The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #72206

Alice M. Litwinowicz, MA, US DHHS, HIV/AIDS Bureau, Office of Policy and Program Development, HRSA, 5600 Fishers Lane, Parklawn Building, Room 7-18, Rockville, MD 20857, 301-443-5838, Alitwinowicz@hrsa.gov

The HIV/AIDS epidemic is growing among traditionally underserved and hard-to-reach populations. Medicaid prescription drug costs and enrollment growth continue to strain State budgets during an economic downturn. In 2003, States addressed budget woes by making dramatic cuts in their Medicaid programs, including restricting eligibility and limiting benefits. Since the Medicaid program pays for 50 percent of AIDS care, changes to the program threaten the care of persons living with HIV/AIDS (PLWHAs) and will place even greater strains on the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act programs. Budget difficulties are forcing States to limit their Ryan White AIDS Drug Assistance Programs (ADAP). Many States are putting people on waiting lists, tightening eligibility guidelines and reducing the number of drugs available to the underinsured. This paper will analyze how changes in the Medicaid program, which serves as the major health care safety net for PLWHAs, are challenging the CARE Act program, as the payer of last resort. It will summarize major cost control strategies, including managed care waivers as potential means to reduce Medicaid spending, explain the interaction of these two programs for PLWHAs and analyze the impact to the ADAP program, where many States supplement the CARE Act funds with their dollars. The findings will be examined in light of these converging trends - access to HIV treatment, optimum therapy, health care disparities, drug resistance, continuing advancements in AIDS treatment and continued numbers of persons infected with about 40,000 new cases of HIV occurring each year.

Learning Objectives:

At the conclusion of the session, the participant will be able to:
• Describe five types of Medicaid program changes due to budget shortfalls.
• Identify three ways the budget difficulties have impacted the CARE Act, including the ADAP program.
• Assess strategies for HIV care using both Medicaid and the Ryan White CARE Act program.

Keywords: HIV/AIDS,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.