Another 2,000 at risk of being bumped because of budget woes

The Florida Department of Health plans to drop about 350 uninsured HIV/AIDS patients from a federally funded program that pays for all or most of their drugs, because of a budget crisis.


Another 2,000 or more HIV-positive patients are at risk of being bumped from the drug subsidy program unless the state can close a $16 million shortfall in the next few months, officials said Tuesday.

"We are all pursuing every possible legal and financial option we can to make up the deficit," said Tom Liberti, chief of the state's Bureau of HIV/AIDS. "No one wants to disenroll one patient."

In June, the shortfall forced the Health Department to put more than 2,300 patients so far on a waiting list for the AIDS Drug Assistance Program. About 1,100 live in South Florida and about 300 in Central Florida. The program also halted coverage for many drugs that infected people take for HIV-related complications.

Dropping patients saves about $10,000 per person per year, Liberti said. The state expects the 350 people to lose coverage in about 30 days, with nearly all of them able to continue getting free or low-cost medicine through manufacturer assistance programs, he said. The state helped those on the waiting list get assistance from the drug makers.

But activists said losing coverage from the program threatens to disrupt the supply of drugs and the drug-taking schedules of HIV-positive patients, most of whom have been stable for years. Taking the medicine on a rigid schedule is crucial, experts say, because missing even 5 percent of doses gives the virus a chance to become resistant to the drugs.

"We are playing with people's lives here," said Michael Rajner, of Fort Lauderdale, an HIV-positive activist who was among those briefed on the situation.

The cutbacks are hitting hard in South Florida, where the rate of new HIV infections per capita is the highest in the nation. The state has by far the largest waiting list among nine states forced to start them.

Florida's AIDS drug program is in trouble because enrollment has swollen to about 11,000, a result of patients losing jobs and insurance during the down economy, and also living longer thanks to better drugs.

The 350 to be dropped have incomes more than three times the federal poverty level, or $43,710 for a family of two. Until now, the program covered HIV patients with incomes up to four times the poverty level, or $58,280 for a family of two. Cutting eligibility is the least painful money-saving step available now, Liberti said.

Rajner said the change will cause a deeper ripple, because it will force counties to drop those same uninsured patients from other federally funded programs that pay for their doctor visits, hospital visits, dental treatment and other care.

President Barack Obama in June found $25 million to help states shrink their waiting lists. Florida got some good news last week when federal officials allowed more flexibility in how the state uses its $6 million share.

Liberti said the prospects for Florida's drug program look much brighter next year, as the state expects to get more money from at least five different sources.

Chief among them: States with waiting lists stand to get another $50 million in a budget bill that comes before Congress after the election, said Deborah Parham Hopson, an HIV/AIDS chief at the U.S. Health Resources and Services Administration.

But none of that extra money would be available until April 1. Liberti said Florida's $100 million-a-year drug program now stands about $16 million short of the amount it needs to make it to April 1.

Liberti is asking the Health Department to funnel more money on an emergency basis, and is seeking federal clearance to negotiate lower prices from drug companies.

If those moves don't work to save enough, he said the program may be forced to temporarily drop "a minimum of 2,000 people, maybe more."

Some activists also are upset by another change. Officials said the state plans to drop patients from the drug program who fail to pick up their medicine within a five-day window at the end of the month. Officials say the move encourages patients to take drugs on time, but Rajner said it will harshly punish people for small mistakes.