In the news ... 2007

California State HIV/AIDS Budget Issues

July 2, 2007

The California HIV Alliance prepared a budget request for Fiscal Year 2007–2008 that can be viewed at www.projectinform.org. For the first time, ADAP was fully funding with no need for additional state general fund in spite of no federal increase. This unusual situation allowed the Alliance to focus on priorities outside of ADAP. The two highest priorities were increasing funding for the state Therapeutic Monitoring Program, which provides viral load and resistance testing vouchers to local health jurisdictions to cover costs for people who can’t otherwise afford the tests, and establishing innovative HIV testing programs aimed at increasing the numbers of Californians who know their HIV status and, hopefully, those who seek care as a result. The testing programs are intended to provide the 20 to 25 percent of Californians who don’t know their HIV status more accessible opportunities to take an HIV test.

In the first set of budget hearings, the Assembly Budget Subcommittee agreed to increase state general fund by $4.5 million for the Therapeutic Monitoring Program (TMP) and to fund a request by the Budget Committee Chair, John Laird (D-Santa Cruz), to increase prevention funding for specified areas by $5.6 million. The Alliance’s request for funding for innovative testing programs was not funded in the Assembly. The Senate Budget Subcommittee funded only the items in the Governor’s January budget proposal.

As the budget process unfolded, it became clear that not only could the ADAP be fully funded for 2007–2008 with no new state general fund dollars, but due to a number of factors there would be money that could be re-directed out of the ADAP to other areas. The state’s effort to ensure that all ADAP clients who are eligible for Medi-Cal are signed up for their benefits, payments of Medicare drug co-pays for dual eligibles that strengthened the state’s rebate funding and the state’s leadership efforts in securing supplemental rebate agreements from pharmaceutical companies are all factors in significant savings in the ADAP.

The Governor’s May Revise budget, released in mid-May, proposed that $10.2 million in Ryan White Part B/Title II funds be redirected to existing care programs that have not received increases in several years, including the Early Intervention Program and Home Health and Community Based Care. The Governor’s budget also proposed redirecting $9.8 million in state general fund that is not needed in ADAP to several programs: $4 million for the TMP, $1.8 million to assist California areas that became Transitional Grant Areas (TGAs) under the newly authorized Ryan White Program, $2 million for HIV surveillance efforts to ensure the state meets the 2009 deadline for a complete HIV count which will be necessary to maintain the state’s Ryan White funding, $1.5 million for development of an integrated client database, and $500,000 to strengthen community based assistance connecting people to their benefits.

In addition to redirecting the $9.8 million, the Governor’s budget proposal returned $7.2 million in general funds back to the state. In light of the fact that the Governor’s budget proposal also cut some important health and human services funding and many in the Legislature were struggling to restore some of those proposed cuts, the Alliance revised its testing request to $2.5 million. The Alliance asked Assemblyman Laird and both Budget Committees to redirect this amount to innovative testing programs, leaving $4.7 million to be returned to the state. On May 22, the Senate Budget Subcommittee heard the Alliance's request to protect $2.5 million for testing but did not approve it, and the Assembly Budget Subcommittee refused to even hear the request.

Alliance members are disappointed by these actions and will continue to press the Legislature to approve the testing initiative. If we are unable to secure the money through the budget process, we will work with the State Office of AIDS to explore the possibilities of utilizing existing funding in these new program areas. The number of people who don’t know their HIV status in California is unacceptably high and has been static for at least four years and California continues to suffer the same number of new HIV infections each year. It is time for the state to provide leadership with innovative testing initiatives aimed at those who don’t have access to regular health care. Existing programs are not making strides in this area.