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Protecting People With HIV in the California Budget

February 2010

California has been facing a massive budget deficit for the past several years, a problem that is expected to continue for the next several budget years. A weak economy, structural barriers to increasing revenues, "solutions" from previous budgets that imposed future costs, earmarked revenues and limited options to balance the budget are some of the contributors to the difficulty the state faces. Governor Schwarzenegger and the Legislature have chosen to cut spending in essential social programs rather than show the leadership necessary to adequately address the state's fiscal crisis by examining appropriate revenue sources in addition to cutting state spending.

In February 2009, the Legislature and the Governor passed a budget for the 2009-10 fiscal year. The budget contained a shortfall that needed correction almost as soon as it was signed into law. The Governor proposed severe cuts to health and human services in a budget amendment process that started in early spring. That proposal included an $85 million cut from HIV services, eliminating state funding for Education and Prevention, Home and Community-based Care, the Therapeutic Monitoring Program, Early Intervention programs, Housing, and Epidemiology and Surveillance. It also reduced funding to the State Office of AIDS and to the AIDS Drug Assistance Program (ADAP).

Project Inform and our partners mounted a strong advocacy campaign, including a rally in Sacramento, lobbying, and compelling testimony from people living with HIV, providers, and doctors. The Legislature restored the worst of the cuts only to have the Governor remove even more state general fund from the programs with his veto of the Legislature's proposal. By August, the state was reeling from deep cuts to HIV services, Medi-Cal and other important programs that people with HIV depend on to stay healthy.

In spite of protests, many of which were organized by Project Inform and our partners, and law suits questioning the cuts, the money was not restored and the fight against HIV in California has suffered a serious blow. As local health jurisdictions struggle to find innovative ways to continue essential services, it is unclear what the overall impact of the cuts will be.

In fall 2009, the Governor and his administration began development of the FY 2010-11 budget and it became clear that ADAP was moving quickly towards a large shortfall in funding. Advocates estimated that $100 million more would be needed to ensure that ADAP could continue to serve all who qualify and need the services. The Legislative Analyst's Office later confirmed the amount.

Again, advocacy campaigns were mounted, with press conferences and rallies. People with HIV and their allies turned out in force, attending events and contacting the Governor. More than 80 organizations signed on to a letter demanding that the Governor fully fund ADAP in his budget proposal. In spite of a budget deficit of close to $20 billion and proposed cuts to many important health and human services programs, the Governor put $97 million in state general fund into ADAP, allowing it to serve all who need it, with one important exception. ADAP will no longer serve 36 municipal jails, resulting in a $9.5 million reduction in the overall program, and raising concerns that those in municipal jails may not continue to get the HIV treatment they need during their stay in jail and as they transition back to the community.

Currently, the Legislature is developing its response to the Governor's proposal. We have an uphill battle to ensure that ADAP retains the necessary increase it received in the Governor's budget and that people in municipal jails get the treatment they need. Medi-Cal serves about 50% of those with HIV in California and we will also have to fight against the devastating cuts that have been proposed for that program. In addition, California is preparing to renew its Medi-Cal waiver, the plan that outlines how it will serve seniors and people with disabilities. Project Inform will be working to ensure that people with HIV are represented in that process.

The work of this last year and the victories we have won together would not have been possible without partners and coalitions but most importantly, people with HIV and their allies who have been strong advocates throughout the process. Unfortunately, California continues to face huge budget challenges, record levels of unemployment, and decreased revenues. Given the unwillingness of California elected officials to raise appropriate revenues and the continued proposed cuts to essential services, our work is far from over.

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