Florida Cuts $5 Million in Services for Home-Bound People With HIV/AIDS, While Broward County AIDS Funds Go Unspent
Florida's Agency for Health Care Administration is cutting $5 million in funding for a program that serves home-bound individuals with HIV/AIDS as part of an effort to trim $1.3 billion from the state's current budget, the Miami Herald reports. The elimination lowers this year's program budget to $19 million and could result in more individuals being placed in hospitals or nursing homes, a move that would cost taxpayers "significantly more," according to social workers who estimate that hospital or nursing home care costs twice as much as home care. About 6,000 HIV-positive Floridians rely on the program for in-home nursing care, social services and meal delivery. AHCA officials left registered nursing care "entirely intact" but reduced the time allotted for personal care from about three hours a day to no more than five hours a month. "By reducing this service to five hours per month, what are we telling someone? Sorry you're incontinent, but you must wait another week till your personal care attendant shows up," Paul Gallotta, a case manager who coordinates care for about 60 people enrolled in the program through Broward House, said, adding, "Regrettably, given the demographics of this disability, a lot of clients don't have family, and, for those that do, it's not easy when you have parents in their advanced years take care of someone that sick." Other cuts limit prepared meals to 27 per month and skilled licensed practical nurse care to no more than two hours per month. Physical therapy, home cleaning, respiratory therapy, health assessments and respite care services were completely cut. Bob Maryanski, who oversees the Medicaid program, acknowledged that the reductions and eliminations "hurt" but said AHCA, along with "virtually every state agency," was "forced" to make the cuts. "We tried to do it in a way to minimize the pain as best we could," he said, noting, "This is a very vulnerable and fragile population, which makes it even more difficult." He said AHCA tried to maintain as many medical services as it could, keeping intact registered nursing care, money for prescription drugs and at least two hours of massage therapy every month. In addition, case management services, which he called the "core of the Medicaid program," were kept in place. "We were able to restore some cuts and take some money from elsewhere. We wanted to have as much case management as we could," he explained. However, Gallotta said it is not enough. "It seems like they have almost deliberately gutted this thing. They say they are giving us half a loaf. But, in actuality, half a loaf is almost no loaf," he said (Miller, Miami Herald, 2/19).
Money in Broward County Goes Unspent
Meanwhile, almost $1 million in federal money earmarked to help people with HIV/AIDS in Broward County, Fla., went unspent last year, the South Florida Sun-Sentinel reports. More than $615,000 in Ryan White CARE Act funding was given to Broward County in March 2000 because of the high prevalence of HIV/AIDS in the county. Last year, 22,950 HIV infections and 13,332 AIDS cases were reported in Broward County. An additional $314,000 that was received in March 2001 also has not been spent. The county's HIV Planning Council, which is responsible for overseeing how the $13.8 million it receives in assistance each year is distributed, largely attributed the delays to the failure of new health care initiatives designed to target minorities and to help people adhere to their drug treatment regimens. The council also cited "complex bureaucratic rules" and delays in receiving federal criteria for minority-focused programs as reasons for the unspent funds. The council, which said the delays are "not unusual" and are "within the national norm," is examining new ways to distribute the funds and recently put a "large part" of the money toward the purchase of antiretroviral drugs for low-income residents. Alan Tiano, deputy executive director of the Wansiki Foundation, which received a grant for a drug therapy case management project that failed, said the redistribution is not necessarily negative. "It shows money is being managed and allocated thoughtfully. They'd rather roll it into next year than waste it," he said, explaining that Wansiki's funds were returned "as soon as administrators saw [the project] wasn't succeeding." However, other AIDS activists and several county commissioners blamed the "politicized" nature of the council for the delays. Commission Chair Lori Parrish said, "We have all these people suffering and yet agencies are turning back money. It doesn't make any sense. I want to know what's the problem." Council Chair Naomi Parker acknowledged that there is some "political infighting" on the council but said it "has not affected the distribution of money." She said that she is also concerned about the unspent funds, adding, "Every dollar matters. It matters in terms of getting people to good medical care and it matters in reducing the infection rates in the county" (Wyman, South Florida Sun-Sentinel, 2/19).