Office of AIDS Faces $80 Million Cut Amidst Increasing Need for Service

According to the OA’s revised budget, Medicare Part D program will further add to low-income, senior and disabled patients’ healthcare costs in January, 2010, when it includes increases to its prescription coverage premiums, allows providers to reduce formulary coverage, and lists other out-of-pocket expenses for enrollees.

The Governor’s revised budget eliminates general fund support for the entirety of OA’s remaining programs, according to Anne Donnelly, with San Francisco’s Project Inform. A $67.8 million dollar cut from the general fund would eliminate HIV counseling and testing, surveillance of patients – which helps the state comply with the Ryan White program, OA’s early intervention and education programs, therapeutic monitoring program for drug-resistance testing, viral load testing, housing assistance and home care.

While program advocates contend all OA programs are vital, not only to the health and lives of clients with HIV/AIDS but also to containment and prevention of the disease in the state, they also have weighted the department’s services.

“We’re in the process of assessing programs for priority,” said Courtney Mulhern-Pearson, policy analyst for the San Francisco AIDS foundation. “We know that our first priority is to keep ADAP whole.”

Donnelly concurs, “The consensus of this alliance places top priority on ADAP funding.”

Both Donnelly and Mulhern-Brown are aware of the June 15 deadline and the coalition of California’s AIDS organizations, including AIDS Housing Alliance, AIDS Project Los Angeles, San Francisco AIDS Foundation, CARES and Project Inform, planned to meet today.

Among the frustrations of AIDS advocates and activists over the OA cuts is the Medicare Part D prescription drug program’s costly “Doughnut hole.” The federally-funded program does not allow 7,498 (21.87 percent) of ADAP clients with Medicare Part D coverage to count ADAP's medication payments as part of their true out-of-pocket (TROOP) annual cumulative prescription expense. This restriction keeps these chronically ill (catastrophic) patients trapped in the Part D prescription coverage “Doughnut hole” throughout most of the year – forcing ADAP to remain the source of funding.

Federal advocacy continues to support a change in Part D to allow ADAP payments to count toward TROOP costs that would enable ADAP clients to move from the “Doughnut hole” into catastrophic coverage. However, there is currently no federal legislative or regulatory activity addressing this issue.

“We’ve been lobbying for a couple of years – certainly, there’d be significant cost savings for ADAP,” Mulhern-Brown told CPR.

But Kessler believes it’s too late to look for alternative revenue sources. “Let’s be clear, cuts are going to happen,” said Kessler. “The discussion about revenue has passed and I do not believe the Office of AIDS will be immune to cuts. The best we can hope for is some kind of rational prioritization.”

“Our hope as advocates is that what the governor has proposed - which is severe - will be mitigated by the legislature,” Kessler told the California Progress Report. “What the pro tem has said, which I agree with, is that we hope the legislative approach to these cuts will be surgical.”

Kessler believes ADAP is “a great example” of the importance of some of the programs facing cuts. “People will die, or will have to make these terrible choices between food and medication, which really isn’t a choice at all. We really need people to wake up and engage in what’s happening. Lives are at stake.”

A veteran Sacramento lobbyist, Kessler called the current fiscal crisis, "the worst I've ever seen."

This week, Equality California generated 28,596 letters opposing OA cuts to members of the legislature through its action alert. In an OP-ED piece appearing in Thursday’s Bay Area Reporter, EQCA’s executive director, Geoff Kors, pleaded with legislators to recognize the economics of the governor’s proposal.

“More than 35,000 middle- and working-class Californians rely on ADAP as their primary source for costly HIV medications, which the state can get at steeply reduced rates for which individual patients and health systems do not qualify. Without continuing to fund ADAP at its current level, we are turning our backs on neighbors and friends who depend on this program not only to thrive, but to survive. We are forcing them to pay for needed medication that they could otherwise not afford. If these cuts go through, these Californians will be forced to choose between paying for medicine or paying for food and rent.”

The coalition of AIDS service organizations supported by EQCA has scheduled a rally at the Capitol on Wednesday, June 10, 2009.