Minn. To Charge ADAP Participants for Antiretroviral Drugs; Considering Waiting List To Cover Expected Budget Shortfalls

Minnesota on July 1 will begin charging AIDS Drug Assistance Program participants up to 7% of their incomes to remain in the program and an additional $20 a month for drugs because of state budget shortfalls, the Minneapolis Star Tribune reports. The state also is considering instituting a waiting list if the state Legislature does not provide $10 million over the next three years to cover the expected shortfalls, according to the Star Tribune. More than 1,200 -- or one in four -- HIV-positive people in Minnesota participate in the program (Lerner, Minneapolis Star Tribune, 6/20). The number of people on waiting lists nationwide for enrollment in ADAPs has increased from 1,263 in April to 1,629 this month, according to the latest "ADAP Watch" released by the National Alliance of State and Territorial AIDS Directors. ADAPs, which are state-managed, federally funded programs, provide HIV treatment to low-income, uninsured and underinsured HIV-positive individuals. According to the "ADAP Watch," Alabama, Alaska, Arkansas, Colorado, Idaho, Iowa, Kentucky, Montana, North Carolina, South Dakota and West Virginia have waiting lists and/or access restrictions. Alabama, Arkansas, Colorado, Indiana, Oklahoma, South Dakota, Utah and Washington have implemented other cost-containment strategies since April. In addition to Minnesota, Massachusetts, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, Oregon, South Carolina and Texas are anticipating new or additional restrictions during fiscal year 2004, which ends March 31, 2005, according to NASTAD (Kaiser Daily HIV/AIDS Report, 6/8). The federal government funds about 75% of Minnesota's ADAP, with the state providing the remainder of the funding. Since 2001, the number of ADAP participants in Minnesota has grown by about 50%, according to the Star Tribune.

Reaction
Critics say that the fees and potential waiting list could lead some HIV-positive people to abandon treatment, possibly undermining efforts to stop the disease's spread, according to the Star Tribune. "There's going to be lots of heartbreak because of this," Dr. Keith Henry, an AIDS specialist at Hennepin County Medical Center, said. "If a patient gets sick, the costs will be quite high," Henry said, adding, "All it takes is one patient having a bad outcome, and a little bit of savings is often wiped out." Bob Tracy of the Minnesota AIDS Project said that the budget shortfalls have been "created by the 'no new taxes' policy of this administration," adding, "Now they're saying it's up to low-income people with HIV to solve the problem." Shirley York, director of the HIV/AIDS division of the state Department of Human Services, said that Minnesota currently has no plans to institute a waiting list because that option "would really be at the bottom of our list of things that we would want to do." York added that she believes that the Minnesota ADAP is headed in the right direction, saying, "It's a matter of assuring that we have adequate funding to do it" (Minneapolis Star Tribune, 6/20).