North Dakota CARES/Ryan White Part B
Program
Krissie Guerard
TB/HIV/RW Program Manager
North Dakota Department of Health
May 14, 2009
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.
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.
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
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
Case Manager Locations
ND CARES/Ryan White Part B
Program
• “Payer of last resort”
• Eligibility criteria
• Case management
• State direct services
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
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
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 $200 biannually for glasses
• Substance abuse treatment services– 80% paid
ND CARES/Ryan White Part B
Program• State Direct Services
– Supportive Services• Transportation to medical appointments or
support groups (gas cards reimburse for cost of travel)
• Nutritional supplements (ordered by MD)
• Other assistance: – Continuation of Health Insurance (DHS)
ND CARES/Ryan White Part B
Program• Emergency Assistance
– Must be related to situations that may arise due to client’s HIV status and necessary to maintain access to care
– Funds available for limited amounts, limited uses, and limited time period
• Rent, rental deposit, utility bills
– Case by case assessment
ND CARES/Ryan White Part B
Program
• AIDS Drug Assistance Program– Medications must be
listed on ND CARES’ Reimbursable Medications List.
– ND CARES pays 100 percent, or co-pay if privately insured.
ND CARES 2008 Clients
• 77% Male• 68% Aged 25-45 years• 56% HIV • 80% White• 74% < 200% FPL ($ or less)• 93% Enrolled in ADAP• 40% Heterosexual
Sex
23%
77%
23% Women
77% Men
Race
80%
15%
5%
White
Black
Native
Income
52%
22%
7%
19%
Less than 100% FPL
200% FPL
300% FPL
400% FPL
Risk
0
5
10
15
20
25
30
35
Hetero MSM IDU MSM/IDU Perinatal Unknow n
40% 37% 10% 8% 3% 19%
ND CARES/Ryan White Part B Program Funding
2006
$320,858
2007
$343,556
2008
$343,526
2009
$350,440
0
50000
100000
150000
200000
250000
300000
350000
400000
Do lla r
A m o u n t
North Dakota CARES/Ryan White Part B
Program
Questions????