Calif. Governor Vetoes Funding for Program That Would Maintain Medicaid Reimbursement Rates for AIDS Drugs
California Gov. Arnold Schwarzenegger (R) on Saturday used his line-item veto power in signing the state fiscal year 2004-2005 budget to eliminate $750,000 in funding intended to maintain Medicaid reimbursement rates for HIV/AIDS medications at community clinic-based pharmacies, the Los Angeles Times reports (Halper/Nicholas, Los Angeles Times, 8/1). Although the veto will not increase prescription drug costs for beneficiaries of Medi-Cal, the state's Medicaid program, it could cause some pharmacies to stop participating in Medi-Cal, the San Francisco Chronicle reports (Gledhill, San Francisco Chronicle, 8/1). The veto "triggered anger" among AIDS advocates, who said that community clinics -- which would have benefited most from the provision -- could not afford to continue competing with the medication prices offered by large chain pharmacies, according to the Times. AIDS Healthcare Foundation is planning to challenge the veto in court, the Times reports (Los Angeles Times, 8/1). "The [Schwarzenegger] administration is attempting to save money to the Medi-Cal program through pharmacy rate restructuring," AHF President Michael Weinstein said, adding, "But driving very ill patients away from clinic-based pharmacies and into Rite Aid and Walgreens is just bad policy and bad medicine." Weinstein said his group's legal challenge "will likely prevail" because the state must base Medi-Cal rates "on actual costs to medical providers." He added, "This cut clearly doesn't meet the test" (AIDS Healthcare Foundation release, 7/31).
AIDS Drug Assistance Program
The San Francisco AIDS Foundation on Saturday lauded Schwarzenegger for fully funding the state's AIDS Drug Assistance Program at $234 million, including a $27 million increase, according to an SFAF release (SFAF release, 7/31). ADAP -- which is financed with both state and federal funds -- provides HIV treatment to low-income, uninsured and underinsured HIV-positive individuals. Schwarzenegger in May released a revised budget, excluding a provision from his original proposal that would have capped ADAP enrollment at the current level of 23,900 enrollees. If implemented, the cap would have prevented more than 1,400 HIV-positive people in California from accessing antiretroviral drugs, and existing enrollees would have faced reduced benefits. The original budget also would have cut funding for HIV/AIDS prevention and treatment programs by 2%. However, the signed budget increases state ADAP funding by 13%. The $27 million increase brings state spending on the program to $67 million and provides funding to cover the cost of increased enrollment and drug prices and the use of additional drugs by current beneficiaries (Kaiser Daily HIV/AIDS Report, 5/17).
Report Recommends HIV Cases Be Tracked by Name
In related news, a state report highlighting recommendations to restructure the California government suggested that the state track new HIV cases by name instead of alphanumeric codes, the Los Angeles Times reports. California in 2002 established its current HIV/AIDS tracking system, which uses codes to track HIV cases and names to track AIDS cases. The restructuring panel, called the California Performance Review, concluded that the code-based system is "labor intensive, less accurate and more complex than the name-based system" and could result in the loss of $50 million in federal funding, according to the Times. California is the only one of the five largest states to use code-based data. The report noted that 36 other states use name-based tracking. The report found that the state Office of AIDS does not have sufficient funding to evaluate its tracking system and show that it meets CDC standards. According to the Times, CDC "considers code-based data to be unreliable." The complete report is scheduled to be formally released on Tuesday.
Although some health professionals and AIDS advocates have said that a code-based system is "too cumbersome" and leads to more unreported cases, others say that using patients' names would "compromise confidentiality and make them less likely to get tested," the Times reports. Weinstein said that the current system is "unworkable" and "complicated," making it difficult for the state "to determine whether a person is being counted twice." Fred Dillon, SFAF director of policy and communications, said, "Even with name reporting, many jurisdictions say they don't have the time to report, so to say this would fix the system completely is false" (Rivera, Los Angeles Times, 7/31).