The state now has the strictest income qualifications in the nation for patients who want help from the federal AIDS drug assistance program. Single people can make no more than about $12,250 a year, 125 percent of the federal poverty level, to get medicine.

That means some patients have to scrimp on other expenses to buy medicine, or they rely on drug company programs that distribute medicine free to the poor and uninsured.

About 3,000 North Carolinians got AIDS drugs through the federal program last year. State health officials estimate that 800 to 900 more could be added if state lawmakers give permission to raise the income floor to $24,500 a year.

Legislators appear ready to do that.

The state Senate approved the increased income limit in its version of the state budget, which passed last month. Democratic House leaders included the expansion in their budget proposal, which is expected to be voted on this week. The House and Senate must then agree on a budget, which will go to Gov. Mike Easley for his signature.

"Being able to serve more people in need in the AIDS drug assistance program is a critical tool that we have in ending AIDS in North Carolina," said Evelyn Foust, the AIDS director with the state Department of Health and Human Services.

People who take AIDS drugs and stay in treatment are less likely to pass the virus to others, Foust said.

Getting more people into the program depends upon Congress' agreeing to spend more, because state officials want to use federal money to pay for the expansion.

Chance of federal help

Prospects for more federal money look good, though the final numbers are not set.

Congress is still working on revisions to the Ryan White CARE Act, the main federal program that helps pay for medicine, medical services and other assistance for people infected with HIV.

U.S. Sen. Richard Burr, a Winston-Salem Republican, is a chief advocate for changing the way federal money is distributed to get more AIDS help to North Carolina and other rural states.

The federal bill includes more money for the AIDS drug assistance program, which would mean about $6 million more a year for North Carolina, Burr said.

"That may allow North Carolina to be a little flexible on where the poverty cutoff is," he said.

The states' decision

States set up their drug assistance programs, deciding income limits for recipients and how many varieties of drugs are available. States use different methods to limit spending.

Alabama, for example, allows patients to make up to $24,500 a year but has a waiting list, according to a Henry J. Kaiser Family Foundation survey published in March. South Dakota allows people to make up to $29,400 but does not cover a certain class of drugs and limits spending on each patient.

States don't have to spend their own money on the drug program, but many do.

In North Carolina, state money makes up about $12.1 million of the program's $30.4 million budget. Though the state has the nation's lowest income eligibility, it eliminated its waiting list in 2004.

The state program pays for all classes of AIDS drugs, but patients hovering just above poverty don't qualify.

Dallas Midgette, 54, is a former lab technician who was diagnosed with HIV in 1990. He lives in Wilmington on disability payments of about $1,500 a month, too much to qualify for the AIDS drug program.

Midgette said he has been getting his medication through a program at UNC-Chapel Hill. He had to sign up in May for prescription drug insurance through Medicare.

If he qualified for the AIDS drug program, it would pay for three prescriptions and save him money.

Without help from the AIDS drug program, Midgette doubts he'll be able to pay all his household bills and take all his drugs.

"I will pick and choose my medications," he said.

Patients in a bind

Drug manufacturers offer free AIDS drugs to some people who cannot afford them, but it's a challenge to get patients on those lists.

Most patients take multiple medicines made by different companies, all of which have different rules, said Kathryn Schley, a social worker in a Wake County HIV clinic. Some patients qualify for some company programs, but not others. Other clients don't qualify for the federal drug program or the company giveaways.

Occasionally, patients will try to make less money so they can qualify for free AIDS drugs.

"They are making as little money as they would need to qualify for these programs," Schley said.

North Carolina will not know how much federal money will be available until Congress finishes its work on the Ryan White legislation. Burr is pushing to change the distribution formula, which is weighted toward states with large cities, where AIDS first hit hardest.

"North Carolina has one of the fastest-growing HIV new-case populations in the country, and in many cases, that is a rural explosion," Burr said. "This is a preventative investment to make sure that we delay or eliminate what we know to be a very expensive annual cost for full-blown AIDS."