State Update — June 2002

Gov. Ryan Vetoes HIV Prevention Funding; ADAP Funding Protected

A long and contentious battle over the state's 2003 budget ended in mid-June with Governor George Ryan using his line-item veto to cut $2.25 million in HIV prevention funding for minority communities along with hundreds of millions of dollars in human service, corrections, and education funding.

The governor's veto came at the end of the Illinois General Assembly's spring legislative session, which dealt with a record number of AIDS-related issues. The AIDS Foundation of Chicago (AFC), which played a key role in pursuing sound AIDS-related funding and legislation, recently released a recap of highlights from this year's session. A detailed chart of AIDS-related legislation monitored by AFC is available online.

With state revenues down by at least $2 billion from last year, the governor and lawmakers struggled to reach agreement on the annual budget that began July 1, 2002. Capitol insiders characterized this year's fiscal woes as the worst in 50 years.

The AIDS Foundation of Chicago (AFC) began to mobilize grassroots support for HIV prevention funding in February when the governor announced intentions to eliminate the $2 million HIV prevention appropriation as part of his FY03 proposed budget. The governor's "Memorial Day" revised budget again called on lawmakers to eliminate the program.

During AFC's annual lobby day in April, more than 70 AIDS advocates from across the state met in the State Capitol to urge lawmakers to preserve the program. Members of AFC's statewide advocacy network also generated hundreds of calls to legislators and the governor in support of the appropriation. In addition, Karen Reitan, AFC's state affairs director, testified before House and Senate appropriations committees on the importance of continuing HIV prevention services.

After heated debate over spending and revenue plans, which included provisions to increase cigarette and gambling taxes, lawmakers finalized a budget bill May 31 that would have appropriated $2.25 million for HIV prevention in minority communities-a $250,000 increase. The governor's vetoes, totaling more than $504 million in spending, were announced three days later. Despite an aggressive lobbying effort by AFC and its constituent and legislative allies, a vote to override the veto failed in the State Senate, 29 to 25, just 7 votes short of the 36 needed for passage.

Eliminating the appropriation is especially shortsighted given the disproportionate impact of HIV/AIDS on people of color communities. According to state figures, 2 in 3 reported HIV cases occur among people of color. African Americans and Latinos account for nearly 60% of cumulative AIDS cases and only 27% of the state's population.

The appropriation, first created in 2001, supported projects serving minority communities at 18 agencies in Chicago, and in Cook, Kane, Madison, Peoria, St. Clair, Will, and Winnebago counties. Without renewed funding, thousands of people at high risk for HIV infection will not receive education and support that could save their lives.

AFC thanks all those who joined us in advocating for HIV prevention services. Special thanks to Senators Carol Ronen, Barak Obama, Steve Rauchenberger, and Donne Trotter and Representatives Beth Coulson, Monique Davis, Sara Feigenholtz, Mary Flowers, Larry McKeon, David Miller, Rosemary Mulligan, Harry Osterman, and many others for championing HIV prevention funding.

Other AIDS-related items in the state budget:

AIDS Drug Assistance Program: Despite instituting a one-time $3 million reduction in state funding for the AIDS Drug Assistance Program (ADAP) in November 2001, Governor Ryan supported funding ADAP at the original FY02 amount of approximately $7 million. AIDS advocates had feared that the governor would recommend funding the program at a dramatically reduced amount, which could have required drastic eligibility changes and service reductions. Fortunately, the legislature concurred with the governor by adequately funding the program for FY03.

Hepatitis C Awareness and Testing: Despite the governor's call for the elimination of a $250,000 hepatitis C awareness and testing program, lawmakers included the funding in their final budget bill. The governor vetoed the appropriation, which withstood a Senate vote to override it.

100% Campaign: The budget implementation bill eliminated a statutory requirement to raise the Medicaid spend-down threshold from 83% of the federal poverty level (FPL) to 100% FPL beginning July 1, 2002. In mid-June, however, the Illinois Department of Public Aid announced that it would promulgate new administrative rules to establish the higher income threshold as of July 1, 2002. The reform benefits thousands of low-income seniors and people with disabilities, including substantial numbers of people with AIDS, who were previously required to "spend down" their monthly income in order to qualify for Medicaid benefits. The AIDS Legal Council of Chicago and the SSI Coalition for a Responsible Safety Net led a broad coalition in 1999 that succeeded in persuading lawmakers to adopt the reform.

Pharmaceutical Access for Medicaid Clients: As part of the budget implementation bill, lawmakers inserted language protecting access to HIV/AIDS-related medications for Medicaid beneficiaries. Noting that the Illinois Department of Public Aid (IDPA) may decide to limit Medicaid recipients to no more than four brand-name prescription medications per month, the provision requires IDPA to exclude drugs used to treat HIV/AIDS, medications prescribed for "urgent conditions," and drugs for which there is no generic equivalent from this policy.

Office of Rehabilitation Services: Concerned that insufficient funding might affect home services for homebound people with AIDS, AFC lobbied for increased funding for the Office of Rehabilitation Services (ORS). The program received a $40 million increase, which was $26 million less than had been estimated to maintain services. Fortunately, officials for the Illinois Department of Human Services, which operates ORS, assured lawmakers that there would be no changes in program operation. It is widely expected that declining case loads and the shifting of some ORS client to new seniors programs will allow for continued operation of ORS at its current funding level.

FamilyCare: According to the state budget, Illinois will receive $40 million in federal funds to begin implementation of FamilyCare, which will provide Medicaid coverage to low-income parents of children covered by the state's KidCare program. According to the National Center on Poverty Law, some 40,000 individuals, including many living with HIV/AIDS, could become eligible for FamilyCare coverage by next year.

Non-budget issues addressed by the Illinois General Assembly this year:

HIV Prevention:

Commission on Medical Instruments: Senate Joint Resolution 58 (Senate sponsors: Rauschenberger, Syverson, Trotter, Ronen; House sponsors: Feigenholtz, Currie, Wirsing, Osmond, Miller) passed the Senate on April 18 and the House on May 9. The resolution creates the Commission on Medical Instruments, which will review scientific literature regarding syringe availability as a public health tool and advise the General Assembly on syringe access public policy.

Assistance for Inmates and Family Members: In its original form, House Bill 4115 (Flowers, D-Chicago) would have required mandatory HIV testing of all inmates and notification of their HIV status to their family members. AFC strongly opposed this bill and, in partnership with the ACLU and the Howard Brown Health Center, asked Representative Flowers to consider redrafting the bill, which she agreed to do. In its amended form, HB 4115 required the state to make HIV prevention education available to all inmates in Illinois correctional facilities and to create a new program designed to educate inmates' partners and family members about HIV prevention. The bill passed the House Judiciary Committee-Criminal Issues on February 15, but was not called for a vote on the House floor.

Medicaid Access:

Prior Authorization: Lawmakers amended Senate Bill 2201 (Parker, R-Northfield) to include a provision to protect access to antiretroviral drugs for Medicaid recipients who need them. Since the beginning of the year, the Illinois Department of Public Aid (IDPA) has expanded the number and classes of medications that it must approve before authorizing payment from Medicaid. If a drug requires prior approval, the prescribing physician or pharmacist must seek IDPA payment authorization to determine if Medicaid will cover the cost of the drug. In order to discourage any future attempt to establish prior authorization for HIV medications, State Senator Steve Rauschenberger (R-Elgin) and State Representative Barbara Flynn Currie (D-Chicago) amended SB 2201 to require IDPA to conduct a study on the impact of the proposed regulation and report findings to the General Assembly before establishing prior authorization requirement for HIV medications.

Pharmaceutical Access: House Bill 4000, (Franks, D-Woodstock) which limited Medicaid recipients to four brand-name drugs each month, would have adversely affected access to HIV/AIDS medications. AFC opposed the bill until the sponsor added an amendment exempting "antiretrovirals and drugs used to treat HIV and AIDS and opportunistic infections related to HIV or AIDS." The bill died in committee.

Access to Information:

Internet Filters: The AIDS Foundation of Chicago joined with the Illinois Library Association and the American Civil Liberties Union to oppose House Bill 1215 and Senate Bill 698 that would have required public libraries to install internet filtering software on computers used by minors as a way block access to inappropriate websites. AFC opposes mandating the use of filters because studies have shown that the technology often blocks access to HIV prevention and other AIDS- and healthcare-related websites. While language requiring filters was inserted into the two bills, neither bill received final approval before the session ended.

Human Rights:

Human Rights Bill: House Bill 101 (McKeon, D-Chicago), commonly called the "gay rights" bill, would add sexual orientation to the classes of individuals protected from discrimination in employment, housing, access to financial credit, and access to public accommodation. The AIDS Foundation of Chicago joined our partners at Equality Illinois and the ACLU in supporting the bill, which passed the House but was never heard in the Senate.