1. North Dakota CARES/ Ryan White Part B Program Krissie Guerard TB/HIV/RW Program Manager North Dakota Department of Health May 14, 2009

2. 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.

3. 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.

4. 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

5. 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

6. Case Manager Locations

7. ND CARES/ Ryan White Part B Program “Payer of last resort” Eligibility criteria Case management State direct services

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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.

14. 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

15. Sex

16. Race

17. Income

18. Risk

19. ND CARES/ Ryan White Part B Program Funding

20. North Dakota CARES/ Ryan White Part B Program Questions????