North Dakota CARES/Ryan White Part B

Program

Krissie Guerard

TB/HIV/RW Program Manager

North Dakota Department of Health

May 14, 2009

Federal Legislation:The Ryan White Comprehensive

AIDS Resources Emergency (CARE) Act: addresses the unmet health needs of persons living with HIV disease (PLWH) by funding primary health care and support services that enhance access to and retention in care.

Federal Legislation:

Intent: to reduce the use of more costly inpatient care, increase access to care for underserved populations, and improve quality of life for those affected by HIV disease.

CARE Act Programs• Part A: emergency assistance to EMAs (Emerging

Metropolitan Areas) and TGAs (Transitional Grant Areas) that are most severely affected by the HIV/AIDS epidemic

• Part B: grants to state and territories that focuses on improving access to primary care and support services

• Part C: provides early intervention services by funding comprehensive primary health care in an outpatient setting for people living with HIV disease

CARE Act Programs

• Part D: coordinates services and access to research for children, youth and women with HIV/AIDS

• Part F: SPNS projects, AETCs, dental programs and minority AIDS initiative

Case Manager Locations

ND CARES/Ryan White Part B

Program

• “Payer of last resort”

• Eligibility criteria

• Case management

• State direct services

ND CARES/Ryan White Part B

Program•Eligibility Criteria:

– Proof of HIV status

– Resident of North Dakota • Must produce a state issued ID within 60

days of enrollment– Verification of income: up to 400% FPL– Receipt of other services (Medicare,

Medicaid, PI), or lack thereof

ND CARES/Ryan White Part B

Program• Case Management Services

– Client centered activities, including:• Initial comprehensive assessment of

needs/personal support systems

• Development of individualized service plan

• Coordination of services required to implement plan

• Client monitoring to assess efficacy

• Periodic re-evaluation/revision

• Client-specific advocacy/review of utilization of services

ND CARES/Ryan White Part B

Program• State Direct Services

– Outpatient services specific to preventive care for treatment of HIV/AIDS

• Outpatient medical services: MD visits, lab/diagnostics– 80% paid

• Oral health care – Up to $500 annually

• Mental health services– 80% paid

• Optometric/Ophthalmic services– Up to $200 biannually for glasses

• Substance abuse treatment services– 80% paid

ND CARES/Ryan White Part B

Program• State Direct Services

– Supportive Services• Transportation to medical appointments or

support groups (gas cards reimburse for cost of travel)

• Nutritional supplements (ordered by MD)

• Other assistance: – Continuation of Health Insurance (DHS)

ND CARES/Ryan White Part B

Program• Emergency Assistance

– Must be related to situations that may arise due to client’s HIV status and necessary to maintain access to care

– Funds available for limited amounts, limited uses, and limited time period

• Rent, rental deposit, utility bills

– Case by case assessment

ND CARES/Ryan White Part B

Program

• AIDS Drug Assistance Program– Medications must be

listed on ND CARES’ Reimbursable Medications List.

– ND CARES pays 100 percent, or co-pay if privately insured.

ND CARES 2008 Clients

• 77% Male• 68% Aged 25-45 years• 56% HIV • 80% White• 74% < 200% FPL ($ or less)• 93% Enrolled in ADAP• 40% Heterosexual

Sex

23%

77%

23% Women

77% Men

Race

80%

15%

5%

White

Black

Native

Income

52%

22%

7%

19%

Less than 100% FPL

200% FPL

300% FPL

400% FPL

Risk

0

5

10

15

20

25

30

35

Hetero MSM IDU MSM/IDU Perinatal Unknow n

40% 37% 10% 8% 3% 19%

ND CARES/Ryan White Part B Program Funding

2006

$320,858

2007

$343,556

2008

$343,526

2009

$350,440

0

50000

100000

150000

200000

250000

300000

350000

400000

Do lla r

A m o u n t

North Dakota CARES/Ryan White Part B

Program

Questions????