- The Washington Times - Monday, October 15, 2012

Virginia’s first-ever waiting list for its AIDS drug assistance program for low-income individuals has been eliminated in less than two years thanks to a boost in funding, a host of cost-saving maneuvers, and partnerships among local, state and federal groups.

Due to budget constraints, new enrollment to the state’s AIDS Drug Assistance Program (ADAP) was closed in November 2010 to everyone except pregnant women, children and people receiving treatment for potentially fatal infections that exploit weakened immune systems.

Before the eligibility restrictions went into effect in November 2010, more than 3,500 people were enrolled.

In December 2011, enrollment in the program was slightly less than 2,500 and the waiting list reached a peak of 1,112 people.

About 2,700 people were enrolled in the program as of June of this year. About 600 were on the waiting list, which ended in August.

The monthly cost per patient also decreased — from $2.9 million in June 2010 to an average of $1.7 million this year. The state was able to find approximately $10.3 million in savings from the program through measures like Medicare rebates and removing inactive clients.

During 2011, state contributions of about $4.8 million also helped sustain 451 clients on the program. Their average monthly client costs were $906. Still, nearly all of the funding for the program comes from Ryan White Treatment Extension Act Part B grant funds from the federal government, named after the Indiana boy who was diagnosed with AIDS at the age of 13 and died in 1990 at 18. Virginia competed for — and won — $3 million in emergency relief fundingin 2011 and 2012.

As more money became available, the state gradually loosened its eligibility requirements. From November 2010 through this June, nearly half of the people who were wait-listed enrolled in the program. Others found coverage through Medicaid or private insurance, were no longer eligible, or could not be contacted.

“I think that the ability to eliminate the wait list is critically important both to individual and public health,” said Diana L. Jordan, director of the State Department of Health’s Division of Disease Prevention.”I think the key is that earlier treatment reduces HIV transmission as well.”

Between November 2010 through this June, in addition to the 49 percent of those on the list who enrolled in the program, about 15 percent of people on the ADAP waiting list were removed because another payer, like Medicaid or private insurance, began covering their drugs. A fifth were removed because they could not be contacted by telephone or mail, and more than 100 were ineligible because they moved out of state, were incarcerated, or exceeded the program’s income limits. The income eligibility limit for the program is 400 percent of the federal poverty level — $43,560 for a single person or $89,400 for a family of four.

When the waiting list began, the state actively worked to find alternative programs, some through private insurance companies, to prevent gaps in treatment for those who were not enrolled in ADAP.

The Department of Health contacted people on the waiting list every six months to check in and ensure that they were receiving care. Despite its efforts, the department discovered that about 10 percent of people were not receiving their medications. However, that figure included people who had submitted improper paperwork and those the department was unable to contact. Those people were referred to a case manager or medical care provider to make sure they got the assistance they needed.

Brandon M. Macsata, CEO of the nonprofit ADAP Advocacy Association, said that while the elimination of waiting lists is welcome news, Virginia also removed more expensive drugs from the program and tightened eligibility requirements over the last two years, creating what he called an “invisible waiting list.”

Mr. Macsata said that in several other states, the waiting list started again several months after being winnowed down to zero.

“The dollars aren’t keeping up with the bodies. There’s no guarantee that in three months, there won’t be a waiting list,” he said. “If you’re making somebody one day eligible and the next day not eligible, that’s not [fixing] the crisis.”

Ms. Jordan said the state has revamped its service model, which will allow more clients to use health insurance for coverage — a more cost-effective way to serve clients.Fewer restrictions are in place for people who want to enroll, and money will enable some medicines previously removed for cost reasons to become available again, such as ones that treat mental health disorders.

“We’re not seeing a reduction in demand,” Ms. Jordan said. “We’re seeing an increase in our ability to serve people.”

Ms. Jordan said that community partners like the Northern Virginia Regional Commission and District Department of Health, as well as strong connections to the state’s medical community and clients themselves have been invaluable in the process of providing alternate forms of treatment as they tweaked the system in the face of dwindling funds.

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