Florida Phasing Out Project AIDS Care, Other Medicaid Waivers

Thousands of Floridians living with AIDS could be losing financial assistance they say is essential to living a normal life, and some AIDS groups are worried the state won’t carry through on its promises.

On a recent Tuesday morning, Brandi Geoit sits at a conference table at the West Coast Aids Foundation headquarters. Across from her in the small New Port Richey office with butter-yellow walls is Dwight Pollard, a 61-year-old man living with AIDS.

Geoit tells him a new Florida law means patients like him could lose some of the financial help they’re getting through Medicaid.

“We’re not sure if you would keep your Medicaid because you’re still pending for your social security. And you haven’t qualified for Medicare yet because you’re still not old enough,” Geoit said.

Pollard no longer works, and depends on a special Medicaid waiver to cover his health care costs. Medication alone can cost $15,000 a month.

His partner, Ed Glorius, was sitting next to Pollard as he heard the news.

“It just doesn’t make sense,” Glorius said. “It doesn’t make sense to put people’s lives in turmoil. We’re better off than most and I’m freaking out. I’m waking up first thing in the morning thinking about this every day.”

Pollard is one of about 8,000 Floridians with AIDS who get help paying for doctor visits, medications and various home health services through this Medicaid waiver fund, which is called Project AIDS Care. Last month, Gov. Rick Scott signed a bill formally eliminating this waiver for AIDS, along with waivers for cystic fibrosis, developmental disabilities and elder care.

Florida’s Agency for Health Care Administration said while the waiver is going away, AIDS patients in Florida will not see a loss or gap in services. The agency declined repeated requests for interviews, but issued a written statement, explaining transition into a Medicaid Managed Medical Assistance plan.

“We will continue to provide the same services through the same providers for these individuals. The PAC (Project AIDS Care) waiver is essentially a waiver that expanded Medicaid eligibility to those diagnosed with HIV/AIDS and allowed the recipients to access needed medical services (e.g., physician services) and drugs. Given the advances in pharmaceuticals available to treat HIV/AIDS, most PAC recipients in the waiver only need those medical services and case management. With this transition, their eligibility will be maintained and they will continue to have access to the medical services, drugs and case management under the MMA waiver through the health plans. They will see no reduction in services and will be able to continue to see the medical professional they always have.”

The agency said patients will go into the Medicaid Long Term Care program starting this month. Everyone will be transitioned into it by Jan. 1, 2018.

But Geoit estimates 90 percent of her clients will not meet the requirements for long term care, which normally applies to people needing round the clock nursing.

She said her clients will definitely lose certain services that Medicaid doesn’t cover. Massages for those with neuropathy? Gone. Pest control? Gone. And services that are currently covered – like delivered meals, adult diapers and wheelchair ramps – could be lost, too.

So, she’s asked the state to clarify how it’s now different.

“When we asked them, they said, ‘Don’t worry. Reassure your client that they’ll be taken care of.’ And when we asked them point-blank what happened, you know, we were under the impression that a single adult still does not qualify for Medicaid. Has this changed? And they ended the conference call,” Geoit said.

Her program – a non-profit – exists only to manage the Project Aids Care waiver money for 325 clients in seven counties including Pasco, Pinellas and Hillsborough. With the new law, Geoit said her foundation will shut its doors by the end of the year.

For Dwight Pollard and his partner, the State Agency for Health Care Administration’s lack of answers is a concern.

“You don’t need the stress of how you’re going to pay or how you’re going to do this,” Pollard said.

But that’s his reality. And Pollard said until the state agency can give clear answers, he’ll keep searching for other programs that can help pay for his life saving medications.

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2016 Presidential Round-Up: How the Candidates Stack Up on HIV

2015-05-08 | Policy Department, AIDS

The 2016 presidential campaign is already heating up with Election Day still more than 500 days away. While the race is still in the early stretch of primary season, HIV advocates should start looking for the best candidates on HIV/AIDS issues. Several candidates have already joined the race: Hillary Clinton and Bernie Sanders seek the Democratic nomination, and the Republican field is already crowded with official announcements from with Ben CarsonCarly Fiorina, Marco RubioTed Cruz, Rand Paul, and Mike Huckabee.

Key legislation such as the Ryan White Act or the Affordable Care Act (ACA) can be fundamentally altered depending on who is in the Oval Office, impacting the ability for people living with HIV to obtain optimal medical care. There is also evidence that structural issues such as poverty, lack of housing, and HIV stigma can contribute to HIV testing rates or HIV risk behavior, all factors that can be influenced by the Executive Branch. At this point in the election cycle, it is unclear how each candidate will approach issues related to health care reform, HIV prevention and treatment, or reducing income or housing disparities in the United States. However, we can look at previous statements and actions to get a sense of candidates’ positions on important issues to our community.

During her past presidential bid and term in the Senate, Hillary Clinton has supported comprehensive HIV prevention, stating that she would increase the National Institutes of Health research budget and promote HIV prevention programs that were not limited to abstinence-only policies. Prior to the end of her tenure as Secretary of State, she released PEPFAR’s Blueprint: Creating an AIDS-free Generation, which outlined a global strategy for ending HIV transmission. Senator Sanders has stated his opposition to pharmaceutical monopolies that lead to exorbitant prices for HIV medicine. In the past, Marco Rubio has expressed concerns for federal funding cuts to PEPFAR and has noted its importance in contributing to an AIDS-free generation on his website. In contrast, other Republican potential nominees have either not revealed any definitive thoughts about current HIV policy or have past associations that may cause concern for HIV/AIDS advocates. During his 1992 Senate run in Arkansas, Mike Huckabee stated that people living with AIDS should be quarantined, and Rand Paul has been linked to a professional physician organization that has questioned the link between HIV and AIDS (although he has not publically stated his agreement with this position).

Thoughts on the ACA tend to fall along party lines, with all current Republican candidates expressing varying levels of opposition to the law. The National Journal has recently summarized how Republican candidates might approach health care reform, and it is unclear how these approaches might affect access to Medicaid, which has expanded through the ACA and increased insurance access for people living with HIV. Hillary Clinton has expressed strong support for the current health care reform law, encouraging Democrats facing challenges during the 2014 midterm elections to present the benefits of the ACA and stating that if she were “running for reelection in 2014, I would be posing a very stark choice to the voters of my district, or my state, if you want us to go back to the time when your sister with diabetes, or your husband with his heart condition, couldn’t get insurance at an affordable rate, then don’t vote for me, because I think it’s great that your sister and your husband now have insurance”. Senator Sanders voted for the Affordable Care Act but has stated that he did not think it went far enough and continues to advocate a single-payer national health care system.

Same-sex marriage, an important issue for many people living with HIV, is also a dividing point between the Democratic and Republican nominees. Both Clinton and Sanders express support for same-sex marriage, while the current Republican candidates insist that marriage should be defined as being between a man and a woman. The level of opposition varies between Republican candidates, with Huckabee stating that he would support a Constitutional amendment banning same-sex marriages if the Supreme Court ruled in favor of marriage equality, and Cruz being a proponent for a State Marriage Defense Act, which would prevent federal recognition of sex-sex marriages in states that do not currently have marriage equality. In contrast, Marco Rubio has stated that if the Supreme Court rules in favor of same-sex marriage, he “wouldn’t agree with their ruling, but that would be the law of the land that we would have to follow until it’s somehow reversed…which I don’t think is realistic or foreseeable.” Carly Fiorina was a supporter of Proposition 8, which banned same-sex marriages in California via voter amendment, but believes that same-sex couples should have civil unions.

AIDS United continues to follow all candidates as they articulate their positions on issues that are relevant to HIV/AIDS policy. There are many ways that advocates can actively stay informed, including PBS Newshour’s list of candidate positions on issues including health care, immigration, and social issues. Advocates can also volunteer with local HIV prevention and treatment organizations that have efforts focused on the upcoming presidential election or attend town hall meetings to ask candidates about their understanding of the HIV/AIDS epidemic. To stay up to speed on current HIV policy issues, such as the federal ban on syringe exchange or funding for the Ryan White program, check out materials from AIDSWatch 2015.

Your voice can help inform the future presidential nominee on the ways they can support efforts to end the HIV epidemic!

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