Arkansas: Funding Cuts Limit Access to HIV, AIDS Treatments

Funding cuts are forcing Arkansas officials to curtail some services and medications for residents with HIV/AIDS.

State officials administering the federally funded $7.42 million Ryan White Part B program are furloughing some program participants from the rolls, at least temporarily, and establishing a waiting list for those who wish to enter or re-enter the program. After increases in fiscal 2009, recent state and federal cutbacks have brought program funding nearly back to 2007 levels.

Program participants who do not meet new, lower income eligibility guidelines can work with a "service access specialist" to find alternative sources of HIV medication before they are dropped from the program on Dec. 31. Individual pharmaceutical companies often maintain programs that provide their products for low-income persons at little or no cost.

An estimated 5,097 Arkansans had HIV or AIDS as of Dec. 31, 2008, some of whom receive help through the Ryan White program. As of Aug. 13, the AIDS Drug Assistance Program had a 54 percent increase in clients enrolled this year compared with fiscal 2008 -- from 433 to 677 patients.

"We tell our patients: 'Don't miss a single dose [of HIV medication],'" said Dr. Nate Smith, medical director for the Arkansas Department of Health's HIV/STD program. Interrupted treatment can lead to viral resistance to the drugs, and subsequent treatment may require more expensive medications.

In recent years, Arkansas has set the income cap for the program at 500 percent of the federal poverty level, or $54,150 annually for a one-person household. But the program is facing increased demand in response to job layoffs and lost insurance coverage, Smith said.

To cope with funding cutbacks and growing demand for services, Arkansas officials are applying for alternative sources of federal funding. One requirement for such funding, in addition to establishing the waiting list, is reducing the program's income threshold from 500 percent to 200 percent of the poverty level. The state is also curtailing outreach, limiting dental care to emergencies, cutting the plan's formulary, and increasing the prior authorization needed for a dozen medications.

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