Federal dollars that localities use to fund care for those living with HIV have been cut off for months, leaving some who can't afford their own care without services.
Millions in unpaid funds are expected to begin flowing through city and state offices to 81 Maryland health organizations in the next couple of weeks, but the groups say people have already had to slash their budgets for food, housing and some medications.
"When you're on HIV medications, you need food, and some of these people have nowhere else to get it," said Tom Bonderenko, executive director of Moveable Feast, a nonprofit group that provides food to those with illness, including 370 with HIV and AIDS in Baltimore area. "It's been a tragedy these past few weeks."
The new fiscal year for the program began March 1, but passage of the federal budget was delayed until April and the federal agency has struggled to catch up. Maryland is due about $61 million from the Ryan White Care Act in the 2011 fiscal year, and much of that money has not been sent by the federal Health Resources and Services Administration.
Bonderenko said Moveable Feast received some money to cover the first few months of the year but, through July 1, is still owed $146,000. That will rise to $172,000 on Aug. 31.
The group tapped other funding sources but three weeks ago cut food service from 18 meals a week to 18 meals every two weeks, except for the critically ill, whose service was cut by a third. No caretakers or children are being provided services.
At the Moore Clinic for HIV Care at Johns Hopkins, officials plan to pare back services such as housing grants, co-payments for drugs and medications for diabetes and other illnesses suffered by those with HIV.
The clinic, which provides primary care services to 650 people with Ryan White dollars, is also filling some gaps with other funding sources, said Jeanne Keruly, an associate professor of medicine at Hopkins and director of Ryan White HIV/AIDS Clinical Services.
She said it has become hard to plan because the clinic's contract for the year has not yet been renewed and it has been without funding for two months. Last year, the clinic got $3 million.
"We're finding we can't help some people with certain needs," she said. "We also made the decision not to bring in any new patients to the program who were uninsured so we could continue to provide adequate services to those already in the practice."
Gaps in service threaten health, said Dr. Cynthia Sears, a professor of medicine in Hopkins' division of infectious disease and a board member at Moveable Feast. HIV patients get distracted from their care, and those who stop taking medications can develop drug resistance and other ill effects.
Dr. Kathleen Squires, chairwoman of the HIV Medicine Association, a providers group, said the same scenario is playing out nationally.
"The delay in funding is forcing these programs to cut services that low-income HIV-infected patients depend on," she said. "We hope these delays, which have lasted for months, can be resolved immediately so programs that rely on Ryan White grant funding can restore vital services to both new and established patients."
A spokesman for the Health Resources and Services Administration said the $61 million due the Baltimore area in fiscal 2011 comes from two main pots of money that pay for drugs and services.
Agency records show that about $10 million has been paid to the Baltimore region from one fund that pays for auxiliary services and $11 million more is due. Another $19 million has been paid from a fund that includes HIV medication money around the state, and another $21 million is due. Much of the remainder should be available this week or next.
A portion of the money is paid through the Baltimore City Health Department, which expects to begin sending payments to community organizations next week.