Group Title: Health coverage update
Title: Access to HIV/AIDS services in Florida
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 Material Information
Title: Access to HIV/AIDS services in Florida
Series Title: Health coverage update
Physical Description: Serial
Language: English
Creator: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
Publisher: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: July 2008
 Record Information
Bibliographic ID: UF00091098
Volume ID: VID00003
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.


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Florida Center for Medicaid & the Uninsured



I Ind te


HIV/AIDS is the leading cause
of death for adults (ages 15-59)
Approximately half of Americans
currently infected with HIV are not
in care or receiving treatment.
The majority of insured HIV/AIDS
patients are covered through
The annual cost for one HIV-
positive American can be as high
as $20,000.
Florida has the second highest
number of persons infected with
HIV in the nation.
Unlike some states, HIV-positive
Floridians do not qualify for
Medicaid on the basis of testing

Access to HIV/AIDS Services in Florida

2007 marks the 25th year of the AIDS epidemic

The HIV/AIDS pandemic is a global concern. The disease is now the leading
cause of death for adults (age 15-59) worldwide. First documented in the 1980's in
isolated populations, HIV/AIDS has grown to become a disease which adversely
affects the poor, both globally and domestically. Furthermore, the cost of care for
HIV/AIDS has risen significantly over time. This issue brief seeks to explore the
current status of health services for HIV-positive Floridians, and also touches briefly
on coverage for HIV prevention services. The intention of this brief is to inform
policy makers, providers, and health care advocates in their efforts to support
quality health care and healthy populations in our state.

Historical and Epidemiological Context
Human immunodeficiency virus (HIV) is most often transmitted through sexual
intercourse or sharing of injection drug needles; occasionally the infection is
transmitted during birth from mother to infant, but new treatments have reduced
this type of transmission to a relative handful of cases each year. Once infected
with HIV, persons are initially asymptomatic for many years. Such persons are
not considered to have AIDS. Over time, however, the virus' relentless attack
on specific components of the immune system results in a decrease in the body's
ability to fight off infections. AIDS is defined when the immune system becomes
sufficiently impaired, or when persons begin to get sick with AIDS-related

The first cases of HIV/AIDS were diagnosed twenty-five years ago. Overall
incidence of HIV has fallen since a peak in the 1980's, however incidence is rising
within certain subpopulations, including some racial and ethnic minorities, women,
men who have sex with men, and youth.1 The introduction of effective HIV/AIDS
treatments in the 1990s has reduced morbidity and mortality and as a consequence
life expectancy has increased. However, roughly half of Americans currently
infected with HIV are not in care or receiving these treatments.2 Managing the
treatment of HIV is further complicated by comorbid conditions, substance abuse,


and lack of compliance resulting in
drug-resistance. Additionally, although
the US relies on advanced surveillance
and data collection to track the spread
of HIV/AIDS, one quarter of all people
currently living with the disease do not
know their health status, highlighting the
need for increased testing and preventive
services. 4

HIV/AIDS Trends in Florida

The emergence of AIDS in Florida was
sudden. According to Florida's Bureau
of HIV/AIDS, at the end of 1980 there
were 10 diagnosed cases of HIV/AIDS
in Florida, resulting in 10 deaths and
by 1984 there were 471 cases and 434
deaths. Today, approximately 10% of U.S.
HIV positive persons (100,000 people)
live in Florida, one in 229 Floridians is
HIV positive, and
4,000 new cases
are diagnosed each
year.5 Reported AIDs C

Health Disparities
The National
Institutes of
Health define
health disparities
as "differences
in the incidence,
mortality, and
burden of diseases
and other adverse
health conditions
that exist among
specific population
groups in the United

Blacks and Whites. In fact, Blacks
account for over half of all HIV deaths
in the United States, and alarmingly
have lower survival rates upon diagnosis,
indicating a lack of appropriate health

Gender and Age: Although three-
quarters of HIV positive Floridians are
male and over half of these cases result
from male-to-male sexual contact7, the
prevalence of HIV/AIDS has slowly and
steadily risen among females, who now
account for almost one-third of all cases
in the US. In Florida, the percentage
of female AIDS cases rose ten percent
in ten years, reaching 31% by 2005.
Sixty-six percent of female HIV cases in
Florida are among blacks. The primary
mode of transmission to women is
heterosexual contact.8

cases in Florida,

by Race/Ethnicity, 2005

"_ ;- "
16% *

Blck 49%

Source: Centers for Disease Conhol and Pievenhon, Divsion of HIV
Epidemiology, Speial Data Request, Novembei 2006.

Race and Ethnicity: Since the beginning
of the HIV/AIDS epidemic, racial
and ethnic minorities have borne a
disproportionate share of the disease
burden. Nationally, Blacks and Latinos
make up the majority of new diagnoses
and existing cases. Of all racial
disparities, the sharpest is between

Legal Status
and Geography:
HIV rates among
populations is a
continuing challenge.
However, population
mobility increases
the risk for HIV/
AIDS and with
Florida's high rate
of immigration,
focusing on this
high-risk and hard

to reach group
/AIDS Prevention Suivellance and of Floridians will
increasingly become
more important.9
Disparities also
exist geographically
between rural and non-rural counties.
It is presumed that some rural/
urban disparities stem from average
socioeconomic status of residents,
education level, and/or lack of access to
health care. More research into causes
of inequality is needed, especially in
relation to rural women and HIV.10


Health Insurance and the Uninsured: Of
all the trends so far discussed, disparities
between insured and uninsured HIV/
AIDS patients are the most directly tied to
health care access issues. A regular source
of care is essential to appropriate HIV/
AIDS treatment, which calls for disease
management and complex drug regimens.
Correlations between insurance status and
HIV/AIDS point to a lack of access to care
for those without appropriate insurance
coverage, whether public or private. The
lack of a regular source of health care can
lead to delayed treatment, irregular drug
therapy, and even increased mortality.11
The benefits of being insured for HIV-
positive persons were greatly increased
with the introduction of antiretroviral
therapy, an effective but difficult-to-
afford treatment option. In fact, health
insurance has lowered the probability
of six-month mortality by about three-
fourths.12 Although the majority of insured
HIV/AIDS patients are covered through
Medicaid or other programs13, roughly 20%
of HIV-positive people are uninsured.

HIV/AIDS Care: Access and Financing

Research has shown that 42% to 59% of
people living with HIV/AIDS in the US
are not receiving regular care.14 Ensuring
access to appropriate care and emphasizing
prevention must remain a top priority for
the state of Florida in order to maintain
control over a growing epidemic.

Private Insurance, Public Programs, and
the Uninsured: How do HIV-Positive
Floridians Access Care?

Insurance coverage for HIV/AIDS
patients is complicated by the high cost
and utilization of care and the debilitating
nature of the disease. In 1996, new, highly-
active antiretroviral therapy (HAART)
began to decrease the progression of HIV
to AIDS and reduce deaths and AIDS-
related hospitalizations. These medication
combinations are now considered
standards of care. With HAART therapy,

HIV infection has become a chronic
condition, like diabetes and hypertension,
requiring extensive disease management.
Although HAART has dramatically
reduced mortality from HIV/AIDS, it
typically costs between $10,000 $12,000
per patient per year, making the financing
of HIV/AIDS care, including access and
insurance coverage, an important policy
issue. Combined with related medical
costs, the annual cost of care for one
HIV-positive American can be as high
as $20,000, making the financing of care
extremely complex. 15 As a result, many
HIV/AIDS patients receive care through a
patchwork of financing systems.

While employer-sponsored private
insurance generally guarantees good
access to HIV/AIDS care, qualifying for
and maintaining private insurance is often
challenging. Provisions of the Americans
with Disabilities Act (ADA) protect HIV/
AIDS patients from discrimination in the
workplace, and, thus, help them maintain
employment and insurance coverage.
However, despite these regulations, only
31% of people with HIV are privately
insured, in contrast to the general US
population, of which 73% are privately
insured.16 Some HIV-positive Floridians
do not receive insurance benefits through
the workplace, lose coverage by deciding
to reduce hours or find a new job,
cannot afford individual coverage, or are
simply denied coverage by a health plan
because of limited benefits or pre-existing
conditions clauses.

Without private coverage,
how do HIV-positive Floridians
access health care?

A large network of federal, state, and local
programs, both governmental and non-
governmental, provide health care and
support services to HIV/AIDS patients in
Florida. These services are invaluable, but
the lack of a cohesive system continues
to represent a barrier to appropriate care.


Many patients obtain care and financing
through multiple sources, a practice
which inevitably leads to gaps in care or
coverage. 17 Below, several of the largest
sources of financing and provision
of HIV/AIDS care for Floridians are
reviewed. Many patients receive care
through more than one of the following

HIV cases, by county of residence, Florida, 2005
(excluding Department of Corrections)


" ai J

Case Rate per 100,000
D 0.1 to 15.0
15.1 to 30.0
S> 30.0

Based on 2005 statewide population estimates, the 2005
state rate is 36.9 per 100,000 population.
*County totals exclude Department of Corrections cases
(N=322). This map does not reflect HIV incidence.
Numbers on counties are cases reported.

Soure: Flonda Depaorment of Health. Flonda Annual Report Epidemlologic Profile, 2005.

Ryan White and the AIDS Drug Assistance
Program (ADAP)
The Ryan White Comprehensive AIDS
Resources Emergency (CARE) Act
(Ryan White Program) is the United
States' largest federally funded program
financing HIV/AIDS care after Medicaid
and Medicare, and the only disease-
specific program of its kind. In 1990,
when it became apparent that many
urban hospitals were struggling to
keep up with the growing HIV/AIDS
epidemic, the CARE Act was enacted

to fill gaps in care and to improve the
quality and availability of care for low-
income, uninsured, and underinsured
individuals and families affected by HIV/
AIDS. CARE Act clients are typically
the most disadvantaged HIV patients,
coming from low socioeconomic status
and from racial and ethnic minorities.
In 2004, more than 59 percent of clients
served by the CARE Act were people of

Nationally, one in five (20%) HIV-
positive people is uninsured.19 Many of
these receive care through programs
sponsored by the Ryan White CARE
Act. Unlike Medicaid, Ryan White is
not a public insurance program. Instead,
the Health Resources and Services
Administration's HIV/AIDS Bureau
funds grantees nationwide, who, in turn,
deliver care to half a million people every
year. Ryan White has been reauthorized
three times since it was first passed, and
is composed of five Parts. The program
is named after Ryan White, a teenager
whose struggle with HIV/AIDS and
AIDS-related discrimination brought the
disease to public attention.

Florida ranks third in the nation, after
New York and California, in its total
Ryan White funding, estimated at over
$210 million per year. Over half of this
funding goes towards Part B of the Act,
which covers ambulatory health care,
home-based health care, insurance
coverage, medications, support services,
outreach to HIV-positive individuals who
know their HIV status, early intervention
services, and the AIDS Drug Assistance
Program One-third of Florida's Ryan
White resources fund Part A of the Act,
which provides emergency assistance
to Eligible Metropolitan Areas (EMAs)
most severely affected by the HIV/AIDS

The AIDS Drug Assistance Program
(ADAP) is a key component to the
Ryan White program. ADAP provides


its clients with medications, disease
management training, and information. To
qualify for ADAP assistance, the recipient
cannot receive these same services through
Medicaid, Medicare, or another insurance
program. In Florida, the ADAP Wrap-
Around Pilot Project provides select
Medicare eligible clients with assistance
in the payment of their out-of-pocket
Medicare Part D pharmacy and deductible

Another program funded by the Ryan
White program is the Minority AIDS
Initiative (MAI), established to help to
identify and assist people of color who
are HIV-infected but not receiving any
medical care. MAI uses the Antiretroviral
Treatment Access Study (ARTAS), a
short-term intervention, which places an
emphasis on identifying an individual's
strengths and using these strengths to
achieve goals. Most of the MAI clients
suffer from substance abuse and/or
mental health illness and are referred
appropriately. Although the target
population is minorities, MAI does serve
non-minority individuals who know their
HIV status and are not under care. 22

It is important to recognize that the CARE
Act was established to fill gaps in care, not
to be a primary provider of HIV/AIDS care
in the US. The program is strained as the
HIV/AIDS epidemic spreads, with some
states enacting cost-containment strategies
to stretch their Ryan White dollars and
others establishing waiting lists for HIV/
AIDS treatments. High utilization of Ryan
White programs then, is an indicator of
wide-spread lack of access to HIV/AIDS
care. In a report entitled, "Public Financing
and Delivery of HIV/AIDS Care: Securing
the Legacy of Ryan White," the Institute
of Medicine calls for an overhaul of the
current HIV/AIDS health system.23

Florida Medicaid
Roughly 25% of HIV-positive Floridians
are enrolled in Medicaid.24 Unlike in
some states, HIV-positive Floridians do

not qualify for Medicaid on the basis of
testing positive; rather, they must also
have a sufficiently low income level or be
disabled as a result of having AIDS. For
those who do qualify, Medicaid offers a
comprehensive set of benefits, including
prescription drug coverage for drugs
included on the Preferred Drug List.
However, delayed eligibility is an ongoing
concern for HIV/AIDS populations, as
research has proven that early access
to effective treatments can delay the
progression of the disease and improve
quality of life.25

Under the direction of the 1997
Legislature, the Agency for Health Care
Administration (AHCA) established a
Medicaid disease management initiative
to control costs and improve health
outcomes for its chronically ill recipients.
In 1999, AHCA awarded a contract to the
AIDS Healthcare Foundation (AHF)26 to
provide disease management services for
Medipass HIV-positive recipients. This
contract brought thousands of Floridians
under AHF's disease management
program, 'Positive Healthcare.' In a 2004
report, Florida's Office of Program Policy
Analysis and Government Accountability
(OPPAGA) indicated that AHF's program
was effectively cutting costs and had

Insurance Coverage Among Persons With HIV/AIDS
in Care, United States, 1996


Medicare Medicaid Private Uninsured
Insurance Status

Source: Institute of Medicne. Public Fninang and Doeivery of HIV/AIDS (ae. Washngton, DC: National Academes Piess; 2004.


reached the majority of recipients who
were eligible for its services.27

Under Florida Medicaid Reform in
some counties, operation of disease
management programs is being
transitioned to contracted health plans
and MediPass is being discontinued. It
is still too early to measure the effects of
this transition on Florida's HIV/AIDS
population. A recent debate over the
discontinuation of AHF services has
not yet been resolved, as advocates and
patients continue to appeal the decision.
The action by AHCA has prompted
AIDS Healthcare Foundation to file
a lawsuit against the agency.28 Post-
reform assessment of HIV/AIDS patient
satisfaction and quality is recommended.

HIV-positive Floridians who do not
qualify for Medicaid may be eligible for
the Medically Needy Program. After
incurring a pre-determined amount of
medical bills each month (based on
income and household size) a Floridian
can apply for Medicaid to cover
additional costs. This supplemental
coverage is applied for and granted on
a month-by-month basis.29 For high-
utilization clients such as HIV/AIDS
patients, tracking and submitting medical
bills could represent a significant barrier
to accessing this program.

Florida's Project AIDS Care (PAC) is
a waiver program authorized under
federal legislation enabling state
Medicaid agencies to provide home
and community-based services to AIDS
patients as a more humane and more
cost-effective way to ensure appropriate
care.30 PAC is a 'special enhancement' of
Florida Medicaid, which pays for certain
services not covered under the standard
Medicaid benefit package. These services
are often delivered in the home and go
beyond health care to include social
services. Other states have implemented
Medicaid waivers to expand services
and eligibility, a policy issue that will be

discussed further below.

Florida Department of Health
The Florida Department of Health's
Bureau of HIV/ AIDS is a champion of
public health and prevention, but also
facilitates certain aspects of HIV/AIDS
care and financing. The AIDS Insurance
Continuation Program (AICP) is a state
program for persons who are diagnosed
with AIDS or are HIV-symptomatic, and
who cannot afford to pay their private
insurance premiums. The program makes
direct payments (up to $750/month)
to participants' employers or insurance
companies for continuation of medical,
dental, and vision coverage.

AICP is funded by Florida's Department
of Health (via federal and state dollars)
and managed by the Health Council of
South Florida, Inc., a private nonprofit
agency. It is administered through
regional community-based organizations.
The program is designed to save
Florida money by keeping HIV/AIDS
patients insured and out of other public
programs.31 Additionally, the DOH offers
confidential and anonymous testing and
counseling to the general public through
any of its county health department

Medicare is a federal health insurance
program that covers people over 65 years
of age and Americans with a permanent
disability. Medicare accounts for just
over one-quarter of federal spending
on HIV/AIDS care in the US and is an
important source of coverage for people
living with HIV/AIDS who qualify for
Social Security Disability Insurance
(SSDI). Only a small fraction of HIV-
positive Medicare recipients qualify on
the basis of age only, as just 3% of HIV-
positive Americans are over the age of

Since the 2006 approval of a new
prescription drug benefit, Medicare's


stake in HIV care has risen. As discussed
above, pharmaceuticals comprise a large
and costly portion of HIV care based
on current standards. According to
the Department of Health and Human
Services, all drug plans contracted
through Medicare are required to cover
all anti-retroviral drugs. However, some
research shows HIV-positive recipients
having problems filling prescriptions. In a
recent survey, seventy-five percent of HIV
medical providers reported that they had
patients who went without medications.34

Medicare beneficiaries are required to join
Medicare plans, however the Ryan White
Program's ADAP has supported Medicare
beneficiaries during their transition to
new drug plans, helping to cover plan
premiums, co-pays, and medication
costs.3536 Dual-enrollment in Medicare
and Medicaid is common, with roughly
two-thirds of HIV-positive Medicare
enrollees also covered by Medicaid.37
However, as of January 2006, Medicaid
drug coverage terminated for any dual
eligibles, and Medicare Part D picked up
full prescription coverage. The effects of
Medicare Part D on HIV/AIDS care will
be an ongoing focus of research.

Veteran s Affairs (VA)
The VA health care system, widely known
for its large-scale integration, is both a
payer and provider of HIV care, making
it the largest single provider of HIV care
in the US. As a federal program, the VA
serves almost 20,000 HIV-positive veterans
annually. The VA's National HIV/AIDS
Program provides testing, treatment, and
counseling for veterans, and is a resource
of disease-related information, guiding
patients through all steps of the health
care process: getting tested, adjusting to
diagnosis, and making treatment decisions.
There are sixty-seven VA locations in
Florida providing care to an important
segment of our population.38

HIV/AIDS Prevention and Public
Health Services: Access and Financing

The national leader in HIV/AIDS
prevention is the Centers for Disease
Control and Prevention (CDC). The
CDC estimates that approximately 40,000
new HIV infections occur in the United
States each year. Prevention of these
new infections is extremely cost effective,
compared to the expense of treating the

Table 1. HIV (not AIDS) and AIDS cases, top ten reporting states, 2004.
(2005 data not available)

Reporting Number of AIDS Cases % US AIDS Cases Number of HIV Cases*** % US HIV Cases
New York 7,641 17% 6,033 18%
Florida 5,822 13% 5,107 15%
California 4,679 10% N/A N/A
Texas 3,298 7% 4,143 12%
New Jersey 1,848 4% 1,704 5%
Illinois 1,679 4% N/A N/A
Georgia 1,640 4% 2,154 6%
Pennsylvania 1,629 4% 1,330 4%
Maryland 1,451 3% N/A N/A
North Carolina 1,137 3% 1,099 3%
Remainder of US* 13,913 31% 11,993 36%
Total Cases 44,737 100% 33,563 100%
*Date HIV reporting initiated for Florida, July 1997; New Jersey, Jan. 1992; New York, Dec. 2000; North Carolina, Feb. 1990;
Pennsylvania, Oct 2002; Texas, Jan 1999; Georgia, 2003.
**Remainder of States where HIV is reportable as of 12/02: Alabama, Alaska, Arizona, Arkansas, Colorado, Idaho, Indiana, Iowa,
Kansas, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, South Dakota, Utah, W.
Virginia, Wisconsin and Wyoming.
Connecticut has confidential HIV infection reporting for pediatric cases only.
Washington reports symptomatic infection and name-to-code-based system. California, District of Columbia, Hawaii, Illinois, Kentucky,
Maryland, Massachusetts, Rhode Island and Vermont
report HIV on a code-based system. Delaware, Maine, Montana, and Oregon report on a name-to-code-based system. New Hampshire
has other type of reporting.
Data only from those states where HIV is reportable.
Includes only persons reported with HIV infection who have not developed AIDS.
Source: CDC HIV/AIDS Suveillance Report, Vol. 16.


disease.39 HIV prevention services
include diagnostic testing for HIV
and other STDs, and interventions
to reduce transmission, such as
counseling, condom distribution,
prevention case management,
substance abuse treatment, and
mental health services. These HIV
prevention services can be delivered
in a variety of clinical settings,
and the reduction of barriers to
early diagnosis of HIV and access
to other prevention services is
critical. The CDC has endorsed a
strategy called the 'Advancing HIV
Prevention (AHP) Initiative' which
aims (1) to make HIV testing a
routine part of medical care, (2)
to increase diagnosis outside of
medical settings, (3) to prevent
new infections, and (4) to decrease
perinatal transmission. In response to the
CDC's Initiative, the Florida Department
of Health's Bureau of HIV/AIDS has
established teams to tackle each of these
four goals.40

Because disparities persist and HIV
does not affect all communities equally,
the effectiveness of prevention efforts
can be maximized by targeting specific
populations and implementing programs
at the local level. Recognizing this,
Florida's Department of Health (DOH)
has stepped up its commitment to
addressing HIV/AIDS prevention in
minority populations and has established
an enormous range of projects related
to the issue. For example, the DOH
established a statewide media campaign
entitled, "We Make the Change"
as well as community mobilization
meetings which involve the grassroots
organizations in the work of the
HIV/AIDS Minority Network. The
network was created to build capacity
and develop links between community
organizations and the DOH, and
to provide peer-based support and

Another program, the HIV/AIDS

Factors Affecting HIV/AIDS Disparities:

Late diagnosis of HIV.
Access to/acceptance of care.
Delayed prevention messages.
Non-HIV STD's in the community.
Prevalence of injection drug use.
Complex matrix of factors related to
socioeconomic status.

Source: Flondo Department of Health, 2005.

Prevention Education Project, works
to strengthen HIV/AIDS prevention
education and school health education
in Florida. The Perinatal HIV Program
works to prevent mother-to-child HIV
transmission by educating women and
health care providers on the importance
of HIV testing for pregnant women and
the availability of treatment to prevent
perinatal transmission. The number of
newly diagnosed HIV and AIDS cases
in infants has declined 96 percent since
1992, less than two percent of HIV-
infected women deliver an infected
infant each year.

Financing for HIV prevention services
varies according to type of service and
type of payer. The major providers of
funding for HIV/AIDS care (Medicaid
and Ryan White) also allocate funding
for most HIV prevention services.
However, these services generally are
optional services and therefore must
be supported by legislative or other
administrative decisions. Some HIV
prevention decisions are controversial
due to disagreements regarding the best
methods to reduce risky sexual behavior
and shared injection drug use. It is also
difficult for providers to document and
bill for HIV prevention services such as
counseling. Financing organizations may


be able to identify new methods to provide
incentives to encourage more access to
HIV prevention services.


Florida has the 2nd highest number of
persons with HIV/AIDS in the nation.
The majority of these persons do not have
private insurance; rather, they receive care
through a variety of publicly funded service
programs. Treatment for HIV is available
and effective, but very expensive. In 2007,
the system continues to evolve, with
Medicaid Reform changing the financing
and organization of care for a large
number of Floridians with HIV infection.
Although the Reform effort has resulted in
numerous complaints from various parties,
it is still too early to determine the actual
impact of Reform on health outcomes.

Funding for HIV prevention programs is
likely to be cost effective but often difficult
to implement due to competition for
funding from programs providing direct
care for persons who are already infected.
HIV prevention programs are likely to
reduce costs related to HIV over the long
run, but require initial funding and societal
acceptance. More data on the impact of
financing options on healthcare outcomes
and utilization should be available in the
near future.

Prepared by:
Lisa Chacko, MPH
Robert Cook, MD, MPH
Melisa Foronda, BHS

End notes

1 Centers of Disease Control. "Advancing HIV
Prevention: New Strategies for a Changing Epidemic-
United States, 2003." Morbidity and Mortality Weekly
Report. Vol. 52, No.15; 2003.

2 Fleming, P., et al. HIV Prevalence in the United
States, 2000, 9th Conference on Retroviruses and
Opportunistic Infections, Abstract #11, Oral Abstract
Session 5, February 2002.

3 Orwat, J. HIV/AIDS in Massachusetts: A Decade of
Change and Challenge. The Massachusetts Health
Policy Forum Issue Brief No. 24. Dec. 2004.

4 Glynn, M. & Rhodes, P. Estimated HIV prevalence in
the United States at the end of 2003. National HIV
Prevention Conference; June 2005; Atlanta. Abstract

5 Florida Department of Health: Bureau of HIV/AIDS
Home Page

6 The Kaiser Family Foundation Fact Sheet. The HIV/
AIDS Epidemic in the United States, July 2007.

7 The Kaiser Family Foundation, statehealthfacts.
org. Data Source: Centers for Disease Control
and Prevention, Division of HIV/AIDS Prevention-
Surveillance and Epidemiology, Special Data
Request, November 2006.

8 Florida Department of Health. The Perinatal HIV

9 Gushulak, B & MacPherson, D (2004). Population
mobility and health: an overview of the relationships
between movement and population health. J Travel
Med, May-Jun; 11(3):171-174.

10 Florida Department of Health. HIV/AIDS in Rural and
Non-Rural Counties, Florida, 2006.

11 Institute of Medicine. Board on Health Care Services.
Care without Coverage: Too Little, Too Late, 2002.

12 Goldman DP, et al. "Effect of Insurance on Mortality
in an HIV-Positive Population in Care." Journal of the
American Statistical Association, Vol. 96, No. 455: 883-
894, 2001.

13 The Kaiser Family Foundation HIV/AIDS Policy Issue
Brief. Financing HIV/AIDS Care: A quilt with many
holes, May 2004.

14 Fleming, P., et al. HIV Prevalence in the United
States, 2000, 9th Conference on Retroviruses and
Opportunistic Infections, Abstract #11, Oral Abstract
Session 5, February 2002.

15 The Kaiser Family Foundation HIV/AIDS Policy Issue
Brief. Financing HIV/AIDS Care: A quilt with many
holes, May 2004.

16 Kaiser Family Foundation, State Health Facts Online,
Health Coverage & Uninsured, Distribution of
Adults, 19-64 by Insurance Status, 2000-2001, www.


17 Institute of Medicine. Public Financing and
Delivery of HIV/AIDS Care: Securing the Legacy of
Ryan White, 2005.

18 Health Resources and Services Administration.
Ryan White Care Act: Care Act Overview,
July 2006.

19 Institute of Medicine. Public Financing and
Delivery of HIV/AIDS Care: Securing the Legacy of
Ryan White, 2005.

20 EMAs must have reported at least 2,000 AIDS
cases during the previous 5 years and have a
population of at least 500,000.

21 Health Council of South Florida. AIDS Drug
Assistance Wrap Around Pilot Project. http://www.

22 Florida Department of Health. Florida Annual
Report Epidemiologic Profile 2005. www.doh.state.

23 Institute of Medicine. Public Financing and
Delivery of HIV/AIDS Care: Securing the Legacy of
Ryan White, 2005.

24 Bureau of Health Systems Development, Division
of Medicaid, Florida Agency for Health Care
Administration, 2007.

25 Institute of Medicine. Board on Health Care
Services. Care without Coverage: Too Little, Too
Late, 2002.

26 'Positive Healthcare' was the first disease
management program designed specifically for
HIV-positive Medicaid recipients US, and the first
DM organization to receive accreditation from
the National Committee for Quality Assurance

27 Office of Program Policy Analysis and Government
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35 Department of Heath and Human Services.
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36 The Kaiser Family Foundation. HIV/AIDS policy fact
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37 The Kaiser Family Foundation HIV/AIDS Policy Issue
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38 US Department of Veterans Affairs, Facilities
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