Howard Jacobs The California budget crisis is having a tremendous effect upon proposed funding and legislative discussions in Sacramento concerning HIV/AIDS. Planned funding cuts to HIV prevention education, the University AIDS Research Program and to public insurance programs including Medi-Cal and Dental-CAL as well as increases in co-payments for access to medications on the AIDS Drug Assistance Program (ADAP) will have a significant impact upon people living with AIDS and clients of Being Alive.

In fact, the budget crisis is so severe, in order for ideas to have a chance at becoming law most bills are being introduced at no or low cost to the state. The outlook for people living with AIDS is grim without major grass roots involvement and an organized effort to contact our elected officials about HIV-specific and Medi-Cal funding cuts as well as the severe, burdensome, ADAP co-payment increases.

Proposed cuts in physician reimbursement rates for people on Medi-Cal and the elimination of programs such as Dental-CAL will make accessing life saving outpatient medical services more difficult and more expensive for people living with HIV. Public programs that help people improve oral care are now in potential jeopardy and may be faced with future closure. You read that right, people in California who rely on Dental-CAL for oral care, will no longer have that program available if the budget proposal passes in its current form. Physicians, in addition, will be less likely to accept Medi-Cal or have incentives to become specialty providers of complicated HIV medical services if re-imbursement rates for outpatient medical services continues to decline.

Proposed ADAP CO-payments for people making 200% above the federal poverty level, or approximately $17,700 per year, has caused great concern among community activists. Current law requires ADAP CO-payments when one makes 400% above poverty level. The ADAP CO-payment structure would start at $25 per month per prescription and would increase as one's yearly income increased to the ADAP eligibility maximum. Anyone making less than 200% above the federal poverty level would not be subject to these CO-payments If these proposed increases in CO-payments to the ADAP occur, thousands of Los Angeles residents enrolled in the program would be required to pay an unreasonable share of cost for their prescription medication.

The ADAP CO-payments at such a low-income level are quite serious and may cause serious consequences. The average person on the ADAP program orders over six drugs per month with a potential co payment of over $150 per month. This is a significant amount of money and will have a devastating effect upon the quality of life for a person with AIDS in Los Angeles County. Many PWAs will have to look for other programs to meet their daily needs if they are forced to pay these CO-payment amounts. Others may ration their medications to take them as often as they possibly can without sacrificing their ability to pay rent or meet a car payment.

$17,700 in LA County is $1475 per month, a very small amount for one to live on when one takes into account housing, transportation, insurance, food, utilities and other medical CO-payments, yet, many of us survive on less than $17,700. Everyone, regardless of their income, still needs to be concerned, since additional strains on already over-burdened AIDS support systems, such as Section Eight housing, transportation services, and low cost mental health counseling, will be impacted because of the potential for increased need.

In addition, CO-payments for prescription drugs may lead to an increase in the number of missed doses or drug rationing, when one has to balance their other fiscal needs. We know a decrease in compliance leads to an increase in drug resistant strains and therefore, increased cost as well as increased AIDS deaths.

Finally, cutting HIV prevention education dollars and decreasing our commitment to the University AIDS Research Program sends a message that a cure is not the priority of the state nor that HIV transmission can be stopped through comprehensive, culturally sensitive strategies including community outreach and education. We must remind our elected officials that HIV is a preventable disease and our goal is a cure for everyone with AIDS.

Along with impacting these budget concerns and spreading the word on the need for letters, telephone calls, e-mail messages, faxes and visits to our Assembly Members, State Senators and Governor about HIV funding issues, the Board of Directors at Being Alive is also taking positions on legislation to increase health care coverage for every Californian, to allow for equal rights under domestic partnerships, to protect privacy of medical healthcare records, and other policies that impact the state's HIV/AIDS community.

For more information on Being Alive's positions on California 2003-2004 state legislation, please contact Being Alive's Executive Director. To learn whom your elected officials are and how to contact them, please call the LA County Board of Registrars at 800.815.2666 or just Click Here.

Howard is a member of Being Alive's Board of Directors.

Sec. Thompsons AIDS Medicare Drug Benefit Letter To Feinstein 11-24-03