Georgia on My Mind: ADAP Short-Term Success, Long-Term Issues Remain

By: Jen Laws, Board Member, ADAP Advocacy Association, and HIV/transgender health advocate 

In September 2020, the National Alliance of State and Territorial AIDS Directors (NASTAD) released details from their request for information from their members and partners regarding COVID-19 impacts on HIV prevention programs, hepatitis programs, and Ryan White HIV/AIDS Programs (RWHAP). While the findings were promising in terms of federal flexibilities, the details of impacts among Ryan White HIV/AIDS programs, in particular State AIDS Drug Assistance Programs (ADAPs), were quite concerning. Among reported impacts, NASTAD stated “A majority of respondents also reported anticipating increased burden to the RWHAP as people lose their health insurance and income due to the economic downturn.”

Georgia ADAP advocates took note and began investigating the status of the state’s ADAP. However, despite requests, the state provided no information until a November meeting. At that time, Georgia’s Department of Public Health (DPH) shared they anticipated an $11 million funding gap for the program. Similar to the situation in Texas, DPH cited a HRSA rule on state matching funds and an “increase in enrollment” in order to justify introducing cost containment measures (e.g., reducing formulary inclusion, lowering income limits for eligibility, waitlists). However, under closer scrutiny, advocates ran into a familiar problem: the state had not increased funding for ADAP in over a decade, despite the program having grown by about 130% since the last increase. So why now the issue?

Georgia, like every other state, is grappling with the economic impacts of COVID-19 on tax revenues and appropriately planning their budgets.

Artwork provided by The Feminist Farmwife

Highlighting Georgia’s new HIV diagnosis rates, efforts aimed at Ending the HIV Epidemic, and the necessity to provide HIV medications as both treatment and a prevention activity, Equality Georgia lead the effort of asking the state legislature to finally increase funding for the state’s ADAP. Legislators in the House were widely amenable to the necessary increases, but Senators were skeptical and required a bit more effort. State Senators visited service sites and spoke with providers and PLWH about the funding and program concerns. Senators found what advocates and PLWH already know: federally funded providers already maximize their federal dollars – the issue in Georgia isn’t the use of federal funds at the provider level, it is lack of regular program funding increases on both the state and federal level to match the needs of the moment. Indeed, no one is paying the same for medications or care as they did a decade ago.

Advocates also organized four days of community-based “lobbying” including phone calls and emails to members of the Senate appropriations committee before finding success. A key, they said, was being selective: focusing on messaging regarding longer term costs of failing to act now and only targeting Senators on the appropriations committee. 

Jeff Graham, Executive Director of Equality Georgia said, “It is the value of keeping people healthy and in many instances, that means that people are able to retain their jobs.

“People are able to continue to be productive members of society by having this support, and frankly, the cost of medications itself is far lower than the cost of providing the intensive medical care if people don’t have access to medications early on and get sick and get hospitalized,” he added.

Ultimately, advocates argue, this wouldn’t have been an issue if the state were maximizing its use of 340B rebate dollars and had expanded Medicaid – a talking point expansion advocates across the state would benefit from latching onto.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.