Health Planning Council of Southwest Florida

Ryan White Part B Program
The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is Federal legislation that addresses the unmet health needs of persons living with HIV disease (PLWH) by funding primary health care and support services that enhance access to and retention in care. First enacted by Congress in 1990, it was amended and reauthorized in 1996 and again in 2000 and 2006/7. The CARE Act was named after Ryan White, an Indiana teenager whose courageous struggle with HIV/AIDS and against AIDS-related discrimination helped educate the nation.

Like many health problems, HIV disease disproportionately strikes people in poverty, racial/ethnic populations, and others who are underserved by healthcare and prevention systems. HIV often leads to poverty due to costly healthcare or an inability to work that is often accompanied by a loss of employer-related health insurance. CARE Act-funded programs are the “payer of last resort." They fill gaps in care not covered by other resources. Most likely users of CARE Act services include people with no other source of healthcare and those with Medicaid or private insurance whose care needs are not being met.

CARE Act services are intended to reduce the use of more costly inpatient care, increase access to care for underserved populations, and improve the quality of life for those affected by the epidemic. The CARE Act works toward these goals by funding local and State programs that provide primary medical care and support services; healthcare provider training; and technical assistance to help funded programs address implementation and emerging HIV care issues.

The Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB) as lead responsibility for implementing the CARE Act. HRSA is an agency of the U.S. Department of Health and Human Services (HHS). CARE Act programs include:

In Southwest Florida, there is a state Part B program allocation, three (3) Part C programs, AETC opportunities, and access to Part D services. The Health Planning Council of Southwest Florida is the lead agency for the state of Florida in Area 8 for the Ryan White Part B program. The Florida Ryan White Part B program is administered through the Florida Department of Health, Bureau of HIV/AIDS. In the State of Florida’s Statewide Coordinated Statement of Need, there are seven (7) core services: Medical Care, Pharmaceuticals, Dental Care, Case Management, Health Insurance, Substance Abuse Treatment and Mental Health Treatment. In Area 8, the local planning body – Regional HIV/AIDS Council (RHAC) – recommended funding priorities in-line with these core services. The RHAC makes funding priority recommendations to the Health Planning Council of Southwest Florida who in turn develops and implements programs to allocate the funding and serve those most in need.

Under the service delivery model implemented in July 2005, the reduction was absorbed by reducing administrative functions and focusing on the core services, particularly primary medical care. Of the total direct care funding, 75% is spent on "core" services (medical, drugs, health insurance, dental, mental health, substance abuse) and 25% is spent on "support services" (case management, transportation food assistance). Below is the 2008-2009 Ryan White Part B direct services budget.

Ryan White Part B Apr 08 – Mar 09
Total Direct Services	$ 1,678,184
Medical	$ 802,400
Case Management	$ 412,516
Prescription Drugs	$ 168,697
Health Insurance	$ 98,900
Dental	$ 145,856
Mental Health	$ 28,348
Transportation	$ 6,900
Substance Abuse	$ 4,567
Food Assistance	$ 10,000

The RHAC is a 15-member planning body that plans for services and advises the HPCSWF on funding priorities and service delivery issues and policy development. The RHAC is comprised of county health department directors / administrators, one community representative from each county, a prevention representative and a patient care representative. The RHAC meets every other month and has four standing committees that meet regularly: Clinical Committee, Case Management Committee, Prevention Committee and the Physician Advisory Committee.

The Program Data Report (PADR) provides a look back at who we served in Southwest Florida during the reporting calendar year. Below are results from the 2007 PADR. This data is a compilation of data from the Ryan White Title II contracted providers and does not include agencies contracted under Ryan White Title III (Hendry County Health Department, Collier Health Services in Immokalee, and AIDS Reource Council).

Housing Opportunities for Persons with AIDS (HOPWA)
The Housing Opportunities for Persons With AIDS, known as HOPWA, is funded through a grant from the Department of Housing and Urban Development (HUD) to provide states ("HOPWA") and designated eligible metropolitan areas (“HUD HOPWA") with resources and incentives for meeting the housing needs of persons with HIV disease and AIDS. The Department of Health, which contracts with lead agency organizations at the local level, administers Florida^s HOPWA program. The state HOPWA program provides temporary housing assistance to eligible individuals. The services include: Transitional Housing, Assistance with Rent, Mortgage, Utilities and Supportive Services (such as Case Management).

Services are provided to income eligible individuals with documented HIV disease and their families. By coordinating HOPWA services through the Ryan White Title II consortia, HOPWA participants have ready access to a variety of support services that contribute to a stable housing situation. Services not approved include: payments which exceed actual costs, payments made directly to clients, cash payments of any kind (including checks made out to cash), property taxes that are not included in mortgage payments, long distance telephone charges, fines and penalties, down payment or closing costs on a home.

In Area 8, there are two HOPWA programs: “state HOPWA" in Charlotte, Collier, DeSoto, Glades, Hendry and Lee counties and “HUD HOPWA" in Sarasota county and includes Manatee county. The Health Planning Council of Southwest Florida is the lead agency for both programs.

The current 2008-2009 State HOPWA budget for Area 8 (Charlotte, Collier, DeSoto, Glades, Hendry and Lee) totals $850,000. The direct client services budget is shown in the table below. The 2009-2010 budget beginning July 1, 2009 will remain the same.

State HOPWA Jul 08 – Jun 09
Total Direct Services	$ 750,975
Case Management	$ 158,100
Short Term Rent, Mortgage, and Utility Assistance	$ 592,875

The Sarasota/Manatee HUD HOPWA program currently has a total budget of $351,819. This reflects a 29% decrease in funding. The local area coalition is has made recommendations on how to distribute the decrease.

AIDS Insurance Continuation Program (AICP)
The AIDS Insurance Continuation Program (AICP) is a statewide program for persons who are diagnosed with AIDS or are HIV positive with symptoms and who, because of their illness, are unable to maintain their private health insurance coverage. The program makes direct payments (up to $750/month) to each client's employer or insurance company for the continuation of medical, dental, mental health and optical coverage. The AICP does not pay for disability or life insurance. The AICP will also pay any fees associated with conversion of a COBRA policy to an individual policy or policy upgrades. The program will also pay client co-payments and deductibles on an as-needed basis.

The AICP is funded by Florida's Department of Health through a combination of federal and state monies. The overall program is managed by the Health Council of South Florida (Miami). It is administered through local community-based organizations (CBOs), including the Health Planning Council of Southwest Florida.

The AICP benefits participants, health care providers and the government. Participants are able to remain under the care of their doctors without worrying that they will be forced to accept alternative coverage, such as Medicaid. Also, since AICP clients retain their private insurance, they generally have greater access to various HIV/AIDS treatments. Providers such as doctors and hospitals also benefit from the AICP because private health insurance companies tend to offer higher payment rates than public programs. The government and taxpayers achieve savings as a result of the AICP because insurance companies continue to pay for actual health care and treatment, while the program pays for each AICP client^s insurance premium. This relieves the public from paying the full cost of HIV/AIDS care.