31 Days, 31 Ways: State Underfunds HIV Medication Program

Throughout the month of August, The Texas Tribune is featuring 31 ways Texans' lives will change come Sept. 1, the date most bills passed by the Legislature — including the dramatically reduced budget — take effect. Check out our story calendar here. 

Day 27: Lawmakers didn't cut spending for the Texas HIV Medication Program, but it remains nearly $20 million short of what's needed to treat a growing number of low-income patients living with the disease.

As of 2009, health officials reported that more than 66,000 Texans were living with HIV. That number grows by about 6 percent every year, mostly because survivors of the disease are living longer. Since 1987, the Texas HIV Medication Program (THMP) has provided life-saving medications to low-income residents whose annual incomes are 200 percent of the federal poverty level or below (which is $21,780 per individual in 2011) . It does so through a joint state/federal program called the AIDS Drug Assistance Program (ADAP) and the state-funded State Pharmaceutical Assistance Program (SPAP). In 2010, ADAP served 14,251 Texans; SPAP served 1,541.

Public health officials say providing medications to patients in the early stages of their diagnosis offers a better chance to suppress the spread of the virus. Even short lapses in medication can lead to dire consequences for patients and for public health.

Though lawmakers kept funding for THMP static for the next biennium, they did not grant the additional $19.2 million orginally requested to address the growing caseload and rising medication cost. Instead, lawmakers added a provision to the state budget that would allow THMP to request a transfer of funds from the Medicaid budget to the HIV medication budget. Department of State Health Services Spokeswoman Carrie Williams told the Tribune on Monday that their agency isn't sure whether requesting that money will actually be necessary, but they "would ask for the dollars" before making any changes to eligibility.

Providers at Legacy say they have doubts whether that money would be granted, considering the Medicaid budget is already underfunded by nearly $5 billion.

"This mechanism allows lawmakers to say that they did not cut the program, but at the same time, the Texas Department of State Health Services can’t guarantee that cuts and restrictions won’t be made to the program over the next two years," said Randall Ellis, the senior director of government relations for Legacy Community Health Services in Houston, a leading provider of care to the largest community of HIV/AIDS patients in Texas. The Department of State Health Services "is exploring options that will cut eligibility and benefits of the program. With fewer funds available, Legacy and its partners in Texas will have to ration the care and treatment it gives to people living with HIV/AIDS."

However, Williams clarified DSHS is not actively trying to cut benefits. 

"We are not pursuing any such plans or proposals at this time, and we have no reason to believe we'll need to make such changes anytime soon," she said. 

In an interview with the Tribune, Ellis said the lack of guaranteed state funding for the program will have "consequences in both the care of people living with HIV/AIDS and in prevention efforts." Already, he said, "Texas has one of the strictest eligibility requirements and one of the most restrictive formularies for its HIV medication programs in the country." Restricting access to HIV medications could increase the cost of care and hospital visits, he said. Though the new fiscal year is just days away, Ellis said providers are still unclear how the budget cuts will be passed down to their patients.

Outside of the budget cuts, lawmakers passed HB 2292 during the session, which authorizes the continuation of an advisory board to oversee the Texas HIV Medication Program. The board is scheduled to meet in October to determine how to move forward with cost-containment measures in the midst of limited resources.

Bottom line: It will take time to know exactly how the budget cuts will affect HIV patients, and whether they will stymie the state's efforts to treat and stop the spread of the infection.

Web resources:

The Texas Department of State Health Services THMP FAQ page.

The Texas Department of State Health Services HIV/STD Information page, including presentations about THMP's cost-containment issues.

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