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Same-sex marriage could be bad for AIDS patients

by Roger Brigham
EDGE Media Network Contributor
Wednesday Jun 18, 2008

Same-sex marriage could be bad for AIDS patients

AIDS services agencies and gay-rights groups tell EDGE they have no clear idea of how much same-sex marriages could affect individuals currently on disability or government assistance for HIV-related care. Until answers are forthcoming from Sacramento, they urge caution.

"I'm in contact with the state AIDS office pretty much every day," Jason Roundy, Benefits & Work Services Program Manager for AIDS Project LA, told EDGE. "I want this answered because I'm already getting these phone calls. People are moving forward."

"It's a very grey area," said Shannon Minter, legal director for the National Center for Lesbian Rights and the lead counsel in the case that led to last month's California Supreme Court decision to allow same-sex marriages. "If we had clear answers, we'd be giving them. There's a lot of uncertainty here."

The confusion over how federal disability would be affected stems from the lack of recognition from the federal government.

"People who are receiving federal benefits (such as disability payments) will not be affected because the federal government is not going to recognize the marriage," Mintner said. "Even so, there is some uncertainty there. It is not 100 percent clear yet whether the federal government is going to give any deference to how states determine a person's income under state law.

"I think the risk for federal benefits right now is fairly low, but it's not zero."

Because California is a common property law state, California uses a couple's combined income to determine state disability eligibility. State disability payments in other states could be affected depending on how that state calculates income and whether or not that state recognizes the legitimacy of a California same-sex marriage.

"People in state benefit programs should be extremely cautious before making any decision that could effect benefits linked to income," Minter said. "Once they marry or enter into a domestic partnership, their partners' income will be attributed to them."

The issue becomes even cloudier for people who enrolled in the AIDS Drug Assistance Program: a program authorized federally under the Ryan White Act but funded at least in part by individuals states and administered differently by different states. That federal-state administrative and funding mix leaves open the question of how marriages not recognized by the feds will be handled by California and other states.

My main concern is the continuity of access to medicatons. Yeah, we don’t have the policies and the rulings yet, but you have to consider the fact you are joining your assets when you marry. When the jury is in, marriage is marriage.

Asked about the effect on ADAP benefits, Minter said, "I was afraid you were going to ask that. That's a good question."

"Specifically there isn't a (state) decision yet," Roundy said. "I spoke with someone from the AIDS office earlier today. They actually need to discuss it. They have not set policy on it yet. They are working on the policy in Sacramento."

This is not chump change we are talking. A 2006 study by Cornell University estimated that AIDS care typically costs about $2,100 a month, with three fourths of that going toward drug prescriptions. AIDS caught in its late stages can cost $4,700 a month because of increased hospital time, indicating that starting treatment early has the potential to cut costs by more than half.

In California alone, there were nearly 19,000 patients covered by ADAP in June of 2007, according to the National ADAP Monitoring Project Annual Report, and nationally that figure was nearly 102,000. Ninety-five percent of those people are from 25 to 64 years old.

Federal ADAP spending skyrocketed from $52 million in 1996 to $790 million in 2006, with individual states kicking in additional funds on top of that. The U.S. Health and Human Services Department estimates that more than 142,000 people received medications through ADAP in 2004, none of them with adequate health insurance or the financial resources necessary to cover the cost of medications. Nationally, an average of 73,000 clients are served each month, and 40,000 new infections are reported annually.

"My main concern is the continuity of access to medications," said Roundy. "Yeah, we don't have the policies and the rulings yet, but you have to consider the fact you are joining your assets when you marry. The reality is that when the jury is in, marriage is marriage.

"People have worked so hard and worked so long for equal rights to this (marriage) position, but the advocacy didn't necessarily talk about the burdens and obligations of marriage--taxes and so forth. I think it is potentially more impactful than people are thinking about right now."

For now, single POZ people dependent on government assistance should way their options carefully before getting married--and talk with their local AIDS services agencies.

"AIDS treatments can cost multiple hundreds of dollars," Roundy said. "People have ADAP for a reason.

"The basic overall message is: slow down, look really carefully what you're doing, and understand that your marriage could have impact on the public assistance you receive."

Roger Brigham, a freelance writer and communications consultant, is the San Francisco Editor of EDGE. He lives in Oakland with his husband, Eduardo.


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