Date: Mon, 02 Feb 1998 17:57:48 -0800 Subject: HIV/Healthcare CA Budget and Legislative Update - 020298 From: "Eric J.C. Astacaan" MEMORANDUM TO: All Interested Parties FM: Eric Astacaan, LIFE Lobby DT: February 2, 1998 RE: HIV/Healthcare California 1998-99 Budget and Legislative Update ---------------------------------------------------------------------------- ----------------------------------------- I. HIV/AIDS Budget: Below please find Governor Pete Wilson's proposed state budget for fiscal year 1998-99. Department of Health Services AIDS Funding. Funding for the Department of Health Services HIV/AIDS programs totals $221.2 million. The bulk of next year's increase is earmarked towards the AIDS Drug Assistance Program. AIDS Drug Assistance Program (ADAP). Governor Pete Wilson proposed an increase of $35.9 million in the AIDS Drug Assistance Program (ADAP) for fiscal year 1998-99 (commencing on July 1, 1998 through June 30, 1999). Of this increase, $15.6 million will be coming from the State General Fund, $16.7 from the Federal Trust Fund, and $3.6 million from Reimbursements, i.e., drug rebates. The increase will be used to "meet the significantly increasing demand for new and more effective drugs and address rising caseload costs due to a caseload increase." Total ADAP funding (excluding viral load testing and Statewide AIDS Drug Consortia funds) for 1998-99 amounts to $124.7 million ($55.8 million from General Fund, $57.5 million from Federal Trust Fund, $11.4 million from drug rebates). Education and Prevention. Funding for education and prevention actually will decrease by about $687,000. This reduction comes as a result of federal funds cutbacks. Of the $27.1 million allocated for this program, the Governor proposed a flat funding of $19.7 from the State General Fund, while Federal Funds will contribute $7.4 million, as opposed to $8.1 from last year. Other Areas: Other programs are virtually flat-funded for the next fiscal year. These programs include no-cost HIV testing, early intervention, epidemiological studies, etc. University of California AIDS Research. The governor proposed an increase of $366,000 for AIDS research within the University of California. Funding for AIDS research totals $8.4 million, all of which is coming from General Fund. Department of Corrections: Funding for the CDC's AIDS Treatment and AIDS Facilities totals $12.3 million, an increase of $313,000 from last year's budget. Other California Departments with AIDS Programs: The Mental Health Department's AIDS Counseling ($1.5 million), Youth Authority's AIDS Screening ($200,000), Social Services Department's Licensing of Longterm Chronic Care Facilities' funding schemes ($26,000) are all receiving flat funding for 1998-99. The Department of Education, as well as the Department of Alcohol and Drug Program, will suffer cutbacks in their AIDS programs because of decrease in federal funding, their sole source of funds. Education Department's HIV/AIDS Awareness Project School Grants will have $393,000 as opposed to $459,000 last year. The Alcohol and Drug Program's HIV/AIDS Outreach will have $125,000 versus $349,000 from last year; however, their Counseling/Testing/Early Intervention projects will receive $9.2 million versus last year's allocation of $8.6 million. HIV/Healthcare Related Budget Medi-Cal: 1998-99 total costs for Medi-Cal are projected to be $18.5 billion, including $6.8 billion General fund -- essentially the same amount from 1997-98. The state is expecting a caseload decrease of 7.6 percent below the 1996-97 level; however, the costs remain constant due to increased levels of service, and cost increases in managed care, long-term care, and Medicare health insurance premiums. Supplemental Security Income/State Supplemental Payment Program: The state is projecting a caseload increase of 1,075,400 recipients in 1998-99, with a projection of $2.2 billion for SSI/SSP General Fund expenditures, as opposed to $2.1 billion in 1997-98. Analyses/Recommendations: The governor does understand the need for increased funding for ADAP and we should acknowledge this. However, the ADAP formulary should be expanded to include other drugs such as drugs for opportunistic infections or drugs dealing with pain management. Regarding other funding issues, there are certain aspects of the proposed HIV/AIDS budget that certainly should be revisited. For instance, as the federal government cuts its funds for education and prevention, we should look at a state augmentation. Controversies abound as to the efficacy of our education and prevention programs. I think we can make a case for funding university-led studies to determine the efficacy of the various education and prevention programs and to bolster the ones that are effective. We also should look into recommending a line-item to institute a new system of HIV surveillance, i.e., unique or coded identifier. This brings into the discussion the most explosive issue that I think we will deal with this year: names reporting of HIV infection. I think that as part of our strategy when we propose an alternative to names reporting, we should simultaneously call for a funding scheme, which could be done with our work on the budget process. II. Pending Legislation The deadline for introduction of bills is February 20th, 1998. As such, we will keep you updated on bills that get introduced. Since the session started, only a couple of bills have been introduced or amended. We expect a bill sponsored by the California Medical Association (CMA) to be introduced before the deadline dealing with HIV surveillance. Last year, CMA passed a resolution calling for mandatory names reporting of HIV infection. LIFE Lobby vigorously opposes any attempts to implement any type of HIV-reporting that is name-based. Instead, LIFE supports the use of systems that respect and protect confidentiality and privacy, such as unique or coded identifiers. Other pending bills include: AB 20 (Migden) - Position: Support: This bill is similar to AB 1099, which was vetoed by Wilson last year. AB 20 would make it possible for Medi-Cal recipients living with AIDS and other disabilities to go back to work without the fear of losing their Medi-Cal benefits. It would exempt up to $2500/month in earnings from counting toward the "share of cost" requirement under Medi-Cal. This exemption would hold until the individual is eligible for and receives full medical insurance coverage from work. This bill passed the State Assembly, 71-5, and has been forwarded to the State Senate. SB 535 (Vasconcellos) - Position: Support: SB 535 would establish a Medical Marijuana Research Center within the University of California to determine the efficacy of medical marijuana use. The bill is pending in the State Assembly for a floor vote. AB 1052 (Villaraigosa) - Position: Support: AB 1052 would provide for the automatic addition of any new AIDS vaccines and/or "anti-viral agents" used prophylactically within the Medi-Cal formulary. This bill is pending in the State Senate for a floor vote. AB 881 (Runner) - Position: Oppose: AB 881 would have required every general acute care hospital in the Los Angeles County area, to test every newborn infants. This bill was amended to be a pilot project. It was originally scheduled to be heard in the Assembly Health Committee two weeks ago, Jan. 13th, but was taken-off calendar by the author. This bill needed to pass by the end of this month. This bill is considered "dead" this year. SB 705 (Rainey) - Position: Oppose: This bill would criminalize "intentional" transmission of HIV. It is pending in the State Assembly for a floor vote. If you have any questions about this update, please give us a call at (916) 444-0424. Thank you. **************************************************************************** ************************** This legislative update has been brought to you by LIFE: California's Lesbian, Gay, Bisexual, Transgender and HIV/AIDS Lobby. LIFE has been lobbying on behalf of California's lesbian, gay, bisexual, transgender and HIV-affected communities since 1986. Our organization is the oldest and largest institution representing these communities in California's State Capitol and is proud to celebrate over a decade of service. If you would like further information about LIFE's activities, events or membership, please contact our office at: LIFE: California's Lesbian, Gay, Bisexual, Transgender & HIV/AIDS Lobby 1301 H Street Sacramento, California 95814-1906 Phone: 916-444-0424 Fax: 916-444-3059 E-Mail: life.info@lifelobby.org Website: http://www.lifelobby.org