Kevin Dedner, MPHSection Chief

HIV/AIDS & Hep C SectionCenter for Health Protection

Arkansas Department of Health

Analogy of ADAPs

What fuels the faucet?•Funding•Client utilization:

•Based on trust•Well-targeted testing

What causes leaks in the faucet?•Clients transitioning out of care•Clients lost to care•Clients incarcerated•Clients transitioning to other payers

(i.e. – Medicaid and Medicare)•Clients gaining employment and employer sponsored insurance•Clients moving our of state

Status of State ADAPs

ADAP Budget

ADAP Client Utilization

What Happen?◦ Tremendous Growth in the Program

2006 to 2007 = 2% increase in clients enrolled (346 to 354) 2007 to 2008 = 22% increase in clients enrolled (354 to 433) 2008 to 2009 = 54% increase in clients enrolled (433 to 667)

◦ State Budgets under strain- Reduced Funding from States

◦ Downturn in the Economy People lost their jobs and healthcare insurance

Provide care to those who need it most Ensure consistency in services available to

clients Provide a stable funding stream to providers

and clients Stabilize the program

Reduced income eligibility from 500% to 200% FPL effective May 26, 2009. Curtailed outreach activities Reviewed and reduced dental treatment plans. Implemented weekly monitoring report of expenditures, commitments, and

caseload. Reviewed the formulary. The following changes were made.

◦ 56 drugs are being removed.◦ 12 drugs will require prior authorization.

A Patient Assistance Program was developed. Established an Advisory Group that has met two times. Conducted 11 focus group sessions statewide: 5 with patients and 6 with

providers. Results are being compiled. 

Required Medicare Part D clients with incomes <150% FPL to apply for Low Income Subsidy.

Sought Patient Assistance for Hepatitis C patients. The state has 10 slots available. Medications cost $16,000 per year.

Dismissed clients with incomes >200% FPL.◦ Notify October 1.◦ Effective January 1.

Strengthen the policy on payments of insurance premiums and drug co-pays to assure it is cost effective.

ADAP Waiting Lists and Cost-Containment

ADAPs with Waiting Lists (2,090 individuals, as of July 1, 2010)Florida: 523 individualsHawaii: 10 individualsIdaho: 26 individualsIowa: 97 individuals

Kentucky: 198 individualsLouisiana: 112 individuals*

Montana: 20 individualsNorth Carolina: 783 individualsSouth Carolina: 187 individualsSouth Dakota: 22 individuals

Utah: 112 individuals

Arizona: reduced formulary Arkansas: reduced formulary, lowered financial eligibility to 200% of FPL Colorado: reduced formulary Georgia: waiting list as of July 1, 2010 Illinois: reduced formulary Iowa: reduced formulary Kentucky: reduced formulary Louisiana: capped enrollment, discontinued reimbursement of laboratory

assays Missouri: reduced formulary North Carolina: reduced formulary North Dakota: capped enrollment, cap on Fuzeon, lowered financial

eligibility to 300% FPL Utah: reduced formulary, lowered financial eligibility to 250% FPL Washington: client cost sharing, reduced formulary (for uninsured clients

only)

Arizona: waiting list California: proposed elimination of ADAP services in city and

county jails Florida: reduced formulary, lowered financial eligibility Illinois: reduced formulary, lowered financial eligibility, monthly

expenditure cap Ohio: reduced formulary, lowered financial eligibility, capped

enrollment, client cost sharing, annual and monthly expenditure caps Oregon: reduced formulary, client cost sharing, annual

expenditure cap Wyoming: reduced formulary

Funding Co-infections Unmet Need Lost to Care Late Testers (Targeted Testing) Access to Care Homophobia/Stigma/Discrimination

National Alliance of State & Territorial AIDS Directors

Southern AIDS Coalition Arkansas Department of Health

Kevin Dedner, MPHHIV/STD/Hepatitis C Section

Arkansas Department of Health4815 West Markham, Slot 33

Little Rock, AR 72205 

Direct Dial: 501-661-2408Toll Free: 1-888-499-6544

Fax: 501-661-2082kevin.dedner@arkansas.gov