With more patients insured, county trims HIV medical care spending

Los Angeles County officials on Tuesday cut back on contracts to provide medical care to AIDS and HIV patients, citing increased numbers of people now insured under the federal healthcare overhaul.

The move to cut $4 million from the contracts, paid for with federal monies, marked the latest clash between the county and the powerful nonprofit AIDS Healthcare Foundation, one of the largest providers of medical services to HIV patients in the region.

The foundation and the county have tangled politically and in court over other contracts and issues, including enforcement of requirements for adult film actors to wear condoms and a foundation drive to create a new, breakaway public health department serving the city of Los Angeles.

Patients and foundation staff and supporters -- including former L.A. City Councilman Bill Rosendahl -- acknowledged the number of patients relying on the care provided under the federal Ryan White Program has decreased. But they argued that about 24,000 county residents with HIV are not receiving any care.

Officials estimate that more than 10,000 people in the county are HIV-positive and don't know it, while another 13,000 are believed to be aware of their diagnosis but are not getting treatment. 

AIDS Healthcare Foundation board Chairwoman Cynthia Davis said the county should maintain the current level of safety net spending on HIV outpatient services "to ensure that these hard-to-reach and medically underserved clients" are properly identified and treated.

Patient Eduardo Martinez told the board that he was celebrating his 57th birthday after living with HIV for 29 years.

"I'm very happy and lucky to be here, thanks to Ryan White and thanks to all the clinics in L.A.," he said. "So please, help us help these 24,000 people."

Mario Perez, head of the county's HIV response programs, said the number of patients enrolled in Medicare, Medicaid and private insurance has increased. And that has helped reduce medical visits paid for under the  Ryan White program--from about 33,500 to an estimated 24,000 this year.

The trends show the Affordable Care Act has "worked as intended" in L.A. County, Perez said.

Cutting back on the outpatient care contracts will allow the federal money to be used for other services not covered by patients' health insurance.

Supervisor Sheila Kuehl, whose district includes West Hollywood, said the federal funds could be freed up to help copays for doctors visits, among other things.