A flood of HIV patients is overwhelming the state assistance program of last resort, the HIV Drug Assistance Program (HDAP), prompting public health officials to seek an emergency infusion of cash to avert rationing medications.

Enrollment in HDAP has soared by more than 70 percent in the past year, with spending growing from about $1 million a month to more than $1.4 million as of March. If the increases continue at the same pace, public health authorities warned recently, the drug plan will face a $6.6 million deficit for the budget year that starts July 1.

Reductions in the state's Medicaid benefits are probably one reason for the unprecedented surge in demand, state health authorities and AIDS specialists said. Last year the Legislature tightened income rules for HIV patients to qualify for medical coverage under the MassHealth plan and, as a result, patients have been shifting off that program and onto HDAP.

The drug plan is designed to provide coverage to patients who don't have insurance or whose health care policies do not provide enough coverage. While states run the program, most of the money historically has come from the federal government. Massachusetts is receiving $15 million this year.

Controlling a deficit without additional funding would require "gruesome options," said Dr. Calvin Cohen, research director for Community Research Initiative. Among the possible controls: establishing a waiting list, tightening restrictions on who is eligible for the plan, or limiting the drugs that are available.

-Adapted from the Boston Globe, By Stephen Smith, May 14, 2004

05/2004