To be 'eligible' or not to be 'eligible' - that is the question!

Webster’s New World College Dictionary defines the word eligible, eli·gible (el′i jə bəl), as an adjective to be 1) fit to be chosen; legally or morally qualified, 2) suitable or desirable, esp. for marriage or 3) Football allowed by the rules to catch a forward pass. The latter reference using a sports analogy is interesting, because imagine playing a game of football where half-way through the game the referees change the rules on you, making it harder for you and your team to win!

Now, consider these numbers: 99, 257, 89, 207.

Unfortunately, those are NOT just numbers - but rather they represent real people. They represent the numbers of people living with HIV/AIDS who one day were 'eligible' to receive services under the State's AIDS Drug Assistance Program ("ADAP"), then the next day were no longer eligible in Arkansas, Ohio, Utah and Virginia, respectively. Last time I checked, HIV-infection is a chronic disease if properly treated and AIDS is a life-threatening illness if not properly treated by anti-retroviral medications. By Arkansas, Ohio, Utah and Virginia changing their ADAP eligibility rules, did they send a message to these 652 people living with HIV/AIDS that their lives were no longer worth saving? Or maybe the States' actions were a way of saying to these people, "You are no longer suitable, or desirable."

These four states represented only the beginning of this emerging public health crisis, as other states are poised to follow their lead. A dangerous precedent has been set, and now numerous states are sliding down a very, very, very slippery slope.

Late last year, a warning was issued by the ADAP Advocacy Association (aaa+) that the ADAP waiting lists were only the “Tip-of-the- Iceberg” as an increasing number of HIV/AIDS patients were being kicked-off programs as states were changing their eligibility criteria.

The "invisible" ADAP waiting lists had yet to truly emerge. It begs the question, how many people heeded that warning?

At that time, several states had changed their program eligibility, thereby making clients who would have otherwise been eligible to receive services no longer eligible for ADAP. Arkansas reduced its financial eligibility to 200% Federal Poverty Level ("FPL"), North Dakota reduced its financial eligibility to 300% FPL, Ohio reduced its financial eligibility to 300% FPL, South Carolina lowered its financial eligibility to 300% FPL and Utah reduced its financial eligibility to 250% FPL. With these changes, many people living with HIV/AIDS could be forced to choose between basic necessities and their anti-retroviral medications.

The Ohio Department of Health issued a Notice of Public Hearing in accordance with Chapter 119 of the Revised Code (R.C.) and by authority of R.C. 3701.241, the Director of the Ohio Department of Health (ODH), or his designee, will conduct a public hearing at the time and place listed above, to consider the proposal to rescind current O.A.C. rules 3701-44-01 to 3701-44-08; and to file new rules 3701-44-01 to 3701-44-04. These rules pertain to the Ryan White Part B program administered by ODH.

To read the entire public notice, visit http://www.registerofohio.state.oh.us/pdfs/phn/3701_NO_136139_20110420_1518.pdf.

Now, Florida's ADAP - which is in complete disarray and shambles from gross mismanagement - is attempting to restrict their program eligibility from 400% FPL to 200% FPL. If approved, then thousands of Floridians living with HIV/AIDS would be put at risk.

Changing the eligibility requirements is "penny wise, pound foolish" because any small savings achieved in the near term is eliminated by the long-term costs assumed over time.

“If you cut the eligibility from [the current] 400 percent of the federal poverty level to 200 percent of the federal poverty level, that takes out a large income range where people can work and advance in their careers, accept promotions and eventually leave the ADAP system,” Jesse Fry told the Florida Department of Health at a recent public hearing in Tallahassee, Florida (The Florida Independent, 04/27/11).

As if the growing ADAP waiting lists weren't bad enough, now the "tip-of-the-iceberg" is rearing its ugly head with vengeance. Hopefully people living with HIV/AIDS will be given rules for the game by the state, and the state will honor its commitment and stick to them! After all, living with HIV/AIDS is no game!