AFC Urges Governor, General Assembly to Reverse Decision in the Interest of Public Health

On April 15, the Illinois Department of Public Health (IDPH) announced plans to restrict access to the AIDS Drug Assistance Program (ADAP) to new applicants with incomes at or below 300 percent of the federal poverty level ($32,670 for a single individual) beginning in July.  The current limit to qualify for Illinois ADAP is 500 percent of federal poverty ($54,450 for a single individual).

“This is a sad day for the fight against HIV/AIDS in Illinois,” said David Ernesto Munar, President/CEO of the AIDS Foundation of Chicago (AFC).  “The new policy will keep ADAP out-of-reach for hundreds of individuals who have nowhere else to turn for help.  Many will simply forgo treatment, at great risk to themselves and their partners.”

 

Jointly funded by the federal and state governments, ADAP provides HIV medications each month to more than 4,200 Illinoisans who have no other means to afford their lifesaving medications, which can cost $18,000 or more per year.

All current program recipients, including those with incomes between 300-500 percent of poverty, will continue to receive ADAP services, provided they meet other eligibility criteria and reapply for the program every six months.  Stemming spiraling costs that threaten continuity of care for existing program clients motivated the changes, state officials said. 

The announcement comes on the heels of two years of financial pressure on the program.  Record numbers of people with HIV became eligible and joined ADAP as a result of the economic downturn, high unemployment, and losses of private health insurance.  Illinois has struggled to keep its program solvent in the face of inadequate federal funding.  Nationally, nearly 8,000 people with HIV in 11 states are on ADAP waiting lists.

In 2009, Gov. Quinn redirected an additional $7 million, including portions of the state’s HIV prevention, housing and care budgets, toward ADAP to avoid financial collapse.  With pressure from state lawmakers to achieve even greater savings in government services to close the historic budget gap, public health officials forecast a $1.8 million shortfall for ADAP in 2012 without cost-containment measures.  In addition, Illinois received nearly $5 million this year in one-time supplemental federal funding because the state’s caseload grew so significantly.   However, slower growth to date means Illinois may not receive this funding  next year.

“We’re fully committed to continuing to work closely with the General Assembly, Governor Quinn, IDPH, and federal lawmakers to identify additional funds that will allow unrestricted ADAP access for Illinoisans who desperately need HIV medications to survive and thrive,” said John Peller, AFC Vice President of Policy.

While unsupportive of the service reductions, AFC recognizes that absent additional state and federal funding, ADAP officials were left with few options to safeguard services for existing ADAP clients.   
However, one aspect of the cost-cutting plan that is particularly concerning to AFC is the decision to redefine eligibility criteria rather than institute a waiting list. 

“No one wants to see an ADAP wait list in Illinois but if service cuts are unavoidable, a waiting list is preferred to new eligibility criteria,” Munar said.  “A waiting list keeps alive hope that the program can be stabilized and that full access can be restored.  In addition, a wait list allows the state to closely monitor the health of those denied medications and affords these individuals greater opportunities to seek assistance directly from pharmaceutical companies.  A wait list could also make Illinois eligible for emergency federal funding assistance.  Finally, the wait list becomes a powerful reminder to public officials about the persistent, unmet needs for HIV medication access.”

Based on past enrollment data, the new eligibility criteria will likely affect 100 or more individuals annually who might otherwise become eligible for ADAP.  Many clients in this income bracket are working but uninsured and unable to afford the high cost of HIV medications without assistance. IDPH expects the change in eligibility to save $1.3 million, or just under 3 percent of program costs.

“Denying access to HIV medications will cost taxpayers in the long-run,” Munar noted. “Without medication access, HIV-positive people are at high risk of dangerous opportunistic infections, costly hospital stays, and irreversible damage to their health.  Just as important, HIV-positive people can dramatically reduce chances of transmitting the virus to others by adhering to a regular medication treatment.  Illinois might save $1.3 million now, but the state will likely foot the bill later in increased hospital care and more cases of HIV transmission.” 

As part of a responsible budget response, AFC urges Illinois officials to consider creative solutions, such as pursuing a waiver application with the federal government to expand Medicaid coverage for non-disabled low-income people with HIV.  The Obama Administration directed the federal Medicaid program to create a streamlined application process for expanded HIV care as part of the National HIV/AIDS Strategy.  Illinois should explore this option as a way to match its state HIV investments with federal Medicaid funds.  Doing so will effectively decrease the need for ADAP.

In addition, AFC urges the Illinois House to abandon its artificially low revenue estimate for the next state fiscal year. This overly conservative estimate will force $1.3 billion in needless funding cuts to vital programs such as ADAP.  The General Assembly and Governor Quinn should also consider other measures to prevent loss of state revenue, such as requiring businesses to follow current depreciation rules instead of newly enacted federal rules.  This change would retain several hundred million dollars in state revenue that would otherwise be lost. 

For more information on ADAP, visit www.aidschicago.org/adap. View the April 15 IDPH memo.

 

Improve HIV/AIDS Outcomes in the FY 12 State Budget:
Tie Budgeting for Outcomesto the National HIV/AIDS Strategy,
Overhaul Grantmaking, and Sustain Public Health Programs for Former Inmates with HIV

Testimony presented by John Peller, Director of Government Relations, AIDS Foundation of Chicago
Before the Illinois House Human Services Appropriations Committee, March 21, 2011

Thank you for your long history of support for HIV prevention and care services in Illinois.  We know Illinois faces yet another difficult budget year, and you have new and unprecedented duties to allocate funding among equally deserving programs for disadvantaged populations.  We appreciate our long partnership with the legislature, the Illinois Department of Public Health (IDPH), and administration to improve HIV care and prevention outcomes.  Today, we will provide recommendations for the FY 2012 state budget and discuss one of the subjects of the hearing, the intersection between corrections and HIV programs.

 

I. FY 2012 STATE BUDGET RECOMMENDATIONS. 

The AIDS Foundation of Chicago (AFC) has two recommendations for the FY 2012 state budget.  They are to adopt National HIV/AIDS Strategy goals for Budgeting for Outcomes, the state’s new outcome-oriented process for determining what programs should be funded next fiscal year.  Second, the state should overhaul the IDPH grant-making process.

HIV prevention and care programs are cost-effective: We’re here to testify about IDPH HIV programs that literally keep people with HIV alive and save the state millions of dollars annually by preventing new HIV cases. Today, there are an estimated 46,000 people living with HIV in Illinois, and about 1,500 people are newly reported as diagnosed with HIV each year.  The lifetime cost of treating a person with HIV is estimated to be over $300,000 for medical care alone.  It will cost $450 million over the coming decades to provide lifetime medical care for people diagnosed with HIV this year alone, and another $450 million for people diagnosed next year, and so on.  Because HIV disproportionately affects low-income people, the majority of these costs will be borne by the state. 

Governor Quinn proposed an 11% or $3.5 million reduction in state HIV funding for FY 12.  The Governor would reduce funding from $30.88 million in FY 11 to $27.34 million in FY 12.  He also proposed consolidating four HIV-related budget lines into one.  We do not support a funding reduction for HIV services, and are wary of a move to consolidate budget lines.  Funding reductions to essential HIV prevention and care services will likely increase new HIV cases, worsen health outcomes, and escalate state HIV treatment costs.

The proposal to merge four budgetary line items into one raises transparency questions. What is the commitment to each of four worthy activities—the AIDS Drug Assistance Program (ADAP) and HIV prevention; HIV/AIDS hotline; HIV correctional projects; and HIV services for hard-hit minority communities—that would be lumped into a single appropriations category?  Without greater clarity of the actual funding amount that would be allocated for each of these important activities, we cannot at this time support this consolidation, which risks diminishing accountability and transparency.

Despite the state’s ongoing fiscal crisis, it would not be for Illinois to reduce funding for programs that save lives and money.  HIV programs work by slowing the spread of a communicable disease that remains incurable and costly to treat. 

RECOMMENDATION 1: Adopt National HIV/AIDS Strategy goals for Budgeting for Outcomes.  In weighing your decisions about HIV-related appropriations, please take into consideration the National HIV/AIDS Strategy, which President Obama released last year to improve outcomes and results in the U.S. fight against HIV/AIDS.  The federal HIV/AIDS Strategy compliments the state’s new Budgeting for Outcomes process, which requires the state to make budgeting decisions based on progress towards achieving goals.  We urge you to ensure that all state budget decisions are made with the Strategy in mind to allocate funding more rationally and effectively.  The HIV/AIDS Section within IDPH has started a community process to implement the Strategy in Illinois, and we look forward to continuing to participate in the process.

The Strategy has three goals that should be adopted for Budgeting for Outcomes:  reduce new infections, engage people with HIV in medical care, and reduce health disparities.  Illinois should leverage the Strategy in making budget decisions that follow three of the Strategy’s recommendations:

1. Improve outcomes: To improve outcomes, IDPH should benchmark current outcomes, set targets, and measure progress towards achieving those targets.  Improving outcomes also requires reallocating funding toward efforts that will yield the greatest results.  For example, HIV testing programs that reported the highest levels of new cases of diagnosed HIV might be prioritized for funding over other programs with fewer results.

2. Better target funds to populations at greatest risk: IDPH should ensure funds reach populations at greatest risk of contracting HIV or of dropping out of care, starting by benchmarking what groups are receiving interventions now.  This should be done for all HIV funding sources across state government. Effective interventions for gay men and men who have sex with men of all races, and particularly young African Americans and Latinos, should receive a renewed focus.

3. Improve coordination: The state should improve coordination of HIV programs within IDPH, between levels of government, and in the community.  IDPH should improve transparency and accountability for its scarce HIV investments.  

Maintaining support for the AIDS Drug Assistance Program (ADAP) is a critical element of implementing the national Strategy in Illinois and achieving Budgeting for Outcomes results.  ADAP is unquestionably one of the state’s most effective and cost-effective programs.  ADAP:

• Reduces long-term medical care costs by promoting early intervention and treatment.  While it costs $30,000 or more per year to treat someone in the late stages of HIV disease, early treatment can cost half as much per year. 

• Fosters independence by keeping people with HIV healthy enough to work, increasing their dignity, and allowing them to be productive members of society. 

• Prevents new HIV cases.  People receiving HIV treatment have lower levels of the virus in their bodies, and are as a result significantly less likely to transmit HIV.  In fact, research indicates that there is near-zero likelihood of transmission for an individual who is successfully treated for HIV.

ADAP has achieved $2-$3 million in efficiencies that will slow the growth in the program. IDPH released in January 2011 information indicating that ADAP may need an additional $6 million in state funding next fiscal year.

RECOMMENDATION 2: Overhaul the IDPH grant-making process.  IDPH will save money and improve outcomes by overhauling the department’s grant-making process.  For example, many community-based organizations, including ours, do not yet have executed grant agreements for the current fiscal year—which ends in three months.  IDPH has delegated to community-based agencies the responsibility for providing services, but the survival of these organizations is threatened by the delays in grant agreements.  The IDPH grant agreement process is deeply flawed and must be fixed.  We call on IDPH to immediately release a request for proposals for FY 2012 as a first step to improve the process.

II. THE INTERSECTION BETWEEN CORRECTIONS AND PUBLIC HEALTH PROGRAMS

The second topic of this hearing is the intersection between corrections and human service programs. I want to highlight a vital program that assists people with HIV returning to the community from prison or jail, but is jeopardized by consolidating budget lines and grant-making delays.  The HIV and Corrections Re-entry Project, funded by IDPH through the HIV and Corrections budget line proposed for consolidation, achieves the following outcomes:

• Reduces recidivism, saving the state over $1.1 million per year in prison costs: Just 15% of clients returned to prison or jail, compared to 50% in the regular population. 

• Reduces long-term medical care costs by promoting early intervention:  More than nine out of ten clients are successfully linked to specialized medical care with support from this program.  Because they are accessing HIV treatment, long-term health care costs related to an AIDS diagnosis are reduced.

• Prevents new HIV cases in the community:  In addition to primary medical care, former inmates with HIV receive housing, mental health and substance abuse treatment, education/training, employment assistance, supportive services, and HIV prevention education to stabilize their lives.  Intensive case management links clients to these services, which, combined with medical treatment, reduce significantly the likelihood that former inmates will transmit HIV to community members.

Unfortunately, this program’s successes have been jeopardized for three years in a row because IDPH is unable to award and execute grant agreements on a timely basis.  This year, three out of five intensive case managers were laid off because agencies could not pay their salaries with no guarantee of funding. New intake was halted.  Over forty clients—one in three—could not be located when the program finally resumed.

These delays increase costs for the state, increase new HIV cases, and worsen health outcomes for participants. 

III. CONCLUSION

We appreciate our long partnership with the legislature, IDPH, and the administration to improve HIV care and prevention outcomes.  We look forward to further discussing these recommendations with you. 

Contact: John Peller, Director of Government Relations, [email protected], (312) 719-6208.

Facing a grim fiscal environment despite the recent state tax increase, Illinois Governor Pat Quinn proposed February 16, 2011 a $26.9 billion state general fund budget for Fiscal Year 2012 that cuts state HIV programs by 11%.

The Governor’s proposal consolidates four separate Illinois Department of Public Health (IDPH) HIV funding accounts into one, and cuts overall state funding by $3.48 million.  The four funding accounts slated for consolidation are:
·         HIV and Corrections ($1.94 million)
·         Minority HIV/AIDS Prevention ($3.15 million)
·         HIV/AIDS hotline ($355,000)
·         AIDS Drug Assistance Program (ADAP) and other HIV programs: ($25,43 million)

Total HIV funding of $30.88 million in FY 11 would drop to $27.34 million in FY 12.  Budget documents released today do not outline how the $27.34 million would be allocated among the consolidated program areas, including the AIDS Drug Assistance Program.

 

 

While consolidating the HIV budget could streamline programs, result in more targeted and effective use of resources, and improve outcomes, the overall funding cut is cause for significant concern. In addition, it is unclear how consolidated funds would be used.

In July 2010, President Obama released the National HIV/AIDS Strategy, which establishes ambitious targets to reduce new HIV cases, link more people with HIV to medical care, and reduce health disparities.  Unquestionably, these targets will be even more difficult to reach with reduced state funding.

In coming weeks, the AIDS Foundation of Chicago (AFC) will assess the impact of proposed reductions on HIV services in Illinois, and is committed to restoring proposed funding cuts.  AFC will also examine the impact of the budget proposal on other program areas that help vulnerable populations, including housing and services for homeless individuals.  AFC’s 2011 Policy Priorities outline leading advocacy issues for the  year ahead.

AFC urges advocates to attend HIV/AIDS Lobby Days on March 1-2 in Springfield to tell legislators the impact proposed funding cuts will have on their lives.  Advocates can stay up to date on budget issues by subscribing to AFC’s Online Action Bulletin.

The 2011 Illinois state legislative session started with a whimper on Tues. Feb 8, when the Amtrak train carrying the AIDS Foundation of Chicagos’ crack Springfield lobbyist, John Peller, rolled into town two hours late.  Not to fear… six legislators were stuck on the train too, giving Peller extra time to advocate for their support for key HIV issues.  Although the House stayed in Springfield for just 24 hours, it was enough time to introduce a thousand or so new bills.  Peller provided an update today to state HIV advocates, and we’re sharing his presentation on the state of the state budget, possible AIDS Drug Assistance Program (ADAP) cuts, and bills that AFC is supporting and opposing.  Stay tuned for more information.  The legislative session starts for real the week of Feb 15.

Download the presentation.

There are two important changes to Illinois ADAP that will benefit people with HIV who get their medications from either private insurance or Medicare.  In addition, a third change may make it possible for people on ADAP to afford comprehensive health insurance under the new Illinois Pre-Existing Condition Insurance Plan. 

1.  More help with co-pays and premiums if you get your HIV medications through your insurance. ACTION NEEDED: If you have private insurance and earn less than $54,450 a year, consider applying for ADAP.

ADAP used to enroll only people whose private insurance required them to pay more than 20% of the cost of each prescription, or who had co-pays of more than $100.  ADAP will now enroll anyone with private insurance and pay your out-of-pocket costs, including any deductibles and co-pays. Note that your private plan must be able to coordinate with the ADAP pharmacy.  In addition, the insurance company cannot require prescriptions for more than a one-month supply of medication.  (ADAP will not a fill a three-month supply.)  In addition, you must meet the other ADAP eligibility requirements.

 

2. More help with co-pays and deductibles for people who get their HIV medications through a Part D Medicare Plan. ACTION NEEDED: If you have Medicare and your income is less than $54,450, consider applying for ADAP.  You can get help paying for your medications.

If you are on Medicare and your income is under $26,917, you are probably already getting help with your premiums and co-pays from either Social Security Extra Help or Illinois Cares Rx. Your Part D prescription drug premiums are being paid and you probably don’t spend more than about $6 for each HIV medication.  ADAP can now help you with these small co-pays too. Every dollar is probably important to you, so enroll in ADAP and get help with those co-pays.  

If you are on Medicare and your income is over $26,917, but under the ADAP limit of $54,450, you probably couldn’t afford your HIV medications last year, and got them from ADAP.  Effective January 1st, 2011, the Affordable Care Act (the 2010 health care reform bill) allows the money ADAP spends on your behalf on your HIV medications to count toward your out-of-pocket costs.  What does this mean to you? This year, you can get your HIV medications from your Medicare Part D plan all year, and ADAP will pay your out-of-pocket costs for HIV medications.  The money ADAP spends on your HIV medications will help you get out of the Part D “donut hole”.  ADAP will continue to help with your co-pays for HIV medications once you are in the “catastrophic” phase of the Part D program.  You only have to pay 5% toward your non-HIV medications.

One caution:  Some people on ADAP now never reach the donut hole for their non-HIV medications.  That means they are paying 20% of the costs of their non-HIV medications all year long.  With this change, they will reach the donut hole, and may have to pay 100% of the cost of their non-HIV drugs during the donut hole period. 

As with private insurance plans, your Medicare Part D plan must coordinate with the ADAP pharmacy in order for you to be able to take advantage of these changes. 

3. New Health Insurance Option for People on ADAP.

Have you been without insurance for six months or more?  (ADAP or free medical care from a Ryan White clinic doesn’t count).  If so, you may be eligible for the new Illinois Pre-Existing Insurance Plan (IPXP).

Another change that health care reform has already brought to Illinois is the establishment of a new insurance plan for people who are uninsured and unable to buy insurance on the private market.  Premiums for this new policy range from $135 to $653 per month, depending on your age, where you live, and whether you are a smoker. Illinois CHIC will pay up to $500 toward your premiums and Illinois ADAP will also help with your co-pays and deductibles for your HIV medication. This is a tremendous opportunity for people on CHIC and ADAP to obtain comprehensive health insurance.  More information is available here.

If you have questions, call Illinois ADAP at 800-825-3518 or visit the ADAP website. Note that as of February 7, the criteria listed on the ADAP application and website does not reflect the policies above, announced at a January 21, 2011 meeting of the ADAP Medical Issues Advisory Board.

Yes, it’s complicated!  You can also get more information about any of these changes from the AIDS Legal Council of Chicago.  Call toll-free from anywhere in Illinois, 866-506-3038.

 

Hundreds of individuals living with HIV/AIDS in Chicago will now receive local, high-quality care, thanks to a new grant awarded to the AIDS Foundation of Chicago (AFC) by AIDS United. The grant to AFC is one of 10 awards granted to communities across the country by AIDS United to support its Access to Care (A2C) initiative. The awards are all supported by a federal grant to AIDS United from the Social Innovation Fund (SIF) to improve the lives of people living with HIV/AIDS.

The grant to AFC from AIDS United will support the development of a new outreach and support service network called Connect2Care, which will help people living with diagnosed HIV/AIDS (PLWHA), and particularly PLWHA of color, connect or reconnect to continuous HIV medical care and other essential services. AFC will partner with four experienced HIV/AIDS organizations—including Chicago House, Michael Reese Research and Education Foundation, South Side Help Center, and Vital Bridges—to establish regional C2C hubs that will conduct outreach and networking activities targeting PLWHA who are not engaged in HIV care to create seamless systems from HIV diagnosis to care.

Each hub will work with medical and support service providers on Chicago’s north, west, near south, and far south sides. In addition to outreach and linking clients to medical care and support services, case-finding and linkage activities, AFC will work with the hubs, the Midwest Training and Education Center, and medical and social service providers across Chicago to develop systems that immediately link PLWHA who are out of care or inconsistent in care to coordinated systems of HIV medical care, education, and supportive services in their region.

HIV/AIDS continues to disproportionately affect men and women of color in Chicago, including African-American and Latino gay men and other men who have sex with men (MSM). According to the Illinois Department of Public Health, there were 24,847 people living with HIV/AIDS in the Chicago area at the end of 2007, not including unreported cases, which are estimated at approximately 7,000, based on projections by the U.S. Centers for Disease Control and Prevention. There are more than 600,000 people living with HIV/AIDS in the United States that are not receiving the life-saving care they need.

“AIDS United is proud to be supporting the work of the AIDS Foundation of Chicago and its community collaborators with this SIF grant,” said Mark Ishaug, AIDS United President and CEO.  “In addition to developing innovative ways to help get people living with HIV in Chicago into the care they need, the AIDS Foundation of Chicago’s commitment to matching its grant from AIDS United with resources from the local private sector will significantly increase the funding available for critical access to care activities for Chicago’s populations most impacted by the epidemic.” 

The Social Innovation Fund targets millions of public-private dollars to expand effective solutions across three issue areas: economic opportunity, healthy futures and youth development and school support.  AIDS United’s recent $3.6 million SIF award is in support of the “healthy futures” issue area, and requires a 2:1 match from the private sector to create a funding pool of more than $10 million annually. The funding pool will aim enhance the health and welfare of people living with HIV/AIDS through interventions like the one being developed by  the AIDS Foundation of Chicago and its community collaborators that work to increase access to life-saving HIV care and treatment.

“By advancing innovative client services and working closely with medical and social service providers, we hope to transform Chicago’s HIV service landscape to meet clients’ needs and preferences, and support early and continuous care engagement,” said David Ernesto Munar, AFC President/CEO. “According to the Chicago Department of Public Health, nearly 50% of all PLWHA in Chicago are not receiving the HIV care they need. Our grant from AIDS United and the Social Innovation Fund will give us the capacity to help these individuals get the life-saving support they need.”  

For more information about the A2C Initiative, visit:  www.aidsunited.org/community-impact/access-to-care-a2c.

CHICAGO (October 14, 2010)– HIV advocates breathed a sigh of relief on October 13 when Chicago Mayor Richard M. Daley released a 2011 city budget plan that preserves HIV funding and largely maintains city support for the Chicago Department of Public Health (CDPH).

The 2011 budget is the last one that Mayor Daley will present.  He announced on October 13, 2010, that he would step down after running the city for 21 years.

Mayor Daley recommended that HIV funding remain level at $4.3 million.  Last year, HIV funding was cut by $175,000.  City funding is largely used for HIV prevention programs and supplies, housing services, and awareness activities.  

Overall proposed city funding for CDPH was reduced by just 0.2%, from $33.87 million in 2010 to $33.80 million in 2011, and five positions will be eliminated.

Mayor Daley proposed to close the city’s $654 million budget deficit by tapping reserve funds.  The proposed budget avoids massive job and service cuts that would have otherwise resulted.

The Chicago City Council will hold hearings on each agency’s budget over the next several weeks. The CDPH hearing is scheduled for Thursday, October 21.  City Council is expected to approve on the 2011 budget in November.

AFC will lobby City Council members to appropriate the highest funding amounts possible for public health programs, including HIV services.  

Read Mayor Daley’s budget press release.

 

View the city budget proposal:
2011 Budget Overview and Revenue Estimates (PDF)
2011 Mayoral Budget Recommendations (CDPH section begins on p. 145)
2011 Program and Budget Summary (CDPH section begins on p. 105 of the PDF)
2011 Draft Action Plan (Details spending plans for Housing Opportunity for People with AIDS (HOPWA) spending plans and other HUD funding, PDF)
2011 Preliminary Budget Estimates (PDF)