The Future of the Ryan White CARE Act in the Post-ACA Era Jason King Advocacy & Legislative Affairs Manager AIDS Healthcare Foundation – Southern Bureau

Ryan White HIV/AIDS Treatment Extension Act of 2009 S (111 th ): Sponsored by Senator Tom Harkin (D-IA), the Ryan White HIV/AIDS Treatment Extension Act of 2009 only ensures funding through Unless a Ryan White CARE Act reauthorization occurs, and certain funding changes are not made, Congress will continue to appropriate funds based on current Ryan White appropriations methodology.

Rates of Diagnoses of HIV Infection by State Data source: Epidemiology of HIV in 2011;

National HIV Surveillance System Rates of Persons Living with HIV Infection

2011 CDC Surveillance

Sequester Impact on the South Sequestration, which went into effect March 1, could disenroll up to 15,000 people. Half of these people live in the South. According to the National Alliance of State and Territorial AIDS Directors, as of June of 2012, 33% of ADAP clients were served in the South. Up to half of these clients may lose their ADAP benefits due to sequestration Due to lack of funding, states may be unable to mitigate the impact of the sequester on their ADAP programs and be forced to close enrollment to new clients. Most southern states are not moving forward with Medicaid expansion and will have to continue to rely on Ryan White for their medical care

Sequester Impact on the South 1.

Treatment Cascade

National HIV/AIDS Strategy (NHAS) In July of 2010, the Obama administration put forth the National HIV/AIDS Strategy to be implemented and overseen by the Office of National AIDS Policy. There are four goals: Reduce new infections Increase access to care and improve health outcomes for people living with HIV Reduce HIV-related disparities and health inequities Achieve of more coordinated response to the HIV epidemic

Achieving a More Coordinated Response to the HIV Epidemic Consistent with goal 4 of NHAS, reauthorization of Ryan White presents a unique opportunity to harmonize NHAS’s three other main goals. The CARE Act can and should be harmonized with the changes in health care delivery brought about by ACA to provide a more effective response to the HIV epidemic.

ACA and its Effects on PLWHA Patients currently receiving care through Ryan White will be able to benefit from Medicaid through those states that are accepting Medicaid expansion. Patients currently regular care will have the opportunity to access coverage through the insurance exchanges.

The Need for Ryan White There will be a need for a Ryan White CARE Act, in its current form, for the the foreseeable future. Most Americans are not linked to or retained in HIV care. Neither Medicaid nor insurance exchanges may provide all the services currently available under the RW CARE Act. 20% of Americans are unaware of their HIV status. Treatment is prevention.

The Need for Ryan White There will be a need for a Ryan White CARE Act, in its current form, for the the foreseeable future. Most Americans are not linked to or retained in HIV care. Neither Medicaid nor insurance exchanges may provide all the services currently available under the RW CARE Act. 20% of Americans are unaware of their HIV status. Treatment is prevention.

How Ryan White May Evolve to be More Effective Post-ACA More Ryan White CARE Act resources need to be devoted to: Testing, to find those Americans unaware of their HIV status. Linking people with HIV into care. Treatment management and adherence. “Wrap around” services not covered by Medicaid or insurance.

Jason King Advocacy & Legislative Affairs Manager AIDS Healthcare Foundation – Southern Bureau 110 SE 6 th St., Suite 1960 Fort Lauderdale, FL (954)