TennCare changes impact HIV care

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KNOXVILLE – Bredesen’s TennCare reforms may have disastrous implications for the HIV/AIDS community in our state. The entire system of care will be shaken by the Governor’s TennCare reform initiative.

Additionally, a majority of those currently insured are expected to lose their TennCare. Coverage for most of those lucky enough to remain covered is threatened by the Governor’s planned legal attacks on the consent decrees he has criticized.

Brian Varner, Director of Education with Knoxville ’s Tennessee AIDS Support Services warned, “The upcoming cuts in TennCare are hitting at a time when Medicaid is also on the chopping block. This ‘double-whammy’ will undoubtedly result in a lower standard of care and increased out-of-pocket costs for Tennesseans.”

Comprehensive care for persons living with HIV/AIDS (PLWHAs) in Tennessee is delivered through the cooperation of government agencies, community-based organizations, university-affiliated medical resources and other health care venues. This system provides some of the best care available and has achieved remarkable success in terms of preventing disease progression. Community members now fear that a very different system will quickly come to be and express concerns about how that will affect health outcomes for PLWHAs in Tennessee .

“Virtually no new HIV-positive persons will be accepted into the TennCare program after the changes, except for those with dependent children,” noted local HIV/AIDS activist Mark Hubbard.

Currently, more than half of the HIV+ persons in Tennessee receive their medications through TennCare coverage, and nearly half have other medical costs paid by TennCare. In Nashville , the Comprehensive Care Center (CCC), one of the largest freestanding HIV/AIDS clinics in the country, estimates that more than 500 of its more than 2000 patients will lose medical coverage.

Designated as one of Tennessee ’s AIDS Centers of Excellence, the CCC says that the average patient’s annual cost for care is $2,500 along with $12,000 for medications. The center expects the burden of uncompensated care to rise from $270,000 to $2,020,000 annually.

Federal monies administered through the Ryan White CARE Act support the HIV Drug Assistance Program (HDAP) in our state. Because of TennCare, we have never had a waiting list. After the changes, needs may exceed capacity in less than a year. Virtually every state that borders Tennessee has a waiting list, and last year Alabama , for example, exceeded 600 persons waiting. Necessarily, these states must restrict the number and types of medications covered.

“There is no guarantee that patients who will be moved from TennCare to the HDAP program will be adequately covered. Those who are newly diagnosed face even more uncertainty,” Hubbard said.

The Comprehensive CARE Center expects 700 of its more than 2000 active patients will be forced to make this move.