Download Ensuring Necessary Funding for Ending AIDS In the United States

The AIDS Institute
Federal and State Update
Florida Patient Care Planning Group
April 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)
FY 2012 Appropriations - Select HIV/AIDS Programs
(In Millions)
HOPWA
Program
$332 m
CDC - HIV
Prevention
$786 m
Ryan White
Program
$2,392 m
NIH - AIDS
Research
$3,060 m
Budget Sequestration
NIH: 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 lowincome, 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
Ryan White HIV/AIDS Program Appropriations History
(In Millions)
$2,500
Total FY12 funding of $2.392 billion
$2,000
Funding
$1,500
$1,000
$500
$0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
FY 2012 Appropriations - Ryan White Program
(In Millions)
Dental
$14 m
SPNS
$25 m
AETCs
$35 m
Part D
$77 m
Part A
$671 m
Part C
$215 m
ADAP
$933 m
Part B Care
$422 m
Total = $2.392 b
Ryan White Program Appropriations
History 1991-2012
$900
$800
$700
$600
Part A
Part B Base
ADAP
Part C
Part D
Dental Reimb.
AETCs
Millions
$500
$400
$300
$200
$100
$0
Source: HRSA HIV/AIDS Bureau; The AIDS Institute
Ryan White Program
FY12: $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
Ryan White Program FY14
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 in the Future
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 & B
Collapse Parts C & D
Impact of Sequestration
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.”
5.1% cut = $122 million
NIH AIDS Research
• New Drug Development
• Behavioral Research
• Treatment as Prevention
• Vaccine
• Basic Science
• Cure
• Microbicides
NIH AIDS Research
FY12: $3.06 billion (Flat)
FY14 Community Request: $3.6 billion (+$540 million)
5.1% cut = $156 million
Housing Opportunities
for 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 Opportunities
for People with AIDS
FY12: $332 million (-$2.3 million)
FY14 Community Request: $365 million (+$33 million)
Impact of Sequestration
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.”
5.1% cut = $17 million
HIV/AIDS Programs & the Budget
•
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
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.
Florida 2013 Legislative Session
 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.
Florida 2013 Legislative Session
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 520
Emergency Medical Services: Deletes requirement that
EMTs, paramedics, & 911 public safety telecommunicators
complete course on HIV & AIDS.
Florida 2013 Legislative Session
HB 735 | SB 808
Needle 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.
Florida 2013 Legislative Session
HB 1003
Prescription Drug Benefit Plans: Creates specialty tier
prescription drug moratorium & study; requires report to
Governor & Legislature.
SB 1010
Health 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.
Florida 2013 Legislative Session
HB 1139 | SB 1250
Medical Cannabis: Authorizes qualifying patient to
possess & administer medical cannabis.
HB 1255 | SB 1328
Testing 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.
Florida 2013 Legislative Session
SB 7038 | SB 1816 Healthy Florida – Senator Negron’s Alternative to
Medicaid Expansion
Revising 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 Expansion
SB 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.
Affordable Care Act Implementation
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
Affordable Care Act Implementation
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.
http://www.flsenate.gov/Session/Bill/2013/7144/BillText/Filed/PDF
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 Ruppal
[email protected]