Texas Health Department Proposes Tightening ADAP Eligibility Criteria; 4,200 Texans Could Lose AIDS Drug Coverage
Under a Texas Department of Health proposed regulation that would lower income eligibility limits under the Texas HIV Medication Program -- the state's official AIDS Drug Assistance Program -- approximately 4,200 Texans could lose coverage of their HIV/AIDS drugs, the Houston Chronicle reports. If the regulation, which is currently undergoing a 30-day public comment period, is approved by the board of health, some 1,700 people could lose coverage beginning in January, and another 2,500 people could lose coverage by July (Ross Hughes, Houston Chronicle, 11/1). Currently, the eligibility limit is 200% of the federal poverty level, or $17,720 for an individual. The proposed regulation would lower that limit to 140% of the federal poverty level, or $12,404 for an individual. In addition, the regulation would prohibit enrollees from deducting the cost of drugs from their incomes, which had allowed patients to "earn more and still qualify," the Fort Worth Star-Telegram reports (Huff, Fort Worth Star-Telegram, 10/31). Health officials say that the program faces an estimated $37 million shortfall over the next three years due to increasing demand for the drugs and an overall state budget deficit (Houston Chronicle, 11/1). Dr. Celine Hanson, bureau chief of HIV and STD prevention at the health department, said that the program's costs were increasing for several reasons. More people with HIV/AIDS are eligible, with a projected 11,500 enrolled in the program in 2002, compared to about 9,000 who were enrolled in 1999. In addition, the average cost per client has almost doubled since 1996 to about $9,500 annually, and with the advent of more effective but more expensive drugs, costs per client will continue to rise, Hanson said. The department's board is expected to consider the issue at a board meeting in January or February.
AIDS advocates say they were "blindsided" by the proposed regulation, which was approved by the health department during an Oct. 18 board meeting (Fort Worth Star-Telegram, 10/31). "When you knock those people off [the program], you know what happens to them? They die. That's wrong. Straight up wrong. It's a death sentence," state Rep. Garnet Coleman (D) said. But state health department spokesperson Doug McBride said, "From the standpoint of a state agency making these decisions, you take a beating on it from advocates. Something had to be done. You can't wait until you're out of money" (Houston Chronicle, 11/1). Hanson added, "Our concern is that we are proactive and keep the program solvent for clients and not allow the program to get into trouble. ... [W]e are trying to do the least harmful approach. The drive to do this is nothing more than fiscal." Pamela Donnelly, associate executive director at AIDS Outreach Center, which serves nine counties in the state, said, "I feel like they've put the cart before the horse. ... But let's see what we do get, and let's see then what corners we have to cut" (Fort Worth Star-Telegram, 10/31).