Miami Herald - March 15, 2003
Andrea Robinson, arobinson@herald.com

The Miami resident estimates he saves $2,000 a month on drugs and $400 on food, as well as money on transportation passes for doctor visits and trips to support groups.

"It saves on stress and adds to the quality of life, especially the financial blessing," Le Claire said.

But the crucial support program may not be available to thousands of newly diagnosed HIV patients because of fiscal belt-tightening by the federal government, advocates say. It comes at a time when Florida is experiencing soaring increases in reported HIV infections and significant decreases in AIDS-related deaths.

"Because of the recession and talk of war, we're dealing with a federal government that's less likely to fund healthcare programs," said Gene Copello, executive director of Florida AIDS Action, based in Tampa. "If I were an agency, I wouldn't plan on getting any type of increase."

Meanwhile, local activists are also concerned that state-funded Medicaid benefits for HIV patients may be on the chopping block for similar reasons. On Wednesday, more than 60 Miami-Dade County gay-rights advocates will head to Tallahassee to speak with Gov. Jeb Bush and legislators against that idea.

The federal program, which has been funded under Title I provisions of the Ryan White Care Act, provides subsidized medical, dental and support services to more than 7,300 low-income HIV patients in Miami-Dade and 5,300 in Broward County.

Patient advocates and service providers are awaiting final word on how much money will be allocated for this year, but all agree it won't be enough to meet the needs.

The prescription coverage, the costliest part of the program, is expected to receive more funding, but that would come at the expense of the other services, they say. Around the state, AIDS advocates are warning agencies that help HIV and AIDS patients to expect the same funding levels as last year -- despite the increase in clients.

LEFT ON SIDELINES

That means money for doctor visits and prescription services would be available for those already enrolled, but many new patients could be left on the sidelines.

Some agencies are even discussing capping enrollment in their programs.

"It's a possibility if we don't get sufficient funding," said William Green, an administrator with Broward County's HIV/AIDS programs.

The concern over funding levels comes as agencies are trying to cope with an increase in people seeking their services. Florida reported a 21 percent increase in new HIV infections in 2002. The Florida Department of Health attributes some of the gains to aggressive outreach programs and testing of people who previously were infected.

Christine Stroy Martin, director of a Miami-area case management organization, said the stepped-up outreach is creating some problems for budget-pressed agencies. She predicted that agencies would be forced to put up waiting lists for transportation and grocery vouchers for new clients.

"Once you get them into care, what can you offer them?" Martin asked. Clients "have problems with transportation. The reason the services came along was to be supportive to ensure they get medical care."

Another factor is that advances in medicine have led to a 62 percent drop in AIDS-related deaths in the past five years.

Judith Williams, chief administrator of Miami-Dade's HIV/AIDS planning council, said that poses tremendous challenges for the state health system.

"It means you have more people seeking healthcare," she said.

"Those numbers are steadily rising. You have a program that's not increasing [in funding]. Something has to give."

Last year, Florida received more than $227 million to help pay for drugs, doctor visits and medical support costs of uninsured and underinsured HIV patients who don't qualify for Medicaid. The bulk of it, almost $100 million, went to cover prescription expenses.

Another $72 million was earmarked for six metro areas around the state, including Miami and Fort Lauderdale, to pay for doctor visits and other medical costs.

FEDERAL DELAY

Advocates are now hoping for even more this year. Congress recently passed a long-delayed spending bill that awaits President Bush's signature. The measure contains a $121 million increase for AIDS care, but most of that is slated for prescription costs. An increase for other services was so small that most allocations to the states likely will remain at the 2002 levels.

Budget managers say larger, more established healthcare and service providers may have room to cut. But smaller agencies that primarily serve minority communities may not have anything to cut.

"For these newer organizations, any change in funding could have significant impact on their operation," said Daniel Wall, chief coordinator of Miami-Dade's grants program.

AIDS activists complain that the austerity moves are the result of congressional focus on international and terror-related concerns and away from domestic ones.

Those issues have also affected Florida's budget, which provides Medicare finding. The Legislature is reviewing a proposal by Bush to eliminate Medicaid services for most of the 26,000 people in the state's medically needy program.

IN-BETWEENERS

The state currently puts $116 million of its own money into the program, which provides medical assistance to those who earn too much money to qualify for Medicaid but not enough to pay for their pharmacy or medical expenses.

Florida AIDS Action estimates that about 1,200 of those people have the virus.

Those cuts -- if approved -- would force those people to seek assistance from the federal Title I program, a payer of last resort for clients who can't pay. They would be in addition to any newly diagnosed people who enter the system.

The state estimates that 68,545 people in Florida are living with HIV or AIDS. Miami-Dade has 19,122, Broward has 11,010, and Palm Beach has 6,145, according to the state Department of Health.

However, those figures do not include results of people who test positive under the anonymous testing system. So the number of infected people likely is higher.

The talk of further cuts alarms low-income patients such as Le Claire. Last year, he was dropped from a utility assistance program that saved him about $1,200 a year.

"It's asinine," he said. "That never should have happened. There have been a lot of budget cuts, which disturbs me beyond belief."

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