1. Policy Update Michael Ruppal Executive Director, The AIDS Institute
Director, Center for Public Policy Research and Ethics at USF Health Division of Infectious Disease & International Medicine

2. Policy Update National HIV/AIDS Strategy Budget and Appropriations
Ryan White Program
HIV Prevention
Health Reform
Hepatitis

3. National HIV/AIDS Strategy
Sets out Goals, Strategies and Activities to:
Reduce New Infections
Increase Access to Care & Viral Suppression
Decrease Disparities
Increase Government Coordination
Timeline for Activities, Periodic Status Reports
Future Steps Decided by Next President
Community Advocacy to “End AIDS”

4. Budget & Appropriations
FY17
Federal budget is operating under a Continuing Resolution (CR) thru 12/9/16
House and Senate Committees Passed Different Bills
Each contains different increases and decreases
Difficult to reconcile
Both Maintain HIV and Hepatitis Funding for:
CDC HIV Prevention ($789 m)
CDC Hepatitis Prevention ($34 m)
HUD HOPWA ($335 m)
Both Increase Overall NIH Funding
Senate: $2 b House: $1.25 b

5. Budget & Appropriations – FY17
Ryan White HIV/AIDS Program
House Flat Funds ($2.3 b)
Senate Proposed Cuts
Part C ($4 m)
Special Programs of National Significance ($25m)
Secretary’s Minority AIDS Initiative
House Flat Funds ($54m)
Senate Proposed Cut ($6 m)
Other House Cuts
Teen Pregnancy Prevention Program & Title X
ACA

6. Budget & Appropriations – FY18
Expect Difficult Budget Environment
New President and New Congress
Budget Control Act (Caps Discretionary Spending)
Sequestration Kicks in w/o Congressional Changes
Other budgetary demands
Competing health issues (Zika, opioids)
& other diseases
Non-health related

7. Ryan White Program
Authorization expired, but continuing through Appropriations
Program evolving as clients gain health coverage (Medicaid & Marketplace Exchange Plans)
Varies by state, Medicaid expansion key
Ryan White is the payer of last resort
Most funding based on Formula (case counts)
Supplemental Funding and Direct CBO funding (Parts C & D)
The AIDS Institute Analysis
Parts A & B: Florida Ranks #15 by $/case count
Add in C & D: Florida Rank moves to #34
Some flexibility to distribute money based on need with Supplemental Funding
340B Income creating difficulty in states spending money

8. Ryan White Program Unknown when Reauthorization will occur
No community consensus on changes
Desire to assist the South
Interest by Congress unknown
Next Administration?
Issuers for Consideration
Part Structure
Formula and non-formula distribution
Funding more need based
Coverage of PrEP
Hepatitis C

9. HIV Prevention
Focus on right populations, right areas with the right tools
Gay men, youth, African-Americans and Latinos etc.
New tools
PrEP
Federal funding for Syringe Services
Billing for HIV testing
Focus on testing, linkage to care and remain on treatment
Treatment is Prevention
Accountability of grantees

10. Health Reform Ensuring it works for people with HIV, hepatitis and
other chronic conditions
Concern over Patient Cost-sharing, Drug Formularies, Utilization Management, Network Adequacy
Florida Discrimination Complaint
Enforcement of Patient Protections
2017 Plans to be made public soon & Open Enrollment
Debate over ACA Future
Improvements or repeal
Drug Pricing

11. Hepatitis
Opportunities to End Hepatitis B & C as a public health threat
WHO Goals
National Academies of Sciences Reports
Federal HHS Action Plan
Update to be released in October
Very Small CDC Budget for entire country
Hep C Cure Rx
Medicaid restrictions (Florida Lifted Most)