CARE AND TREATMENT FOR PEOPLE WITH HIV/AIDS IN TENNESSEE

December 1, 2005

The Tennessee Medicaid program, TennCare, and the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act have supported a high quality system of care for people living with HIV and AIDS in Tennessee.  Recent eligibility and benefit changes to TennCare along with multiple years of flat funding of the CARE Act now threaten this vital safety net. 

The continuation of Ryan White funded programs, including the HIV Drug Assistance Program, is now critical for Tennesseans living with HIV. Many have been disenrolled from TennCare and have no other access to life-saving treatment. They now rely on Ryan White programs for care. HIV care providers estimate that this added burden may overwhelm Ryan White funds, and soon threaten the continuation of this last-resort access to HIV medications for many Tennesseans.

TENNESSEE RYAN WHITE FUNDING FY 2004

·            A majority of Tennessee’s Ryan White funding (85.6%) is from the Title II program and supports health care and support services including the AIDS Drug Assistance and Insurance Assistance Programs.

Source:  The Kaiser Family Foundation. Tennessee State Health Facts. Available online at www.statehealthfacts.kfforg.

THE HIV/AIDS DRUG ASSISTANCE PROGRAM IN TENNESSEE

·         The Tennessee HIV/AIDS Drug Assistance Program (ADAP) anticipates implementing a waiting list mid grant year 2006. As of September 2005, nine states reported ADAP waiting lists.

·         The Tennessee HDAP served 481 clients in 2004. Nationally the number of clients served by ADAP ranges from 2 in Montana to 1,180 in Indiana.

·         The income limit for the Tennessee ADAP is 300 percent of the federal poverty level (FPL) or $28,710 annual income for an individual. Nationally – the income limit ranges from a low of 125% FPL in North Carolina to more than 500% FPL ($50,000 annual income) in Massachusetts.

·         The Tennessee HDAP covers 93 drugs on its formulary.  Nationally – the number of drugs on ADAP formularies ranges from 25 in Louisiana to open formularies in Massachusetts, New Jersey and New Hampshire.

Source:  National Alliance of State and Territorial AIDS Directors.  Data available from The ADAP Watch and the 2005 Annual Report of the National ADAP Monitoring Project at www.nastad.org.

THE INSURANCE ASSISTANCE PROGRAM IN TENNESSEE

▪          The Tennessee Insurance Assistance Program (IAP) served 522 individuals in FY 2004/05, providing more than $1.3 million in payments for premiums, deductibles and medical/prescription co-payments.

▪          The income limit for IAP is the same as ADAP, 300% of FPL.  IAP provides comprehensive coverage for in-patient as well as out- patient care for a client's complete medical needs.

▪          Since TennCare began disenrollment in August, program enrollment has increased 30%.  More than 150 individuals who lost TennCare have been added to the program, at a projected annual cost of more than $1.2 million--in effect doubling program costs.

▪          Without coverage, these individuals will be forced to rely on ADAP and other CARE programs at a higher cost to taxpayers.  Without coverage, they will also lose access to in-patient care as well as medications not covered by ADAP.

TENNCARE CUTBACKS HURT PEOPLE WITH HIV/AIDS

·         In 2004, 3,204 people with HIV/AIDS were covered by TennCare.

·         It is estimated that 38% or 1,251 people with HIV/AIDS lost TennCare coverage in 2005 as a result of the changes made to the TennCare program.

·         People who do not lose TennCare coverage are subject to benefit limits including a 5 prescription (only two of which can be brand name) drug limit and 12 physician visits (beginning January 1).  Antiretrovirals are excluded from the drug limit.

THE IMPACT ON THE NASHVILLE SYSTEM OF CARE

·         The Comprehensive Care Center (CCC) is the largest provider of HIV/AIDS primary care in Tennessee.

·         CCC estimates that 25% of its 2,000 clients with HIV/AIDS lost TennCare coverage.

·         CCC expects its uncompensated care burden to increase by seven times to a level that is nearly half the Center’s entire budget as a result of its clients losing TennCare coverage.

·         Nashville CARES is the largest provider of HIV/AIDS prevention and support services in Tennessee.

·         In FY 2004/05, 1,100 (73%) of its clients received case management, transportation, advocacy, mental health, and/or nutrition services that were underwritten in part by Ryan White funding.  These services were essential to clients' ability to access needed medical care.  For example, 71% of clients who received case management used it to meet healthcare needs.  And 82% of those who received transportation assistance used it for doctor visits, while 56% used it to pick up medications at their pharmacy.

·         Cutbacks in TennCare will require a redirection of Ryan White funds to pay for medical care and medications and reduce coverage of social services that are essential to clients accessing and making effective use of HIV treatment.

HIV/AIDS IN TENNESSEE

·         Number of people reported to be living with HIV/AIDS in Middle Tennessee/Nashville Region – 4,437

·         Number of people reported to be living with HIV/AIDS in Tennessee in 2004 – 12,561

·         Statewide a majority of people living with HIV/AIDS are male (75%) and Black (56%) or White (42%), not Hispanic