Governor Arnold Schwarzenegger has decided to fully fund the AIDS Drug Assistance Program in his proposed 2009-10 budget, but people with AIDS who are on Medi-Cal could face reduced help.

For the 2008-09 fiscal year, the budget for Medi-Cal is $38.5 billion, with $14.4 billion of that coming from state funds. Total reductions for Medi-Cal would be $1.1 billion over the next 18 months, going into effect as soon as the state budget passes.

Medi-Cal provides health care to low-income people, including many who are living with AIDS. Proposed cuts to the program would lang=EN deny coverage to thousands of people on Medi-Cal by lowering income eligibility and increasing costs for some residents who are aged, blind, or disabled, according to advocates for people living with AIDS. The state could also lose hundreds of millions of dollars in federal matching funds.

Citing 2006 data from the state AIDS office, Dana Van Gorder, executive director of Project Inform, an estimated 160,000 people in California are living with HIV/AIDS. People who have HIV but who haven't been diagnosed with AIDS aren't eligible for Medi-Cal.

Anne Donnelly, Project Inform's director of health care policy, said in a statement that proposed cuts to Medi-Cal and other health and human services programs "would limit access to quality health care for some of the most vulnerable Californians. ... This at a time when the federal government and state are redoubling efforts to assure that undiagnosed people with HIV learn their status and that HIV-positive people engage in care and treatment."

Mark Cloutier, CEO of the San Francisco AIDS Foundation, said in a statement,  "These Medi-Cal reductions will likely lead to poorer health outcomes for the most vulnerable people living with HIV."

According to the foundation, Schwarzenegger's proposed budget is designed to close a projected $41.6 billion budget gap through the end of the next fiscal year by raising $14.3 billion in new revenue, cutting spending by $17.4 billion over the next 18 months, and relying on borrowed funds.

Stephen Leader, a San Francisco man who is living with AIDS, said he was unaware of the changes coming up, and he's been hurt enough already.

Leader said the state Medi-Cal program used to pay his federal Medicare premiums, but it doesn't anymore.

In a message he wrote to the Bay Area Reporter , he said, "What really upsets and bewilders me" is that the state began picking up his Medicare premiums in August, then stopped in October.

Leader wrote that he's stuck on a $100-a-month roller coaster ride, which is sizable considering his income is about $1,700 a month.

The changing income "makes it difficult to plan and budget. This isn't the first time [the state] has done this. I just wish they would make up their minds," wrote Leader.

Tony Cava, spokesman for the state Department of Health Care Service, said people with AIDS can be found in any of Medi-Cal's several programs, and the change in eligibility requirements depends on the program.

In the program for aged, blind, and disabled people, for example, there's a proposal to scale back an expansion of the program that occurred in 2001.

At that time, the income level to apply for the program was increased from 69 percent to 127 percent of poverty, adjusted for inflation.

Now, there's a proposal to partially reduce this expansion to the income levels for Supplemental Security Income and State Supplemental Payments (funds that the state adds on to the federal supplemental income).

As a result, Cava said, 73,000 people would no longer be eligible for Medi-Cal. The change would be effective May 1.

To qualify for the SSI and SSP payments, an individual can't make more than $870 a month, said Cava.

Both SFAF and Project Inform pledged to work with other HIV/AIDS advocates to ensure Medi-Cal's strength as the state budget is debated over the coming months.

ADAP will provide medications to approximately 35,000 Californians next fiscal year, about 12 percent of whom live in San Francisco. The total cost of the program for fiscal year 2009-10 is $418 million.