The new state budget, signed into law on June 27th:

• Establishes an HIV pre-exposure prophylaxis (PrEP) financial assistance program, which will cover PrEP-related medical expenses for those with annual incomes below 500% of the federal poverty level;
• Allows the California Department of Public Health (CDPH) Office of AIDS’ Health Insurance Premium Payment (OA-HIPP) program to cover insurance premiums and medical out-of-pocket costs for all eligible people living with HIV in California, including those with employer-based coverage;
• Eliminates the cost-sharing requirement for AIDS Drug Assistance Program (ADAP) clients with annual incomes between 400 and 500% of the federal poverty level;
• Provides $100,000 for CDPH to purchase and distribute hepatitis B vaccine to local health jurisdictions to vaccinate high-risk adults;
• Allocates $600,000 for CDPH to purchase hepatitis C rapid test kits to distribute to community-based testing programs;
• Provides $500,000 to CDPH for the certification of non-medical personnel to perform rapid HIV and hepatitis C testing in community-based settings; and
• Supports $200,000 for technical assistance to local governments and increases in the number of syringe exchange and disposal programs throughout California as well as the number of jurisdictions in which syringe exchange and disposal programs are offered.

Details about these budget items can be found on page 32 of the Budget Summary.

Of note, lawmakers supported a new investment of nearly $1 billion for the Department of Health Care Services to provide curative hepatitis C medications to Medi-Cal beneficiaries living with the virus. We hope that these additional resources for hepatitis C treatment encourage the state to fully align the Medi-Cal hepatitis C treatment utilization policy with the professional guidance developed by the experts at the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (www.hcvguidelines.org) and the notice provided by the federal Centers for Medicare and Medicaid Services, noting that access restrictions based on disease severity violate federal law. Lifting the remaining disease severity restrictions in California would bring the state into compliance and ensure adequate access to these curative treatments for people living with hepatitis C.

In addition to the budget items outlined above, Project Inform welcomes the investments lawmakers made in the 2016-2017 budget to help curb the alarming epidemics of opioid overdose and sexually transmitted infections, both conditions that overlap with and relate to the HIV and viral hepatitis epidemics. Lawmakers identified $3 million for the provision of naloxone in community settings and $5 million to enhance the work of the CDPH STD Control Branch.

We are disappointed that the California HIV Alliance’s request for $4.8 million in State General Fund to increase provider reimbursement rates in the AIDS Medi-Cal Waiver Program, to be on par with rates for similar home- and community-based services waiver programs, was not included in the budget. This critical program supports people with physical and mental challenges due to HIV/AIDS, allowing them to remain in their homes and communities rather than be institutionalized. The AIDS Medi-Cal Waiver Program has been underfunded for years, even in comparison to other similar waiver programs. Many AIDS waiver providers have been forced to shut their doors at a time when more people are living with HIV and people with HIV are aging and facing health challenges. Project Inform and our partners in the California HIV Alliance will continue to advocate for fair reimbursement rates for this important program.

We are also disappointed that the Governor and the Legislature did not allocate funds for and include legislative language that would have created an interdepartmental state task force to develop collaborative and strategic action plans to address HIV, hepatitis, sexually transmitted infections, and the opioid epidemic with a focus on drug user health. These interrelated conditions require coordination and integration of public health, health care delivery, and corrections efforts in order to leverage resources and effectively address them. Currently in California there is inadequate collaboration and little strategic action across the necessary departments. However, we are pleased that the legislature supported the concept and included it in the budget conference with the Governor. The California Department of Health and Human Services has agreed to work with us to further coordination and strategic planning. We also look forward to working with the legislature toward this end.

Project Inform wishes to express special thanks to the Chair of the Senate Budget and the Conference Budget Committees, Senator Mark Leno, and his staff. Senator Leno has been a strong supporter of public health investments, particularly the HIV and viral hepatitis-related budget items, and we hope that a new legislative champion will emerge as Senator Leno is termed out at the end of this year.

Project Inform also wishes to extend gratitude to Assembly Member Mike Gipson (D-Carson) for authoring two important bills related to HIV and hepatitis C, which to date have received overwhelming support in the Assembly and are now being heard in the Senate. We are hopeful both bills will move through the Senate and be signed into law by Governor Brown. The bills are:

• AB 2640, co-sponsored by AIDS Project Los Angeles and the Los Angeles LGBT Center, which would ensure that HIV-negative individuals at high-risk for acquiring HIV receive information about all methods that reduce the risk of contracting HIV, including PrEP and post-exposure prophylaxis (PEP), during HIV post-test counseling.
• AB 2179, sponsored by Project Inform, which would allow non-medical personnel to administer rapid hepatitis C testing without having to first become certified HIV test counselors. To date, the bill has received unanimous support in the Assembly and in the Senate Business & Professions and Senate Health Committees.

Project Inform also applauds the Governor for signing SB 10, authored by Senator Ricardo Lara, which will allow undocumented Californians to purchase health insurance in Covered California. They will not be allowed to receive the federal subsidies that assist other low-income people. This will continue to make it difficult for many to access insurance. Nevertheless, this is an important step toward more universal health care coverage. Undocumented Californians with HIV have access to the OA-HIPP, an insurance assistance program that helps with health insurance premiums and out-of-pocket medical costs.