San Diego County’s AIDS Waiver program, one of the three largest AIDS case management agencies, is slated to close June 30, 2004. The county, faced with impending budget cuts to reduce the state deficit, is trying to conserve costs, but the announcement has many clients and caseworkers surprised.

“My case manager basically told me that her boss had informed them that if they could find other jobs they should start looking for them because they were losing their funding,” said Kendall McAllister, who is enrolled in the AIDS Waiver program. “So it came as quite a shock. I knew that they were starting to have some budget problems but I didn’t realize it was that bad.”

According to the county, the AIDS Waiver program loses $1 million a year. With the governor’s proposal to decrease Medi-Cal reimbursement by another 10 percent to reduce the state budget deficit, the county has decided to terminate the AIDS Waiver program.

“The main reason the program is closing is that the revenue that the state provides for the program to the county does not cover the operating expenses for staff salaries and benefits and so forth,” said Rick Wanne, program manager at the County of San Diego’s Aging and Independence Services department. “The county covers the difference in what the state reimbursement is, and has done so for at least eight years, minimum. The cost of doing business has increased dramatically over time — salaries, benefits and so forth — and the revenue has not changed [to keep up with it]. The county dollars that cover the difference from expenditures to revenue are not there anymore, basically due to the state budget crisis. Those county dollars are drying up; they’re having to go to other things, and the resources are just not there anymore.”

The county operates three AIDS case management programs. The AIDS Medi-Cal Waiver program and the CMP program, which stands simply for Case Management Program, are programs of the State Department of Health Services Office of AIDS and operate through the county. The AIDS Waiver program has approximately 170 clients, while CMP has 15. The third program, federally funded through the Ryan White Foundation, serves ten clients.

“A lot of people are unaware that this is even happening,” McAllister said. “I was at Auntie Helen’s the other day and the gentleman that works in there, he’s case-managed through AIDS-Waiver and he was totally shocked. He had no clue that he was losing case management.… This is what I’m hearing from quite a few people — they’re not even getting told that they’re losing case management.”

The program waives the regular Medi-Cal service restrictions on in-home care in order to minimize institutionalization and hospitalization for those living with HIV and full-blown AIDS. The program provides a variety of in-home services for its clients, including skilled nursing care, case management, personal care, home making services, counseling, nutritional services, medical equipment and handicap accessible adaptations for clients’ homes.

This is not the first time many of these clients have had to shift programs when their case management folded due to funding cuts. McAllister was among the many clients who was originally case managed through the now defunct San Diego AIDS Foundation. He found out about the AIDS Waiver program when he was a volunteer at Helping Hands.

“The [AIDS Waiver] program was really set up for people to die comfortably, with dignity, at home and not have to go a hospital or nursing facility to die,” said Wanne. “But they were only enrolled for less than six months on most occasions.… As the new medications have come out and advanced, we’ve seen a real transition of the disease from a very, very acute, deadly disease here in the United States to a chronic disease, which is a good thing. In some ways, as a societal issue, having two programs in San Diego is probably not needed. That was one of the contributing factors to the program closing — there are just not enough clients in San Diego who meet this very specific eligibility criteria for the AIDS Waiver program to support two.”

According to Wanne, North County Health Services, a nonprofit organization, operates the same three AIDS case management programs as the County of San Diego; though they are located in North County, they serve the whole county as well.

The plan for the transfer is twofold, Wanne said. The ten Ryan White clients will be transferred to an in-house program at the County Office of AIDS Coordination in North County, and the AIDS Medi-Cal Waiver and CMP clients will be transferred, with the State Department of Health Services overseeing the process, to North County Health Services.

Members of Local 2028, AIDS Waiver clients and caseworkers met at the Board of Supervisors meeting on Tuesday morning to address the issue. They were concerned that the services in North County will not be adequate.

“We’re trying to get the Board of Supervisors to understand that these people who are already suffering are going to suffer even more by losing the county services,” said Mary Grillo, executive director of Local 2028. “We’re really concerned with the quality of services that will result with this transfer from the County to the nonprofit. It’s not a criticism of the nonprofit, we just know that they can’t possibly — for the amount of money they will receive — be able to provide these services without having these services suffer in the long run.”

“The program and the services it delivers for case management will be delivered in exactly the same way to the clients, just with a different provider,” said Wanne. “The funding is there. The way the funding is set up for AIDS Waiver is what is called ‘fee for service.’ Similar to a doctors’ office or a clinic, when the program serves the client, the program is reimbursed for that month of service. There is a set fee that is paid to the program by the state for each month of service that the client is enrolled. So there is no cap on the number of clients that can be in a program — it’s not like a grant. North County Health Services, all they are really planning to do is basically ramp up their staffing to accommodate this transition, and they will collect the revenue that we were collecting.”

The ten caseworkers and two supervisors will not automatically be transferred to North County.

“The goal for the county is that all of our current staff will be placed in existing county job vacancies,” said Wanne. “The goal is that there will be no layoffs at all. The comfort part of this as far as time is concerned is that we have until June 30, 2004, to complete the transfer of clients and the placement of staff in other positions.… So everybody — clients and staff — should be taken care of, that is the goal.”