• Contents
• Introduction
• Study 1: Factors Contributing to Variations in Per Capita State AIDS Drug Assistance Program Expenditures
• Study 2: ADAP Supplemental Funds
• Study 3: The Role of Title I-Funded AIDS Pharmacy Assistance Programs in Ensuring Access to HIV Therapeutics
• Study 4: Issues Associated With Capped Enrollment and Waiting Lists

Study 2
ADAP SUPPLEMENTAL FUNDS

Jeffrey Levi, Julia Hidalgo, John Palen, E. Blaine Parrish, Kendra Williams, and Anthony S. Lara

Background

The ADAP supplemental funds allocated in FY 2003 amounted to $21 million, or 3 percent of the total amount allocated to the CARE Act ADAP earmark budget. ADAP supplemental funds are meant to assist the States that are most challenged in supporting their ADAP. Not all eligible State ADAPs, however, have accessed supplemental funds. ADAP supplemental funds target jurisdictions that met specific qualifications as of January 1, 2000. Only States that met at least one of the following criteria on that date are eligible to apply:

• Financial eligibility restriction to less than or equal to 200 percent of Federal Poverty Level (FPL)
• Medical eligibility restrictions
• Limited formulary composition for antiretroviral drugs (ARVs)
• Limited formulary compositions (fewer than 10 medications) for the treatment of opportunistic infections.

States are also required to match the Federal supplement award at a rate of one State dollar for every four Federal dollars. The CARE Act requires that States receiving ADAP supplemental funds maintain their current levels of effort in their ADAP funding. In FY 2003, 27 States and territories were eligible to apply for ADAP supplemental funds. Of those jurisdictions, 17 received ADAP supplemental funding: Alabama, Colorado, Georgia, Guam, Idaho, Kentucky, Louisiana, Nebraska, North Carolina, Oklahoma, Puerto Rico, South Carolina, Texas, Virgin Islands, Virginia, West Virginia, and Wisconsin. States that were eligible based on FY 2000 criteria butdid not apply included Alaska, Arizona, Iowa, Maine, Montana, North Dakota, South Dakota, Tennessee, Utah, and Vermont.

HAB requested that GWU staff collect information about the following topics:

• Why States are not availing themselves of ADAP supplemental funds
• Whether different criteria might be established to determine need for ADAP supplemental funds
• The likely impact of reducing the ADAP supplemental match requirement or modifying the eligibility criteria for ADAP supplemental funds.

Methodology

In a separate study sponsored by HAB, Positive Outcomes, Inc. (POI) staff interviewed ADAP coordinators in States that met the FY 2000 criteria for ADAP supplemental funds but did not request them. Under an agreement with HAB, POI provided interview notes to GWU staff to assist in this study. Additional information gathered by GWU staff included information gathered from HAB, the National Alliance of State and Territorial AIDS Directors, and the CARE Act legislation. The following information reflects a synthesis of those data.

Limitations

No limitations were identified in conducting this study. State ADAP staff was very cooperative with study staff.

Major Findings

Why are States not availing themselves of the ADAP supplemental funds?

• The State ADAP supplemental match requirement is the most difficult hurdle to overcome. State ADAPs reported that neither direct matching funds for ADAP nor in-kind resources used to support the match are available in a time of tight State budgets.
• Some State ADAP coordinators reported that because the ADAP supplemental funds are not stable and there is no guarantee of future funding, they are concerned that they might increase enrollment in one year based on newly awarded supplemental funds only to have to disenroll clients the next year because of inadequate funds.
• Several State ADAPs are not willing to change their eligibility requirements (e.g., financial, medical restrictions, limited formulary) to receive supplemental funding. In some States, eligibility requirements must be established by the State legislature. Without pre-identified Federal funds to support expanded enrollment or benefits, State legislators are unwilling to make changes in ADAPs that might require State funds.

Would the establishment of different criteria improve the participation of States or the effectiveness of the ADAP supplemental program?

• Needs-based distribution of ADAP supplemental funds could influence the impact of these funds as well as State participation. Using needs-based distribution of supplemental funds would take into consideration the uniqueness of each State’s needs. Several ADAP coordinators commented that their request for ADAP supplemental funds was far short of their projected requirements. They also commented that several other State ADAPs received more supplemental funds than they had requested.
• State ADAP coordinators indicated that multiyear, guaranteed minimum funding would make them more likely to apply for ADAP supplemental funds.

What are the likely effects of reducing the ADAP match requirement or modifying the eligibility criteria for supplemental funding?

• State ADAPs reported that slightly modifying the match requirement will have little impact because State budget crises currently preclude allocation of any State matching funds.
• Modification of the eligibility criteria was not seen as removing as significant a barrier to accessing supplemental funds as the State ADAP match requirement. Criteria such as a financial eligibility restriction of 200 percent of FPL or lower, medical eligibility restrictions, limited formulary composition for ARVs, and limited formulary compositions were not seen as being as immutable a barrier as the State match.

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