Emergency Expansion of Ryan White Funding
In response to the recent outbreak of COVID-19, the Michigan Department of Health and Human Services Division of HIV and STD Programs is providing emergency financial assistance to Ryan White-funded agencies to support their clients living with HIV. Medicine, medical supplies and food — if the client is not currently funded for food bank services — are covered by this emergency funding. Items named in a letter addressed to program staff and clients include things such as hand sanitizer, household cleaning products, masks, gloves and fever reducers.
"Ryan White funding isn't usually allowed to buy cleaning supplies, hand sanitizer [or] food," said Kelly Doyle, CEO of CARES, a Ryan White funded-agency in Southwest Michigan. "So this really opens up for us being able to do things for our clients right now in this crisis to help them, whether people are quarantined or self-quarantined, to be able to clean themselves and clean their environment. Our clients are also family members who often take care of other family members."
MDHHS is currently working with Medicaid and Script Guide to secure an additional 30-day supply of medications for clients as well. It is recommended that pharmaceuticals be mailed or delivered to individuals' homes.
Additional funding to defray the cost of travel for the delivery of medicine, medical supplies and/or food will also be covered by MDHHS for people living with HIV.
An Agency Responds
Community AIDS Resource and Education Services is a nonprofit AIDS organization serving 10 counties in Southwest Michigan. Approximately 400 clients are served by two Kent County locations. At present, CARES is not offering its clients particular guidelines regarding COVID-19 beyond what state leadership has suggested.
"I'm not advising the clients anything specific," Doyle said. "I'm letting the guidance from MDHHS come down. What I am doing is I'm having case managers call their clients to talk and listen to clients to keep them calm and hear what they need, and … ask them, do they need cleaning products or fever reducers or food — that kind of thing. So that's the guidance I put out to my staff Friday. They're going to start calling them in the next couple days to be able to keep them calm."
Doyle described precautions the CARES locations are taking in the face of the pandemic.
"Right now, everything's moved so quickly," she said, referring to the pace at which the public is receiving new information and recommendations. With the first reports of cases, she said they began with more frequent hand washing and by disinfecting surfaces in the office with bleach wipes on a daily basis.
"As this progressed, we started working towards meeting face-to-face only in emergency situations," Doyle said. "And most likely next week, we'll have a lot of our staff working from home to minimize having too many people around to create that issue of transmission."
For clients whose HIV is well-maintained, Doyle said it's likely they'll suggest delaying routine appointments at present because "it would probably be healthier for them."
"Now, if they are newer clients or they're having health issues, we have a clinic that we can have them come to," Doyle said. "And of course, we would try to screen for any of the COVID symptoms beforehand."
CARES' clinic is staffed by Western Michigan University School of Medicine clinicians who have their own policies, Doyle indicated. She added that they're working on a plan to use telemedicine when appropriate.
Gov. Whitmer's office addressed telemedicine's role during the COVID-19 pandemic in a March 12 statement that announced her administration would immediately begin allowing Medicaid beneficiaries to access the service. In Michigan, 3,931 clients of Ryan White-funded agencies relied on Medicaid alone for health insurance in 2018.
"When we expand access through telemedicine, we can help reduce the number of Michiganders who need to visit their health care provider in person, which will help slow the spread of disease and ensure our health facilities have adequate staff and resources to care for those who are sick," said MDHHS Director Robert Gordon, in the statement.
For all expenses covered by the Ryan White Program, CARES is reimbursed by MDHHS after purchases are made and paperwork is filed. That's what enabled Doyle to swing into action and shop for supplies over the weekend — or, at least attempt to do so.
"Because of the nature of people buying so much stuff so quickly, we just went out and stockpiled some things [earlier] to have that, to be able to this week provide," Doyle said. "And even with that, I wanted to be able to get thermometers and hand sanitizer and bleach wipes, and those are the things that I can't find. At all. Like, zero, which is frustrating."
As CEO, Doyle is looking ahead for her clients and staff. And she sounded satisfied with the way the state has stepped in to help her agency.
"This is just the beginning, I think," Doyle said. "I feel more confident because Governor Whitmer has taken this on very strong. [She's] not messing around. I appreciate that."
The federal government's Health Resources and Services Administration's Ryan White HIV/AIDS Program provides HIV primary medical care, essential support services and medications for low-income people living with HIV who are uninsured and underserved. The Program funds grants to states, cities, counties and local community-based organizations that serve people living with HIV to improve health outcomes and reduce HIV transmission among hard-to-reach populations.
It is estimated that 9,179 clients were served by Ryan White Program providers in Michigan in 2018. At that time there were 16,306 individuals living with HIV in the state, according to MDHHS statistics.
It should be noted that the impact of COVID-19 on people living with HIV is not yet known. However, many people who are HIV-positive may experience increased risk factors: these include advanced age, chronic medical problems and immune suppression – indicated by a low CD4 T-cell count or not receiving antiretroviral treatment.
For information on how to access emergency financial assistance, individuals served by Ryan White-funded agencies should contact their case managers or agencies. For regular updates on COVID-19: Michigan.gov/coronavirus.