AIDS Program Advocates Call for Stable Funding and Minor Changes in Ryan White Renewal
July 31, 2012
CQ HEALTHBEAT NEWS
AIDS Program Advocates Call for Stable Funding and Minor Changes in Ryan White Renewal
By Rebecca Adams, CQ HealthBeat Associate Editor
The Ryan White HIV/AIDS program should not face dramatic changes when it is reauthorized, its funding should remain stable and only minor adjustments should be made to ensure flexibility as the program adapts to the parameters of the health care law, activists say in comments due to federal officials on Tuesday.
Officials for the Health Resources and Services Administration (HRSA), which oversees Ryan White, asked for comments as they prepare for the reauthorization of the program. It provides grants to treat low-income people infected with the virus who are uninsured or whose coverage does not pay for all of their needs. The authority for the program ends in September 2013, but appropriators could continue to fund the program even if the authorization lapses.
Coverage options for HIV/AIDS patients is expected to change, at least in some states, just a few months after the expected reauthorization date when the health care law is implemented in January 2014. Currently, 41 percent of people in the Ryan White program are uninsured. About 34 percent have Medicaid, 13 percent have Medicare, and 12 percent have private insurance. The patients who have some coverage use the Ryan White program to help them pay for cost-sharing such as co-pays and the cost of the expensive drugs they need to keep the virus under control.
Many of the patients who are now uninsured are adults who would be eligible for Medicaid in 2014 — if they live in a state that chooses to opt in to the expansion under the health care law (PL 111-148, PL 111-152).
“The AIDS Institute strongly supports continuation of the Ryan White HIV/AIDS Program in its current configuration with minor adjustments, as necessary, to ensure that the potential benefits of health reform can be realized,” said one comment typical of the advocacy groups.
Doing the Math
The groups want to forestall any effort to cut the authorized spending levels. They fear that some may advocate for flat funding or reductions under the assumption that the expanded coverage the health overhaul provides could take care of patients’ needs and that there would be less demand for Ryan White services.
The activists also are concerned about the impact of potential across-the-board funding cuts for the program as part of sequestration, which is scheduled to begin early next year unless Congress intervenes. Advocates say that a potential 7.8 percent cut could have a dramatic impact on Ryan White treatment and other prevention programs.
And advocates say that implementation of the health law is too uncertain, especially considering that several states may not expand their Medicaid programs.
“There is no guarantee the coverage expansion will occur on January 1, 2014,” said the letter from the AIDS Institute. “Additionally, even if it occurs as planned, Ryan White beneficiaries will not automatically transfer to other coverage overnight. There must be an adequate time for states, localities and grantees to transition their patients to new systems of care and treatment, and possibly to new providers.” The group called for language that would “allow a reasonable period of time, of at least one year, to transition Ryan White clients to new payers and systems of care.”
State-by-State Concerns
Jeff Allen, an official with the Partnership for Comprehensive HIV/AIDS Planning in Ormond Beach, Fla., said that because state officials can choose whether or not to expand Medicaid, coverage around the country will remain piecemeal.
“Many southern states (Including Florida) may refuse to participate in Medicaid expansion, leaving the poorest and most vulnerable [patients] without access to Medicaid or subsidies to purchase private insurance on the exchanges,” Allen wrote.
One example of an adjustment that advocates say could be needed is a change to the grants rules that require cities and states to spend 75 percent of grant funds on medical services and 25 percent on supportive services such as outreach, transportation, language services, and respite care for persons caring for individuals with HIV/AIDS. As the program’s mission shifts with the implementation of the health law, advocates say that more of the money should be allowed to be spent on support services. More patients may get access to medical care under Medicaid or private insurance in the new exchanges, they say, but that coverage could have restrictions on care, such as limits on the amount of prescription drugs for patients or limited mental health counseling.
The National Alliance of State and Territorial AIDS Directors (NASTAD), which represents public health officials that administer state HIV/AIDS prevention and care programs, called for new expedited procedures for groups to apply for waivers from the 75 percent rule. The group also asked for more flexibility and technical assistance that would encourage community groups to pay premiums, deductibles and co-payments for patients.
“The Ryan White Program will be needed to continue to provide vital enabling services as well as fill in gaps where state Medicaid programs and private exchange plans fall short,” wrote Julie M. Scofield, the NASTAD executive director.
Rebecca Adams can be reached at radams@cq.com.