Conflict and Negotiation Project, Research Paper Example

Executive Summary

Florida is the second leading state with the most people infected with HIV/AIDS. The majority of these people infected with HIV do not have access to private insurance because they are unable to afford it. They do however; use alternative methods of obtaining health care and treatment through a variety of public services funded by the state or federal government. Although HIV treatment is widely available, it can be costly to the point where most people simply cannot afford it based on their regular income. There are issues of health care reform regarding HIV treatment for those in need of it. Such issues involve the state of Florida being able to offer everybody treatment for HIV/AIDS through certain programs catering to populations based on age, income, and infection status. The following analysis explores how HIV impacts the state of Florida and what measures are being approached to resolve these issues. Prevention measures and health care accessibility are addressed with analysis based on contemporary research conducted. Prevention measures and health care accessibility are addressed with analysis based on contemporary research conducted.  Florida offers a variety of sources for people living with HIV to receive health care and treatment. The level of accessibility is continuously being improved for those in need of it. While health care is generally expensive when being treated for HIV, the state of Florida has made it significantly more affordable. Relationships have been established with state and federal government entities, as well as with local programs to make this possible. In order to further assist in the prevention of HIV/AIDS, agencies in Florida have launched educational and community programs to inform the general population of the threat it poses. As Florida continues their efforts in the fight against HIV/AIDS, this research explores in detail how these efforts are being executed, the effects they have on the stakeholders, and how the current situation can continue to innovate.

Introduction

Medicaid is intended to provide free medical coverage for lower income citizens; however state underfunding in Florida has led to an underserved population in HIV care, treatment, and services. The issues which this report analyzes are focused on fluctuations in Medicaid funding in the state of Florida. Medicaid is a program which is collectively funded by both the federal government and states. Federal government allocates states funding based on a specified percentage of Medicaid program expenditures. This relationship of funding Medicaid from federal government and state is called the Federal Medical Assistance Percentage. Conflicts in the medical treatment of HIV patients in Florida are attributed to the funding levels of Medicaid which is the result of budgetary issues. Florida has yet to converge their state Medicaid program with Obamacare. Various organizations take part in major roles in being able to provide medical treatment for Florida residents infected with HIV and these organizations themselves are evaluated as they relate to the conflicts of concern. The primary organizations being evaluated are Medicaid, the Ryan White Foundation, Medicare, The Department of Veteran’s Affairs, Florida’s Agency for Healthcare Administration, Florida’s AIDS Healthcare Foundation, Florida’s Department of Health Bureau, Health Council of South Florida, and Florida’s Department of Health. Residents of Florida seeking HIV treatment look to these three organizations as primary sources of medical care. (Record, 2013)That is the role these organizations play and why they were selected.

As in many other parts of the world, HIV was an unexpected and sudden epidemic in Florida. Florida’s Bureau of HIV-AIDS discloses that near the end of 1980, ten cases of HIV cases were diagnosed in Florida alone. Then a few years later in 1984, a sky-rocketing 471 new cases of HIV were diagnose among Florida residents. Currently, about 10 percent of the total HIV cases in the US reside in Florida. This amounts to about 100,000 HIV cases in the state of Florida, which is about one in every 229 residents. The bureau also reports that there are about 4,000 new cases diagnosed each year. (Rosica, 2014)

The most important concern however is the disparities separating HIV patients who are insured from those who are not. Issues regarding access to health care are utmost tied directly to these discrepancies. A standard source of health care is a necessary approach towards effective HIV treatment which requires strong management of the disease along with a composite of drug administration procedures. Lacking a standard source of health care may lead to a setback in treatment, sporadic drug therapy, and possible increases in fatalities. Health care benefits of those insured for HIV treatment were significantly boosted when anti-retroviral therapy was introduced to patients. Although highly effective in treating HIV, this treatment option was more difficult to afford among patients. About 20 percent of HIV infected people in Florida do not have some type of health insurance, but the majority of those who are insured are covered by Medicaid among other programs such as Medicare or the Ryan White Program.  According to research, anywhere between 42 percent and 59 percent of people living with HIV in the US on average, do not have access to regular health care. Despite such high numbers of people infected with HIV not having access to health care treatments, Florida continues to emphasize that advancing treatment options is a top priority to maintain control of the epidemic. (Rosica, 2014)

Obtaining health insurance coverage for HIV patients is difficult due to the high costs it carries and the enervating essence of the disease. When the materialization of high-active antiretroviral therapy (HAART) hit the scene in 1996, the progression of HIV to AIDS was greatly reduced, resulting in significantly fewer fatalities. Fortunately these innovative medication methods are considered the common practice of treatment for HIV patients today. Because of HAART therapy, HIV does not carry the death sentence it once did. Rather, HIV is able to be treated as a chronic condition such as diabetes though it still maintains its viral properties and requires extensive management. While HAART may have revolutionized HIV treatment, it has a financial string attached to it costing anywhere from $10,000 to $12,000 per year for a single patient. This makes financing HIV treatment with access and insurance coverage to it a significant issue in policy. Because HIV treatment is also combined with other related medical treatments, the annual cost of full treatment for a single HIV patient can go as high as $20,000. This makes for motley financing of treatment. Such complexities in financing HIV treatment leads to patients receiving health care through multi-financing systems. (Dunkleberger, 2014)

Getting private insurance through employer-sponsored programs in general provides well access to treatment for HIV, but being able to qualify for and even maintaining it can becomes a challenge. However, the American with Disabilities Act (ADA) has upheld provisions that protect HIV patients in the work environment which assists them in maintaining employment while remaining insurance covered. Yet despite these ADA provisions, only about 31 percent of those infected with HIV in Florida are privately insured. This percentage contrasts with the nearly 73 percent of people with HIV in the US general population that are privately covered. This contrast may attribute to the fact that a number of HIV positive people in Florida don’t receive insurance through their employers, forfeit coverage by relocating jobs, inability to finance individual insurance, or are denied coverage by their current plan due to limited benefits or pre-conditioned clauses. (Trent, 2013)

In the state of Florida there is a strong network established consisting of local, state, and even federal programs that contribute treatment and support services to people with HIV. Although these governmental and nongovernmental services of health care for HIV positive people are invaluable, the lack of an integrated system still presents boundaries to appropriate and necessary care. Because many HIV patients are forced to gain health care by financing it through multiple sources of providers, gaps will often arise in their coverage. Medicaid and state funding step in when Floridians of low income cannot afford private insurance. Medicare steps in for elder Floridians over the age of 65 who seek HIV treatment. The Department of Veteran Affairs steps in for veterans seeking HIV treatment. Research was conducted by analyzing each of the organizations being evaluated in this report. The findings were that there are different organizations that cater to different populations in Florida seeking HIV care that vary based on income and age. (Rosica, 2014) (Record, 2013)

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, also known as the Ryan White Program, is a program specific to assisting in health care for those living with HIV. This federally funded health care program is a primary source in the US of financing coverage for HIV patients. Urban hospitals throughout the nation struggled to keep up with the outbreak of the HIV epidemic, so the CARE act was established to help assist in filling any gaps found in health care for patients. This significantly improved the access and quality of health care especially for lower income and underserved people infected with HIV. The majority of CARE Act patients come from lower socio-economic status and ethnic minorities, most of which are disadvantaged HIV patients. (Record, 2013)

The nearly 20 percent of HIV positive people who do not have access to insurance in the US receive health care through Ryan White CARE sponsored programs. However, the Ryan White program is not a public insurance program such as Medicaid. The HIV Bureau of the Health Resources and Services Administration funds grantees such as the Ryan White program to distribute health care treatment to nearly 500 thousand patients on an annual basis. Since it was first enacted in 1990, the Ryan White program was re-authorized three times and composes of five segments. This is certainly one solution in treating HIV patients and although it is not Medicaid and not state funded, it was a selected organization base on the role it plays specifically in the state of Florida in regards to providing treatment to HIV patients. (Record, 2013)

Florida is ranked number three in the nation in receiving the most funding from the Ryan White program, trailing New York and California. It is an estimated $210 million in annual funding from the Ryan White program that Florida receives for HIV positive residents. Of this amount, over half of it is contributed to Part B of the CARE Act. Part B provides coverage for the costs of ambulant health care, medications, intervention and support services, home based care, and to the AIDS Drug Assistance Program. About a third of the Ryan White Program resources in Florida contribute to funding Part A of the CARE Act. Part A helps to cover emergency assistances for those most affected from HIV/AIDS in the Eligible Metropolitan Areas (EMA). (Record, 2013)

One of the Ryan White program’s primary components is its AIDS Drug Assistance Program (ADAP). ADAP clients are provided with medication, HIV management coaching, and information assistance. In order to get qualified for ADAP benefits, services from other providers such as Medicaid or Medicare cannot be received concurrently because this results in a conflict of unnecessary excessive funding. Florida offers the ADAP Wrap Around Pilot Project which provides selected clients eligible for Medicare with assistance in financing their out of pocket Part D Medicare pharmaceuticals and deducted expenses. (Record, 2013)

Although the Ryan White CARE Act has significantly improved health care for HIV positive people in need of it, the Act is not intended to serve as a primary provider of coverage. Rather, the CARE Act was initially established with the intent of filling the gaps in health care. The program continues to be constrained as the HIV epidemic continues to spread as some states have enacted strategies for purposes of cost containment while other states have established waiting lists for treatments of HIV. The fact that the Ryan White program is being over utilized demonstrates the lack in access to standard HIV health care in Florida.

Nearly 25 percent of Florida residents infected with HIV are receiving treatment under Medicaid. The state of Florida does not consider testing positive for HIV a qualification for receiving Medicaid services. In addition to testing positive for HIV, Medicaid applicants must also fall under the lower income brackets or have disabilities resulting from AIDS. Qualified Medicaid applicants have access to a broad set of services such as coverage for prescription drugs that are on the Preferred Drug List. Research shows that the earlier HIV is treated, the better that chances are at maintaining quality of life. Despite this fact, applicants continued to experience delays in eligibility. As previously mentioned, Medicaid in Florida is both state and federally funded. (Trent, 2013)

Following the Legislature of 1997, the Agency for Health Care Administration (AHCA) enacted a Medicaid management system for disease to control with the intention of minimizing treatment costs and improving health for chronically ill patients. Then in 1999, the AIDS Healthcare Foundation (AHF) was given a contract by the AHCA to service in disease management for Medipass HIV patients. This contract enabled thousands of HIV positive Florida residents to receive care through the AHF’s Positive Healthcare program. Florida’s Office of Program Policy Analysis and Government Accountability (OPPAGA) indicated in 2004 that the AHF program had significantly cut costs and was able to cover the majority of the recipients eligible for treatment. In some counties however, the Florida Medicaid Reform operations of disease management programs are being turned over to contract health plans while Medipass is discontinuing. These organizations are all mentioned in the introduction as they regard Florida’s health care network on the state level. Their role in state funding is that Florida state tax dollars are funding them. (Trent, 2013) (Record, 2013)

The Medically Needy Program, administered by Medicaid in Florida, may provide eligibility for treatment to HIV positive Florida residents who fail to qualify with Medicaid. Based on household income, Florida residents in need of treatment can apply to Medicaid to cover any additional costs from the incurrence of monthly medical bills. So, this supplementary coverage is granted for qualified applicants on a monthly basis. Though for those infected with HIV or AIDS, keeping track of medicals bills may present a boundary standing in the way of access to the program. Again the organization that administers this program is Medicaid in Florida.

Florida has a waiver program called Project AIDS Care (PAC) which is federally authorized by legislation. PAC enables Florida state Medicaid agencies to service AIDS patients living in community housing as a humane and more cost-efficient method of providing appropriate treatment. PAC is a unique establishment of Florida State Medicaid that covers certain costs which are not covered under the standard Medicaid benefits. Such PAC services are often provided in the patient’s housing quarters and include social security. (Record, 2013)

Florida’s Department of Health Bureau of HIV/AIDS is a leader in public health and disease prevention. Also, the Bureau assists in certain components of HIV/AIDS health care and financing. The AIDS Insurance Continuation Program (AICP) is a Florida States program for symptomatically diagnosed people of HIV and AIDS. The AICP offers coverage for such patients who are unable to afford private insurance premiums. (Record, 2013)

Through federal and state tax dollars, Florida’s Department of Health is able to fund the AICP while they are managed by the non for profit agency known as the Health Council of South Florida. Administered via community based regional organizations, the AICP is intended to preserve Florida finances by maintaining coverage for HIV and AIDS patients while keeping these patients out of public programing. Florida’s Department of Health also provides confidential, anonymous testing as well as counseling to the general public from any of the country health department centers.

Medicare utilizes social security funds by providing health insurance for Americans over the age of 65 with permanent disabilities.  Nearly a quarter of federal funding is directed to Medicare patients being treated for HIV and AIDS. This is another primary source of insurance coverage for those living with HIV/AIDS and who qualifies for Social Security Disability Insurance (SSDI). However, because just about 3 percent of Americans with HIV are over the age of 65, very few applicants of Medicare qualify on an age basis. Medicare is effective in treating Floridians with HIV in the elder age bracket. The issue is that few applicants qualify for it due to the conflict of age requirement. (Record, 2013)

Another federal health care system used in Florida is the Department of Veteran’s Affairs or VA. Because it both pays for and provides treatment services for HIV patients, the VA has become the largest establishment in the US for HIV care. The federal program services nearly 20,000 HIV patients every year. The VA National HIV/AIDS Program offers to their patient veterans testing, treatments, and guidance counseling. This branch program of the VA is a solid source of information relating to disease and guides patients through the necessary steps of the health care process. Florida alone has 67 VA centers that provide health care and services to veterans of the population. (Dunkleberger, 2014) (Record, 2013)

The Center for Disease Control (CDC) reports that there are about 40 thousand new cases of HIV in the US each year. Not all communities are affected by HIV equally however. So, prevention can be more effective by integrating local programs in specific communities that suit their unique HIV conditions. Florida’s Department of Health has enhanced their commitment to assisting in prevention and treatment of HIV in minority populations by establishing a wide spectrum of programs in regards to this issue. (Record, 2013)

Investigative research into Florida’s approach to HIV prevention and treatment strategies was conducted by first analyzing how the state is affected by the disease. Seeing how state and federal resources are utilized for varying programs of care and treatment, it was necessary to conduct first research on Florida’s primary establishments regarding the topic. The findings addressed concerning conflicts around the HIV disease in a sequential format with each federal and state program catering to specific issues on the spectrum of HIV/AIDS treatment.

As far as Florida’s HIV prevention and treatment strategies are concerned, the groups of individuals most instrumental in getting the issues of HIV guided towards a resolution were all of the establishments analyzed; Medicaid, Medicare, The Ryan White Foundation, The Department of Veteran Affairs, Florida’s Agency for Health Care Administration, The AIDS Healthcare Foundation in Florida, Florida’s Project AIDS care, Florida’s Department of Health Bureau of HIV/AIDS, The Health Council of South Florida, and Florida’s Department of Health. That reason being that they were the primary contributors in providing health care and treatment to HIV/AIDS patients of lower income who could not afford it based on their income alone. The primary stakeholders of issues regarding care and treatment for HIV were of course those infected with the diseases in need of it. Then there are the secondary stakeholders which are the tax payers and finance donors who assist in funding these programs. Although not perfect as there are still about 20 percent of HIV infected residents in Florida still not receiving health care, the ongoing resolutions these programs have executed have strengthened relationships with stakeholders. In order to assist everybody living with HIV/AIDS, the momentum these treatment programs is accumulating must continue and this means continued federal and state funding. Relationships have been strengthened because coverage in Florida for those seeking HIV treatment is being maximized. Patients do have more confidence in the system as they are enrolling and participating in the programs mentioned. As far as how the tax payers feel about how their money is being spent, the feelings vary among individuals but the research presented shows that although tax dollars are not spent perfectly, they certainly are not being wasted. (Record, 2013) (Rosica, 2014)

Possible improvements to these health care processes should involve an educational factor. Many times people are infected with HIV because they are not educated on the issue. In order to enhance prevention of the disease, citizens of Florida need to be educated on what approaches to take. Information on sex such as wearing condoms and an emphasis on getting tested should be included in these educational factors. HIV along with other STD’s are transmitted in a number of ways from sex to drugs and future generations need this information integrated into their education. An educational program that teaches on HIV and STD prevention should be enacted and funded by the state of Florida and should become a required curriculum for county schools. There is an HIV prevention educational measure being taken in Florida, but it just needs more emphasis on it as there are still 4,000 new cases of HIV in the state every year. Florida currently has the Prevention Education Project which is an educational project that is intended to strengthen HIV prevention through school health education.

Another good measure is the campaign program that the Florida Department of Health has integrated to further educated HIV prevention. Florida’s Department of Health enacted a state-wide media campaign with the slogan “We Make the Change”. This campaign also involves mobilization of community meetings that inform and teach about HIV prevention. The campaign was initially enacted to stimulate networking between communities and organizations to offer peer-to-peer support and education. (Record, 2013)

These organizations evaluated and implemented alternatives to resolve issues regarding HIV prevention by spreading the message of how imperative methods and precautions of prevention are. This helps to resolves preventative issues while the health care establishments can focus more on treatment of patients. More of the spectrum of HIV issues and concerns is covered by these organizations and it must continue to expand to maximize prevention. (Record, 2013)

Conclusion

In conclusion, HIV/AIDS has definitely impacted the state of Florida in a negative way. However, based on the analysis of the state’s approaches as well as federal approaches, being a resident in Florida and living with HIV/AIDS has its benefits. The various programs are designed to aid specific cases of people who are HIV positive. All factors from income level, age, and socio-economic status are taken into consideration when being evaluated. Because most of the public programs discussed are funded by state or federal government, HIV treatment is reasonably accessible in the state of Florida. This is made possible due to the continuing improvements in Florida’s health care systems. For example, Medicaid, Medicare, The Ryan White Program, The Department of Veteran’s Affairs, as well as the other programs enacted in the state are able to offer a diverse array of treatments to people living with HIV/AIDS which reaches out to virtually every level of the health care accessibility spectrum. When employers do not cover the costs of HIV treatment and when private insurance cannot be afforded, the establishments evaluated in this analysis play their respective roles. Consider the realistic scenario where Medicaid reaches out to HIV positive people of low income and those who acquired disabilities from living with AIDS. Medicare covers the elderly brackets of HIV positive people over the age of 65 through social security. The Department of Veteran’s Affairs provides and insures treatment for US Military veterans and their families. The Ryan White Program—specific to people with HIV/AIDS— plays their role as a secondary source of HIV treatments by filling in any gaps between these establishments. Community involvement has also assisted in HIV prevention through their educational programs and campaigns. While health care in any state is not perfect, the state of Florida has demonstrated their efforts to make health care accessible to anybody with HIV. More work needs to be done to reach out to the remaining underserved population but based on this analysis it would appear that Florida is in forward motion with their resolutions.

References

Dunkleberger, L. (2014, August 15). Florida leads nation in turning down Medicaid money. Retrieved April 6, 2015, from HP Politics: http://politics.heraldtribune.com/2014/08/15/florida-leads-nation-turning-medicaid-money/

Record, K. (2013, January). State Health Reform Impact Modeling Project. Retrieved April 6, 2015, from HIV Health Reform: http://www.hivhealthreform.org/wp-content/uploads/2013/03/Florida-Modeling-Report-Final.pdf

Rosica, J. (2014, January 25). Florida lawmaker tries again for federal funds for Medicaid expansion. Retrieved April 6, 2015, from Tampa Tribune: http://tbo.com/news/politics/florida-lawmaker-tries-again-for-federal-funds-for-medicaid-20140125/

Trent, F. (2013, December 2). Medicaid in Florida: Take the $50 billion. Retrieved April 6, 2015, from Florida Trent: http://www.floridatrend.com/article/16517/medicaid–take-the-money