2004 Environmental Scan: Selected Findings Conducted for the Ryan White Planning Council by RTH Research Group, LLC

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2004 Environmental ScanSelected Findings
Conducted for the Ryan White Planning
CouncilbyRTH Research Group, LLC

• Roberto Trevino, Ph.D.
• Alan Jay Richard, Ph.D.
• Diana Lemos, B.S.

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Demographic Trends
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Age-Adjusted HIV/AIDS Mortality Rates for Texas
are Similar to those for California
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Texas exhibited less overall reduction in
mortality and greater ethnic disparity after the
introduction of HAART than California
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Medical Trends
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Ongoing HIV Clinical Trials by Type
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HIV Vaccine Research

• Since the first HIV vaccine trial enrolled
  volunteers in 1988, 49 clinical trials of 26
  different vaccine candidates have been studied in
  clinical trials by NIH
• At least 13 different gp120 and gp160 envelope
  candidates have been evaluated in phase I/II
  trials
• Most research has focused on gp120 rather than
  gp140/gp160
• NIH spends the most on vaccines, but not enough
  is being spent in HIV vaccine development

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Number of Cases and NIAID Research Dollars Spent
on Anthrax and HIV/AIDS Vaccines, 2002
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Vaccine Trials by Vaccine Type
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Vaccine Trials by Client Population
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Current Approved Anti-Retrovirals
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HIV Prevention Trials Network Studies by Targeted
Population
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HIV Prevention Trials Network Studies by
Intervention Type
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Funding Trends
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Federal Funding Trends

• Total Federal Funding for HIV/AIDS is a Small
  Fraction of the Federal Budget
• Federal funding Continues to Increase but
• Increases do not keep pace with the epidemic
• Increases are concentrated in mandated funding
  categories
• Increases Reflect Changing Policy Priorities
• In recent years, increases do not include
  minority services, housing services, prevention
  services, substance abuse services, or mental
  health services

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Federal Funding Trends (Cont.)

• Federal funding Continues to Increase but
• Funding for Care and Assistance represents a
  shrinking proportion of all federal funding
• The Minority Initiative, targeting minority
  groups disproportionately affected by HIV/AIDS,
  represents a tiny and shrinking fraction of
  overall HIV/AIDS funding
• Minority Initiative SAMHSA funding - the only
  funding from that agency targeting people living
  with or at heightened risk for HIV/AIDS - is
  estimated to drop dramatically in the 2004 budget
  year

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Total Federal HIV/AIDS Funding Increased
Steadily, with a More Dramatic Increase Between
2000 and 2001
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Meanwhile, the Number of Persons Living with
HIV/AIDS Also Continues to Increase
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So Spending Per Person Living with HIV/AIDS has
Actually Decreased Slightly since 2001
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Yearly Changes Among Funding Categories Reveal
More Shifts in Priorities
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Starting in 2001, Total HIV/AIDS Funding
Increases Began to Outpace Increases for Care and
Assistance
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Starting this Fiscal Year, the Proportion of
HIV/AIDS Funding Designated for International
Assistance Increases, while the Proportion
Designated for Prevention, Cash/Housing
Assistance, and Research Decreases
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Federal HIV/AIDS Funding Trends, Programs Over 1
Billion, 2003-2005
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Federal HIV/AIDS Funding Trends, Programs Under 1
Billion, 2003-2005
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The Minority Initiative as a Proportion of Total
HIV/AIDS Funding
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The Minority Initiative and Other HIV/AIDS
Funding, 1999-2004
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Minority Initiative Allocations, 1999-2004
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State Funding Trends

• States Budget Crisis Arises from
• Economic Downturn
• Tax Cuts enacted in the 76th session
• Cumulative effect of funding deferments
• Texas Medicaid Costs are Rising
• Continued to Rise When Enrollments were Declining
• Enrollments have Begun to Increase Again
• 78th Legislative Session Implemented Cost-Control
  Measures for Medicaid
• Preferred Drug List
• Managed Care Expansion
• Disease Management
• Prior Authorization of High Cost Medical Services

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State Funding Trends

• Health and Human Services Commission to Issue
  Smart Cards with Fingerprint Scans to Prevent
  Medicaid Fraud
• State Plans to Discontinue Primary Care Case
  Management and Replace it with HMOs
• State Cuts in Medicare and Deep and Far-Reaching
• Total Health Care Cuts in the 78th Legislative
  Session Add Up to Over 1 Billion
• Cuts Include 42.1 Million for Mental Health
  Alone
• State Budget Cuts in Medicaid Mean Texas Will
  Lose 1.6 Billion in Federal Medicaid Assistance
• State Comptroller Advocating 1 Increase in
  Cigarette Tax to Restore Cuts
• Current Legislative Behavior Make It Unlikely
  that Texas Will Use the ETHA Option If It Becomes
  Available

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State Funding Trends ADAP

• Size of Texas ADAP is Already Modest Compared to
  Other States
• Texas ADAP Serves an Estimated 25 of Texans
  Living with HIV/AIDS
• Texas Imposes a 3-Drug Limit on ADAP Use
• Fifteen States Have ADAP Waiting Lists or
  Restrictions
• Six More Are Contemplating Such
• This Year, Texas Participated in Joint State
  Negotiations to Obtain Lower Drug Pricing for
  ADAP

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Early Treatment for HIV Act (ETHA)

• Allows States to Create Medicaid Eligibility
  Category Specifically for HIV
• Similar to Previous Breast Cancer Legislation
• In 1999, Congress expanded Medicaid to give
  states the option of extending Medicaid to women
  with breast and cervical cancer
• Women in this option are not required to
  demonstrate disability or low income
• 44 states have expanded Medicaid to provide women
  access to cancer treatment
• Texas became one of those states in February 2001

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Early Treatment for HIV Act (ETHA)

• Would Shift Costs from ADAP to Medicaid
• Would extend coverage to an estimated 18,000
  people at a per-person cost of 5600
• Currently has 20 cosponsors in the Senate
• Filed in the House on March 3 with 66 cosponsors

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Adult and Child Enrollment in Texas Medicaid,
1996-2001
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Texas Medicaid Monthly Average Enrollment, Adult
Categories, 1996-2001
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Average Monthly Enrollment and Non-Federal Texas
Medicaid Expenditures, 1996-2003
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Ryan White Funding by Title, US and Texas
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Discretionary SAMHSA HIV/AIDS Funding, Texas and
Houston
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Conclusions and Recommendations Funding
Distribution

• Do Not Rely on HOPWA or SAMHSA Funding to
  Contribute Substantially Beyond Current Levels
  Federally
• CDCs New Prevention Strategy May Increase
  Availability of Some Limited Social Services for
  HIV People
• Funding Should Target Services Toward Minority
  Men and Women Who Have Sex with Men
• Texas May Implement ETHA, But May Not, So Do Not
  Rely on It

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Conclusions and Recommendations Finding More
Funding

• Greater Coordination Between CDC Planning Group,
  Ryan White Planning Council, and HOPWA/SAMHSA/NIH
  Grantees
• Pooling of needs and resources data
• Sharing of administrative costs
• More inter-agency, cross-program collaborative
  projects
• Potential to Increase Quality of Service
• Strength in Numbers (Data and Analysis)
• Strengthens Houstons Case for HIV/AIDS Funding
• Strengthens Individual Agency Applications for
  Discretionary Funds
• Provides Information for Groups Dedicated to
  Policy Change
• Make Greater Use of Federal Competitive
  Grantmaking
• Example SAMHSA Funds
• Texas Receives Over 30,000,000 in Competitive,
  Discretionary Funds from SAMHSA
• Of These Funds, Less Than 5,000,000 Went to
  Houston in 2003-2004
• A Coordinated Effort Could Help Increase the
  Availability of Mental Health, Substance Abuse,
  and Other Non-Medical Services for People with
  HIV/AIDS in the Houston EMA
• Similar Coordination Could Increase the Flow of
  Discretionary Funds from Other Agencies