JOINT COMMISSION ON HIV /PREVENTION PLANNING COMMITTEE MEETING

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1 (J ( '),, LOS ANGELES COUNTY COMMISSION ON HIV 3530 Wilshire Boulevard, Suite 1140 ' Los Angeles, CA 900)0 ' TEL (2 13) FAX (213) JOINT COMMISSION ON HIV /PREVENTION PLANNING COMMITTEE MEETING Emergency Meeting: Responding to State Budget Cuts June 4, :00 AM - 11:45 AM St. Anne's Maternity Home

2 LOS ANGELES COUNTY COMMISSION ON HIV 3530 Wilshire Boulevard, Suite 1140 Los Angeles, CA TEL (213) FAX (213) LOS ANGELES COUNTY HIV PREVENTION PLANNING COMMITTEE (PPC) 600 South Commonwealth Avenue, 10 th Floor Los Angeles, CA TEL (213) FAX (213) JOINT COMMISSION ON HIV/ PREVENTION PLANNING COMMITTEE (PPC) MEETING AGENDA Emergency Meeting: Respon.ding to State Budget Cuts JUlJe 4, 2009 A 9:00 am -11:45 am LOCATION: Foundation Conference Room St. Anne's Maternity Home 155 North Occidental Boulevard, Los Angeles, CA Call to Order CommissionIPPC Co-Chairs 9:00am A. Roll Call 2. Approval of Agenda MOTION #1 CommissionIPPC 9:05am 3. Public Comment, Non-Agendized Public 9:10am 4. State Office of AIDS Report State Office of AIDS 9:20am 5. Overviewllntroduction CommissionIPPC Co-Chairs 9:30am p* A. Overview of Budget Cuts p* B. LA County Impact C. mv Continuum of Care 6. Recess 7. Joint Public Policy (JPP) Committee Report A. JPP Committee Recommendations B. AdvocacylInfonnation C. Next Steps D. Roles/Responsibilities - 9:05am - 9:10am - 9:20am - 9:30am - lo-.3oam CommissionIPPC lo-.3oam - 10:45am JPP Committee Co-Chairs 10:45am - 11:4Oam 8. Adjournment 11:4Oam - 11:45am A. Roll Call CommissionIPPC Co-Chairs

3 Commission on HIVIHIV Prevention Planning Committee (PPC) Meeting Agenda June 4, 2009 Page 2 of2 PROPOSED MOTIONS: P= Presentation Planned p.~ PowerPoint Presentation Planned MOTION III: Approve the Agenda Order. COMMISSION MEMBERS: I Carla Bailey, Co-Chair Anthony Braswell, Co-Chair II Sergio A VIDa Anthon)! Bongiorno Carrie Broadus II Robert Butler Nettie DeAu&!:!stine Whitne:\,: Engeran-Cordova II Douglas F!le (Non-votin,u Te!!)' Goddard (,4ltemate2 J effre)! Goodman/Sharon Chamberlain II Joanne Granai Mike IohnsonlEllzabeth Mendia I Brad Land II Ted Liso CAIlemate2 Quentin O'Brien II Manuel NegretefJim Chud II Dean Page Mario Perez (Non-votin,u II Everardo OrozcolRon Osorio II Robert Sotoma)!orlMarcos Aviles Chris Villa CA Itemate2 II Kath)! Watt II Fariba Younai QUORUM: II 15 II II AI Ballesteros II Eric Daar II David Giugni II Lee Kochems II Anna Long II Angelica Palmeros II Pcg,Ta)!lor II I I I I PPC MEMBERS: AJ King, Community Co-Chair I Terry L. Smith, Community Michael Green, Gov. Co-Chair Co-Chair Sophia Rumanes, Gov. Co-Chair I Traci Bivens-Davis II Scott CamE bell Jull-Ann Carlos Tyrone Carter I John COEeiand II Cesar Cuadra Trevor Daniels Daniel Deniz I David Giugni II Mario Gonzalez Phi lie Hendricks Jeffre)! King I Lee Kochems II Miguel Martinez Victor Martinez Sandra Olivas I Ron Osorio II Ricki Rosales J ill Rotenberg Precious Stallworth I Enrigue T 0Eete II Kimberlee Woods Tim Young I QUORUM: II 14 II ADDITIONAL INFORMATION: Public comment addressing specific agenda items can be made at any time during the meeting. Please complete a request for public comment time and identify the item you would like to address. Otherwise, all otlier public comment will be delivered during the designated time on the agenda. Interpretation services for the dealyhearing impaired or for the non-english-speaking are available free of charge upon request. Please contact Dawn McClendon at (213) (phone), (213) (FAX) at least five working days priorto the meeting date to arrange this service. For additional information about the Commission, please contact Dawn McClendon at (213) All Commission/PPC meetings are open to the public. If you wish to address the Commission/PPC, please pick up a form at the sign-in table Or see staff. NOTE: All Commission/PPC meeting minutes, tapes and documents are available for review and inspection at the Commission on HIV offices located 3530 Wilshire Boulevard, Suite 1140, Los Angeles, CA 900 I 0. To make an appointment to review tapes or documents, please call Dawn McClendon at (213) I I S:\2009 Calendar Year\Commission\Meclings\June 2009V une 4 - PPC-Commission\Agen-Emerg Cmmssn-PPC Mtg Final.doc

4 LOS ANGELES COUNTY COMMISSION ON HIV 3530 Wilshire Boulevard, Suite 1140' Los Angeles, CA ' l1el (2 13) ' FAX (2 13) www. hi vcomm i ss i on ~la. info 5..LJ...,VIEW IINTRODUCTION A Overview of Budget Crisis B LA County Impact C. HIV Continuum of Care

5 LOS ANGELES COUNTY. COMMISSION ON HIV OVERVIEW OF PROPOSED STATE BUDGET CUTS Julie Cross Benefits Consultant June 4, /2010 Budget Reductions Five Implemented/Proposed Layers of Budget Cuts To Date 2009/2010 Budget May Revise May Revise Contingency May Revision Adjustment #1 May Revision Adjustment #2 2 1

6 Proposed General Fund Reductions: State Office of AIDS $2.4 million Education and Prevention $12.3 million AIDS Drug Assistance Program c::> With recommendation to reduce formulary and charge premiums for persons above 200% FPL) $43.4 million to other OA programs Total proposed reduction = $80.1 million 3 Impact of Reduction on Office of AIDS Programs AIDS Drug Assistance Program (ADAP): Formulary reduction/premiums 200% FPL Education and Prevention Programs Surveillance Counseling and Testing Early Intervention Programs Therapeutic Monitoring Program Home and Community Based Care Housing 4 2

7 Proposed Reductions: Medi-Cal. a"'"., ' D,.,,., " Elimination of optional benefits: July 1, 2009 Eligibility reductions: seeking federal waiver Reduced coverage for legal immigrants to restricted/emergency coverage only Eliminate restricted/emergency coverage for undocumented immigrants Elimination of managed care mental health 5 Proposed Reductions: Medi-Cal (cont.) Elimination of other "State optional" services: dialysis, non-digestive nutrition, aged 65+ breast and cervical cancer treatment program Reduction to reimbursement rates for private hospitals, SNFs Reduction to certain substance abuse treatment programs. Additional "savings" by creating new anti-fraud and drug purchasing programs 6 3

8 Proposed Redu,ctions: In-Home Support Services (IHHS) Reduce domestic service eligibility to people with a functional index score of 4 only Increased cost-sharing for eligible clients 7 Proposed Reductions: (551) Supplemental Security Income Additional reductions to monthly income 1/1/2009: $907 5/1/2009: $870 7/1/2009: $850 9/1/2009: $

9 Budget Reductions: Other Programs, Move Proposition 99 funds into Medi-Cal: impact on the risk pool Elimination of Cash Assistance Program for immigrants and the CA Food Program for immigrants Elimination of CalWORKs 9 Budget Reductions Timeline Accelerated timeline Joint Conference Committee on Budget vote as early as 6/5/2009 Legislature vote Governor signs 10 5

10 ".OiSCUSSion QUESTION S and ANSWERS 11,. Reference These slides are available on the Commission website at 12 6

11 State of California AIDSIHIV Program Funding Detail Other California Departments with AIDS Programs May Revision ($ In Thousands) Funding Category Department of Mental Health AIDS Counseling University of California AIDS Research Department of Education AIDS Prevention Education State Mandates-AIDS Prevention Instruction Department of Corrections and Rehabilitation Adult Health Care Trans.itional Case Mgt. For my/aids parolees AIDS Treatment and AIDS Facilities Juveriile Health Care AIDS Screening Department of Social Services Residential Care for the Chronically III Perinatal Substance AbuselHlV Infants Department of Alcohol and Drug Programs mv Counseling/Testing/Early Intervention Commission on State Mandates Legislative Mandates Total Other CA Departments, AIDSIHIV TOTAL CALIFORNIA AIDSIHIV FUNDING II v 3/ (Actual) (Estimated) General Federal General Federal Fund Fund Total Fund Fund Total $1,500 $0 $1,500 $0 $0 $0 9,214 0 $9,214 9,214 0 $9, $ $325 I 0 $1 I 0 $1 2,170 0 $2,170 2,391 0 $2,391 45,075 0 $45,075 52,138 0 $52, $ $ $ $ $ $ ,496 $12, ,540 $12, $ $8i4 $59,098 $12,929 $72,027 $64,928 $12;973 $77,901 $554,024 $432,555 $1,121,623 $537,149 $519,919 $1,229,788 If Effective July 1, 2008, fundmg for the AIDS Counselmg program was ellmmated and transferred to the Depart1nent of Public Health (Budl!;eted) General Federal Fund Fund Total $0 $0 $0 9,214 0 $9, $325 I 0 $1 2, $2,391 57,513 0 $57, $ $ $ ,540 $12, $865 $70,344 $12,973 $83,317 $461,656 $563,590 $1,255, No changes from the Governor's Budget. However, the May Revision includes unallocate.d reductions to the University of California (UC) in and It is currently unknown whether the UC will reduce funding for AIDS Research programs. 31 The 2005 Budget Act transferred funding for local agency mandates to the Commission on State Mandates Local Assistance budget display. The funds listed in the table are for testing, disclosure, and counseling services to benefit victims of crime, as mandated by Chapter 1088, Statutes of These expenditures are estimates of the actual cost claims to be submitted. No funding has been appropriated for local mandate costs incurred in fiscal years and , H:\BudgetIAIDS Charts\ MR AIDS Charts PUBLIC 6/3/2009,2:10 PM

12 State of California AIDSfIllV Program Funding Detail Department of Public Health (DPH) and Department of Health Care Services (DHCS) May Revision ($ In Thousands) Funding Category Support DPH Office of AIDS (OA) DPH Other Programs DHCS Audits and Investigations TOTAL SUPPORT 81 1/ 21 1/ (Actual) Estimated General Federal Special General Federal Special Fund Funds Fund Total Fund Funds Fund. Total $5,728 $12,089 $1,268 $19,085 $6,599 $13,403 $1,088 $21, $5,728 $12,682 $1,415 $19,825 $6,599 $14,057 $1,213 $21, (Budgeted General Federal Special Fund Funds Fund Total $3,643 $14,197 $1,164 $19, $3,643 $14,870 $1,308 $19,821 Local Assistance (DPH OA) Education & Prevention HIV Counseling and Testing Epidemiologic Studies/Surveillance Early Intervention Therapeutic Monitoring Program AIDS Drug Assistance Program (ADAP) Housing Home and Community Based Care CARE/Health Insurance Premium Payment Care Services (Consortia) Planning/Technical Assistance TOTAL OA LOCAL ASSISTANCE TOTAL OA (SUPPORT + LOCAL ASST) 51 FFS Medi-Cal (DHCS) 61 Estimated Part D (DHCS) TOTAL FFS and PART D MEDI-CAL (DBCS) TOTAL AIDS/HlV FUNDING 91 3/,11 41 $30,478 $6,188 $0 $36,666 $24,628 $6,416 $0 $31,044 8,825 1, ,460 8,225 2, ,759 9,051 1, ,643 8,651 1, ,229 8,133 6, ,836 7,433 6, ,416 8, ,000 8, ,000 90,564 88, ,6i1J 312,706 96,349 88, , ,302 1,215 3, ,675 1,093 3, ,633 6,727 5, ,789 6,327 5, , , , , ,700 3,300 16, , , , ,309 $166,293 $132,923 $133,629 $432,845 $160,706 $133,105 $171,507 $465,318 $172,021 $145,541 $134,897 $452,459 $1(17,305 $147,037 $172,595 $486,937 $274,021 $274,021 $0 $548,042 "$253,214 $359,784 $0 $612, , $322,905 $274,021 $0 $596,926 $304,916 $359,784 $0 $664,700 $494,926 $419,626 $135,044 $1,049,596 $472,221 $506,946 $172,720 $1,151,887 $0 $6,416 $0 $6, , , , , , , ,049 92, , , , , , , , , , , $84,049 $139,324 $229,177 $452,550 $87,692 $154,050 $230,341 $472,083 $247,225 $396,423 $0 $643, $ $396,423 $0 $700,043 $391,312 $550,617 $230,485 $1,172,414 1/ Some funding for other DPH programs related to the AIDS program are reflected in,the DPH Total Support budget display but are not included in program ofthe Governor's Budget. 2/ Effective July 1,2007, Audits and Investigations is in the DHCS. This funding was previously included in the Office of AIDS support funding line. 31 Funding for Education and Prevention includes $1.052 million which was previously budget~d under the California Children Services program. This funding has been and will continue to be used for mv education. and prevention (intervention) services for children and youths (up to og024).. 41 ~upport funding for ADA;P is included above in the Office of AIDS' support budget reflects General Fund savings of $12.3 million as a result of implementing drug formulary revisions and a monthly premiums for beneficiaries (effective January 2009) whose income exceeds 200 percent 'of the federal poverty level, as proposed in the May Revision. 51 Reflects IUV/AIDS-related expenditures by the Medi-Cal program. Actual expenditures are included fo(fiscai year Current year expe~ditures reflect the impact of budget-balancing reductions enacted in Expenditures for are estimates bas'ed on a growth factor of 5.5 percent. 111ese figures are difficult to project because Medi-Cal does not project AIDS costs separately from other Medi-Cal costs. In addition, the DHCS does not track AIDS-related expenditures for Medi-Cal eligibles that receive treatment in Managed Care systems, and so expenditures reflect Medi-Cal Fee-For-Service payments only and reflect the impact of enhanced Federal Medical Assi~ta"ce Percentage, pursuant to the American Recovery and Reinvestment Act of On January t, 2006, Medi-Cal mv/alds beneficiaries that are also Medicare eligible were enrolled. in a Medicare Part D plan and Medicare began paying for the majority of the beneficiaries drug need. Medi-Cal uses the percent ofhiv/aids drug expenditures from calendar year 2003 of the expenditures of Part D drugs (4.26%) to estimate the IDV/AIDS related expenditures ofmedi~cal's Part D payments. 71 The 2007 Budget Act includes $5.6 million General Fund to restore IUV Education and Prevention funding for various local health jurisdictions to ful'!ding levels. Effective July 1,2008, HIV Education and Prevention funding reflects an increase of$1.35 Inillion General Fund transferred from the Department of Mental Health's AIDS Counseling program. S! reflects a $3.4 million General Fund reduction, as proposed in the May Revision. 91 Except for the ADAP, reflects the elimination of General Fund ($64.4 million) for local assistance; as proposed in the May Revision.

13 June 3, 2009 Office of AIDS Program Activities by State or Federal Funding Education and Prevention Programs &J.f Infi;fJ./YlA'rf()~ Supported by State General Fund in FY 2008/09 ($24.628m) Education and Prevention Contracts with LHJs for Health EducationlRisk Reduction through LHJs and CBOs (99%; 1 % Fed. Funding) LEO (data systems to support CDC reporting and QA) I Early Intervention Programs. (7% oftotal funding for EIP is from this GF appropriation; 52% of all EIP is from GF. Includes 20% ofbridge 2 and 41 % of Positive Changes 3 ) Syringe Exchange Programs (12) Technical Assistance - IDU/Syringe Exchange - provides assistance statewide to local health jurisdictions and communities dealing with issues related to syringe exchange. Also helps stabilize existing syringe exchange programs and assist local communities, health jurisdictions and community-based agencies start syringe exchange programs where there are none. Technical Assistance and Capacity Building - LHJs - assists LHJs to identify best prevention interventions to respond to the epidemic in their communities. Includes identifying skill sets needed to implement interventions and provide services in most effective and efficient ways. Technical Assistance and Capacity Building- Transgender Communities - sponsored a statewide HIV conference to address Transgender areas of access to healthcare, prevention and root causes of high rates of HIV infection in this population in CA. Technical Assistance and Capacity Building - African American Communities - supports meetings and facilitation of regional and statewide African American groups that address the disproportionate impact of HIV among women, youth and gay men in the African American community. Technical Assistance and Capacity Building - Latino Communities - supports meetings of the CDPH/OA Latino Advisory Board that has produced a report and recommendations on addressing the impact of HIV in Latinos in CA and nationally. Statewide Community Planning/Prevention LA Men's Wellness Center (new as of 1109) CHRP Prevention Research Grants 4 SYNC (Studies of Youth in Northern CA; 1 of5 sites) Supported by Federal Funds in FY 2008/09 ($6.416m) Health Education Materials Partner Services Rapid HIV testin~ in Labor & Delivery 5 Early Intervention Programs (15% of total EIP is from this FF appropriation; 48% of total funding for EIP is FF. Includes 5% of comprehensive primary HIV care and prevention counseling; 54,% of 1

14 June 3,2009 BridgeD and 32% of Positive Changes') Prevention Intervention Trainings II Technical Assistance and Capacity Building - Transgender Communities - Center of Excellence provides leadership, professional training, policy advocacy, research development, and resources to increase access to culturally competent HIV prevention services for trans gender people in California. Technical Assistance and Capacity Building - African American Communities - Staff working in 5 regions throughout CalifornIa increase the abilities and resources of California communities by working with community based organizations to prevent the spread of mv / AIDS among African Americans at the highest risk forhiv infection. Technical Assistance and Capacity Building - Latino Communities - conducted a statewide needs assessment regarding Latinos and HIV services and followed with trainings and workshops to service providers to address gaps in service skills.. Statewide Community Planning/Prevention 2

15 June 3, 2009' HIV Counseling and Testing Programs Supported by State General Fund in FY 2008/0,9 HIV Counseling and Testing (C&T) Contracts with LHJs for C&T throughlhjs and CBOs (92%; 8% Fed. Funding) HCV Testing Contracts with LHJs NIGHT (outreach to engage people in HIV testing) contracts with LHJs HIV Rapid test kits and Lab slips to support C&T contracts HIV Counselor (C&T) Training C&T "Opt-Out" study Supported by Federal Funds in FY 2008/09 HIV Testing Counselor and Outreach Training Testing in 3 Bay Area Emergency_ Departments l) HIV/AIDS Telephone Hotline (for public) ($8.225m) ($2.534m) E pidemjologic Studies/Surveillance Supported by State General Fund in FY 2008/09 ($8.651m) Active Surveillance contract with LHJs ARIES network hosting (data system to support HRSA reporting and QA) Barriers to Care Study, SBl159IPharmacy Sale of Syringes Study, SYNC (4 sites), Enhanced Perinatal Surveillance Supported by Federal Funds in FY 2008/09 Core and HIV Incidence Surveillance 10 National HIV Behavioral Surveillance II Medical Monitoring Project 12 ($1.578m) 3

16 June 3, 2009 Early Intervention Supported by State General Fund in FY 2008/09 ($7.433m) Early Intervention Programs (44% oftotal EIP is from this GF appropriation; 52% total funding for EIP is GF. Includes 56% of comprehensive primary HIV care and prevention counseling; 26% of Bridge 13; and 31% of Pathways 14) Treatment Education Training (estep) Provider Training, Education and Support Supported by Federal Funds in FY 2008/09 ($6.983m) Early Intervention Programs (34% of total EIP is from thisff appropriation; 48% of total funding for EIP is FF. Includes 39% of comprehensive primary mv care and prevention counseling; 27% of Positive Changes 15 ; and 69% of Pathways 16) Therapeutic Monitoring Program Supported by State General Fund in FY 2008/09 Resistance Testing Viral Load Testing ($8.000m) Housing Sup~_orted by State General Fund in FY 2008/09. RALF Program (bed nights for residential-care/skilled nursing) Housing development and capacity building Supported by Federal Funds in FY 2008/09 Housing Opportunities for Persons with AIDS (HOPWA) Program ($1.093m) ($3.540m) 4

17 June 3,2009 Home and Community Based Care Supported by State General Fund in FY 2008/09 Case Management Program (CMP)!7 (54% State Funds) Supported by Federal Funds in FY 2008/09 Case Management Program (CMP) l~ (46% Fed. Funds) ($6.327m) ($5.426m) CAREIHIPP Supported by Federal Funds in FY 2008/09 Private health insurance Qfemium payments ($1.700m) Care Services Supported by Federal Funds in FY 2008/09 Medical care and support services contracts with LHJs and CBOs ($15.173m) Planning/Technical Assistance Supported by Federal Funds in FY 2008/09 ARIES (data system to support HRSA reporting and QA) Statewide Community Planning/Care ($1.309m) 5

18 June 3, Plan for had been to move to CDC funding 2 Bridge - peer-based olltreach to engage and retain in care (also see table below) 3 Positive Changes - intensive prevention counseling for those in care (also see table below) 4 CHRP in process research - African American Women's Intervention; Trial of African American MSM/W lntervention; Trial of Latino MSM Intervention 5 Targeted Federal Funds for this program cannot be reallocated. 6 Bridge - peer-based outreach to engage and retain in care (also see table below) 7 Positive Changes - intensive prevention counseling for those in care (also see table below) 8 Prevention with Positives, Men who have Sex with Men, Group, and Comprehensive Risk Counseling and Services 9 Targeted Federal Funds for this program cannot be reallocated 10 Targeted Federal Funds for this program cannot be reallocated 11 Targeted Federal Funds for this program cannot be reallocated 12 Targeted Federal Funds for this program cannot be reallocated 13 Bridge - peer-based outreach to engage and retain in care (also see table below) 14 Pathways - Mental health and substance abuse counseling (also see table below) 15 Positive Changes - intensive prevention counseling for those in care (also see table below) 16 Pathways - Mental health and substance abuse counseling (also see table below) 17 OA does not fund the Medi-Cal Waiver program although OA staff supported in part with General Fund mariage the program 18 OA does not fund the Medi-Cal Waiver program although OA staff supported in part with General Fund manage the program Additional Explanation of Sources of Funding for EIP-Associated Programs E&P EIP Total GF FF GF FF Primary Medical 5% 56% 39% 100% Care ($10.9m) Bridge ($2.4m) 20% 54% 26% 100% Positive Changes 41% 32% 27% 100% ($1.8m) Pathways ($l.3m) 31% 69% 100% Total ($16.4m) 7% 15% 44% 34% 6

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20 LA County HIV/AIDS Response Pnnciple I I]() Coullty I~; r:()i1hll1l1('(j I() flli llllt;litllnq 11]( : r l1()~ ; 1 r()\jw;l, l:fft:chvi :. C(l~;1 ( :111 (; 1( :111. l iiv iaii ):-'; ~; ( : I Vlc(' r:()ll:lrlljljllllllill illi()w~; f(lr fl1,lxlillljlil dl:;i:;i~;t: Plt'Vt'IlII()1l dl; lql\():;i:;,llld 1:1\:;1111':; pt'r :;(IIl:' WIIIl I HV,'AII):-'; i lll' ilhlt '!o liulv(' 0) (~'.. "".".

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23 10 ANGELES COUIITY co, J N. ON HIV STATE BUDGET CUTS BRIEF #2 Update: May 30, 2009 Governor's Revised HIV/AIDS Cuts Will Be Devastating Governor's HIV/AIDS Service Cuts Revised On May 26, 2009, California's Department of Financ;e (OaF) released details about the Governor's proposed cuts of general funds from the State Office of AIDS (OA). The information varied somewhat from the Governor's original OA budget cut proposal that had been shared with the public the prior week, but the revised budget cuts continue to promise a destructive impact on people with and at risk of HIV/AIDS in California. The Governor's revised budget includes 'a $12.3 million cut in general fund support (roughly 13%) to the AIDS Drug Assistance Program (ADAP), and eliminates general fund support for all other OA programs ($67.8 million). In total, the Governor is proposing $80.1 million in cuts to critical HIV/AIDS services that help to preserve the health and lives of Californians living with or at risk for HIV/AIDS. The following Hiv/AIDS programs are targeted for severe reductions or elimination under t he Governor's current proposal: AIDS Drug Assistance Program (ADAP), HIV counseling and testing, HIV education and prevent ion, Early Intervention Programs (EIPs), Therapeutic Monitoring Program (TMP), HIV surveillance, Home/community based care programs, Housing programs, and CARE/Health Insurance Premium Payments (CARE/HIPP). Cuts Jeopardize Federal Funds for HIV Services In many cases, these cuts further jeopardize direct services for Californians living with HIV because they limit the OA's ability to fulfill the federal grant requir ements. Matching ("Maintenance of Effort" (MOE)] requirements, for example, mandate that the State contribute to HIV programs to be eligible for federal funds. The Governor's plan could result in the State losing a portion, if not all, of its federal Ryan White HIV/AIDS Program and CDC grants. The cuts will also impact local jurisdictions: local Ryan White grants are, for li!xample, based on case reports from surveillance-proposed to be eliminated. If the State legislature approves t he Governor's proposed HIV budget cuts, lifesustaining HIV/ AIDS programs and services could be eliminated. These solutions not only harm Californians, but cost the State more in the long-run: IT'S REAL: THE TIME TO ACT IS NOW!!! LOS ANGELES COUNTY COMMISSION ON HIV 3530 WilSHIRE BOUlEVARD. SUITE l OS ANGElES, CAliFORNIA TEL S.2S16 FAX m s LAINFO

24 Page 20f2 The Therapeutic MonitO[ing Program pays for testing that helps medical providers choose the most effective and cost-efficient medications/treatments. The home/community based care program provides home-based services to gravely ill people with HIV, helping them maintain independence and avoid more costly nursing home care. Early Intervention Programs (EIPs) ensure that newly diagnosed Californians with HIV are enrolled in medical treatment early on, when treatment is less costly and more effective. HIV counseling and testing programs help people learn their HIV status to access care earlier and to take precautions to prevent transmission to others. CARE/HIPP contributes to insurance premiums: a more cost-effective option than the State paying for care directly. HIV education and pre)lention programs are the most cost'effective and humane way of reducing HIV/STD transmission. Impact of Budget Reductions on ADAP The Governor proposed the $12.3 million reduction in general funds from ADAP based on the following plans: (!) Saving $10 million through reductions to the ADAP drug formulary-removing drugs from the formulary and/or reducing access to certain drugs; <2l Generating $2.3 million in revenues by charging ADAP enrollees with incomes above 200% Federal Poverty Level (200% FPL = $21,660 for a Single Household in 2009) premiums to maintain coverage under ADAP. Although specific details of the formulary reductions and premium plan have yet to be released, it is clear that these cuts will severely limit access to life-sustaining medications for Californians with HIV/AIDS. The Governor's proposed reduction to ADAP could threaten the State's a.bility to meet federal MOE requirements, putting federal Ryan White funds for ADAP and other programs in jeopardy. The loss of general funds and Ryan White support, in turn, could cripple ADAP's ability to earn pharmaceutical rebates (which currently contributes 50%+ of the ADAP budget). What Can We Do? California is facing disaster, but the solut ion cannot balance the State budget on the backs of the most vulnerable and those who can least afford it. Ca lifornians with HIV/AIDS will already suffer from current and proposed cuts to Medi-Cal, Social Security and other public benefits programs. In addition, hundreds or t housands more people with HIV/AIDS must turn to these programs during this economic crisis. Call, write and visit your State representatives and urge them not to support these cuts. Write the State Conference Committee on Budget (before June 5) to let them know how these cuts will impact you. Call, write and visit your Congressional representatives to urge their advocacy for federal support/intervention in California's budget crisis. Help plan, and support and attend, protest rallies around the State (LA on June 5, Sacramento statewide on June 10). S:ICommltt.e - Joint PubliC PolicylPolicy BriefslBnef-State Budget Cuts # doc

25 LOS ANGELES COUNTY COMMISSION ON HIV RECORTEAL PRESUPUESTO DEL ESTAOO RESUPIBI #2 AcWailadOn: 2drPi«>, DB Los Recortes Modificados del Gobernador para Fondos de VIH/SIDA Seran Devastadores LG s Recortes Revisados del Gobernador para los Servicios de VIH/SIDA EI 26 de Mayo, 2009, el Departamento de Finanzas (DOF, por sus siglas en ingles) public6 detalles sobre los recortes propuestos por el Gobernador para los fondos generales de la Oficina del SIDA del Estado (OA, por sus siglas en ingles). La informaci6n de la propuesta original del Gobernador cambi6 un poco sobre los recortes al presupuesto de la Oficina del SIDA del Estado que se habfan com partido con el publico la semana anterior, pero la revisi6n a los recortes del presupuesto continua teniendo el potencial de un impacto destructiv~ sobre las personas con y a riesgo del VIH/SIDA en Cal ifornia. La revisi6n del Gobernador al presupuesto incluye un recorte de $12.3 mi- liones en apoyo del fondo general (aproximadamente 13%) al Programa de Ayuda para Medicamentos del SI DA (ADAP, por sus siglas en ingles), y elimina el apoyo del fonda general para todos los demas programas de la Oficina del SIDA en California ($67.8 millones). En total, el Gobernador propone $80.1 millones en recortes a servicios crfticos del VIH/SIDA que ayudan a preservar la salud y vida de los Californianos que viven con 0 a riesgo del VIH/SIDA. La siguiente lista de programas del VIH/SIDA ha sido seiialada para reducciones severas 0 eliminaci6n bajo la propuesta actual del Gobernador: Programa de Ayuda para Medicamentes del SIDA (ADAP) Consejeria y Pruebas del VIH Educaci6n y Prevenci6n del VIH Programas de Intervenci6n Temprana Programa de Monitoreo Terapeutico Vigilancia epidemiol6gica del VIH Programas de Cuidado Medico basados en el Hagar 0 la Comunidad Programas de Vivienda Pagos de la Prima de Seguro de Salud o Cuidado Medico (CARElHIPP, por sus siglas en ingles). Los Recortes Com prometen los Fondos Federales para Servicios del VIH En la mayoria de los casos, estes recortes comprometen mas los servicios directos para los Californianos viviendo con el VIH porque limitan la habilidad de la Oficina de LOS ANGElES COUNTY COMMISSION ON HIV 3530 WILSHIRE BOULEVARD. SUITE LOS AN GELES, CALIFORNIA TEL FAX WWIV.HIVCOMMISSION la.~fd

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