ADAP & Minorities Kentucky’s Perspective Merinda Brown . Kentucky Health Insurance Continuation Program Administrator . Merinda.Brown@ky.gov . Mahri Bahati . Kentucky ADAP Coordinator . Mahri.Bahati@ky.gov . 800-420-7431 .
2009 Program Setup • Hybrid State • Kentucky Clinic Pharmacy Contract • $8,075,275.00 Grant Award • $3,532,873 (Base) • $4,330,107 (ADAP) • $212,295 (EC) • $232,000 Supplemental Grant • $0 State Funds • $250,000 funds were taken 2007-2009 • 1395 Active Clients 55 Newly enrolled clients per month Increase from 35 clients per month in 2007: 51.5% increment
Ryan White Part B Services KADAP clients have to be enrolled inthe Kentucky HIV/AIDS Care Coordinator Program (KHCCP) funded primarily through the Ryan White HIV/AIDS Treatment Modernization Act of 2006, otherwise known as the Ryan White Program (RW Program) or Part B Program. KHCCP acts as an umbrella for other RW Part B services that include the Kentucky AIDS Drug Assistance Program (KADAP) and the Kentucky Health Insurance Continuation Program (KHICP).
Ryan White Part B Services KHCCP provides Care Coordination for PLWH/A in six regions throughout Kentucky * Ft. Mitchell Northern Kentucky District Health Department * * Louisville Volunteers of America * Lexington Bluegrass Care Clinic * Henderson Matthew 25 Elizabethtown Matthew 25 * * * London Cumberland Valley District Health Department Paducah Heartland Cares Bowling Green Matthew 25 These locations were chosen to provide for statewide coverage and provide clients with local access to needed services. The intent of KHCCP is to facilitate the provision of quality care and services to PLWH/A in a timely manner that is consistent across a continuum of care. The optimal goal is to provide PLWH/A the tools to become self-sufficient.
KADAPEligibility Requirements • HIV positive - Western Blot test result; - Signed/dated statement from a medical provider or Counseling and Testing counselor verifying HIV status; - A discharge summary or other diagnostic hospital record; - Medicaid or Social Security diagnosis documentation. • Enrolled in the Kentucky HIV/AIDS Care Coordinator Program • Resident of Kentucky (provide at least one proof): - Copy of current signed lease or; - Current utility bill or; - Current valid driver’s license or official state ID with address • Proof of income 300% or below FPL (provide at least one) -2008 W-2 or 1099, -Two recent paycheck stubs; -Social Security statement; -Food stamp award letter -Please provide proof of income for all amounts listed.
KADAPEligibility Requirements • Statement of No Income (If applicable) • (If you have no income, you MUST include a signed statement that you have no income and explain how you are meeting your needs of daily living). • Proof of insurance or Medicare Part D Plan (If applicable) • (If you have insurance, you MUST submit a copy, FRONT AND BACK, of your insurance card) • Proof of application to Social Security Disability (If applicable) • (Persons with income less than $695 per month with a CD4+ count <200 and/or an AIDS defined Opportunistic Infection, MUST apply for Social Security Disability and include a copy of the letter of application/denial.) • Assets less than $10,000
Application Process • Applications are processed centrally by the grantee office in Frankfort, KY • Approval faxed to Kentucky Clinic Pharmacy. Valid for one year. (Notification is sent to pharmacy if a client is decertified within the year.) • Written notification mailed to client and care coordinator. • Recertification annually with KHCCP, and six months from clients birth month for KADAP/KHICP. • Online application system is in test phase: will expedite the process, cut down on administrative responsibilities, and expedite access to medications.
Waiting List • Previous list, 2000–2006: eliminated due to Part D savings, increase in 2006 state funding from $180K to $250K, rebate funds, and savings from new pharmacy contract • Current List Implemented: June 1, 2009 • First come, first served basis • Clients obtain meds using PAP’s • Co-pay assistance through Part B funds via the Kentucky HIV/AIDS Care Coordinator Program • Six to 12 month waiting period • 16 clients currently on the waiting list • 1 African American Male, 2 African American Females • Implementing cost saving & program efficiency measures
HIV Cases by KHCCP Region, 2005-2008, as of 12/31/08 # 1% 2% # 1% 2% # 1% 2% # 1% 2% # 1% 2% # 1% 2% # 1%
Living AIDS Cases by KHCCP Region, as of 12/31/08 # 1% 2% # 1% 2% # 1% 2% # 1% 2% # 1% 2% # 1% 2% # 1%
ADAP Racial and Ethnic Demographics • 28% Black or African American • 6% Hispanic • Heartland CARES (Barren River Region, Paducah, KY) • 0 Hispanics • 19 (1.3%) Blacks or African Americans • 5 Females • 14 Males
ADAP Racial and Ethnic Demographics VOA (Louisville Region, Louisville, KY) • 20 (1.4%) Hispanics • 2 Females • 18 Males • 253 (18%) Blacks or African Americans • 76 Females • 178 Males • 1 Transgender
ADAP Racial and Ethnic Demographics Bluegrass Care Clinic (Lexington Region, Central and Eastern KY) • 42 (3%) Hispanics • 18 Females • 24 Males • 76 (5.4%) Blacks or African Americans • 23 Females • 53 Males
ADAP Racial and Ethnic Demographics Cumberland Valley (Eastern Region, London, KY) • 2 (.14%) Hispanics • 1 Female • 1 Male • 1 (.07%) Black or African American • 1 Female
ADAP Racial and Ethnic Demographics Matthew 25 (Purchase Region, Henderson, KY) • 7 (.50%) Hispanics • 3 Females • 4 Males • 21 (1.5%) Blacks or African Americans • 4 Females • 17 Males
ADAP Racial and Ethnic Demographics Northern Kentucky (Northern Region, Ft. Mitchell, KY) • 7 (.50%) Hispanics • 7 Males • 15 (1.07%) Blacks or African Americans • 4 Females • 11 Males
African Americans & Hispanics not enrolled in ADAP by KHCCP Region Lexington Region, Central & Eastern, KY • Not on Meds • 12 African American Males • 3 Hispanic Males • Private Insurance • 12 African American Males • 2 Hispanic Males • Medicaid • 32 African American Males
African Americans & Hispanics not enrolled in ADAP by KHCCP Region Northern Region, Ft. Mitchell, KY • Not on Meds • 3 African American Males • 1 African American Female • Private Insurance • 3 African American Males • 2 Hispanic Males • Medicaid • 4 African American Males • 2 African American Females
African Americans & Hispanics not enrolled in ADAP by KHCCP Region Louisville Region, Louisville, KY • Not on Meds • 24 African Males, 9 Females • 3 Hispanic Males, 1 Female • Private Insurance • 12 African American Males, 2 Females • 2 Hispanic Males • Medicaid • 16 African American Males, 14 Females • 3 Hispanic Males, 1 Female
2007 NASTAD Needs Assessment: African Americans • Three KDPH/NASTAD/OMH focus groups (Louisville, Ft. Mitchell, and Paducah) to gather information on the challenges faced by African Americans regarding access to HIV prevention and care services. • 19 participants: • 8 females • 10 males • 1 transgender • 18 African American • 1 Multiracial
Consumer Findings (2007 NASTAD Needs Assessment: African Americans) • KADAP Related findings: - Link newly diagnosed individuals to care and services • Safeguard confidentiality to prevent barriers to care • Provide support groups for post diagnosed individuals • Include more medical and social services in one location i.e. “one-stop-shops”.
KADAP Related "Positive Findings" - Clinic staff addressed most care needs and pharmacists were instrumental in client care, medication and treatment adherence. - The pharmacists work closely with other care providers - There are Black HIV positive advocates who reach out to empower others - Care coordinators assist clients with access to ADAP, transportation and other services
KADAP Related "Negative Findings" - The pharmacy works slowly sometimes - Clients frustrated by long waits for processing of Supplemental Security Income (SSI) related paperwork - Poor program access by HIV+ homeless populations and exiting inmates - Lack of diverse representation in the health department staff as well as care coordinators and case managers;specifically representation of men who have sex with men (MSM), individuals who identify as transgender, and Black staff members - Staff lack cultural competency and skills to assist clients e.g. illiterate clients
2007 Assessment of Unmet Need: Those Not in Care 4,146 living with HIV/AIDS, only 2,835 in care* Characteristics of 1,311 PLWH/A not in care… * Kentucky data, 2007
2008 Kentucky Statewide Coordinated Statement of Need • Process completed by several workgroups of members • with specific subject matter expertise and experience, • including: PLWHA and a wide range of stakeholders from the • continuum of care provider community. • Identified barriers and service gaps: • Access and adherence to Medications • KADAP resources not keeping up with service demand • Late diagnosis of minorities poses a barrier to medication and treatment efficacy • Limited resources for non-HIV and psychotropic medications • Medication access for incarcerated and discharged inmates • - Rural pharmacies do not carry HIV drugs • Limitations in cultural competency of service providers • Client lack of skills needed to effectively navigate organized health systems and adhere to treatment
2009 Comprehensive Plan The Comprehensive Plan is a roadmap to guide Kentucky’s Part B program with performance measures, goals, objectives and effective strategies to address the barriers to care needs and gaps in services that were identified through KADAP client surveys, the previously listed and other need assessments.
2009 Comprehensive PlanGOALS • Develop and implement a revised program policy and an educational tool to address medication adherence needs and health literacy of clients. • Develop and Implement an Orientation Training Program for new case managers that includes education on medication/treatment adherence, cultural competency, substance abuse and mental health issues. • Develop and implement a Discharge Planning Pilot Program at LaGrange State Correctional Facility, which houses the larges number of HIV+ inmates in Kentucky. • Provide cultural competency training for service providers and enhance links and services to African American communities. • Assess the HIV Unmet Needs of regions with the largest and/or fastest growing population of Hispanics and build the capacity of indigenous organizations to provide HIV education, testing, linkage to care and treatment services. • Assess the HIV Unmet Needs of regions with the highest prevalence of substance abuse, mental health issues and build the capacity of service providers in each area to provide HIV education, testing, linkage to care & treatment services. • Increase efforts to partner with African American churches and indigenous organizations to provide education, testing and linkage to care.
Thank You Merinda Brown . Kentucky Health Insurance Continuation Program Administrator . Merinda.Brown@ky.gov . Mahri Bahati . Kentucky ADAP Coordinator . Mahri.Bahati@ky.gov . 800-420-7431 .