AFC Testimony on Reauthorization of Ryan White CARE Act

House Energy and Commerce Committee
Ryan White Stakeholder Meeting
Wednesday, May 24, 2006
2322 Rayburn

Testimony from Jim Pickett, Director of Public Policy,
AIDS Foundation of Chicago

Thank you for the opportunity to comment on the bipartisan, bicameral Ryan White HIV/AIDS Modernization Act of 2006. I would like to start by thanking the staffs of the House Energy & Commerce Committee and the Senate HELP committee involved in the process for the incredible hard work and dedication that has been devoted to the reauthorization of the Ryan White CARE Act.

I am one of an estimated 42,000 people living with HIV/AIDS in Illinois, and I am lucky. I have my health, I am employed, and I have access to comprehensive health insurance. As we all know, many of my fellow citizens who are living with HIV/AIDS are not so lucky on all three counts. There are many who are battling HIV/AIDS-related illnesses that are unemployed and at the mercy of government-run programs for the critical care and treatment they need. Over a million people are now living with HIV/AIDS in the United States, and at least a quarter of them do not have regular access to care, treatment and essential supportive services. As the cornerstone of the domestic response to the HIV/AIDS epidemic, the Ryan White CARE Act has been, and continues to be, charged with being the payer of last resort and providing high quality, lifesaving services for the poor, the uninsured and underinsured. I would like to cover three things: the proxy, the hold harmless provision, and “core medical services” and associated waiver.

The legislation calls for a .9 proxy to be available to states that have recently adopted name-based HIV reporting or that have agreed to begin HIV reporting by October 1, 2006 but that do not yet have established surveillance systems. Since Illinois began reporting HIV cases by name in January 2006, we are eligible for the proxy and are thankful that one has been created. The AIDS Foundation of Chicago (AFC) strongly supports the .9 proxy, and would oppose a lower percentage being used. The funding reductions that would occur in Illinois with a proxy below .9 would destabilize our systems of care and hurt people living with HIV/AIDS across the state.

AFC understands the bill is trying to address the changes in the domestic epidemic without disrupting existing systems of care. This is a difficult task in the face of inadequate funding. With more people than ever living with HIV/AIDS in this country, and with a minimum of 40,000 new infections occurring every year, the demand for care, treatment and essential supportive services has never been greater. Eighty percent of the Illinois epidemic is concentrated in Chicago’s eligible metropolitan area, and initial data runs by congressional staff and advocates from AFC – though not certified – would indicate that the new funding formula for Title 1 grantees will result in a substantial cut to Chicago for fiscal year 2007. This reduction could very well be greater than 10% compared to FY06. Therefore, AFC asks you to take another look at the recommendations for the hold harmless provision in the new legislation. Currently, the hold harmless provision only applies to the base funding and not the supplemental. AFC suggests that the hold harmless provision needs to be calculated on both the base and the supplemental and that it be maintained for four years at the percentages of 90, 85, 80, and 75. These changes will help to ensure the stability of existing systems of care during the transition to the new funding criteria.

AFC’s final comments are focused on “Core Medical Services” and the waiver. AFC strongly supports continued jurisdictional level flexibility and accountability to determine the appropriate mix of HIV health care and supportive services, taking into account the local assessment of unmet and continuing needs and the availability of other resources. I believe the core services section should be entitled “Core HIV Services” and be reflective of HRSA/HAB’s current definition of core services. In order to ensure that people living with HIV/AIDS have the support they need to access care and services, the definition of core HIV services must include a definition of “case management” that is not be limited to medical case management. It is crucial that substance abuse treatment not be limited to outpatient treatment, as inpatient, residential substance abuse treatment is by far the best and most effective treatment modality for many substance abusers with HIV/AIDS. AFC also recommends the addition of nutritional counseling to the array of core HIV services. Finally, I would like to speak to the provision of the waiver from the 75/25 requirement that shall be granted by the Secretary. The waiver requirement that indicates a jurisdiction must reasonably assert and certify that core medical services are “available to all individuals infected with HIV/AIDS” is impossible to satisfy. The CARE Act is not intended to serve all people living with HIV/AIDS. It is the payer of last resort for the poor and the uninsured/underinsured. For purposes of satisfying the waiver requirement, proving that core services are available for all CARE Act eligible people living with HIV/AIDS is more reasonable and appropriate. For example, each grantee could survey/assess if there were any waiting lists for CARE Act funded core services within their jurisdiction. This would also parallel the ADAP requirement in this section.

Thank you for your serious consideration of these recommendations.