Care May Dwindle for Florida's AIDS Patients

A special Medicaid program for Florida's sickest AIDS patients is facing a $10 million cut -- 43 percent of its funding -- over the next year as part of the Legislature's recent efforts to balance the state budget. Project AIDS Care was designed to save the state money by allowing poor patients with AIDS to continue living, and to die, in their own homes, rather than in nursing homes or hospitals. Officials with hospice groups and other agencies that provide the care contend the reductions are short-sighted: Cutting key services likely will force more patients into institutions, costing more in the long run.

As proposed, the cuts would eliminate five in-home services: physical therapy, housekeeping, health assessment, pest control and therapeutic massage. Several more would be significantly reduced, including in-home meal service. But the toughest loss, advocates say, would be a two-thirds reduction in case management. For sick people who rely on public assistance, a case manager is akin to an administrative assistant for life. He or she helps the patient navigate bureaucracy and find free or low-cost services to augment government aid. Under the proposed cuts, Medicaid will pay just $50 per client per month, which will force agencies to fire some case managers and give the rest more clients than they can adequately serve, said Lorraine Langlois, executive director of Metropolitan Charities Inc. in St. Petersburg.

Medicaid administrator Bob Maryanski said agency staff tried to pick cuts that would disrupt patients as little as possible. The cut was mandated by the Legislature, and half ($5 million) must take effect during the last half of the state's fiscal year, which ends June 30. "The last thing we wanted to do was to cut services to this population," Maryanski said. "It's a fragile population, and most of the patients who use this service have serious medical problems, they can't do a lot for themselves." The cuts will affect 6,000 Florida AIDS patients.

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