2003-2004 BUDGET PRIORITIES
AIDS in New York State
New York continues to be the epicenter of the HIV/AIDS epidemic
in the United States. Since the first cases were identified in New
York City, in 1981, more than 140,000 New Yorkers have developed
AIDS, accounting for almost 20% of the nations confirmed cases.
The epidemic is expanding; raging in our communities of color-making
up 82% of all new cases, rising among young men who have sex with
men, and steadily increasing among women, who now make up one quarter
of New York's AIDS cases. In New York, racism, gender inequality,
drug dependency, social status, poverty and homophobia continue
to create challenges for people living with HIV and AIDS.
GMHC's Budget Priorities
GMHC's Budget Priorities are a reflection of our mission and the
needs of the people we serve. We recognize the state is saddled
with a financial crisis; while mindful of this situation, we believe
it is imperative that GMHC advocate for funds where there are clear
and demonstrated unmet needs.
We urge the state to be vigilant in protecting the health care
needs of at-risk populations, who are the most vulnerable during
times of economic hardship. Concerning these fiscal issues we urge
lawmakers not to forget the AIDS crisis that continues to devastate
our communities.
2003-2004 BUDGET PRIORITIES
Restore $10.9 million in HIV/AIDS funding
One of GMHC's top priorities is to ensure adequate funding to fight
the HIV/AIDS epidemic. In difficult and uncertain times, it becomes
more important than ever to preserve our vital service delivery
structure. GMHC supports maintaining the entire 2002-2003 adopted
HIV/AIDS budget.
$10.9 million appropriated by the legislature last year was excluded
from the Governor's Executive Budget proposal and must be restored.
These cuts result in fewer resources to fight AIDS and HIV infection
in communities of color, for children orphaned by the AIDS epidemic
and for programs that help people living with AIDS adhere to their
complex drug treatment regimens. In tough fiscal times, these vulnerable
populations are the first to feel the effects of economic hardship.
New York must focus on the service delivery foundation; Community
Service Providers have proven effectiveness in service delivery
and provide a wide range of support services. Community Service
Providers (CSPs) like GMHC have been on the frontlines since the
beginning of the epidemic, providing a continuum of HIV/AIDS services.
At GMHC, we continue to see a significant monthly increase in demand
for services-as much as 30% more than at this time last year.
GMHC urges the legislature to baseline the 2002-2003 HIV/AIDS
Adopted Budget
Service providers have been struggling to offer high quality services
to meet increasing needs without adequate funding. These funds should
not be up for review every year, but should be viewed as baseline
funds. Restoration of these items is crucial to service providers'
ability to continue delivering high quality HIV/AIDS services. Restorations
must include:
Restore $10.89 Million in funding
- $1.768 M -CSP
- $1.768 M -MSA/CDI
- $179,000 -HHAP
- $562,500 -Treatment Adherence
- $562,500 -Permanency Planning
- $625,000 -Specialty Contracts
- $446,000 -Legal Services
- $179,000 -NBLCA
- $89,000 -NYAC
- $3M -Assembly Communities of Color
- $1M -Senate Communities of Color
- $750,00 -OASAS Communities of Color
No Increase or Establishment of Prescription Drug Co-Payments in
the Medicaid Program.
In the regular fee-for-service Medicaid program, co-pays for brand-name
drugs would increase from $2 to $3 and generics from $.50 to $1
under the Governor's proposed budget. Co-pays would also be instituted
for the Medicaid managed care program. Yearly out-of-pocket maximum
for pharmacy co-payments would be increased from $100 to $150. Studies
have shown that increased pharmacy cost-sharing for people with
disabilities impedes access and inappropriately reduces utilization
of medically necessary drugs. This is cost-saving measure that disproportionately
impacts individuals with the highest level of need. GMHC urges no
increase or establishment of pharmacy co-pays and yearly out-of-pocket
maximums.
Enact Strong Consumer Protections in any Medicaid
Prescription Drug Prior Authorization Program
In New York State, Medicaid prior authorization procedures are
burdensome to prescribers, pharmacists and Medicaid patients and
-if experiences from other states tell us anything - will result
in lost access to medically necessary drugs. Consumers with serious
illnesses and disabilities, like HIV/AIDS, are the people who are
most impacted by prior authorization. For these reasons, adequate
consumer safeguards for Medicaid beneficiaries subject to pre-approval
for prescription drugs are essential.
GMHC urges the legislature to define adequate safeguards for Medicaid
consumers that minimize negative impact on a patient's access to
prescription drugs. There must be a transparent and streamlined
process for consumers that is time sensitive and where the burden
of program navigation rests with the state and not on consumers.
Oversight of Prison Health Care
GMHC, with the Legislative Action Coalition on Prison Health supports
passage of legislation that expands and improves the healthcare
HIV+ inmates receive in New York State Prisons. GMHC will continue
advocating for legislation (A.4204-Gottfried/S.1840-Mendez) authorizing
the State Department of Health to perform yearly audits of the health
care provided in correctional facilities at an estimated cost of
$1million.
Of the 66,800 inmates in the custody of the Department of Correctional
Services (DOCS), approximately 10,000 are infected with hepatitis
C and more than 6,000 are HIV-infected. According to a 1999 study
by the US Justice Department, New York has the highest known prisoner
rate of HIV in the country. In fact, over a quarter of all prison
inmates known to be HIV+ were in New York State Prisons in 1999.
(Bulletin, Bureau of Justice Department, July 2001, NCJ18456)
Each year, approximately 29,000 inmates return to the community.
Providing adequate and essential medical care to these inmates is
not only crucial to their well being, but also to their families,
and communities.
HEALTH CARE REFORM ACT PRIORITIES
Maintain Family Health Plus Eligibility
Level at 150% FPL
The Governor's proposal would reduce FHPlus eligibility for parents
from 150% of the FPL to 133%. This means that a family of three
earning between $1914 and $1697 a month would not be eligible for
coverage anymore. By reducing eligibility, tens of thousands of
people will be left with no inpatient or outpatient medical coverage
or access to the prescription medications they need. More people
will become uninsured if eligibility for FHP is tightened, health
programs such as ADAP will be stretched even thinner as more people
look to them for help, and emergency rooms will serve more people
who do not have access to the preventative and routine medical care
that Family Health Plus provides. GMHC urges the legislature to
maintain FHPlus eligibility for parents at 150% FPL.
Ensure Adequate ADAP Funding
The AIDS Drug Assistance Program is expected to have as much as
a $50 million shortfall in the coming year, and has already begun
implementing cuts to the program. Thousands of New Yorkers rely
on this highly effective program for their life saving medications
and services. GMHC fully supports the Executive proposal for significant
increased funding to ADAP through the Health Care Reform Act (HCRA).
GMHC urges legislative support for the following annual increases
to ADAP over the next 2 1ž2 year HCRA cycle that will total $46
million:
January -December 2003: funding of up to $40 M
January -December 2004: funding of up to $56M
January -June 2005: funding of up to $30M
(half year)
Stabilize Direct Pay and Medigap Private Insurance
Markets
While other neighboring states have seen sky-rocketing premiums
and increasingly adversely selected direct pay markets, New York
has provided this market segment with a small amount of stability,
even as premiums continue to rise significantly. Direct pay premiums
have been lowered between $25 and $40 per month per person through
HCRA's "stop-loss" reinsurance, even though funds have been insufficient
to cover all high cost claims. When HCRA is reauthorized, this stabilization
fund should be maintained and enhanced to provide even greater stability
to this most vulnerable segment of the insurance market.
GMHC urges the legislature to increase HCRA direct pay market stabilization
fund by 20% annually, over and above the current flat-funding proposal.
Furthermore, threshold and reimbursement limits should be changed
to make more high cost claims eligible for subsidy.
Require State Insurance Department to Hold Rate
Hearings
When premiums in the direct pay market do inevitably go up, the
State Insurance Department should be required to hold hearings to
provide the public with a meaningful opportunity to comment on and
impact the proposed increases.
GMHC urges the Legislature to require the State Insurance Department
to hold a public hearing when an insurer seek a rate hike above
5% and eliminate "file and use" rate procedures.
© 2003 Gay Men's Health Crisis
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