by Bob Roehr
WASHINGTON, D.C. –
The Department of Health and Human Services announced more than $1.1 billion in Part B funding under the revised Ryan White CARE Act. Word came late in the day April 5, administrations of both parties have learned to release information immediately before a holiday weekend if they wish to minimize media coverage.
Part B covers programs that used to be known as Title II. The funding includes base grants ($324.4 million), the AIDS Drug Assistance Program ($775.3 million), and emerging communities grants ($5 million).
"For more than 15 years, Ryan White programs have been the lifeline for thousands of individuals living with HIV/AIDS. The new legislation will greatly expand our ability to serve them with more effective care and services," said HHS Secretary Michael Leavitt in announcing the grants.
Several provisions are new with the reauthorization. For the first time, money will be allocated based on HIV diagnoses rather than AIDS diagnoses. The legislation also requires that grantees spend at least 75 percent of their Part B award on core medical services and that ADAPs fund a core list of antiretroviral drugs on their formularies.
"A dozen states with high caseloads are losing about 4 percent of their funding, while another dozen are getting increases of 25 percent or more," said Ronald Johnson, deputy director of AIDS Action. Among the big losers are Massachusetts, Maryland, New York, New Jersey, and Pennsylvania, while California, Florida, and Illinois are essentially flat-funded.
New York lost 5 percent of its ADAP funding, the maximum allowed under the "hold harmless" provision of the reauthorization legislation, even while its smaller base funding increased by 1.5 percent. California saw its ADAP funding decline by almost 1 percent while its base increased by 5 percent, for an overall decline in total dollars. The two states are home to nearly half of the national epidemic
"Because of the hold harmless provision [which limits a states reduction in funding to no more than 5 percent a year] and an increase of $70 million to base funding, most states didn't lose too much money, and some gained," said Carl Schmid, director of federal affairs with The AIDS Institute.
Another factor that helped ease the burden on ADAP programs this past year was that a large number of patients were transferred to the new Medicare Part D. But Schmid says that is a one time gain that is not going to help the stressed programs this year or in future years.
Modest increases in overall funding do not keep pace with the increased cost of living ,Aei with pharmaceuticals increasing even more rapidly ,Aei let alone the increased caseload of patients. The problem will only increase as the CDC revs up its program of testing to get more people to learn their HIV status.
Johnson is a little mystified as to why switching to HIV names reporting from AIDS case reporting would have the impact that it appears to have had on the distribution of funding. He wants to see the HIV data by state to better understand that effect. That data is gathered by CDC and Johnson has requested to see it, but so far has been unsuccessful. He asks, "Why does it constitute practically a state secret?"
Four emerging communities lost their 2006 status as emerging communities and with it an average of more than $200,000 per jurisdiction. The four are regions that center around the small cities of Greensboro, North Carolina, Oklahoma City, Atlantic City, New Jersey, and Greenville, South Carolina.
Johnson said, "In theory, the states can give [those jurisdictions] money" to make up for the loss. However, he acknowledged that there will be competing demands within each state.
