Which policy to ADAP-T: waiting lists or waiting lines?

The AIDS Drug Assistance Program (ADAP) was initiated in the early 1990s as part of the Ryan White CARE Act, which was designed to " provide emergency assistance to localities that are disproportionately affected by the Human Immunodeficiency Virus epidemic and to … provide for the development, organization , coordination, and operation of more effective and cost efficient systems for delivery of essential services to individuals and families with HIV disease " (Public Law 101-381). The implementation of the Ryan White CARE Act is based on 4 titles and 3 targeted components: Title I provides emergency assistance to high-impact epicenters of the early epidemic through local HIV Health Services Planning Councils; Title II funding goes to states for provision of health care and support services, health insurance continuation , and prescription drugs via ADAP, which constitutes more than one-half of Title II funds; Title III provides funding directly to clinics and other entities that provide comprehensive HIV primary care; and Title IV provides funding for medical care and ancillary support services to children , youths, and women living with HIV infection. The 3 targeted areas of the Ryan White CARE Act include programs that encourage innovation in the provision and assessment of care delivery (Special Projects of National Significance), provide targeted education and training of HIV health care providers (AIDS Education and Training Centers), and provide comprehensive dental care (Dental Reimbursement Program). This vitally important legislation is up for reauthorization this year. By all accounts, the Ryan White CARE Act has been successful in its mission of reducing the burden of HIV care delivery in high-impact areas and in most other regions of the country. Up until now, most HIV-infected patients in need have gained access to care and needed prescription medications. There are some important exceptions, however. Owing to tremendous disparities among medical support revenues in each state, service provision via Ryan White CARE Act funds vary widely [1]. Wealthier states in high-impact areas, such as New York, California, and Massachusetts, have generous Medicaid programs with liberal eligibility criteria, thereby enabling the use of Title I and II monies to supplement their existing statewide aid programs. In Massachusetts, for example, ADAP monies are used to provide all of the medications for eligible recipients through an open formulary. In contrast, among the nation's poorest states, such as Alabama and Mississippi, where Medicaid eligibility is among the most restrictive, ADAP funding …