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Utah May Axe Ryan White Program

Republican legislators have proposed cutting a federal program that funds life-saving medications for low-income Utahns with HIV/AIDS.

Senate President Michael Waddoups, R-Taylorsville, suggested the cuts during a monthly meeting of the Republican-dominated Executive Appropriations Committee, which had met to approve federal grants. Here, he postponed approving 5.2 million federal dollars for the state’s Ryan White Program for a month, in order to examine the program further—particularly to determine if recently-passed federal healthcare reform legislation will take its place.

“It looks to me like we’re funding a program providing insurance and [medical care] that is going to be covered under Obamacare: pre-existing conditions, lifestyle choices and things of that nature,” Waddoups said during the meeting. “I’m just concerned about that.”

“Obamacare” is a colloquial name given to the federal bill, which narrowly passed the Democratic-dominated Congress last month amid strong Republican opposition.

In response to Waddoups’ question, Robert Rolfs, Director of the Division of Disease Control and Prevention, said that Medicaid would “essentially replace” the Ryan White Program in 2014, when all people with HIV would be come eligible to enroll in the government program.

For now, Rolfs said, the 450 low-income Utahns with HIV/AIDS would be unable to receive care without the grant.

“[It covers] medications which have changed this from essentially a fatal disease to one which people can stay alive for,” he said. “And this program pays for medications, as well as supportive services, such as dental care, mental health care, and in some cases provides assistance with housing, and in some cases when it is a more affordable way to do that, pays their health insurance premiums to allow them to continue health insurance, so that they can continue to get this care.”

“To me, this is a life-saving program that is inadequately funded,” he continued, noting that the Department of Health had to “trim the number of people on it” in 2009 because of diminishing funding.

Although the program — named for a teenager who contracted AIDS from a blood transfusion in 1984 — would be mostly funded by federal money, it does require a partial state match of funds. But that money, said Utah AIDS Foundation Director Stan Penfold, need not come from already-strapped state coffers.

“The feds have been very flexible, and [in the past] it’s all been [paid] through in-kind contributions, so there isn’t a single dollar allocation to this match,” he said. “So we’re talking about giving up money to save money, but we won’t save money.”

Penfold said that the possibility of having the grant axed took the foundation and state health officials by surprise. Utah, he noted, has received Ryan White money since 1992 without any trouble.

“But clearly leadership had talked about this before it went into the appropriations committee,” he added.

Articles about the possible cut that have appeared in The Salt Lake Tribune and the Deseret News have stated that Utah’s Ryan White grant for 2010 totals $5.2 million, with $1.4 million of that coming from the state. However, Toni Johnson, Director of the People With AIDS Coalition of Utah, said that she did not know where Waddoups got these figures.

“The state does not give any funding to this program,” she said. “In 2009 they gave $100,000, but nothing for this year. We’re one of the few states in the country that doesn’t support their state’s Ryan White Program.”

This year, Johnson visited the Legislature to ask for $500,000 to fund Utah’s AIDS Drug Assistance Program, the part of the Ryan White Program which exclusively funds antiretroviral and other HIV/AIDS medications. Last year, the program closed to new applicants and kicked nearly 100 people off its rolls because of a nearly $313,000 budget shortfall.

Jennifer Brown, Director of Bureau of Epidemiology, said that the error may have come from adding what the state calls money for Maintenance of Efforts into the federal sum.

“Federal law requires that we maintain our services to people living with HIV in accordance with our previous year’s status,” she explained. “So if we contributed a million dollars last year, we still have to maintain that for the next year.”

Both Johnson and Brown confirmed that match money can come from in-kind donations.

For the fiscal year beginning April 1, 2010, the grant the Utah Department of Health received from the federal government totaled $3,729,185. UDOH, said Brown, submitted a MOE of $1,361,653 for the period between July 1, 2008 and June 30, 2009. The MOE money can come from in-kind donations, rather than state budgets.

Brown also said that ADAP received a supplemental grant of between $400,000 and $500,000 in 2008.
Since word of the grant’s postponement hit the local media, letters have appeared in Utah’s two daily newspapers expressing outrage at the delay. Many have drawn attention to Waddoups’ use of the term “lifestyle choices” in his objection to the grant — a term which many have interpreted as a reference to homosexuality.
Penfold called Waddoups’ phrasing “problematic.”

“It appears to me that this is a continuation of ‘messaging’ that the Legislature had a lot of this session and it’s at the expense of people living in Utah who are potentially going to lose their healthcare, not because of Obama’s healthcare plan but because the state of Utah is going to try and send a message [against Obama’s plan],” he said.

Although the Legislature will not act on the Ryan White funding for another month, Utah Health Director David Sundwall has promised that the program will continue for the next 30 days.

“To be honest with you, it’s kind of a lot of smoke and fury signifying nothing, because we believe the program will be continued,” Sundwall told radio station KCPW. “And we’re quite prepared to answer any questions that President Waddoups or others might have about what does the grant cover.”

Sundwall could not be reached for further comment.

While the Utah AIDS Foundation and public health officials will speak to lawmakers about what the program does and does not cover, Penfold encouraged members of Utah’s gay, lesbian, bisexual and transgender community and their allies to contact their Senators and Representatives to “let them know how important this funding is to Utah.”

“It’s important we make these people [whom the Ryan White Program serves] real,” he said. “They’re on life staving medications and if they don’t have them they’ll get sick very quickly. I think that’s getting missed in this whole message debate.”

“Without support from the community our request to the Legislature keeps falling on deaf ears,” Johnson said. “The community needs to support our request for this money. If [the Legislature] keeps hearing from me, it doesn’t mean anything. The gay community rallies around Equality Utah and their bills but doesn’t around PWACU and our request for money, and I don’t understand why.”

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