January 24,  2018

New HIV Infections in New York State Hit Historic Low, Yet Disparities Continue
There's good news from the front lines of Ending the HIV/AIDS Epidemic (ETE) in New York: the New York State Department of Health released new data showing that HIV diagnoses have hit a record low, down 13 percent from 2015 to 2016, according to the ETE Dashboard. Yet racial, gender, and regional disparities continue. Of particular concern is that certain communities--women, transgender and gender non-conforming individuals, people of color, and individuals living in areas of New York State outside of New York City--are seeing less progress in reduced HIV infections. In the 57 counties outside of New York City, HIV diagnoses dropped less than one percent from 2015-2016, while New York City diagnoses dropped 11 percent during the same time frame. New diagnoses among non-Hispanic blacks and Hispanics are 7.6 and 5.1 times higher respectively than the rate for non-Hispanic whites. And the greatest increase in new infections of women continues to be among African American and Latina women. Read more: HIV rates/FY19 Budget press release
New York must meet the needs of those who are disproportionately impacted by the HIV epidemic by:
  • Meeting ETE funding commitments to address health disparities in specific communities.
  • Ensuring all communities have access to HIV treatment and prevention, including pre-exposure prophylaxis (PrEP).
  • Enhancing rental assistance for the estimated 3,700 individuals living with HIV outside of New York City who are either homeless or unstably housed.
  • Increasing access to employment opportunities for people living with HIV. Learn more: Amida Care Community Magazine: Hire Me! End AIDS With Jobs
  • Enhancing HIV quality metrics in Medicaid managed care to track and assess trends in health plan efforts related to annual preventive screening, viral load testing every six months, viral load suppression, and HIV prevention including the number of PrEP and PEP requests and prescriptions filled. 
Additional recommendations from the New York State Ending the Epidemic Coalition
can be found here.
The Challenges of Federal Pressure on States

The Federal Tax Bill
In late December 2017, President Trump signed into law legislation that disproportionately cut taxes and added $1.4 trillion to the federal deficit. The wealthiest Americans and corporations will receive enormous permanent tax cuts, while hard-working Americans will see smaller cuts that expire in a few years. Additionally, by eliminating the individual mandate, which required all Americans to purchase health insurance, the new tax legislation will lead to increases in health insurance premiums.

Federal Inaction Disrupts Health Insurance Coverage
The Trump administration stopped paying Cost Sharing Reductions (CSR) that reduce the cost of health insurance premiums and enable millions of Americans to afford health insurance. To date, Congress has not reinstated the CSR payments despite bipartisan efforts to do so. Additionally, Congress has failed to reinstate funding for the Child Health Insurance Program (CHIP, or Child Health Plus in New York) that helps children access critical care.

New York State Budget Pressures
New York State is projected to have a budget deficit of between $4.5 and $8 billion dollars. While the deficit resulted in part from a loss of state tax revenues, the enormous variation in the deficit projection is greatly impacted by the uncertain federal environment.

Increasing Threats to Medicaid
Medicaid is still intact, and recipients can expect that the program will be safe in the short term However, the federal government is increasing pressure to cut funding for safety-net programs such as Medicaid, Medicare, Social Security, and the Ryan White Care Act. The tax bill created a $1.4 trillion federal deficit. Elimination of CSR payments could also increase New York State's costs associated with Medicaid if CSR payments are not reinstated by Congress.

Federal funding supports New York State's  Essential Plan, which provides quality health insurance to lower-income working adults who do not qualify for Medicaid. Without the CSR payments, approximately 325,000 of the 750,000 individuals in the program could move to NYS Medicaid at a cost of around $1 billion. Since NYS Medicaid has capped spending, this large increase would push costs over the spending limit. Under NY law, exceeding the cap authorizes the NYS Health Commissioner to reduce Medicaid spending as they see fit to keep NY under the spending cap.
Work Requirements in Medicaid

The Center for Medicaid and Medicare Services (CMS) recently allowed states to submit applications that could change Medicaid to make eligibility for the program contingent on work requirements. Ten states--Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin--submitted applications that include such a request. Kentucky's request was approved; Kentucky now also has approval to charge premiums in Medicaid and stop covering medical expenses for the 90 days prior to the date when a recipient's Medicaid was approved New York State Medicaid does not use work requirements as an eligibility criteria to qualify for or stay in the program.

Medicaid work requirements would harm unemployed people instead of helping them.

  • Medicaid is not welfare. The vast majority (60%) of people on Medicaid who can work are already working. They are working in low-wage jobs or industries that do not provide health coverage to their workers.
  • Most people on Medicaid who aren't working can't work. Work requirements target those with chronic health conditions or who are caring for a sick family member. The policy won't do anything to help them find a job. It just takes away their health care.
  • Increasing the number of Medicaid recipients who work requires a concerted effort to create living-wage opportunities.  
Remember, Medicaid is US : 74 million Medicaid recipients rely on Medicaid for health care coverage. Many (60 percent) work but cannot afford health insurance on their own. They are veterans, women, families with children, and people with chronic conditions like HIV and diabetes.

What can you do to prevent cuts to Medicaid?

Stay involved and be vigilant: Continue to inform your local, stat e, and federal legislators about the valu e of Medicaid to you. Tell your story about how it has helped  you or someone you know. 
Call or visit your state legislators ask them to oppose any state cuts to Medicaid services. http://www.mygovnyc.org/

Send a message to Congress telling them to oppose any federal attempt to cut Medicaid or any of the Social Safety Net programs. Learn more at Medicaid is US:  www.medicaidisus.org  

Call your Senator and Member of Congress. Ask them to restore funding for Cost Sharing Reductions that help make health insurance affordable. Contact the U.S. Capitol Switchboard at (202) 224-3121.

Register to vote--and vote! (Stop by the post office for a form or call 311 to learn more in NYC.) Important elections for statewide office and Congress are on the ballot for this year's election. The offices of Governor, Attorney General, State Legislator, and U.S. Senator are all up for election. Your vote can make a difference!

Find out when and how to register to vote: www.elections.ny.gov or call 311.
Amida Care in the News

In New York State, new  HIV infection rates are at a record low, but more needs to be done to reach the goal of Ending the HIV/AIDS Epidemic by the year 2020. POZ Magazine published Amida Care's op-ed, "  Advocates Call for Increased Investment to End the AIDS Epidemic. "  

Crain's Health Pulse also featured an interview with Amida Care President and CEO Doug Wirth on the importance of investing in housing and peer employment in the FY19 state budget. 

Amida Care's op-ed on the federal tax bill, " Trump's Tax Reform Will Make America Poorer and Sicker,"  was published in Newsweek under Doug Wirth's byline: "[This bill] will worsen an already troubling level of inequality in the United States, increase health insurance costs, lead to millions of Americans losing their health coverage, increase debt, push more people into poverty, and, in the end, create a far greater tax burden on the nation."  

In New York Nonprofit Media's latest Insights Podcast, " Succeeding in an Evolving Health Care Sector," Doug Wirth discusses our unique not-for-profit health plan and model of care that helps our members "get about the business of living."

Amida Care's op-ed, "  Why the CDC Must Speak Freely," written in response to the Trump
Administration's ban on using certain words in CDC budget documents for Congress, was published in the  HuffPost under Doug Wirth's byline: "Words have power. They are powerful tools that can be used to divide or to unite, to hurt or to heal, to oppress or to liberate. They can be deceitful and manipulative or they can be illuminating and life-affirming--and they can make a difference."  
Amida Care published a special community publication, "  Hire Me! End AIDS with Jobs" produced in partnership with Alliance for Positive Change, Alpha Workshops Studio School, Cicatelli Associates Inc., Exponents, The Fortune Society, GMHC, Housing Works, The LGBT Center, National Working Positive Coalition, NYS AIDS Institute, NYS Education Department, and Translatina Network. The magazine highlights employment as one of the most important social determinants of health and key to reaching New York State's goal to End the AIDS Epidemic by the year 2020.