 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
|
| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Lanny T. Cross, AIDS Institute/ADAP, New York State Department of Health, Empire Station, P.O. Box, Albany, NY 12220, 518-459-1641, ltc02@health.state.ny.us and Dana Pierce-Hedge, State of California, Department of Health Services, Office of AIDS, Sacramento, CA 94234-7320.
This paper discusses the multiplicity of factors that have contributed to the rapid growth in enrollment, utilization and expenditures in state operated AIDS Drug Assistance Programs (ADAP) and the policy decisions faced by states when growth outpaces available funding. ADAPs nationally are a major source of health care for the uninsured HIV+ population, providing access to lifesaving medications for more than 150,000 people living with HIV/AIDS at a cost of $1 billion annually. The fiscal stability of ADAP is highly influenced by the health care financing infrastructure in each state. The expansiveness of each state's Medicaid and their systems of private health insurance are significant variables in the determining the extent of the uninsured population that ADAP must serve. As neither entitlement program or health insurer, ADAPs lack the authority to generate or control revenue sources. ADAP administrators must therefore adjust the program parameters to shift individuals to entitlements or private insurance, and balance expenditures with revenues through cost containment. State ADAPs must grapple with the limited number of gateways available to ensure fiscal stability. These options fall under the general headings of revenue enhancement, enrollment, coverage and payment. The successful development of a plan for cost containment requires integration of program, clinical and ethical principles, as well as community education and involvement in the process. The experience of state ADAPs is especially relevant to the public health community in light of current federal proposals to change the status and structure of Medicaid.
Learning Objectives:
Keywords: HIV/AIDS, Access and Services
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: New York State Department of Health
AIDS Drug Assistance Program (ADAP)
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employed by NYSDOH