by Mark Hubbard

State of Tennessee Department of Health Commissioner Kenneth S. Robinson, M.D. and HIV/AIDS/STD Section Chief Jeanece Seals confirmed in May that cuts to major services for Tennesseans living with HIV/AIDS will likely be avoided through June of 2007.

The state had been working fervently with the community for months to address a projected shortfall, and a last minute appropriation of $3 million dollars contained in Governor Bredesen’s supplemental budget allowed the leaders to make the projection.  Relieved advocates emphasized that what happens beyond that date remains unknown, and expressed serious concerns about other issues including the large amount of “one-time” funds used to fund the current fiscal year.

The announcement was made during a regularly held meeting in Nashville. Participants represent the statewide HIV/AIDS care community including persons living with HIV/AIDS (PLWHA’s), case managers and medical care managers, staff and executives from community-based organizations, and the volunteer leaders and administrative agencies who distribute funds allocated by the state for regional services.

During his unprecedented appearance, Commissioner Robinson emphasized that the fight against HIV/AIDS is an ongoing struggle, repeating the refrain, “the more things change, the more they stay the same.” He told the story of his first encounter with an AIDS patient as a physician and went on to describe his decades of involvement in HIV prevention and care as both a physician and pastor. Telling the audience members that they must be objective, diligent, vigilant, and sensitive to realities, he assured them that when it comes to the fight against HIV/AIDS “your governor ‘gets it,’ and this commissioner ‘gets it.’ We are duty bound to protect, preserve, and improve access to care.”

Seals expressed her appreciation to both Commissioner Robinson and Governor Bredesen for responding to the section and the critical needs of those it serves. She thanked everyone for their months of hard work brainstorming, formulating contingency plans, and engaging in advocacy on the issue.

“It took all of our efforts to accomplish this,” she told them, reminding them that the work must continue.

For months, those involved have struggled to find a way to make ends meet. The crisis began last fall with a massive disenrollment of TennCare recipients. Large numbers of newly uninsured PLWHA’s were forced onto Ryan White programs to maintain access to medical care and lifesaving drugs. Some of these persons were later able to access the Medicare Part D prescription drug program, while others were not. The financial impact across the system was felt immediately. Cuts, rationing, and waiting lists were believed to be inevitable and impending until shortly before the May meeting,

Changes were postponed by an aggressive effort to carefully cut costs and to maximize funding. The state eliminated its program to provide eyeglasses for PLWHA’s. Savings were realized when administration of the state’s Ryan White HIV Drug Assistance Program was turned over to a contractor, and the number of covered drugs was reduced. New statewide guidelines and limits for dental benefits were implemented. The section opted to leave some staff positions unfilled; those salary dollars will go to direct services. The program successfully applied to the federal government to recapture over $8 million dollars in unspent funds from prior years. Finally, the $3 million dollar allocation in the governor’s supplemental budget eliminated any immediate plans for cuts.

Meanwhile, advocates are taking to heart the Commissioner’s admonition to stay vigilant. The affected Ryan White programs are only part of the resources used to meet the needs of Tennessee’s PLWHA’s. Agencies and medical providers rely on other federal programs, public and private grants, fundraising events and individual donations to insure that a complete continuum of care is maintained. The federal Ryan White Care Act, which expired in September of 2005, has yet to be renewed and congressional negotiations are currently at an impasse. Proposals for major restructuring leave the affect on Tennessee unknown. Determining the impact of Medicare Part D remains elusive, given that an unknown number of PLWHA’s are receiving subsidies that end January 1. Some of those who didn’t qualify for the subsidies are already encountering dangerously burdensome premiums, deductibles, and co-pays.

Mark Hubbard is the current interim chair of the Tennessee Association of People With AIDS and participates on working groups convened by the HIV/AIDS/STD section.

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