RD308 - AIDS Drug Assistance Program Report - October 1, 2014


Executive Summary:
The Virginia Department of Health (VDH) eliminated the Virginia (VA) AIDS Drug Assistance Program (ADAP) waiting list in August 2012. As of June 30, 2014, 5,173 clients were enrolled in VA ADAP, with 60% receiving medications through insurance support and 40% directly receiving medications through local health departments (LHDs) or other distribution sites. Providing medication access through purchasing insurance plays a key role in ADAP sustainability.

Accomplishments

• 2,310 VA ADAP clients enrolled in qualified health plans available under the Patient Protection and Affordable Care Act (ACA). VA ADAP clients account for about 2% of all clients receiving ADAP services but represent over 17% of ADAP clients enrolled to ACA insurance plans nationwide and 58% of ADAP clients enrolled to ACA plans in southern states.

• A high degree of collaboration among statewide ADAP stakeholders contributed to enrollment success. Regular meetings and multiple communication strategies allowed the VDH to provide updates on enrollment progress, identify challenges and work collaboratively to maximize insurance enrollment.

• VDH is collaborating with state supported HIV/AIDS Resource and Consultation Centers to provide insurance education programs to community partners and consumers.

Challenges

• Client enrollment continues to increase, but federal and state funding has not proportionately risen, with the program reliant upon several one-time sources of funding.

• Several variables will affect future program need, including ACA plan premium costs and formulary composition, geographic coverage of plans, availability of rebates from the pharmaceutical industry, and whether VA will expand Medicaid to provide coverage for all persons with incomes under 138% of the Federal Poverty Level (FPL).

• VDH reduced funds to HIV service contractors by more than 54% and allocated those funds to ADAP services to ensure an ADAP waiting list would not be implemented this year.

Recommendations

• Expanding Medicaid would result in coverage for 72% of current VA ADAP clients and substantial cost savings to VA ADAP.

• A Medicaid demonstration project waiver (1115 Waiver) could serve HIV-positive persons who would otherwise be Medicaid eligible (if expanded Medicaid does not occur). VDH would be able to collaborate with the Department of Medical Assistance Services (DMAS) to apply for an HIV-specific 1115 Waiver.

• Current projections indicate a range of additional funding needs from $5M to a worst-case scenario of $18M (assuming no Medicaid expansion and absence of future one-time funding sources) for the next grant year.