[The entire executive summary can be viewed in the full report.]

Authority for Study

Item 11 B of Chapter 951 of the 2005 Virginia Acts of Assembly directed the joint Commission on Health Care to conduct a study on federal funding to Virginia's HIV/AIDS prevention and treatment programs. Specifically, the Commission was charged with analyzing recent federal funding trends regarding the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act and additional sources of federal funding provided to the Commonwealth for the prevention and treatment of HIV/AIDS.

Background on HIV/AIDS

Acquired Immunodeficiency Syndrome (AIDS) was first reported in the U.S. in 1981. The next year, the first case of AIDS in Virginia was reported. AIDS is caused by the Human Immunodeficiency Virus (HIV), which progressively destroys the body's ability to fight infections and certain cancers by effectively killing or damaging cells in the human immune system. Although no cure has-been found, treatment is available. Prescription medications play a pivotal role in treating HIV/AIDS. Highly active antiretroviral therapy (HAART) is the common term for the use of three or more FDA approved drugs for treatment and is a key component of disease treatment.

From 1999 to 2003, the number of individuals living in the U.S. with AIDS increased 30 percent. During this same time period, the Centers for Disease Control (CDC) reported a 3 percent decrease in AIDS-related deaths, while the number of AIDS diagnoses increased 4 percent. The CDC estimates that by the end of 2003, 1,039,000 to 1,185,000 individuals were infected with HIV in the United States. Of those individuals, it was estimated that 24 to 27 percent were undiagnosed and unaware of their HIV status. In Virginia, approximately 17,000 people are known to be living with HIV/AIDS. The Virginia Department of Health estimates that another 5,000 individuals in Virginia are unaware of their HIV positive status.

Medicaid Coverage for Individuals Living with HIV/AIDS

Medicaid receives the largest portion of federal spending for providing services to individuals with HIV/AIDS. An individual living with HIV/AIDS may qualify for Medicaid if he meets the qualifications of a particular group (low-income children, parents meeting specific income thresholds, pregnant women, the elderly, and individuals with disabilities) and his income and resources fall below required limits.

Medicaid state plans must provide certain mandatory services to individuals who qualify as categorically needy individuals. Examples of mandatory services that are important to individuals living with HIV/AIDS include inpatient hospital services, physician services, and certain forms of long-term care. States may also choose to provide optional services. Examples of optional services important to individuals living with HIV/AIDS that are available through Virginia's Medicaid program include prescription drug coverage and rehabilitative services. In addition, Virginia provides home and community-based care to individuals with HIV/AIDS through its AIDS Waiver. In FY 2004, 274 individuals received services through the AIDS Waiver. The cost of services provided outside of the waiver to AIDS Waiver participants totaled $6,117,320, with over 60% of this amount a result of pharmacy expenditures. The cost of waiver services totaled $608,497, with the average cost per recipient totaling $2,221.

Centers for Disease Control (CDC) Funding

Part of CDC's mission includes funding activities related to HIV surveillance, research, prevention, and evaluation through local, state, national and international levels. Programs involving epidemiology and surveillance are critical to producing the data necessary to target the delivery of HIV prevention and treatment services.

The Virginia HIV/AIDS surveillance program receives funding from CDC to collect federally-mandated HIV/AIDS infection data. In FY 2005, VDH received $467,556 in federal funding, which is less than the $478,460 received by VDH in 1997. As funding is decreasing, data collection demands are increasing. The CDC has developed Incidence and Resistance Projects in which data on new cases of HIV infection and data on HIV drug resistant infections in newly diagnosed HIV cases are to be collected. To expand the Resistance Project with state funds, $265,110 GFs are needed.

Preventing HIV infection has proven to be more cost-effective than treating an individual with HIV/AIDS. However, federal funding for prevention efforts in Virginia peaked in 2001 at just over $5.2 million. Since that time, funding has decreased by $152,000 or 3 percent (to just under $5.05 million in 2005). In addition, VDH is anticipating another 3 percent reduction in the coming year. As a result of decreased federal funding, several programs have been altered to ensure that funds are appropriated to provide the greatest impact in addition to preserving community-based services to high-risk populations. State funding in the amount of $285,000 GFs are needed to offset the loss of federal HIV prevention dollars. Of the proposed state funding, $150,000 would address federal rescissions in 2004-2006. The remaining $135,000 of the $285,000 would restore service funds redirected to rent, salary increases, and other administrative costs at the Virginia Department of Health.

In 2003, CDC initiated a new program, the Advancing HIV Prevention Initiative (AHP). The program is designed to reduce barriers to early diagnosis of HIV infection, access to care, and prevention services for individuals living with HIV. VDH must redirect existing funds to meet the objectives of the AHP initiative. New technology has assisted in the attainment of AHP goals. However, the cost of this new technology prohibits its expansion. For example, oral fluid testing requires no needles and may be conducted directly in the community. Rapid testing allows individuals to receive test results in as little as 20 minutes. VDH has established pilot sites using both testing methods but expansion is difficult due to the cost. To address the demands created by AHP, $164,000 GFs are needed.