treatment of erectile dysfunction is not medically necessary. The state has approved coverage of Viagra in five cases, not involving sex offenders, for treatment of pulmonary hypertension.

Gary Karr (search), a spokesman for the Centers for Medicare and Medicaid Services, said states always have had the right to determine what treatments are medically necessary. "Obviously there was some degree of confusion or misunderstanding from the letter the Clinton administration sent out," he said.

Many states are reviewing whether the treatment of erectile dysfunction is a medical necessity.

"I don't want to give Viagra to sex offenders, that's pretty ridiculous," said Robbie Kerr, director of South Carolina's Health and Human Services Department. "The point to me is not that we're paying for Viagra and sex offenders may somehow get it, the point is, 'Why am I covering Viagra at all?'"

Texas now bans all Medicaid claims for impotence drugs. "We want our Medicaid program to make the very best use of limited taxpayer dollars, and Texas taxpayers should not have to pay for these types of drugs," the state's health and human services commissioner, Albert Hawkins, said in a statement Friday.

The federal government told states this past week that they had to take steps to ensure such drugs did not go to sex offenders. But the fallout could be much broader because Congress has proposed banning coverage of impotence drugs for all Medicaid and Medicare recipients.

Sen. Charles Grassley (search), R-Iowa, said such a restriction would save $2 billion over the next decade.

Some doctors disagree with that approach. They say drugs that allow older people or the ill to maintain a sex life encourages them to lead a healthier lifestyle.

"States that have imposed a ban on coverage of erectile dysfunction are effectively lumping thousands of victims of crippling disease in with criminals," said Dr. Richard Atkins, chief executive officer of the National Prostate Cancer Coalition. "Viagra and similar medications are not a 'lifestyle' drug for these people."