Local
Will health reform make AIDS groups obsolete?
HIV clinics face new competition as clients obtain insurance by 2014
‘Health care reform has been a real motivator around us improving the quality of what we do because we know we’re going to have to get better,’ said Don Blanchon, executive director of Whitman-Walker Clinic. (Washington Blade photo by Michael Key)
When the AIDS epidemic burst on the scene in the 1980s, a cadre of volunteers –many from the LGBT community — emerged to provide compassionate and dedicated care for the sick and dying, services that government agencies and existing charitable groups were not providing.
Since that time, the mostly volunteer-driven, community-based AIDS clinics and advocacy groups created back then have evolved into professionally run facilities receiving millions of dollars in state and federal funds. Like the Whitman-Walker Clinic in D.C., many of the clinics and advocacy groups provide a vast array of services for people with HIV and AIDS, most of whom can’t afford private health insurance.
But in March, Congress approved and President Obama signed into law a sweeping health care reform measure called the Patient Protection and Affordable Care Act. Obama administration officials say it will result in more than 94 percent of all Americans being covered by some form of private or public health insurance by 2014.
Although most AIDS activists and officials with local and national AIDS organizations have hailed the health care reform measure as an unprecedented benefit to people with HIV and AIDS, some believe the law could prompt large numbers of patients to leave the community-based clinics and seek medical care elsewhere.
With a possible loss of clients, community AIDS clinics would be in jeopardy of losing government funding, which is based on the number of clients served. It would be ironic, some have said, if the benefits of healthcare reform result in the closing of community institutions that have served people with AIDS during a time of need.
“The LGBT community and people living with HIV are going to have options that they may not have now,” said Don Blanchon, executive director of the Whitman-Walker Clinic, which has served people with HIV and AIDS since the epidemic began.
“And so for us, health care reform has been a real motivator around us improving the quality of what we do because we know we’re going to have to get better,” Blanchon said. “We know at some point in time almost every District resident is going to have some type of public or private insurance, which means they, in theory, are going to be able to go to a lot of different places for their care.”
Blanchon noted that a financial crisis that Whitman-Walker faced four years ago forced it to take steps that have placed it in an excellent position to flourish under the health care reform law. The Clinic’s board hired Blanchon, a managed care expert, to help the Clinic survive at a time when private donations and fundraising efforts were faltering.
With the board’s full approval and over the objections of some of the Clinic’s longtime supporters and volunteers, Blanchon transformed the Clinic from a volunteer model operation into a managed care type facility with the status known as a “federally qualified health center look alike.”
According to Blanchon and other Clinic officials, the new status enables the Clinic to accept a greater number of Medicaid patients as well as patients with a wide range of private health insurance. Patients covered by these programs allow the Clinic to obtain reimbursement for its services by doctors, its own pharmacy, and other service providers, eliminating the need to rely more on private donors.
Unlike other community-based AIDS clinics, Whitman-Walker will be in an excellent position to take on new patients or retain its existing ones as the new health care reform measure enables the majority of patients to obtain private insurance or Medicaid.
Under the Patient Protection and Affordable Care Act, all lower income individuals, including people with HIV, will be eligible for Medicaid coverage if they fall below 133 percent of the federal poverty level, where an individual has an income of about $15,000 a year or lower.
Under current federal law, low-income people with full-blown AIDS are already eligible for Medicaid coverage. For years, Congress has declined to pass legislation proposed by AIDS advocacy groups calling for Medicaid coverage for low-income people with HIV, with the intent of providing medical services to prevent them from advancing to AIDS.
The new law makes that legislation unnecessary after 2014, when the Medicaid provision takes effect.
Jeffrey Crowley, director of the White House Office of National AIDS Policy, calls the Patient Protection and Affordable Care Act one of the nation’s most significant advances for the care and treatment for people with HIV/AIDS.
“It will fundamentally expand access to insurance coverage for people living with HIV,” he said. “Much of that will be through the mandatory expansion of the Medicaid program.”
He said that similar to all Americans, people with HIV will also be eligible for private insurance coverage through a variety of options based on their income. Among the options will be the purchase of insurance coverage through competitive insurance exchanges. He noted that by 2014, no insurance company can deny coverage based on pre-existing conditions such as HIV or other illnesses.
Keith Maley, a spokesperson for the U.S. Department of Health and Human Services, which will administer most of the provisions of the new health care law, said people with HIV and other illnesses could be immediately eligible for private insurance coverage through high-risk pools.
Those eligible for the immediate coverage must show that they have had no health insurance coverage for six consecutive months, have a chronic health condition, and are not eligible for employer provided insurance or Medicaid.
Crowley noted that the new law has other immediate benefits for people with HIV and other chronic health conditions. As of July 1, private health insurers can no longer use a rescission, a practice that cancels a policy when someone gets sick and needs expensive treatment.
He said the law also immediately prohibits insurers from imposing a lifetime “cap” on insurance benefits. Annual limits on coverage or benefits will end in 2014, he said.
Crowley, a gay man who previously worked for the National Association of People with AIDS before joining the White House staff, said he expects most community-based AIDS clinics and local and national AIDS advocacy organizations to continue to exist after the health care law is fully implemented in 2014. However, he said most will have to change the way they do business.
“I think we know from our experience with HIV that we’ve built up a great HIV workforce,” he said. “We have a lot of expertise. I want to make sure as we build and expand an insurance system through the Affordable Care Act that these HIV medical providers are making sure that they’re part of this new system.”
“Some of them might only receive funding through the Ryan White programs, and I would say they need to look at their future and say that they need to be part of the new insurance system,” he said. “But there’s no question that we’re going to need their expertise and commitment at providing medical care going forward.”
Crowley’s reference to the Ryan White CARE Act, the largest existing federal program created to provide care for low-income people with HIV/AIDS, is expected to change significantly following the full implementation of the Patient Protection and Affordable Care Act, according to officials with a number of national AIDS groups.
Nearly everyone, including Crowley, agrees that the Ryan White program should remain, but most likely in a scaled back form. Congress passed the act in the 1990s as a means of helping cities and states that were grappling with the enormous burden of providing care for people with HIV/AIDS who lacked health insurance coverage and were overwhelming local and state hospitals and health care facilities.
Carl Schmid, director of federal affairs for the AIDS Institute, a national advocacy organization; Michael Weinstein, executive director of the AIDS Healthcare Foundation, the nation’s largest AIDS-related medical care provider; and Jose Zuniga, executive director of the International Association of Physicians in AIDS Care, each said they believe the Ryan White program will be needed for at least some services the new law does not provide.
“It will not solve all of our access issues,” said Schmid of the new health care measure.
Weinstein said that state programs to expand health insurance have been slow to enroll as many people as expected for a variety of reasons, some bureaucratic in nature.
“So I wouldn’t expect an overnight change in 2014,” he said, pointing to a need to keep the Ryan White program operating for some time after 2014.
Weinstein said that in some states, including California, Medicaid reimbursement for medical services is far lower than that provided by private insurance companies. He predicted that people with HIV or AIDS who obtain coverage under the new law through Medicaid might be turned away by private doctors who declined to take all Medicaid patients.
“The reimbursement that we receive from Medicaid or from private insurance is far below our cost and far below what we get from Ryan White,” he said of the AIDS Healthcare Foundation. “So we will suffer a hit in that regard as well as most providers.”
Weinstein said his organization has a wide variety of income streams and the lower reimbursements under the new law “won’t be a fatal blow to us.”
Blanchon of Whitman-Walker said the benefits of the new law greatly outweigh its possible shortfalls.
“Health care reform is going to be a real help to our patients and clearly to the Clinic because more of our patients are going to be insured under more comprehensive benefit programs,” he said.
“And what that means at the end of the day is the Clinic is not going to have to shell out as much free care. So we’re going to be in a position to be able to offer more services to more patients and keep them healthy, and ultimately that’s what we’re here for.”
District of Columbia
Bowser budget proposal calls for $5.25 million for 2025 World Pride
AIDS office among agencies facing cuts due to revenue shortfall
D.C. Mayor Muriel Bowser’s proposed fiscal year 2025 budget includes a request for $5.25 million in funding to support the June 2025 World Pride celebration, which D.C. will host, and which is expected to bring three million or more visitors to the city.
The mayor’s proposed budget, which she presented to the D.C. Council for approval earlier this month, also calls for a 7.6 percent increase in funding for the Mayor’s Office of LGBTQ Affairs, which amounts to an increase of $132,000 and would bring the office’s total funding to $1.7 million. The office, among other things, provides grants to local organizations that provide services to the LGBTQ community.
Among the other LGBTQ-related funding requests in the mayor’s proposed budget is a call to continue the annual funding of $600,000 to provide workforce development services for transgender and gender non-conforming city residents “experiencing homelessness and housing instability.” The budget proposal also calls for a separate allocation of $600,000 in new funding to support a new Advanced Technical Center at the Whitman-Walker Health’s Max Robinson Center in Ward 8.
Among the city agencies facing funding cuts under the mayor’s proposed budget is the HIV/AIDS, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Administration, known as HAHSTA, which is an arm of the D.C. Department of Health. LGBTQ and AIDS activists have said HAHSTA plays an important role in the city’s HIV prevention and support services. Observers familiar with the agency have said it recently lost federal funding, which the city would have to decide whether to replace.
“We weren’t able to cover the loss of federal funds for HAHSTA with local funds,” Japer Bowles, director of the Mayor’s Office of LGBTQ Affairs, told the Washington Blade. “But we are working with partners to identify resources to fill those funding gaps,” Bowles said.
The total proposed budget of $21 billion that Bowser submitted to the D.C. Council includes about $500 million in proposed cuts in various city programs that the mayor said was needed to offset a projected $700 million loss in revenue due, among other things, to an end in pandemic era federal funding and commercial office vacancies also brought about by the post pandemic commercial property and office changes.
Bowser’s budget proposal also includes some tax increases limited to sales and business-related taxes, including an additional fee on hotel bookings to offset the expected revenue losses. The mayor said she chose not to propose an increase in income tax or property taxes.
Earlier this year, the D.C. LGBTQ+ Budget Coalition, which consists of several local LGBTQ advocacy organizations, submitted its own fiscal year 2025 budget proposal to both Bowser and the D.C. Council. In a 14-page letter the coalition outlined in detail a wide range of funding proposals, including housing support for LGBTQ youth and LGBTQ seniors; support for LGBTQ youth homeless services; workforce and employment services for transgender and gender non-conforming residents; and harm reduction centers to address the rise in drug overdose deaths.
Another one of the coalition’s proposals is $1.5 million in city funding for the completion of the D.C. Center for the LGBTQ Community’s new building, a former warehouse building in the city’s Shaw neighborhood that is undergoing a build out and renovation to accommodate the LGBTQ Center’s plans to move in later this year. The coalition’s budget proposal also calls for an additional $300,000 in “recurring” city funding for the LGBTQ Center in subsequent years “to support ongoing operational costs and programmatic initiatives.”
Bowles noted that Bowser authorized and approved a $1 million grant for the LGBTQ Center’s new building last year but was unable to provide additional funding requested by the budget coalition for the LGBTQ Center for fiscal year 2025.
“We’re still in this with them,” Bowles said. “We’re still looking and working with them to identify funding.”
The total amount of funding that the LGBTQ+ Budget Coalition listed in its letter to the mayor and Council associated with its requests for specific LGBTQ programs comes to $43.1 million.
Heidi Ellis, who serves as coordinator of the coalition, said the coalition succeeded in getting some of its proposals included in the mayor’s budget but couldn’t immediately provide specific amounts.
“There are a couple of areas I would argue we had wins,” Ellis told the Blade. “We were able to maintain funding across different housing services, specifically around youth services that affect folks like SMYAL and Wanda Alston.” She was referring to the LGBTQ youth services group SMYAL and the LGBTQ organization Wanda Alston Foundation, which provides housing for homeless LGBTQ youth.
“We were also able to secure funding for the transgender, gender non-conforming workforce program,” she said. “We also had funding for migrant services that we’ve been advocating for and some wins on language access,” said Ellis, referring to programs assisting LGBTQ people and others who are immigrants and aren’t fluent in speaking English.
Ellis said that although the coalition’s letter sent to the mayor and Council had funding proposals that totaled $43.1 million, she said the coalition used those numbers as examples for programs and policies that it believes would be highly beneficial to those in the LGBTQ community in need.
“I would say to distill it down to just we ask for $43 million or whatever, that’s not an accurate picture of what we’re asking for,” she said. “We’re asking for major investments around a few areas – housing, healthcare, language access. And for capital investments to make sure the D.C. Center can open,” she said. “It’s not like a narrative about the dollar amounts. It’s more like where we’re trying to go.”
The Blade couldn’t’ immediately determine how much of the coalition’s funding proposals are included in the Bowser budget. The mayor’s press secretary, Daniel Gleick, told the Blade in an email that those funding levels may not have been determined by city agencies.
“As for specific funding levels for programs that may impact the LGBTQ community, such as individual health programs through the Department of Health, it is too soon in the budget process to determine potential adjustments on individual programs run though city agencies,” Gleick said.
But Bowles said several of the programs funded in the mayor’s budget proposal that are not LGBTQ specific will be supportive of LGBTQ programs. Among them, he said, is the budget’s proposal for an increase of $350,000 in funding for senior villages operated by local nonprofit organizations that help support seniors. Asked if that type of program could help LGBTQ seniors, Bowles said, “Absolutely – that’s definitely a vehicle for LGBTQ senior services.”
He said among the programs the increased funding for the mayor’s LGBTQ Affairs office will support is its ongoing cultural competency training for D.C. government employees. He said he and other office staff members conduct the trainings about LGBTQ-related issues at city departments and agencies.
Bowser herself suggested during an April 19 press conference that local businesses, including LGBTQ businesses and organizations, could benefit from a newly launched city “Pop-Up Permit Program” that greatly shortens the time it takes to open a business in vacant storefront buildings in the downtown area.
Bowser and Nina Albert, D.C. Deputy Mayor for Planning and Economic Development, suggested the new expedited city program for approving permits to open shops and small businesses in vacant storefront spaces could come into play next year when D.C. hosts World Pride, one of the word’s largest LGBTQ events.
“While we know that all special events are important, there is an especially big one coming to Washington, D.C. next year,” Bowser said at the press conference. “And to that point, we proposed a $5.25 million investment to support World Pride 2025,” she said, adding, “It’s going to be pretty great. And so, we’re already thinking about how we can include D.C. entrepreneurs, how we’re going to include artists, how we’re going to celebrate across all eight wards of our city as well,” she said.
Among those attending the press conference were officials of D.C.’s Capital Pride Alliance, which will play a lead role in organizing World Pride 2025 events.
Maryland
Health care for Marylanders with HIV is facing huge cuts this summer
Providers poised to lose three-quarters of funding
BY MEREDITH COHN | By the end of June, health care providers in Maryland will lose nearly three-quarters of the funding they use to find and treat thousands of people with HIV.
Advocates and providers say they had been warned there would be less money by the Maryland Department of Health, but were stunned at the size of the drop — from about $17.9 million this fiscal year to $5.3 million the next. The deep cuts are less than three months away.
The rest of this article can be read on the Baltimore Banner’s website.
District of Columbia
Taste of Point returns at critical time for queer students
BIPOC scholar to speak at Room & Board event on May 2
The Point Foundation will kick off May with its annual Taste of Point DC event. The event will be hosted at Room & Board on 14th Street and feature a silent auction, food tastings, a speech from a scholar, and more.
Point’s chief of staff, Kevin Wright, said that at Taste of Point, the scholars are the star of the show.
“People never come to an event to hear Point staff speak, they come to hear from the people most impacted by the program,” he said. “At its core Taste of Point is designed to center and highlight our scholars’ voices and experiences.”
This year, a Point BIPOC Scholar, Katherine Guerrero Rivera will speak at the event.
“It is a great opportunity to highlight the scholars out there on the front lines making impacts in almost every sector and job field,” Wright said.
Wright pointed out that this year especially is a pivotal time for LGBTQ students.
“In 2023, there were 20 states that passed anti-LGBTQ legislation,” he said. “By this point in [2024] we already have more.”
Wright said the impacts of those legislative attacks are far reaching and that Point is continuously monitoring the impact they have on students on the ground.
Last month, The Washington Post reported that states with anti-LGBTQ laws in place saw school hate crimes quadruple. This report came a month after a non-binary student, Nex Bennedict, died after being attacked at school.
“So, we see this as a critical moment to really step up and help students who are facing these challenges on their campus,” Wright said. “Our mission is to continue to empower our scholars to achieve their full academic and leadership potential.”
This year Point awarded nearly 600 LGBTQ students with scholarships. These include the flagship scholarship, community college scholarship and the BIPOC scholarship. When the foundation started in 2002, there were only eight scholarships awarded.
Dr. Harjant Gill is one of those scholars who said the scholarship was pivotal for him. Gill said he spent his undergraduate years creating films and doing activism for the LGBTQ community.
As a result, his academic record wasn’t stellar and although he was admitted into American University’s graduate program he had no clue how he would fund it.
Upon arrival to American he was told to apply for a Point scholarship and the rest was history.
“It ended up being the one thing that kept me going otherwise I would have dropped out,” he said. “Point was incredibly instrumental in my journey to becoming an academic and a professor.”
More than a decade later, Gill serves on the host committee for Taste of Point and is a mentor to young Point scholars. He said that he donates money yearly to Point and that when he is asked what he wants for a gift he will often tell his friends to donate too.
To attend the event on Wednesday, May 2, purchase tickets at the Point website. If you can’t attend this year’s Taste of Point DC event but would like to get involved, you can also donate online.
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