the aids institute federal and state update florida patient care planning group april 3, 2013

The AIDS InstituteFederal and State Update

Florida Patient Care Planning GroupApril 3, 2013

Michael Ruppal, Executive Director

Budget Sequestration• 5% cuts for Sequestration• Spending plans due in 30 days• Partial awards issues to grantees• FY12: $3.06 billion • FY13: Continuing Resolution through 9/30/13

• ADAP - $35 million from President not included

• FY14 Community Request: $3.6 billion • (+$540 million)

NIH - AIDS Research $3,060 m

Ryan White Program $2,392 m

CDC - HIV Prevention

$786 m

HOPWA Program $332 m

FY 2012 Appropriations - Select HIV/AIDS Programs

(In Millions)

Budget SequestrationNIH: Loss of $157 million in AIDS research funding

297 AIDS research grants would go unfunded, including 32 specifically funding AIDS vaccine research

CDC: Loss of $163 million in AIDS research funding; 297 AIDS research grants would go unfunded

ADAP: 10,000 PLWHAs will lose access

HOPWA: 1,360 fewer households would receive permanent housing, and 1,870 fewer households would receive short-term assistance to prevent homelessness

Source: amFAR and NMAC, 2-20-13

Impact of Sequestration on CDC

HHS Secretary Letter to Senate Appropriations on impacts of Sequestration:

“Sequestration would impair the Department's ability to prevent and treat HIV/AIDS. The cuts to the Centers for Disease Control and Prevention (CDC) translate into approximately 424,000 fewer HIV tests conducted by CDC's health department grantees.”

5.1% cut = $40 million

Ryan White Program• Provides Care, Treatment & Support Services to

546,000 low-income, uninsured and underinsured individuals with HIV/AIDS

• Many people with HIV not insured• Many do not qualify for Medicaid & Medicare; if

they do those programs not always adequate• Funding distributed to States and Large Cities by

formula and Clinics through competitive grants• First authorized in 1990; last authorized in

October 2009

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

$0

$500,000,000

$1,000,000,000

$1,500,000,000

$2,000,000,000

$2,500,000,000

Ryan White HIV/AIDS Program Appropriations History (In Millions)

Fund

ing

Total FY12 funding of $2.392 bil-lion

Part A$671 m

Part B Care$422 m

ADAP$933 m

Part C$215 m

Part D$77 m

AETCs$35 m

Dental$14 m

SPNS $25 m

FY 2012 Appropriations - Ryan White Program

(In Millions)

Total = $2.392 b

Ryan White Program Appropriations History 1991-

2012

$0$100

$200

$300

$400

$500

$600$700

$800

$900

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Milli

ons

Part APart B BaseADAPPart CPart D

Dental Reimb.AETCs

2007

Source: HRSA HIV/AIDS Bureau; The AIDS Institute

200820

092010

2011

2012

Ryan White ProgramFY12: $2.342 billion

• +$13 million to ADAP• All other Parts: Small Across the Board Cuts• Plus World AIDS Day Emergency Funding by

President Obama:• ADAP: +$35 million • Part C: +$15 million

Community Request: • 10% increase for all Parts, except ADAP (+$133

m)• ADAP Enrollment Grew by 13,500 in 2012 or 8%• ACA Coverage begins Jan. 1, 2014

• Fiscal Year begins Oct. 1, 2013• Enrollment will take time• All States Not Expanding Medicaid

Ryan White Program FY14

Ryan White Program Expires (not Sunset) 9/30/13

Funding will still be necessary• 70% of Ryan White clients currently have some

coverage, but it is not adequate and Ryan White services will continue for them

• ACA benefits will not be complete & differ from state to state

• Ryan White can assist with premiums, co-pays, deductibles

• 29 million will still be uninsured• Coverage does not equal access & adherence

Need time and analysis before any changes made

Ryan White Program in the Future

Kaiser (Crowley / Kates) Paper on Ryan White

Collapse Parts A & BCollapse Parts C & D

Ryan White Program in the Future

HHS Letter to Senate Appropriations on Impacts of Sequestration:

“Sequestration would impair the Department's ability to prevent and treat HIV/AIDS…The Health Resources and Services Administration estimates that 7,400 fewer patients would have access to life-saving HIV medications through the AIDS Drug Assistance Program (ADAP). This would cause delays in service and drug provision to people living with HIV and potentially lead to ADAP wait lists for HIV medications.”


Impact of Sequestration

NIH AIDS Research

• New Drug Development

• Treatment as Prevention

• Basic Science

• Microbicides

• Behavioral Research

• Vaccine

• Cure

NIH AIDS ResearchFY12: $3.06 billion (Flat)

FY14 Community Request: $3.6 billion (+$540 million)


Housing Opportunitiesfor People with AIDS

• Administered by HUD

• Provides Housing Assistance to over 63,000 households

• Distributed by formula to 138 Jurisdictions

• An additional 147,000 households eligible for HOPWA

Housing Opportunitiesfor People with AIDS

FY12: $332 million (-$2.3 million)

FY14 Community Request: $365 million (+$33 million)

Secretary Donovan Testimony to Senate Appropriations:

“Not only HOPWA (7,300 households will lose assistance) but 125,000 housing choice voucherholders, ½ of whom are disabled or elderly, will lose assistance and 100,000 homeless or formerly homeless will lose support and risk return to homelessness. The cuts to these programs as well can’t be good for people with HIV/AIDS.”


Impact of Sequestration

• Despite significant overall budget cuts, so far HIV programs have been mostly spared

• Domestic HIV programs have been a priority for Obama Administration & many in the Congress

• At current spending levels, we can not realize our goals anytime soon

• Decisions now will determine the future of HIV/AIDS

• President’s budget April 10, 2013

HIV/AIDS Programs & the Budget

Florida 2013 Legislative Session

The Florida House and Senate released their proposed budgets, which are headed to the full appropriations committees on Wednesday, April 3.

There is a sense of optimism that has not

been felt in recent years with some modest increases this year.

House proposes to allocate about $31.3 billion on health and human services spending.

Senate would spend nearly $30.8 billion, with Medicaid being the largest budget item in HHS.


House budget includes about $20.4 million in anticipation that the Affordable Care Act will lead to more people enrolling in Medicaid who are already eligible but not enrolled.

Anticipated increase in Medicaid enrollment as the ACA is fully implemented in 2014.


HB 365 |SB 732 Prescription Drugs; Authorizing a pharmacist to substitute a biosimilar product for a prescribed product if certain requirements are met, etc. HB 195 | SB 520Emergency Medical Services: Deletes requirement that EMTs, paramedics, & 911 public safety telecommunicators complete course on HIV & AIDS.


HB 735 | SB 808Needle and Syringe Exchange Program: Authorizes DOH to establish needle & syringe exchange program. HB 735 was amended in the Health Quality Subcommittee and is now limited to a pilot project in Miami-Dade County.


HB 1003 Prescription Drug Benefit Plans: Creates specialty tier prescription drug moratorium & study; requires report to Governor & Legislature. SB 1010Health Insurance Coverage for Prescription Drugs; Prohibiting higher copayments, deductibles, coinsurance, or similar charges for nonpreferred prescription drugs as compared to preferred prescription drugs; requiring the Agency for Health Care Administration, with the assistance of the Office of Insurance Regulation, to conduct a study and submit a report to the Governor and Legislature.


HB 1139 | SB 1250Medical Cannabis: Authorizes qualifying patient to possess & administer medical cannabis. HB 1255 | SB 1328Testing for Human Immunodeficiency Virus: Provides that informed consent to perform HIV test must be obtained from legal guardian or other person authorized by law for certain persons; revises situations in which test results may be released.


SB 7038 | SB 1816 Healthy Florida – Senator Negron’s Alternative to Medicaid ExpansionRevising the components of the Florida Kidcare program; revising the eligibility of the Medikids program component. SB 7144 (aka “The Bean Alternative)Health Choice Plus Program; Authorizing the Florida Health Choices, Inc., to accept funds from various sources to deposit into health benefits accounts, subsidize the costs of coverage, and administer and support the program; requiring the corporation to manage the health benefits accounts and provide the marketplace of options that an enrollee in the program may use; specifying healthy living performance goals; providing for payment for achieving health living performance goals, etc.

Affordable Care Act Implementation

Healthy Florida – Senator Negron’s Alternative to Medicaid ExpansionSB 7038 (a proposed committee bill) became SB 1816 by the Senate Appropriations Committee would create a system for newly eligible Medicaid recipients up to 138% PFL under the Florida Healthy Kids Corporation, not the Agency for Health Care Administration, with the ability to draw down the 100% federal match for the first three years. The plan would include modest co-pays and incentive accounts for healthy behaviors. The House, on the other hand, has repeatedly stated that it will not accept federal funds and will not expand Medicaid.


SB 1816 http://www.flsenate.gov/Session/Bill/2013/1816/BillText/Filed/PDF Use Medicaid dollars to extend private health-insurance to 1 million

individuals/families Up to 138 percent of the federal poverty line

$15,000 for an individual $26,000 for a family of three

Coverage would be contracted through Florida Healthy Kids, a state plan that now provides subsidized private coverage for about 250,000 low-income children.

Would have to offer "benchmark" benefits, including preventive care such as;

Yearly physicals Emergency care Maternity care Mental health Substance abuse treatment It would not include preventive dental care

http://www.flsenate.gov/Session/Bill/2013/1816/BillText/Filed/PDF


SB 7144 by Health Policy Relating to Health Care (aka “The Bean Alternative)This “Health Choice Plus” bill would expand Florida Healthy Choices, would not draw down federal funds, would subsidize premiums, and would apply to individuals up to 100% FPL.




Health and Human Services Budget

Appropriations Bills Released

ADAP: Total funding is identical in both the House and Senate bills. The proposal to roll $10 million achieved from drug rebates into the program is spending authority. AICP: Increase of $3.6 million in both the House and Senate bills.

Questions?Thank You

Michael [email protected]

the aids institute federal and state update florida patient care planning group april 3, 2013

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