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SPONSOR: |
Trujillo |
DATE TYPED: |
2/20/03 |
HB |
485 |
||
SHORT TITLE: |
HIV & AIDS Drugs |
SB |
|
||||
|
ANALYST: |
Wilson |
|||||
APPROPRIATION
Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
||
FY03 |
FY04 |
FY03 |
FY04 |
|
|
|
$2,000.0 |
|
|
Recurring |
General
Fund |
|
|
|
|
|
|
(Parenthesis ( ) Indicate Expenditure Decreases)
Responses
Received From
Department
of Health (DOH)
SUMMARY
Synopsis
of Bill
House Bill 485 appropriates $2 million from the
general fund to the Department of Health to provide New Mexico residents with
prescription drugs and services related to HIV and AIDS.
Significant
Issues
1.
The number
of New Mexicans living with HIV/AIDS who benefit from effective medical care
continues to increase as fewer people now die from AIDS. Health care resources spent on effective
management of HIV/AIDS significantly improve quality of life and prevent the
costly consequences of end-stage disease.
2.
HIV
prevention efforts in New Mexico have been effective at maintaining low rates
of HIV/AIDS through targeted outreach to communities at risk. Each case of HIV/AIDS that is prevented
saves more that $150,000 in lifetime medical care costs. Resources spent on HIV prevention and
quality medical care save money by decreasing the need for hospitalizations,
home health care, hospice care and the treatment of debilitating AIDS-related
illnesses.
3.
SB49 would
provide resources for HIV/AIDS medical and prevention services needed to serve
an expanding population. If HIV
prevention efforts are not redoubled, recent increases in New Mexico syphilis
and gonorrhea rates will likely be followed by a increase in HIV
infections.
FISCAL IMPLICATIONS
The appropriation of $2,000.0 is a recurring
expense to the general fund. Any unexpended or unencumbered balance remaining
at the end of FY2004 shall revert to the general fund.
The following table shows the trend of an
increase in federal funding and a decrease in state funding.
|
FY
2001 |
FY
2002 |
FY
2003 |
HIV/AIDs
Services |
|||
Federal |
$2,700.0 |
$2,800.0 |
$3,000.0 |
State |
$7,300.0 |
$7,200.0 |
$5,800.0 |
|
|
|
|
HIV Prevention |
|||
Federal |
$2,200.0 |
$2,300.0 |
$2,800.0 |
State |
$1,400.0 |
$1,100.0 |
$1,000.0 |
The state funding is entirely general fund
except for $426.0 per year for HIV services and $44.0 per year for prevention
which have been appropriated from the Tobacco Settlement.
ADMINISTRATIVE IMPLICATIONS
DOH can manage the additional funding with
existing staff.
OTHER SUBSTANTIVE ISSUES
1.
Prior to
1996, most HIV/AIDS health care resources were spent on hospitalizations for
AIDS-related diseases, home health care and hospice care of people debilitated
by end-state AIDS. At that time, there
was no effective treatment for HIV infection itself. In 1996, effective medical treatment of HIV disease became
available for the first time.
2.
Deaths
attributable to HIV/AIDS in New Mexico have dropped from 173 deaths in 1995 to
29 deaths in 2002. As deaths have
dropped precipitously, the number of New Mexicans living with HIV/AIDS has
increased from 1516 in year 2000 to 1707 in year 2003. HIV/AIDS health care costs have shifted from
end-of-life care to long-term outpatient management of HIV disease of an
increasing population of HIV-infected clients. This has resulted in a dramatic
shift in cost centers with decreasing costs incurred by Medicaid and the Human
Services Department (HSD) and increasing costs incurred by the DOH.
3.
In the last
two years, the DOH has been able to maintain services to the expanding HIV
client population because of increased federal funding that has compensated for
decreasing state funding. Because
client enrollment continues to increase, the DOH must now consider cutting back
on HIV medical care services. The
appropriation contained within SB49 would help to avert those cuts.
4.
If HIV/AIDS
prevention and medical care services are cut, more New Mexicans living with
HIV/AIDS will develop end-stage disease.
Costs will then shift back to end-of-life care including increased rates
of hospitalization, home health care and hospice care. It is anticipated that increasing costs will
then be incurred by Medicaid and the HSD.
5. The
increasing costs in the medications program have been due to increasing client
enrollment, not due to the costs of medications. Client enrollment is increasing because fewer New Mexicans are
dying of HIV/AIDS as a result of effective medical treatment. The number of newly identified cases of
HIV/AIDS remains stable.
6. The
DOH HIV program disseminates prescription drugs indicated for the treatment of
human immunodeficiency virus syndrome to New Mexico citizens who are
financially unable to afford these medications. These drugs are included in a conservative formulary and expenses
are accounted for on a daily basis in the pharmacy. Due to the expense of these drugs, federal funds will not ensure
the availability of enough drugs to supply the needs of New Mexico citizens.
7. In
addition to the expansion in enrollment, there is a need to expand the
medications formulary to include recent advances in HIV treatment. A new class of HIV medications that prevents
HIV from infecting cells will be available within the next year. This medication will not supplant other HIV
medications but will be used in addition to those other medications. The cost of the HIV fusion inhibitor T20 is
anticipated to be $14,000 per client per year.
The use of HIV fusion inhibitors will be severely restricted unless additional
resources become available to the New Mexico HIV/AIDS Medications Program.
8. End-stage
liver disease due to hepatitis C infection has become the leading cause of
death among people living with HIV/AIDS.
An effective treatment for hepatitis C has become available in the past
year. The estimated cost of treatment
for hepatitis C infection is $15,000.
The New Mexico HIV/AIDS Medications Program will be unable to include
hepatitis C treatment unless new resources become available.
9. Behavioral
health services are significantly impacted as referrals are integrated into the
public health service system. Research has shown that substance abuse
contributes to sexual risk taking behavior, which is closely related to an
increase in HIV transmission.
10. Persons
with co-occurring disorders have a higher likelihood of suicide, incarceration,
family conflict, high service use and costs, as well as violence, and HIV
infection. They are more likely to
relapse and are at greater risk for hospitalization and homelessness.
11. Undocumented
adolescent immigrants as a high-risk population, affected with AIDs and/or HIV,
may not have any sources for health care except as provided in the appropriation
in this bill.
DW/prr