Julia Hidalgo, ScD, MSW, MPH and Wendy Warcholik-Moody, PhD. Positive Outcomes, Inc., 117 Jordan Taylor Lane, Harwood, MD 20776, (443) 203-0305, julia.hidalgo@positiveoutcomes.net

Background: The Ryan White CARE Act requires that grantees contribute to the cost of HIV care and CARE funds are used as the payer of last resort (PLR). State and local governments throughout the US report significant budget deficits. As a result, HIV services and other public programs report dramatic budget cuts.

Methods: Grantee data submitted to HRSA were used to assess trends in State and local government HIV care funding, including ADAPs. CARE grantees provided written comments and grantee focus groups were conducted. An econometric index identified metropolitan areas with the worst economic growth in the last four years. A representative sample of six metropolitan areas was selected for case study. Interviews of CARE grantees, other local officials, and care providers were conducted and secondary materials were reviewed in those areas.

Results: State and local government budget cuts and decreased Medicaid benefits resulted in decreased HIV funding in 2003. Concurrently, federal HIV care funds have not offset lost revenue and significant increases in new entrants into care. Reduced services are documented. HIV clinics report that Medicaid either does not fund many of their patients or cover clinic costs. Due to CARE’s PLR policy, clinics cannot balance their budgets with CARE funds and many report deficits. Other safety net programs have also received cuts and cannot absorb service demand.

Conclusions: In reauthorizing CARE in 2005, Congress must balance their interest in partnering with State and local governments with the growing inability of those funders to sustain investment in HIV infrastructure.

Learning Objectives: Based on the information gained from this session, participants will have an improved understanding of

• The growing fiscal crises among State and local governments.
• The impact of these crises on CARE Act grantees’ ability to comply with CARE Act matching fund, maintenance of effort, and payer of last resort requirements.
• The effect of significant reduction in State Medicaid eligibility and benefits on the fiscal solvency of HIV care providers.

Keywords: HIV/AIDS, Financing

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.