AFC to Quinn: Expand Medicaid, implement AIDS Strategy to mitigate budget cuts

June 17, 2011

AFC on June 13, 2011 sent a letter to Illinois Governor Pat Quinn with recommendations on how to implement the state FY 2012 budget, which begins July 1.  The recommendations include implementing a Medicaid expansion for people with HIV and leveraging the National HIV/AIDS Strategy, and touch on issues related to expanding accountability and transparency for state-funded HIV programs.


June 13, 2011

The Honorable Pat Quinn
Governor, State of Illinois
100 W. Randolph, Suite 16-100
Chicago, IL  60601

Dear Governor Quinn:

Thank you for your staunch support of services and funding for the state’s most vulnerable citizens, including people with HIV.  Because of your support of the historic tax increase enacted in January, the state’s finances are far more secure than they otherwise would have been.  However, we recognize that FY 2012 will be an exceptionally difficult budget year, and you face agonizing decisions about programs to continue or cut. 

As you know, state-funded HIV services fared better than expected, but we remain extremely concerned about the potential impact on the lives and health of people with and at risk of HIV.  Overall Illinois Department of Public Health () state HIV funding was cut by $1.5 million or 5% from FY 11.  However, this funding reduction will be exacerbated by increased pressure on the AIDS Drug Assistance Program (ADAP).

To make long-term headway against the AIDS epidemic in the face of these budget challenges, we urge you to take immediate advantage of two new opportunities:


  • Consider applying for a Medicaid Section 1115 waiver to cover people with HIV before they are so sick that they become disabled.  On June 6, 2011, the released a streamlined waiver application and approval process to provide early treatment for people with HIV.  The waiver would allow Illinois to lower long-term health costs by providing early, more comprehensive treatment services for people with HIV; obtain increased federal matching funds for the state’s HIV Medicaid expenditures; and strengthen safety-net health providers by establishing a source of payment for undercompensated care.
  • Fully leverage the , which President Obama released a year ago, to reduce new HIV cases, improve health outcomes for people with HIV, and reduce health disparities.  We commend Dr. Mildred Williamson, Chief of the IDPH HIV/AIDS Section, for establishing a comprehensive process to gather community input and develop an implementation plan for Illinois.  However, we urge high-ranking members of your Administration to engage other state agencies in the planning process to fully coordinate the state’s fight against HIV.  Specifically, we ask you to convene at least two meetings of leaders of key state agencies in the late summer and fall of 2011 to review the draft plan and determine roles for their respective agencies.

State HIV portfolio recommendations: Although we oppose combining all HIV-related budgetary lines in IDPH into one lump sum, as happened in the final budget, we believe this provides IDPH an opportunity to establish new collaborations to maximize available resources.  The state’s AIDS response must consist of a comprehensive array of coordinated activities that directs services to hardest-hit communities with an array of evidence-based activities that yield maximum results.  We recommend that the state:

  • Publicly establish the percentages of state HIV funding that will be allocated to HIV prevention, care, and supportive services such as housing;
  • Publicly lay out the criteria and rationale upon which the funding allocation decisions are made;
  • Publicly describe targeted investments planned for hardest-hit communities with evidence-based interventions and accountability mechanisms to leverage these investments into population-level results;
  • Publicly and transparently publish expected outcomes for each domain, such as the number of high-risk people with HIV who will be identified as HIV positive and linked to care, and report on progress towards achieving those goals.

With declining available resources, the need for heightened transparency and accountability is greater than ever to engender confidence in the strategic investments made by the state to advance the fight against HIV/AIDS.

ADAP recommendations: Earlier this year, IDPH announced that eligibility for new ADAP enrollees would be reduced from 500% of the federal poverty level to 300%.   AFC remains staunchly opposed to this change but also recognizes the state’s fiscal challenges.  Inadequate federal funding unacceptably weakens the program.  We are committed to helping inform state decision-making and the community as Illinois faces these challenges.

SB 1802 will require IDPH to establish a waiting list for individuals who are unable to access ADAP services.  We urge IDPH to immediately establish this wait list when FPL is reduced for new applicants above the 300% FPL threshold and release on its website weekly the number of people on the waiting list.

Thanks to a creative collaboration between the Departments of Insurance and Public Health, Illinois can leverage the Illinois Pre-existing Condition Program (IPXP) to provide comprehensive benefits to people with HIV who have been denied ADAP coverage at a significantly lower cost.  While we applaud IDPH and DOI for coordinating IPXP and HIV programs, we urge the state to strongly consider setting a cap on the number of people for whom IDPH will provide assistance or providing only limited assistance.  We are concerned that additional resources will be diverted from HIV prevention and care programs that assist the most vulnerable clients.

Department of Human Services Programs:  Finally, AFC is deeply concerned about cuts to Department of Human Services homeless prevention (reduced by $915,000 or 38%) and emergency housing assistance funding (reduced by $4.38 million, or 52%).  These programs help people stay in their homes by assisting with rent, utilities, or other expenses.  Thousands of people around the state, including people with HIV, will face homelessness as a result of these budget cuts.  We urge you to closely monitor and track the impact of these funding reductions.

Thank you for your long-standing commitment to health care and social services that improve the lives of low-income people.  We look forward to further discussing the budget implementation issues mentioned here and others.  You can reach me at or (312) 334-0933.


David Ernesto Munar

CC:    Mr. Jerry Stermer
Dr. Damon Arnold
Dr. Tere Garate
State Sen. Heather Steans
State Rep. Sara Feigenholtz
State Rep. Greg Harris
State Rep. Camille Lilly

Categorized under Advocacy, Health insurance and Illinois.

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