A January 2011 federal report provided to The Florida Independent on the condition of anonymity alleges that federal audits and site visits show that Florida’s Bureau of HIV/AIDS failed to use “available resources in the best interest of people living with HIV and AIDS” while administering its AIDS Drug Assistance Program, which provides HIV/AIDS medications to low-income citizens.

The state’s Bureau of HIV/AIDS manages the AIDS Drug Assistance Program — funded by both the state and federal government — to ensure that uninsured, under-insured, or low-income HIV/AIDS patients receive needed medicine and treatment. Florida’s AIDS Drug Assistance Program has been in the midst of a funding crisis since last year, which has resulted in a patient waiting list that is the longest in the nation.

The federal government’s Ryan White HIV/AIDS Program provides HIV-related services in the United States for those who do not have sufficient health care coverage or financial resources for coping with HIV disease. Money for AIDS Drug Assistance Programs goes to all states and territories through the Ryan White program.

The January report (which you can read in full below) was written by the U.S. Department of Health and Human Services’ Health Resources and Services Administration and alleges that administrative, service, and fiscal concerns raised in prior audits and visits remain unresolved and unanswered.

According to the report, in April 2010, Drug Assistance Program management identified and announced a budget deficit of federal and state funds adding up to approximately $25-$32 million. The source of the deficit was attributed to general economic trends but was not detailed in committee minutes or Bureau of HIV/AIDS reports.

The Independent reported earlier this year that, according to the health department, demand for the Drug Assistance Program, fueled by Florida’s struggling economy, has been growing, and that funding has not kept pace. A department spokeswoman said more people are unemployed, and therefore uninsured or underinsured — meaning more patients seeking assistance

The federal report indicates that “an analysis of financial data provided by the Florida Department of Health, Bureaus of HIV/AIDS and the Bureau of Statewide Pharmacy Services indicates that as early as the first quarter of 2009-2010 the deficit was apparent through the analysis of quarterly spending patterns, new enrollments, re-certifications, and total quarterly enrollment.”

However, according to the report, “management failed to analyze the emerging trends and used misleading assumptions in developing cost estimates and deficit projections.”

According to the report:

Florida program management did not provide sufficient due diligence using available data and program experience to trend and project future medication needs and expenditures. In addition management failed to adhere to principles of sound fiscal stewardship by neglecting to initiate and implement cost containment strategies and revenue enhancements before a crisis ensued.

This report summarizes “the multiple missed opportunities and failure of the Florida Ryan White program management to assume a proactive approach to the looming ADAP crisis,” a crisis that “data shows clearly existed for much longer that the current fiscal year.”

According to the report, Florida Drug Assistance Program management “should have recognized the deficit earlier by trending existing data. Cost containment strategies could have been implemented before the end of the grant year 2009-2010 if the program had used the data on the number of patients in ADAP and new patients coming into the system to trend the number of medications per client and the cost per client.”

The report provides data on the estimated savings or loss of revenue that the program management “missed out by not recognizing the deficit and quickly implementing cost-containment measures that had been recommended to the program since early 2010 by the Formulary committee, HIV-AIDS Bureau consultants, and other technical assistance provided by ADAP organizations.”

The report highlights that Florida’s state-run program has “multiple advisory boards yet there is little evidence to support that adequate data report needed to make informed decisions and recommendations have been provided by the planning bodies. The program management’s inability to take quick action to address trend data, program growth, and future expenditures, has caused the current Florida ADAP deficit.”

Other concerns and recommendations highlighted by this report include:

• The Bureau of HIV/AIDS has used AIDS Drug Assistance Program money to pay the salaries of officials with little or no role in administering the program. The report cites the example of program coordinators and one “Senior Health Program Specialist” whose salary is paid through the Ryan White program despite having a “primary duty” with no relation to Ryan White.
• The Bureau of HIV/AIDS was awarded $3.05 million to take 357 clients off the waiting list, but these funds do not show up in financial reports provided by the bureau. The report recommends that the bureau provide documented expenses for the use of those funds, with a list of the 357 clients taken off the waiting list.
• The program developed an ineffective cost-containment strategy. The report lists at least five cost-containment strategies that need to be implemented to continue to reduce the number of patients on the waiting list.
• The Florida Department of Health’s inability to manage the Ryan White grant has resulted in the current deficit, which jeopardizes access to HIV services and medications. The report calls on the department to ensure that Ryan White funds provide access to comprehensive high-quality community-based care for low-income individuals and families living with HIV.
• Despite reports of quarterly meetings between state HIV/AIDS officials and local patient care staff, there is no documented proof of communication, collaboration, and coordination.

Read the report in full:

HRSA Final Report