California: Sacramento's CARES Is Full-Service Provider to HIV-Positive Patients

The Center for AIDS Research, Education & Services (CARES) offers area residents who are HIV-positive comprehensive health care, including primary care, dental, and mental health. The services are free for the uninsured, while insured patients are charged co-payments.

CARES has thrived at a time when other AIDS service organizations (ASOs) have struggled to stay open due to diminishing state and local support. In recent years, Sacramento County has slashed its health services budget by nearly half and gone from six full-time clinics to three -- and soon to one.

"We've been fortunate," said CARES Executive Director Bob Kamrath. "We have not cut services. We've added services." That is because federal funding is the nonprofit's lifeline, comprising 80 percent of its budget. The remainder comes from health insurers and Sacramento County, which provides $250,000 annually.

More ASOs are turning to the CARES model. "The paradigm has shifted away from counties being the core anchor to the safety net system," said Bob Caulk, executive director of The Effort, which works to prevent methamphetamine use. "In the future you're going to see a different arrangement of safety net operations, funded by federal dollars."

CARES receives $3 million per year under the Ryan White Care Act, which provides funding for low-income HIV/AIDS patients. And it operates an on-site pharmacy, which allows it to tap into the federal 340B Drug Pricing Program to purchase reduced-price medicines, netting the ASO about $6 million annually.

CARES serves around 2,100 HIV/AIDS patients. "The only thing we don't have here is specialty care -- podiatry or something like that," said Kamrath. In 2008, at the county's request, it began offering walk-in STD testing.

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