Uncovered

In the last decade, the death rate for people infected with HIV has plummeted. The number of people dying nationwide from the disease has dropped from a high of 52,000 in 1995 to roughly 16,000 per year now. The dramatic reduction is due in large part to the introduction of powerful antiretroviral drugs. Yet poor people infected with HIV in Minnesota could soon find that they no longer have access to those life-saving medications.

There are 1,041 HIV-infected people in Minnesota who depend on the state's AIDS Drug Assistance Program for prescription coverage or health insurance. Currently anyone with income of less than 300 percent of federal poverty guidelines, or $27,930, can enroll in the program for free. But under the new measures, many Minnesotans enrolled in what's known as ADAP will be required to pay for coverage.

As of July 1, people who make more than roughly $9,000 will have to spend as much as 7 percent of their tight budgets on medical care they desperately need. In the worst-case scenario, this would add up to $220 per month. In addition, they will also be facing prescription co-pays of $3 for brand-name drugs and $1 for generics. According to the state's Department of Human Services (DHS), 640 people will be hit by the new fees. If enrollees miss one payment they'll be dropped from the program.

The changes are simply a stopgap measure to prop up a program drowning in red ink. In recent years, as the number of people living with HIV has swelled--largely owing to more effective treatments--and the cost of drugs has skyrocketed, such programs across the country have become financially strapped. Between 1996 and 2002, federal appropriations for AIDS drug programs have ballooned from $52 million to $962 million.

Despite this huge increase in funding, there is still not enough money to cover everyone seeking help. Eleven states now have waiting lists to enroll in their programs, while others have either placed restrictions on which drugs are covered or instituted per capita expenditure limits.

Minnesota is not yet in such dire financial straits. Last year Minnesota received $2.9 million in federal funds for the program, while the state chipped in almost $1 million. But even with the fees being implemented on July 1, which are expected to generate an additional $800,000, ADAP is facing a projected shortfall of $2.1 million--more than half its annual budget.

The problem has been exacerbated by dramatic cutbacks in state health care programs over the last two years. As part of Gov. Tim Pawlenty's budget package to solve last year's $4.2 billion deficit, new fees and caps were introduced to the state's two primary health care programs for poor people, MinnesotaCare and General Assistance Medical Care. And things aren't likely to get better in the near future: Last week, Pawlenty planned to close a $63 million deficit in part by raiding $30 million in federal reserves from a fund set up to provide health care to low-income workers.

Owing to these changes, Minnesota AIDS Project estimates that between 125 and 175 people have switched from other public health care programs to ADAP to cover their medical needs. "It's because we slashed all of these other programs in terms of health care access for low-income people," says Bob Tracy, director of community affairs and education at Minnesota AIDS Project. "Now we have another program, [which] was intended to provide short-term coverage, falling apart because people are being moved to ADAP as a source for ongoing health care. 'No New Taxes' governance means slashing health care programs for low-income Minnesotans."

Consequently, the human services department is scrambling to come up with additional revenues to cover the funding shortfall. "We are in the process of looking under every rock we can possibly look under," says Shirley York, director of the disability services and HIV/AIDS divisions at the DHS. York notes that the department is "strongly committed" to continuing ADAP coverage, and adds that limiting who is eligible for the drug program would be a "last resort."

The state agency is also applying pressure to the Minnesota HIV Services Planning Council--a panel appointed by DHS and charged with establishing priorities for the allocation of federal AIDS dollars--to set aside some money for the drug program. Traditionally, the funds overseen by the planning council have been reserved for other HIV services, such as case management and housing. In August, the council will lay out its funding priorities for the next biennium.

"The Pawlenty administration that created the problem in the first place is now going to the planning council and saying, 'Unless you pony up and pitch in, you're the problem,'" says Tracy. Earlier this week the planning council sent a letter to the DHS asking that any additional changes to the drug program be put off for a year and requesting a meeting with commissioner Kevin Goodno.

Bruce Gohr would also like to speak with the DHS. Two weeks ago Gohr received a letter informing him that he will now be required to pay approximately $14 per month for drug coverage, as well as prescription co-pays.