California Gov. Arnold Schwarzenegger (R) on Friday proposed his $99.1 billion fiscal year 2004-2005 budget, which includes a 2% cut in funding for HIV/AIDS prevention and treatment programs, the Contra Costa Times reports (LaMar/Hannah, Contra Costa Times, 1/10). The budget also includes a provision that would cap enrollment for the state's AIDS Drug Assistance Program, the San Jose Mercury News reports (Feder Ostrov, San Jose Mercury News, 1/10). ADAPs -- which are state-managed, federally funded programs -- provide HIV treatment to low-income, uninsured and underinsured HIV-positive individuals (Kaiser Daily HIV/AIDS Report, 11/26/03). California's ADAP needs an additional $45 million for FY 2004-2005 to cover increased enrollment, the cost of additional drugs for current enrollees and increased drug prices. However, Schwarzenegger's budget did not include any increased funding; the budget instead would cap enrollment in the program at the current 23,900 enrollees. The move would cause more than 1,400 HIV-positive people in California to go without antiretroviral drugs and would reduce benefits for existing enrollees, according to a San Francisco AIDS Foundation release (San Francisco AIDS Foundation release, 1/9). In addition, the budget would cut Medi-Cal reimbursements by 10%, in addition to a 5% cut adopted last year, the San Francisco Chronicle reports (Seligman/DelVecchio, San Francisco Chronicle, 1/10). These cuts could force many providers to stop treating HIV-positive Medi-Cal patients, according to the release (SFAF release, 1/9).

Reaction
"The state's fiscal crisis may require sacrifices all around, but limiting access to ADAP could cost people with HIV/AIDS their health and ultimately their lives," AIDS Project Los Angeles Executive Director Craig Thompson said, adding, "It is simply not cost effective in the short or long term to cap enrollment in this program" (AIDS Project Los Angeles release, 1/9). "Every person who cannot access these lifesaving medications will become increasingly sick, and the cost of their acute health care will add to the financial burdens affecting the state," SFAF Director of State and Local Affairs Dana Van Gorder said (SFAF release, 1/9). Ellen LaPointe, executive director of Project Inform, said, "The governor knows that to truly serve low-income Californians with HIV, he needs to increase ADAP funding by approximately $45 million in this budget. ... It is disappointing that the governor has not only chosen to ignore this, but has gone further to propose additional cuts. We believe this recommendation is shortsighted, and disregards the needs of thousands who are depending on the governor for their continued well-being" (Project Inform release, 1/9). The AIDS Healthcare Foundation has enacted measures in its 12 AIDS clinics in the state that have generated more than $2 million in drug cost savings on just 800 patients, according to an AHF release. AHF President Michael Weinstein said that the "savings potential is enormous" if these techniques are applied to the nearly 24,000 people who are enrolled in the state's ADAP. AHF has proposed cost-saving measures that would prohibit monthly refills less than 27 days from the last refill, eliminate automatic refills, allow prescriptions to be written for a maximum of three months of refills and access federal drug pricing programs to reduce the costs of drugs. "We found pharmacies needlessly refill expensive prescriptions far too often after doctors have changed patient treatment. Too many medications are wasted. The solution is to fix these problems -- not cut off new patients," Weinstein said (AHF release, 1/9).

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