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MAY 24, 2013
Transfer for AIDS Drug Assistance Program Made, but with Costs to Ryan White Program

Dr. Laura Cheever, the Acting Associate Administrator of the HIV/AIDS Bureau at Health Resources Services Administration (HRSA) hosted a short conference call this week to review the $50 million 2011 World AIDS Day funding transfer that President Obama announced. First, she stated that the Ryan White Program is a very high priority for HRSA and that they were working diligently to ensure that the $50 million in funding for the AIDS Drug Assistance Program (ADAP) and Ryan White Program Part C services that started as a result of the World AIDS Day announcement was maintained.

As a quick reminder, the funding was first provided after the congressional appropriations process had been completed and therefore had to be a transfer of funds within the Department of Health and Human Services (HHS) in fiscal year (FY) 2012. The transfer consisted of $35 million for ADAP and $15 million for Ryan White Program Part C grants. The additional funds for ADAP and Part C were not reflected in the final Continuing Resolution for FY 2013 that Congress passed and the President signed, creating a continuity problem. The administration notified Congress last week to inform them that they would transfer funding to make up the $50 million loss that was not including in the FY 2013 CR. Dr. Cheever explained that some of the funding would come from other parts of HHS and some would come from within the Ryan White Program, excluding ADAP and Part C. She stated that the amounts transferred within the Ryan White Program funds are as follows:

Part A: $6.6 million

Part B (base): $4.2 million

Part D: $770,000

Part F Dental: $135,000

Part F AETCs: $345,000

This is about 1% of funding from each of these programs, the maximum amount Secretary Sebelius can transfer per program. In light of this transfer, the administration specifically exempted the Ryan White Program from a different 1% transfer of funds being assessed against all health programs to fund the Affordable Care Act implementation. The entire Ryan White Program will continue to be subject to sequestration at a 5.1% cut across the board.

Of the $15 million for Part C, $5 million will be reallocated within Part C from the Bureau of Primary Health Care (BPHC) to Part C clinics that are community health centers, just as was done in FY 12. The remaining FY ‘13 $10 million will come from changing the FY ’13 grant period for Part C grants to 10 months (July 1, 2013 – April 30, 2014). FY ’14 awards will revert to 12 month grants running from May 1, 2014, to April 30, 2015.

While fully supporting the $50 million in additional funding for ADAP and Part C programs, AIDS United is troubled that other parts of the Ryan White Program are being tapped to pay for the failure of Congress and the administration to include the additional funding in the final FY ’13 CR. These cuts to the other Ryan White Program parts are in addition to the FY ’13 sequester cuts. We acknowledge and commend the President for including the $50 million in his FY 2014 Budget Request. This all underscores the need for advocacy for Congress to pass a Labor/HHS appropriation bill for FY ’14 that includes optimal funding for ADAP, the whole Ryan White Program, and domestic HIV programs at the Centers for Disease Control and Prevention (CDC). We must also continue to advocate for replacing sequestration with a balanced approach to deficit reduction that does not unfairly or unevenly cut spending for health care and programs that serve vulnerable populations.

Immigration Bill Passes Senate Judiciary Committee Without Health Care Access, LGBT Families Provisions

On Tuesday, May 21, 2013, the Senate Judiciary Committee approved S. 744: The Border Security, Economic Opportunity, and Immigration Modernization Act. While the passage of the bill by the committee is commendable, two significant provisions have been excluded.

The first, proposed by Senator Mazie Hirono (D-HI) would expand eligibility of all lawfully present immigrants to Medicaid, the Children’s Health Insurance Program (CHIP), that Supplemental Nutrition Assistance Program (SNAP), and Medicare and would expand Medicaid and CHIP to pregnant women and children. As the law currently stands, those on the road to citizenship are excluded from affordable health care options, like Medicaid, during their provisional immigration status plus an additional five years after that. The current law also prevents aspiring citizens from accessing benefits of the Affordable Care Act during their provisional status, despite the fact that they would be paying taxes. This amendment, along with another Hirono proposal to expand health care access to aspiring citizens, was withdrawn from the committee markup and is not included in the bill that will move to the Senate floor. Having access to adequate health care services is crucial to ensuring that aspiring citizens who are HIV-positive stay healthy and are engaged in care. Furthermore, allowing for full engagement in health care services, including affordable options like Medicaid, can be an important tool in preventing disease before it happens. Partners at the National Latina Institute for Reproductive Health expect there to be opportunities while the bill is on the Senate floor to support health care access and are encouraging individuals to call their Senators about the importance of health care access for all.

The second, proposed by Chair of the Committee Senator Patrick Leahy (D-VT), would allow same-sex spouses to be sponsored for immigration as long as one of the spouses was an American citizen and they were legally married in a U.S. state or in another country that legally recognizes same sex marriages. This would allow gay U.S. citizens to sponsor their spouse for green cards, a right already given to U.S. citizens in opposite-sex marriages. Upon conceding that the bill would not make it out of the committee, Sen. Leahy withdrew the amendment “with a heavy heart.” Because he withdrew the amendment before it was vetted by the committee, however, Sen. Leahy reserved the right to introduce the amendment on the Senate floor when the time comes. The text of the amendment can be found here.

Another amendment about which AIDS United had been concerned, amendment 111, proposed by Senator Ted Cruz (R-TX), failed to pass the committee. This amendment would have made undocumented people ineligible for federal, state or local means tested benefits (benefits only available to those whose income is below a certain level), even for benefits that they might otherwise have been eligible. This is not good public health policy since it would have had the effect of making it much more difficult for undocumented immigrants with communicable diseases such as HIV to access health care. Although it is not part of the Senate bill, this issue may come up when the immigration debate moves to the House of Representatives. Democrats in the House have drafted a provision that would require immigrants seeking citizenship to provide their own health care, and providing that if they receive any government services for health care would render them ineligible for permanent citizenship. This is especially troubling for undocumented immigrants or those seeking citizenship who are living with HIV: it is critical for these individuals to engage with health care services, to ensure their own health and to provide a preventive effect for the community since HIV is an infectious disease. By mid-week some House Democrats, including those in top leadership positions, began expressing discomfort with the provision and negotiations within the Democratic caucus. AIDS United will work with allies to urge Members of the House that this dangerous language should not be included be removed in their version of the bill.

As the immigration debate continues, AIDS United will keep advocating for complete health care access for aspiring citizens and LGBT families at risk of discrimination.

You can read all of the amendments proposed to the Senate Judiciary Committee and the vote results here.

HIV and Food: What You Need to Know About SNAP!

HIV disproportionately impacts low-income individuals who may also be receiving support through the Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps. Congress is currently considering two versions of the Farm Bill, which authorizes funding for SNAP. However, both the House and Senate versions of the bill make dramatic cuts to the program, which is critical to low-income households. Proper nutrition is even more important for people living with HIV; God’s Love We Deliver, an organization that provides nutritious, individually-tailored meals to people who are too sick to shop or cook for themselves – and an AIDS United grantee through the New York City AIDS Fund – has highlighted the importance of proper nutrition for people living with HIV . A well-balanced diet helps people living with HIV maintain a healthy weight, strengthen their immune systems, and prevent infection. It also helps to build and maintain muscle, allowing medications to work better and enabling individuals to handle the side effects of medications.

Our friends at Food Research and Action Center (FRAC) have highlighted the cuts to SNAP that could occur. AIDS United strongly opposes these proposed cuts and the damaging effects they would have on low-income individuals, especially those living with HIV. Read the following blog to learn more!

House and Senate Consider Respective Farm Bills: Please Oppose Harmful Cuts to SNAP

By Jim Weill, President, Food Research and Action Center (FRAC)

The Farm Bill is a comprehensive piece of legislation that guides and authorizes funding for most federal farm and food policies, including the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps). Every five years, Congress takes the Farm Bill through the reauthorization process; the last Farm Bill was passed in 2008.

Currently, both the House and Senate are considering their versions of the Farm Bill, and both have large cuts to SNAP, despite broad support for this program. Seven in 10 voters say that cutting food stamp funding is the wrong way to reduce government spending.

These cuts would reduce already scanty monthly benefits for many SNAP recipients and kick many others out of the program altogether. FRAC – along with a vast coalition of national and state anti-hunger organizations, unions, religious groups, and more – has been vigorously opposing such cuts, noting the harm they will do to the most vulnerable in our society.

First, the Senate bill, S. 954, which was passed by the Senate Agriculture Committee and is (as of press time) being debated on the Senate floor, includes a cut of $4.1 billion over 10 years to SNAP. This cut limits a state option for coordination of SNAP with the Low-Income Home Energy Assistance Program (LIHEAP). Through LIHEAP, states provide energy assistance to low-income households throughout their state, alleviating some of the untenable “heat or eat” choices that households face. The Senate cut could result in 500,000 households losing an average $90 per month in SNAP benefits, while increasing the paperwork burden of states.

To read Jim’s entire post, click here.

Announcements

Visit Your Member of Congress in the District May 27 to May 31

The House of Representatives and the Senate will recess for a constituent work week starting this Monday, May 27, until Friday, May 31. This work period provides constituents with an opportunity to contact and meet their elected officials while they are in their home states and districts. AIDS United urges everyone to meet with their elected officials and to let them know about the importance of responding to the domestic HIV epidemic. With all of the new Members of the House it is extremely important that people living with HIV and those impacted by HIV explain how their lives are affected by this disease. The House and Senate are still debating the Fiscal Year 2014 Appropriations bills. Most of the conversation has been about what cuts will be made where. Constituents must explain that cuts to the HIV domestic portfolio are not acceptable; cuts to the funding programs for prevention, treatment, and care would have an impact on real people’s lives.

Constituents should also talk to their Member of Congress about the importance of health care reform for people living with HIV/AIDS or are vulnerable to HIV transmission.

Constituents can reach their Members of Congress by calling their district offices and scheduling a meeting with the elected officials or their district staff person. Agencies can invite the Member of Congress to visit their AIDS service organization and see their programs in action.

Contact information for your Representative in the House can be found here. A complete list of Senators’ contact information can be found here.


32Years After June 5, 1981 Morbidity and Mortality Weekly Report First Identifying AIDS

June 5, 2013 marks the 32nd anniversary of the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) that first identified AIDS. The MMWR highlighted five patients in Los Angeles that were treated for Pneumocystis carinii pneumonia, a rare form of pneumonia only found in those with severely suppressed immune systems. These patients were the first to be identified in the MMWR with symptoms of what would later be known as AIDS. Thirty-two years later, we finally have the tools, scientific knowledge, and expertise to see the end of HIV.


HRSA Publishes 75/25 Core Medical Service Waiver Policy

HRSA today published revised requirements for Ryan White Program grantees to apply for a waiver of the 75/25 core medical services requirement in Parts A, B, and C. The fundamental changes would allow more flexibility in timing to apply for a waiver and would standardize and simplify the documents needed for application as well. Comments on the policy may be made until June 24th at RyanWhiteComments@hrsa.gov. AIDS United has been pushing for release of this policy so we are pleased that they are moving ahead. The policy will become effective September 23, 2013. HRSA asks grantees to contact their project officers if they have questions about the new policy. Anyone who is not a grantee should contact Theresa Jumento in HAB’s Division of Policy and Data atTJumento@hrsa.gov with questions. The notice can be found here.


CAP Releases Short ACA Guide for LGBT Families

The Center for American Progress on Thursday released a short guide intended to help people understand how the Affordable Care Act (ACA) would benefit LGBT people and their families. The guide provides an overview of the ACA, and has sections on ways to access insurance and benefits that may be particularly helpful for LGBT people and families. Since it is short, it may be an ideal introductory document for LGBT people, or for that matter anyone, who is beginning to think about how to access health care coverage under the ACA. The document can be found here .


Community Consultation on Pre-Exposure Prophylaxis (PrEP) for HIV Prevention Among Black MSM

The George Washington University School of Public Health and Health Services Clinical Research Site and the HIV Prevention Network (HPTN) are hosting “Pre-Exposure Prophylaxis (PrEP) for HIV Prevention Among Black MSM: A Community Consultation” on Tuesday, June 4, 2013, from 5:30pm – 8:00pm at the GWU Public Health Research Clinic, 2013 H Street, NW, Washington, DC 20006.

The goal of the consultation is to engage community representatives, members of the study population, service providers, and advocates of HIV prevention research to discuss PrEP, the HIV prevention research landscape, and encourage greater involvement of Black MSM communities in research moving forward. The HPTN Black Caucus will be conducting a series of these meetings in the 3 cities where HPTN 073 will take place.

Please RSVP by Wednesday, May 29 to Christopher Chauncey Watson at cclwat@gwu.edu or 202-652-4711.

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