Treatment Care Services Program Ryan White Part B

Treatment & Care Services Program: Ryan White Part B AIDS Drug Assistance Program (ADAP) Marcee W. Mortensen, MPH, CHES ADAP Administrator May 10, 2013

Overview Ryan White Part B Funding ADAP Q&A

Ryan White was an Indiana teenager with hemophilia who contracted AIDS through a blood transfusion. He courageously fought AIDS-related discrimination and helped educate the Nation about his disease. http: //hab. hrsa. gov/livinghistory/timeline/1990. htm Ryan White died on April 8, 1990, at the age of 18, just a few months before Congress passed the groundbreaking Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.

Ryan White Program The Ryan White Program works with cities, states, and local community-based organizations to provide HIV-related services to more than half a million people each year. The program is for those who do not have sufficient health care coverage or financial resources for coping with HIV disease. Ryan White fills gaps in care not covered by these other sources.

Ryan White Program HHS U. S. Department of Health & Human Services HRSA Health Resources & Services Administration HAB HIV/AIDS Bureau States / Cities First authorized in 1990, the Ryan White HIV/AIDS Program is currently funded at approximately $2. 29 billion. Federal funds are awarded to agencies located around the country, which in turn deliver care to eligible individuals under funding categories called Parts.

Funding Categories / Parts A provides emergency assistance to Eligible Metropolitan Areas and Transitional Grant Areas that are most severely affected by the HIV/AIDS epidemic. B provides grants to all 50 States, the District of Columbia, Puerto Rico, Guam, the U. S. Virgin Islands, and 5 U. S. Pacific Territories or Associated Jurisdictions. C provides comprehensive primary health care in an outpatient setting for people living with HIV disease. D provides family-centered care involving outpatient or ambulatory care for women, infants, children, and youth with HIV/AIDS. F provides funds for a variety of programs (The AIDS Education & Training Centers Program).

Ryan White Part B of the Ryan White HIV/AIDS Program provides grants to States and U. S. Territories. Part B grants include: • a base grant, • the AIDS Drug Assistance Program (ADAP) award, • ADAP supplemental grants, • grants to States for Emerging Communities, and • an award for Minority AIDS Initiative activities. Grantees are State departments of health or other State entities responsible for implementing and managing state public health programs.

Ryan White Part B • Base Part B grants are awarded to States and Territories using a formula based on reported living cases of HIV/AIDS. • Additional Part B funds are "earmarked" for State ADAPs, which primarily provide medications. • Fundable services include treatment adherence and support as well as health insurance coverage with prescription drug benefits.

Utah’s Funding History Ryan White Part B Allocations, Utah 1991 -2012 Year Base Award ADAP Earmark ADAP Supplemental 2012 $1, 709, 097 $2, 109, 900 $167, 151 2011 $1, 709, 161 $2, 066, 225 2010 $1, 709, 161 2009 Part B Supplemental ADAP Emergency Relief Emerging Communities Minority AIDS Initiative Total Award $38, 481 $931, 936 $0 $0 $4, 956, 565 $0 $26, 006 $931, 936 $0 $0 $4, 733, 328 $2, 020, 024 $308, 083 $50, 547 $724, 806 $0 $0 $4, 812, 621 $1, 707, 728 $2, 114, 540 $377, 648 $71, 736 - $0 $0 $4, 271, 652 2008 $1, 701, 451 $2, 109, 364 $474, 379 - - $0 $0 $4, 285, 194 2007 $1, 701, 451 $2, 114, 540 $459, 398 - - $0 $0 $4, 275, 389 2006 $1, 004, 896 $2, 225, 832 $94, 342 - - $0 $4, 463 $3, 329, 533 2005 $1, 313, 815 $2, 225, 184 - - - $0 $5, 111 $3, 544, 110 2004 $1, 074, 024 $1, 980, 565 - - - $173, 503 $7, 099 $3, 235, 191 2003 $1, 177, 932 $1, 904, 075 - - - $143, 952 $9, 232 $3, 235, 191 2002 $1, 198, 458 $1, 731, 432 - - - $171, 259 $10, 523 $3, 111, 672 2001 $1, 075, 695 $1, 548, 076 - - - $165, 141 $10, 071 $2, 788, 913 2000 $1, 057, 785 $1, 368, 976 - - - $2, 426, 761 1999 $946, 495 $1, 136, 619 - - - $2, 083, 114 1998 $858, 827 $684, 104 - - - $1, 542, 931 1997 $852, 251 $399, 273 - - - $1, 251, 524 1996 $691, 928 $118, 115 - - - $810, 043 1995 $428, 266 - - - $428, 266 1994 $511, 096 - - - $511, 096 1993 $304, 258 - - - $304, 258 1992 $329, 083 - - - $329, 083 1991 $146, 661 - - - $146, 661 *State of Utah contributes approximately $50, 000 annually.

Utah Program Part B Program Manager Grants & QI Administrator Administrative Assistant ADAP Administrator Client Services Coordinator Bureau Financial Manager Finance Support Services Coordinator Administrative Assistant

Funding – Direct Services • ADAP • Health Insurance Program • Core Supportive Services o Ambulatory Outpatient Medical Care o Medical Case Management • Supportive Services o Non-medical Case Management o Medical Transportation

AIDS Drug Assistance Program (ADAP) Assists eligible HIV+ persons with: • HIV medications, • HIV-related medications, and • health insurance premiums Eligibility: • HIV+ • Utah Resident • at or below 250% FPL (Federal Poverty Level) As of April 30, 2013 (564 clients total) • 435 full ADAP clients • 129 insurance service clients • COBRA (premiums & copays): 13 • COBRA - Consolidated Omnibus Budget Reconciliation Act • HIPUtah (premiums & copays): 40 • HIP - Utah Comprehensive Health Insurance Pool, health insurance program for uninsurable individuals • Private (copays only): 67 • Medicare Part D (premiums & copays): 9

Utah ADAP Closure ADAP closures in the past • July to November 2004 • April to May 2008 • September 2009 to August 2010 (145 eligible clients on wait list) • April to December 2011 (76 clients) • 2013 ? Reasons for Program Closure: • Increase in health insurance premiums and medications • Increase in the number of clients utilizing ADAP • Level funding from HRSA over the past years • No contribution by the State of Utah for medications

2013 Utah Outlook • Utah Part B Ryan White Programs remain closed. • Cost containment measures (Fall 2009): • Federal Poverty Level (FPL) lowered from 400% to 250% • Supportive Services no longer funded: Dental, Mental Health, Substance Abuse, etc. • Anticipate level funding to sustain clients currently receiving services.

2013 National Outlook • 31 eligible individuals on waiting lists as of April 11, 2013 • Waiting lists in 3 states (Florida, Idaho & South Dakota) • NASTAD ADAP Watch • Other cost containment measures in 16 states – reduced formulary most common, also include program enrollment caps, annual and monthly expenditure caps, and elimination of supportive services

Upcoming Meetings ADAP Advisory Meeting Monday, July 15, 2013 7: 30 am – 9: 00 am UDOH (288 North 1460 West) Room 215 HIV Treatment & Care Planning Committee Meets annually – one all day meeting Next meeting will be in September 2013 Meeting agenda includes: • Education • Priority Setting • Resource Allocation Committee work is included when writing grants and requesting additional funding.

Contact Info The Ryan White HIV/AIDS Program http: //www. youtube. com/watch? v=rgct. BOX 4 at. I&feature=relmfu Marcee W. Mortensen, MPH, CHES Phone: (801) 538 -6042 E-mail: marceemortensen@utah. gov Amelia Self, MSW Phone: (801) 538 -6221 E-mail: aself@utah. gov