Thousands Could Lose ADAP Coverage if Texas Health Department Approves Stricter Eligibility Rules

More than 4,000 people who are enrolled in the Texas HIV Medication Program, the state's AIDS Drug Assistance Program, likely will lose prescription drug coverage if state officials approve a proposal to tighten eligibility requirements as part of a plan to trim the program's budget, the Austin American-Statesman reports. The program allows about 12,500 low-income Texans to buy prescription drugs at a greatly reduced cost; in some cases, patients pay as little as $15 per month for medications that would otherwise cost $1,149 a month, according to the American-Statesman. But Texas Department of Health officials expect a $34 million shortfall in the program's budget over the next two-year cycle; the program's annual budget is $58 million. As a result, health department officials have proposed revised eligibility requirements under which people earning more than 140% of the federal poverty level, or $12,400 annually, would no longer be eligible, the American-Statesman reports. Current requirements allow beneficiaries who earn up to 200% of the poverty level, or $17,720 annually, to participate in the program (Roser, Austin American-Statesman, 12/14). The program's increased costs are the result of more people with HIV/AIDS being eligible for the program, with a projected 11,500 enrolled in 2002, compared to about 9,000 who were enrolled in 1999. In addition, the average cost per client has almost doubled since 1996 to about $9,500 annually, and with the advent of more effective but more expensive drugs, costs per client will continue to rise (Kaiser Daily HIV/AIDS Report, 11/1).

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Linda Moore, director of clinical resources in the health department bureau for prevention of HIV and other sexually transmitted diseases, said, "The bottom line for us is, we're running out of money. ... If we don't do something, we will have to close the program." Most of the approximately 2,500 comments the agency received about the proposal have urged officials not to cut the program. Sandy Bartlett, community information and education coordinator at AIDS Services of Austin, said, "If [patients are] not able to cover their meds, if they are no longer able to work, they will go into Medicaid and then they will go into Medicare. ... There's nothing cheaper about [the budget cuts]." If the proposal is approved, those affected would have six months to transition out of the program, and the health department would help connect them with other reduced-cost or free drug plans, Moore said. The department's board is expected to consider the issue at a meeting in February (Austin American-Statesman, 12/14).