2005–2006 STATE FUNDING PRIORITIES
About Gay Men's Health Crisis
Gay Men's Health Crisis (GMHC) is a not-for-profit, volunteer-supported
and community-based organization committed to national leadership
in the fight against AIDS. GMHC serves one in every five persons
diagnosed with AIDS in New York City. As the world's oldest AIDS
service provider, GMHC helps over 15,000 men, women and children
and their families each year. GMHC offers a wide range of comprehensive
client services, including hot meals, benefits/entitlements advocacy,
health care advocacy, case management, legal assistance, HIV counseling
and testing, individual and group counseling services, prevention
education, home-based support, and mental health services.
GMHC has been on the frontlines of the AIDS epidemic since it
began, focused on the communities most threatened by HIV and expanding
our service provision as the epidemic expands. The number of GMHC
clients has increased by almost 50% just since 2000. Our clients
reflect the diversity of HIV; 68% are people of color, 63% are
lesbian, gay, bisexual, 19% are women, and more than half reside
outside of Manhattan. Of our total clients served we continue to
see a larger proportion living in poverty. Approximately 70% of
the clients we serve are living an annual income of less than $10,000.
70% of GMHC clients rely on Medicaid, while 15% rely on the AIDS
Drug Assistance Program, ADAP for their medical care and life-saving
prescription drugs.
AIDS in New York State
New York is the epicenter of the HIV/AIDS epidemic in the United
States. Since the first cases were identified in New York City,
in 1981, more than 162,000 New Yorkers have developed AIDS, accounting
for 18% of the nations confirmed cases. New York leads the nation,
with the highest number of persons living with AIDS — 66,660
by the end of 2003. Furthermore, cumulative reported AIDS cases
in New York State have increased 49% since 1996.
The epidemic continues to devastate our communities of color — making
up 81% of all new cases in New York City, sharply rising among
young men who have sex with men, and steadily increasing among
women, particularly women of color, who make up well over a quarter
of New York's AIDS cases and 30% of new HIV infections. In New
York, stigma, racism, gender inequality, drug dependency, social
status, poverty and homophobia continue to create challenges for
people living with HIV and AIDS, and place communities at risk
for HIV.
GMHC's Funding Priorities
GMHC's Funding Priorities are a reflection of our mission and
the needs of the people we serve. We recognize the state is faced
with several financial obligations this year; while mindful of
this situation, it is imperative that GMHC advocate for funds where
there continue to be clear and demonstrated unmet needs. GMHC will
continue to be vigilant in advocating for the health care needs
of at-risk populations, who are the most vulnerable during times
of economic hardship.
Furthermore, GMHC supports the recommendations of the NYS AIDS
Advisory Council and the New York AIDS Coalition (NYAC) who have
worked with the community to develop broad funding priorities that
are sensitive to the state's financial limitations. We would like
to highlight the following issues of particular concern to us in
these 2005-2006 Funding Priorities.
2005-2006 STATE FUNDING PRIORITIES
Restore $8.4 million in HIV/AIDS funding
One of GMHC's top priorities is to ensure adequate funding to
fight the HIV/AIDS epidemic. In difficult and uncertain times,
it becomes more important than ever to preserve our vital service
delivery structure. In addition to reversing the Governor's 2005–06
cuts to HIV/AIDS programs, GMHC urges the legislature to do all
that it can to fully restore funding to levels in the FY 2003–2004
enacted budget.
$8.4 million in total appropriated by the legislature has again
been excluded from the Governor's Executive Budget proposal and
must be restored. Those cuts result in fewer resources to fight
AIDS and HIV infection in communities of color; for funding initiatives
targeting specific geographic areas and at-risk populations; for
education, training and service coordination; for programs that
help people living with AIDS adhere to their complex drug treatment
regimens; and for children orphaned by the AIDS epidemic.
In light of the recent court of appeals decision, we are aware
that this year's budget negotiations will be different from years
past. Still, GMHC strongly urges the Legislature to add funds where
it can and to negotiate with the Governor in order to complete
full restorations for HIV/AIDS services. We thank the Assembly
for its leadership in providing $8.4 million in HIV/AIDS restorations
in the 2004–2005 budget, and encourage the same restorations
in the current budget proposal.
GMHC urges the legislature to baseline the HIV/AIDS Adopted
Budget
Service providers have been struggling to offer high quality services
to meet increasing needs with inadequate funding. We can not afford
to have these allocations up for review every year; they should
be baseline funds and are crucial HIV/AIDS safety net services.
Restorations must include:
Restore $8.4 Million in funding
- $1.768 M CSP
- $1.768 M MSA/CDI
- $179,000 HHAP
- $168,700 Treatment Adherence
- $168,700 Permanency Planning
- $625,000 Specialty Contracts
- $446,000 Legal Services
- $179,000 NBLCA
- $89,000 NYAC
- $3M Assembly Communities of Color
Addressing Rising Needs
Funding for HIV/AIDS services has not kept pace with the growing
epidemic. With the exception of his first year in office, the Governor
has proposed cutting enhanced funding for HIV/AIDS programs every
single year. The HIV/AIDS epidemic, needless to say, has not been
static in New York since the Governor has taken office. The number
of people living with HIV/AIDS is the highest it has been throughout
the epidemic, a fact reflected in the growing caseloads of service
providers throughout the state. AIDS funding has suffered for far
too long. The full needs of the HIV/AIDS community must be met
this year in order to stand any chance of catching up with this
rising need.
Allocate $2 million each in new funding to CSPs and MSA/CDIs
Community Service Providers and Multiple Service Agencies have
been providing high quality valuable services to communities
most at risk since their inception. They have been steadfast
in ensuring a continuum of services in both HIV prevention-related
and support services for those infected and affected by HIV/AIDS.
Over the past five years, funding has been declining even as
they have been facing increasing needs and providing more services.
As services have had to expand to meet rising needs, so should
the resources that support these vital programs, GMHC urges the
allocation of $2 million for CSPs and $2 million for MSA/CDIs.
New York must focus on the service delivery foundation; Community
Service Providers have proven effectiveness in service delivery
and provide a wide range of support services. Community Service
Providers (CSPs) like GMHC have been on the frontlines since the
beginning of the epidemic, providing a continuum of HIV/AIDS services.
At GMHC, we continue to see an increase in demand for services — as
much as 50% more than in the year 2000. The number of GMHC clients
is up nearly 10% just since 2002.
HIV Prevention
We continue to see an increase in new HIV infections in the United
States, particularly in women, especially women of color and in
men who have sex with men, particularly men of color. At the same
time, the CDC has shifted priority away from primary prevention
methods and toward secondary prevention (prevention for those already
HIV+) leaving behind thousands of New Yorkers at risk of getting
HIV. The state must step up to the plate, and ensure the continuation
of vital community-based prevention education and counseling to
New Yorkers in communities hardest hit by this disease.
Recently, two local cases of a rare STD called LGV — lymphogranuloma
venereum, — a form of Chlamydia, have been diagnosed in New
York City. As well, the New York City Department of Health and
Mental Hygiene have reported a case of HIV infection with an unusual
combination of multi-drug resistance and rapid onset of AIDS in
one individual in New York City. While much is still to be determined
about the medical implications of the case it is clear that prevention,
as well as treatment adherence and testing continue to be the most
critical and powerful weapons to fight the AIDS epidemic. These
new cases clearly underscore the need for continued outreach and
stepped up funding for HIV Prevention.
Allocate $3.5 million in new funding for Primary Prevention
Programming
State funding for primary prevention should be targeted to those
most at risk for HIV infection: Men who have Sex with Men, particularly
young men of color; Women, particularly Women of Color; substance
users and prison releases.
Strengthening Medicaid and the Health Care
Reform Act
Medicaid
Medicaid is a lifeline for people with HIV/AIDS; over 65,000 people
living with the disease in New York State depend on Medicaid
for their health care. While GMHC agrees that cost containment
in Medicaid is necessary, it must be achieved by strengthening
our state's program and making prudent reform decisions, not
by making Medicaid even more difficult to access by those in
need of health coverage. The proposed 2006 budget makes numerous
cuts to our health care safety net — the programs that provide
health coverage for over 3 million New Yorkers from all walks
of life, including people with HIV/AIDS. Numerous studies have
shown that imposing greater cost sharing and reducing benefits
for low-income individuals merely forces people to go without
the services and medications they need to stay healthy, worsening
their conditions, delaying treatments, and resulting in more
costly hospital-based care. In particular, GMHC vigorously opposes
proposals that restrict eligibility, reduce benefits or impose
cost-sharing in Medicaid, including the proposal to eliminate
optional services, such as private dental, psychological and
nursing care.
Health Care Reform Act (HCRA)
We implore our elected leaders to ensure that HCRA programs, which
are essential to people living with HIV and AIDS, are reauthorized
and fully funded.
In the upcoming HCRA reauthorization, there should be no
further cuts to Family Health Plus that are targeted at consumers:
- No increase in co-pays
- No cuts in eligibility
- No cuts in benefits
Additionally, the legislature should restore the 2004
cuts to Family Health Plus:
- Rollback increase in prescription drug co-payments
- Rollback asset test in Family Health Plus
- Rollback cuts to facilitated enrollment for Child and Family
Health Plus
As HCRA is reauthorized, it should be a top priority to fully
fund the AIDS Drug Assistance Program, ADAP. NY's ADAP
program effectively supplies tens of thousands of HIV + New Yorkers
with their life-saving medication. The program continues to grow
at a consistent rate of $20 million a year. In the last HCRA
reauthorization, we supported the Governor's proposal for significant
increases to ADAP, enabling the program to continue to perform
at capacity. GMHC supports the continuation of this funding in
order to keep ADAP viable. GMHC supports the Governor's
proposal to reauthorize funding for ADAP over the next 2 and
1/2 years at a rate of $60 million annually.
Additionally, the state should fully fund the direct pay
stop-loss pool in this upcoming HCRA reauthorization
cycle, expand EPIC to the disabled and ensure
proceeds of non-profit conversions go to a charitable trust.
Oppose Preferred Drug Program for Medicaid
Beneficiaries Living With HIV/AIDS
In New York State, a Medicaid Preferred Drug Program (PDP) would
mean curtailed access to medically necessary prescription drugs
for HIV+ Medicaid patients. A PDP with cumbersome prior authorization
procedures without adequate consumer protections will burden prescribers
and pharmacists and — if experiences from our own and other
states tell us anything — will result in lost access to medically
necessary drugs. Consumers with serious illnesses and disabilities,
like HIV/AIDS, are the people who are most impacted by prior authorization.
Consumer protections proposed by the Governor are entirely inadequate:
the proposal exempts anti-retroviral drugs, but not people living
with HIV/AIDS. In fact, the governor's proposal weakens the proposed
legislation that lawmakers have been working on for years. There
must be a transparent and streamlined process for consumers that
is time sensitive; medically appropriate; and where the burden
of program navigation rests with the state and not on consumers.
For these reasons, GMHC opposes PDP and strongly advocates
for significant consumer safeguards, should a PDP be created.
Bring Down Prescription Drug Prices by
Leveraging NY's Buying Power through Bulk Purchasing
If New York State were a nation to itself, it would be the seventh
largest health care economy in the world. As such, it is a major
purchaser of prescription drugs. Each year, Medicaid, ADAP, and
other publicly funded programs spend hundreds of millions of dollars
on prescription drugs for people living with HIV/AIDS. The pharmaceutical
industry is the most profitable in the nation. The industry's sky-high
prices put pressure on consumer access, as well as the bottom lines
of programs that support HIV/AIDS care. New York State should closely
examine the entire range of purchasing strategies employed by other
states and localities, including reimportation from Canada, to
determine how public programs and individual consumers could benefit.
New York State should also create mechanisms that allow private
employers and self-insured plans to take advantage of lower priced
drugs.
Bulk buying and reimportation should be included in a
comprehensive effort to bring down the unreasonably high price
of medications provided by publicly funded programs.
No Increase to Prescription Drug Co-Payments
or Reductions in Coverage
In the regular fee-for-service Medicaid program, co-pays for brand-name
drugs would increase from $1 to $2 and generics from $.50 to $1 under
the Governor's proposed budget. Co-pays would also be increased for
the Medicaid managed care and Family Health Plus programs. Studies
have shown that increased pharmacy cost-sharing for people with disabilities
impedes access and inappropriately reduces utilization of medically
necessary drugs. This is a cost-saving measure that disproportionately
impacts individuals with the highest level of need.
GMHC urges no increase or establishment of pharmacy co-pays.
Maintain Family Health Plus Eligibility
and Affordable Benefits
The Governor's proposal would create barriers to FHPlus eligibility
by imposing a stricter assets test. This means fewer people will
be eligible for FHPlus and it will discourage enrollment due to
increased paperwork burdens. The proposed elimination of funding
for FHPlus facilitated enrollment will make it even harder for
the large numbers of HIV+ uninsured individuals to access coverage
given the complexity of the application process. By reducing eligibility,
tens of thousands of people will be left with no inpatient or outpatient
medical coverage or access to the prescription medications they
need. More people will become uninsured if eligibility for FHP
is tightened, health programs such as ADAP will be stretched even
thinner as more people look to the program for help. The proposal
also diminishes the adequacy of FHPlus benefit package by eliminating
vision, dental, and mental health services and establishing exorbitantly
high co-payments for prescription drugs and outpatient, inpatient
and Emergency Room services. GMHC urges the legislature
to maintain FHPlus eligibility and benefits and reverse the Governor's
proposed cuts.
Place Future Conversion Proceeds in a Foundation
Dedicated to Health
The Governor proposes that proceeds from future conversions of
not-for-profit insurers to for-profits be dedicated in large part
to HCRA, similar to the recent Empire conversion. This is not acceptable.
Future conversions should not go forward unless proceeds go to
a foundation dedicated to the expansion of health care access.
Medicare Part D
Medicare is increasingly an important source of coverage to people
living with HIV/AIDS. GMHC is concerned that the new Medicare Part
D law will likely mean less access to prescription drugs for many
HIV+ New Yorkers, especially dual eligibles. Changes in the law
also necessitate careful transitioning that must occur to avoid
disruption in the prescription drug coverage that is vital for
people living with HIV and AIDS. GMHC supports expanding the EPIC
program to the disabled so that non-ADAP eligible HIV+ Medicare
beneficiaries can access drugs not on their plans' formularies. GMHC
asks that New York State take every precaution necessary to ensure
that dual eligible beneficiaries, thousands of them HIV+, are fully
transitioned to the new Medicare Part D benefit by January 1, 2006.
For More Information:
Michele Bonan
Assistant Director, Government Relations
212.367.1045 micheleb@gmhc.org
Laura Caruso
Director of Health Policy
212.367.1228
laurac@gmhc.org
© 2005 Gay Men's Health Crisis
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