The Ryan White HIV/AIDS Treatment Program
The Ryan White HIV/AIDS Program
Updated April 16, 2008
Judith A. Johnson
Specialist in Biomedical Policy
Domestic Social Policy Division
The Ryan White HIV/AIDS Program
The Ryan White HIV/AIDS Program makes federal funds available to
metropolitan areas and states to assist in health care costs and support services for
individuals and families affected by the human immunodeficiency virus (HIV) or
acquired immune deficiency syndrome (AIDS). The program is administered by the
Health Resources and Services Administration (HRSA) of the Department of Health
and Human Services (HHS).
The Ryan White program is composed of four major parts and several other
components. Part A provides grants to urban areas and mid-sized cities. Part B
provides grants to states and territories; it also provides funds for the AIDS Drug
Assistance Program (ADAP). Part C provides early intervention grants to public and
private nonprofit entities. Part D provides grants to public and nonprofit entities for
family centered care for women, infants, children, and youth with HIV/AIDS. The
other components, sometimes referred to as Part F, include the AIDS Dental
Reimbursement (ADR) Program, the AIDS Education and Training Centers
(AETCs), and the Special Projects of National Significance (SPNS) Program.
In December 2006, the 109th Congress passed and the President signed the Ryan
White HIV/AIDS Treatment Modernization Act (H.R. 6143, P.L. 109-415), which
reauthorized the Ryan White program through September 30, 2009. Unlike the
previous reauthorization, which extended the program for five years, the compromise
legislation provided a three-year extension, eliminating the final two years in the
original version of the bill, which would have resulted in reduced funding in certain
areas. In addition, there is a provision at the end of P.L. 109-415 that repeals the
Ryan White program, Title XXVI of the Public Health Service Act, as of FY2010.
Some members have expressed the intention to revisit Ryan White over the next
three years, to examine whether the structure of the entire program should be
revamped to reflect the current distribution of HIV/AIDS in the United States.
Ryan White programs received $2.142 billion in FY2008; the request for
FY2009 is $2.143 billion. This report will be updated periodically.
Part A (Title I) — Grants to Urban Areas...........................1
Part B (Title II) — Grants to States................................5
Part C (Title III) — Early Intervention Services......................8
Part D (Title IV) — General Provisions............................8
Part F — Demonstration and Training..............................9
List of Tables
Table 1. Federal Funding for the Ryan White Program...................11
The Ryan White HIV/AIDS Program
The Ryan White HIV/AIDS Program makes federal funds available to
metropolitan areas and states to provide a number of health care services for
HIV/AIDS patients including medical care, drug treatments, dental care, home health
care, and outpatient mental health and substance abuse treatment. Each year, the
program provides assistance to an estimated 531,000 low-income or under-insured
men, women, children, and youth who are living with HIV.1 The Ryan White
program was established in law in 1990 (P.L. 101-381) and reauthorized and
amended in 1996 (P.L. 104-146) and 2000 (P.L. 106-345). It was enacted as Title
XXVI of the Public Health Service (PHS) Act and codified as Parts A, B, C, D, E,
and F under 42 U.S.C. § 300ff-111. The program is administered by the Health
Resources and Services Administration (HRSA) of the Department of Health and
Human Services (HHS).
The Ryan White HIV/AIDS Treatment Modernization Act of 2006 (P.L. 109-
Unlike the previous reauthorization, which extended the program for five years, the
compromise legislation provided a three-year extension, eliminating the final two
years in the original version of the bill, which would have resulted in reduced funding
in certain areas. In addition, the provision at the end of P.L. 109-415, (Sec. 703)
repeals the Ryan White program, Title XXVI of the Public Health Service Act, as of
FY2010. Some members have expressed the intention to revisit Ryan White over the
next three years, to examine whether the structure of the entire program should be2
revamped to reflect the current distribution of HIV/AIDS in the United States.
P.L. 109-415 made a number of changes to the Ryan White program including
new methods of determining eligibility for Ryan White funds, new funding formulas,
and new limits on how the funds may be used. As a result of the reauthorization,
HRSA is now referring to the individual grant programs as Parts A, B, C, and D
instead of by their legislative Titles I, II, III, and IV. Funding for the individual grant
programs appears near the end of this report.
Part A (Title I) — Grants to Urban Areas
Part A provides funds to urban areas with high numbers of people living with
HIV, as well as mid-sized cities that have emerging needs for assistance with their
HIV-infected population. The boundaries of the areas are based on the Metropolitan
1 “About the Ryan White HIV/AIDS Program,” at [http://hab.hrsa.gov/aboutus.htm].
2 Statements of Senator Kennedy (Ryan White Act Set For Passage, US Federal News
Service, December 5. 2006) and Senator Schumer (New Jersey, New York Senators Release
Hold on Ryan White Act, US Federal News Service, December 5. 2006).
Statistical Areas of the U.S. Census Bureau and may range in size from one city or
county to multiple counties that cross state boundaries.
Under P.L. 109-415, Part A provides funds to eligible metropolitan areas
(EMAs) with a population of at least 50,000 that have had more than 2,000 reported
AIDS cases in the prior five years. An EMA would stop being eligible if it failed for
three consecutive years, to have (a) a cumulative total of more than 2,000 reported
cases of AIDS during the most recent five calendar years, and (b) a cumulative total
of 3,000 or more living cases of AIDS as of December 31 of the most recent year.3
Prior to P.L. 109-415, a total of 51 EMAs received funding in FY2006; currently
there are 22 EMAs.
The new law established a grant program for transitional grant areas (TGAs),
defined as metropolitan areas with at least 1,000 but fewer than 2,000 cumulative
AIDS cases during the most recent five calendar years. Unless a TGA became an
EMA, it would continue to be eligible as a TGA until it failed for three years to have
(a) at least 1,000 but fewer than 2,000 cases of AIDS during the most recent five
calendar years, and (b) 1,500 or more living cases of AIDS as of December 31 of the
most recent calendar year. A total of 29 areas that had been EMAs prior to P.L. 109-
415 received FY2007 funding as TGAs in March 2007. The new law also allowed
five metropolitan areas to receive funding as TGAs that were not previously eligible
as an EMA: Indianapolis, IN; Baton Rouge, LA; Charlotte, NC; Memphis, TN; and
Under P.L. 109-415, amounts reserved for Part A EMAs and TGAs would be
adjusted based, in part, on the changing eligibility status of metropolitan areas. If an
EMA failed to meet the eligibility criteria for three consecutive years and thus ceased
to be an EMA, in the first subsequent year, any amount reserved for EMAs would be
reduced by the amount of the formula grant received in the preceding fiscal year by
the metropolitan area that was no longer an EMA. If the former-EMA qualified as a
TGA, the amount reserved for TGA grants would increase by the amount of the
reduction in EMA reserved funds. If the former-EMA did not qualify as a TGA, the
amount by which EMA reserved funds decreased would be equal to $500,000 plus
the amount of the formula grant received in the preceding fiscal year by the
metropolitan area that was no longer an EMA; that money would be made available
for Part B grants. Similarly, if a TGA failed to qualify as a TGA and did not qualify
as an EMA, the amount reserved for TGA funds would be reduced by $500,000 plus
the amount of the formula portion of the TGA grant for the former-TGA in the
preceding fiscal year, and those funds would be made available for Part B grants. If
a TGA qualified as an EMA in a subsequent year, the amount reserved for TGA
grants would decrease by the amount of the grant made to the former-TGA in the
preceding FY and an equal amount would be reserved for EMA grants.
Under P.L. 109-415, 75% of Part A funds must be spent on core medical
services, defined as outpatient and ambulatory health services, AIDS Drug Assistance
Program (ADAP) treatments and pharmaceutical assistance, oral health care, early
3 If an EMA no longer qualified as an EMA for FY2007, it was treated as a transitional grant
area (TGA), even if it would not otherwise qualify as a TGA.
intervention services, health insurance premium and cost-sharing assistance, home
health, medical nutrition therapy, hospice, home and community-based health
services, mental health and substance abuse outpatient services, and medical case
management. The requirement may be waived if (1) there was no waiting list for
receiving treatment (under the Part B ADAP program), and, (2) core medical
services were available to all individuals with HIV/AIDS who were eligible to
receive such services under Part A. The remaining 25% of funds may be used for
support services, such as: outreach services; medical transportation; language
services; respite care for persons caring for individuals with HIV/AIDS; and, referrals
for health care and support services.
Under the new law, two-thirds of the Part A appropriation is distributed through
formula grants, and the remaining one-third is distributed via discretionary
supplemental grants awarded on the basis of need; the distribution under the old law
was approximately fifty-fifty. In March 2008, grant awards for EMAs and TGAs
were announced for FY2008.4 A report on the awarding of supplemental funds under
Part A is due to Congress not later than 45 days after the awards are made.
Prior to P.L. 109-415, formula grants had been distributed to EMAs in
proportion to an estimate of the number of living AIDS cases in each EMA.5 Under
P.L. 109-415, funding distribution is based on the number of living HIV and AIDS
cases in each EMA or TGA from states that use a names-based HIV reporting system.
The requirement for names-based reporting influenced a number of states to change
from code-based reporting. During 2006, eight states (Illinois, Maine, Delaware,
Washington, California, Oregon, Rhode Island, and Montana) switched, as did
Massachusetts in January 2007, and by the end of 2007, the remaining states
(Vermont, Maryland, and Hawaii) planned to switch to names-based reporting of
HIV cases.6 The Centers for Disease Control and Prevention (CDC) collects the
statistics used in the Ryan White formula. CDC initially indicated their preference
for names-based reporting in 1999 in order to avoid double counting; the agency
recommended names-based reporting in 2005. For purposes of the formula, areas in
states without a sufficiently accurate and reliable names-based reporting system will
4 FY2008 formula and supplemental grant awards can be found at
[http://newsroom.hrsa.gov/releases/2008/RWPartAMarch.htm]. FY2007 formula grant
awards can be found at [http://newsroom.hrsa.gov/releases/2007/partaformulaawards.htm]
and [http://newsroom.hrsa.gov/NewsBriefs/2007/TGAawards.htm]; FY2007 supplemental
grant awards can be found at [http://newsroom.hrsa.gov/releases/2007/citiesHIVAIDS.htm].
5 The number of living AIDS cases was estimated from the number of reported AIDS cases
over a 10-year period with weighting factors to reflect that not all reported cases were still
alive. Under the 2000 reauthorization (P.L. 106-345), statistics on HIV cases would have
been used in the Ryan White grant formulas as early as FY2005 if the Secretary of HHS
found that HIV incidence data were sufficiently accurate and reliable. In June 2004, the
Secretary determined that HIV case reporting was incomplete and could not be used to
distribute the grants. Under P.L. 106-345 HIV case data would have been used for
determining FY2007 grant amounts. However, P.L. 106-345 did not contain a transition
period for states that were moving to name-based HIV reporting, as recommended by the
CDC. P.L. 109-415 contains a three-year transition period for qualifying areas.
6 Carla K. Johnson, “HIV Patient Names to be Tracked in All 50 States by Year’s End,” The
Associated Press, April 1, 2007.
have a reduction of 5% in the number of non-AIDS HIV cases reported for the
eligible area to account for duplicate cases.7 In addition, the amount of the formula
grant in these areas may not exceed that of the preceding fiscal year by more than 5%.
Amounts made available due to this limitation would be used for supplemental Part
As was the case in the 1996 and 2000 reauthorizations, P.L. 109-415 has a hold
harmless provision that protects grantees from large decreases in funding.8 The hold
harmless provision is funded with money that would have been distributed through
Part A supplemental grants. If the supplemental funds were insufficient to fund the
hold harmless in a year, the Secretary would reduce on a pro rata basis the grant
amount for each EMA other than those eligible for the hold harmless provision,
though the reduction would not be allowed to result in any additional EMA becoming
eligible for the hold harmless provision. A hold harmless provision in the FY2008
Consolidated Appropriation Act (H.R. 2764, P.L. 110-161) also had an impact on the
FY2008 funding of Ryan White Part A grants to metropolitan areas.9
Part A grants are made to the chief elected official of the city or county in the
EMA that administers the health agency providing services to the greatest number of
persons with HIV. The official must establish an HIV Health Services Planning
Council, which sets priorities for care delivery according to federal guidelines.
Under P.L. 109-415, Planning Councils are not mandatory for TGAs, unless the TGA
was an EMA in FY2006. The Council may not be directly involved in the
administration of any Part A grant. Membership of the Council must reflect the
ethnic and racial make-up of the local HIV epidemic.
P.L. 109-415 contains new restrictions on the use of unexpended funds. Starting
in FY2007, if an eligible area does not obligate all supplemental grant funds within
one year of receiving the award, the eligible area will be required to return any
7 P.L. 109-415 identifies the states that had a system that provided sufficiently accurate and
reliable names-based reporting as of December 31, 2005: Alaska, Alabama, Arkansas,
Arizona, Colorado, Florida, Indiana, Iowa, Idaho, Kansas, Louisiana, Michigan, Minnesota,
Missouri, Mississippi, North Carolina, North Dakota, Nebraska, New Jersey, New Mexico,
New York, Nevada, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas,
Utah, Virginia, Wisconsin, West Virginia, Wyoming, Guam and the U.S. Virgin Islands.
8 P.L. 109-415 extended the hold harmless provision for three years for EMAs that received
a hold harmless grant amount in FY2006. For FY2007, an EMA that had received a hold
harmless grant amount in FY2006 would not receive less than 95% of a grant amount equal
to what the EMA would have gotten in FY2006 (including the hold harmless) if the FY2006
formula had distributed two-thirds of the FY2006 appropriation. For FY2008 and FY2009,
under the language of P.L. 109-415 the EMA would not receive less than 100% of the grant
amount for FY2007. The hold harmless does not apply to TGAs.
9 The provision in P.L. 110-161 ensures that an area’s total funding under Part A for FY2007
is not less than 86.6% of the amount of the area’s total funding under Part A for FY2006.
An October 5, 2007 Government Accountability Office (GAO) report, “Ryan White Care
Act: Impact of Legislative Funding Proposal on Urban Areas” (GAO-08-137R), analyzed
the impact of a previously proposed hold harmless provision in an FY2008 LHHS
appropriations bill (H.R. 3043) that was not enacted. The GAO report can be found at
[ h t t p : / / www.ga o.gov/ n ew.i t e ms / d08137r .pdf ] .
unobligated funds. Similarly, starting in FY2007, if an eligible area does not obligate
all formula grant funds within one year of receiving the award, the eligible area will
be required to return any unobligated funds. However, the eligible area may request
a waiver of the cancellation of formula grant funds, explaining how the eligible area
intended to spend the funds. If the waiver is approved, the eligible area will have one
year in which to spend the funds. If the funds are not spent by the end of the waiver
year, the eligible area will be required to return the unexpended funds. Regardless of
whether the waiver is granted, the eligible area’s formula grant funds will be reduced.
The reduction in formula grant funds will be equal to the amount of the unobligated
balance, and the reduction will not be taken into account in applying the hold
harmless provision for the subsequent fiscal year. The reduction in formula grant
funds will not apply if the unobligated balance was 2% or less. Any returned grant
funds will be additional amounts available for supplemental grants, subject to both
(1) the mandatory transfer of funds from Part A to Part B when a Part A area loses
eligibility, and (2) the hold harmless provision for Part A formula grants.
Part B (Title II) — Grants to States
Part B provides grants to all 50 states, the District of Columbia, Puerto Rico,
Guam, the U.S. Virgin Islands and five territories in the Pacific. Grant funds can be
used for home and community-based health care and support services or health
insurance coverage for low-income persons through Health Insurance Continuation
Programs. A major portion of Part B funding is used for drug treatments under the
AIDS Drug Assistance Programs (ADAPs) for individuals with HIV who cannot
afford to pay for drugs and have limited or no coverage from private insurance,
Medicaid, or Medicare Part D. In April 2008, grant awards for Ryan White Part B
grants were announced.10
P.L. 109-415 made changes to the formula used to distribute Part B base awards.
As in Part A, the formula uses the number of living HIV and AIDS cases rather than
an estimate of the number of living AIDS cases. The new Part B formula is based
on three factors: (1) 75% of the award is based on the state’s proportion of the
nation’s HIV/AIDS cases; (2) 20% is based on the state’s proportion of HIV/AIDS
cases outside Part A-funded areas (EMAs and TGAs); and (3) 5% is based on the
state’s proportion of HIV/AIDS cases in states with no Part A funding.11 States
without a sufficiently accurate and reliable names-based HIV reporting system will
have a reduction of 5% in the number of non-AIDS HIV cases reported for the state
to account for duplicate cases. For these same states, the amount of the grant may not
exceed that of the prior fiscal year by more than 5%. As is the case for Part A grants,
10 FY2008 Part B awards for base, ADAP and emerging communities grants can be found
at [http://www.hhs.gov/news/press/2008pres/04/20080404a.html]. FY2007 Part B grant
awards can be found at [http://www.hhs.gov/news/press/2007pres/20070405a.html].
11 The new formula attempts to correct for a problem under the old formula: states with
EMAs receive a larger amount of money, per case, than states without an EMA. U.S.
Government Accountability Office, Ryan White CARE Act: Factors that Impact HIV and
AIDS Funding and Client Coverage, GAO-05-841T, June 2005.
on support services (defined above). Two-thirds of the Part B appropriation (non-
ADAP) is used for the Part B base awards.
A new Part B supplemental grant program was created by P.L. 109-415.
Eligible states must have a demonstrated need for supplemental financial assistance
and not more than 2% of their grant funds cancelled, or waivers permitting carryover
of funds (see below). Priority in making supplemental grants is given to states with
a decline in funding under Part B due to the changes in the distribution formula.
Supplemental grant funds must be used for core medical services. One-third of the
Part B appropriation (non-ADAP) is reserved for these new supplemental grants. Not
later than 45 days after awarding supplemental funds under Part B, a report is due to
Congress concerning such funds.
A hold harmless provision was maintained under the new law.12 This provision
is funded by reducing the amount reserved for the new Part B supplemental grant
program, and by any unobligated funds repaid by the states (see below). If there are
insufficient funds for the hold-harmless provision, then P.L. 109-415 allows for a pro
rata reduction of all Part B state grants, excepting those states receiving
hold-harmless funds. However, such reductions will not be made in an amount that
results in other states becoming eligible for the hold harmless.
Starting in FY2007, states are required to obligate grant funds by the end of the
grant year for Part B formula grants, supplemental grants, emerging communities
grants, ADAP grants, and supplemental ADAP grants. For supplemental ADAP
grants, supplemental grants and emerging communities grants, if there is an
unobligated balance at the end of the grant year, the state must return the amount and
the funds will be used for additional supplemental grants (subject to the hold
harmless provision). For Part B formula grants and ADAP grants, if there is an
unobligated balance, the state must either return the unexpended funds, or apply for
a waiver to use the funds in the next fiscal year. If the waiver is approved, the funds
would be available for one more year, called the carryover year. If the state fails to
use the funds in the carryover year, the state must return the funds, which will be
used for supplemental grants (subject to the hold harmless provision). However, for
states with an unobligated balance for their Part B formula grant or an ADAP grant,
the amount of the grant for the next fiscal year will be reduced by the amount of the
unobligated balance, regardless of whether a waiver is approved, except if the
amount of the unobligated balance is 2% or less, then the reduction will not apply.
The funds from any such grant reduction will be used for supplemental grants
(subject to the hold harmless provision).
P.L. 109-415 also made changes to the grant program for emerging
communities, which are now defined as metropolitan areas with at least 500 and
fewer than 1,000 reported cases of AIDS during the most recent five calendar years.
The metropolitan area will continue to be an emerging community until the
metropolitan area fails for three consecutive fiscal years: (1) to have the required
12 For FY2007, a state can not receive less than 95% of the grant amount received in
FY2006. For FY2008 and FY2009, a state can not receive less than 100% of the FY2007
number of AIDS cases; and (2) to have a cumulative total of 750 or more living cases
of AIDS as of December 31 of the most recent calendar year. The grant amount will
be determined by the amount set aside by the Secretary (authorized at $5 million) and
by the proportion of the total number of living cases of HIV/AIDS in emerging
communities in the state to the total number of living cases of HIV/AIDS in
emerging communities in the United States.
P.L. 109-415 changes the way funds will be allocated to the state ADAPs. As
is the case for other Part A and Part B grants, ADAP funds are distributed based on
each state’s proportion of living HIV and AIDS cases rather than on an estimate of
the number of living AIDS cases. States without a sufficiently accurate and reliable
names-based HIV reporting system will have a reduction of 5% in the number of
non-AIDS HIV cases reported for the state to account for duplicate cases. For these
same states, the amount of the ADAP grant may not exceed that of the prior fiscal
year by more than 5%. A hold-harmless provision also applies to the ADAP
formula.13 The amount set aside for ADAP supplemental grants is changed from 3%
to 5% of the ADAP appropriation. States are eligible for supplemental ADAP grants
if they demonstrate a severe need to increase the availability of HIV/AIDS drugs.
P.L. 109-415 changes some of the eligibility criteria for the ADAP supplemental
grants. The new law allows the state-match requirement ($1 state for every $4
federal) for ADAP supplemental grants to be waived under certain circumstances.
However, states with 1% or less of the nation’s HIV/AIDS cases will be required to
provide matching funds in order to receive a supplemental ADAP grant. The new
law also establishes, for the first time, a formulary, that is, a list of HIV/AIDS
therapeutics that all ADAPs must provide. The list will be based on the Clinical
Practice Guidelines for use of HIV/AIDS Drugs.14
In previous years, many states have had to implement cost containment
measures, such as waiting lists, due to insufficient ADAP funds. In order to provide
assistance with this problem, on September 18, 2007, the Bush Administration
announced supplemental ADAP grants totaling $39.5 million to 14 states, the Virgin
Islands, and Puerto Rico.15 According to a report by the National Alliance of State
and Territorial AIDS Directors and the Kaiser Family Foundation, the new Medicare
Part D prescription benefit is also helping to alleviate the waiting lists, but as of
March 2008 one state (Montana) had a waiting list of three people.16
13 For FY2007, a state can not receive an ADAP grant that is less than 95% of what it
received in FY2006. For FY2008 and FY2009, a state can not receive less than 100% of the
FY2007 ADAP grant amount.
14 Guidelines are found at [http://www.aids.gov/treatment/drugs/].
15 A list of the September 18, 2007, supplemental ADAP grants can be found at
[http://newsroom.hrsa.gov/releases/2007/RyanWhitePartsBCD.htm]. Previously, the Bush
Administration announced on June 23, 2004, what it described as a one-time $20 million
initiative for 10 states with ADAP waiting lists (Alabama, Alaska, Colorado, Idaho, Iowa,
Kentucky, Montana, North Carolina, South Dakota, and West Virginia).
16 The National Alliance of State and Territorial AIDS Directors and the Henry J. Kaiser
Family Foundation, National ADAP Monitoring Project Annual Report, April 2008, at
[ h t t p : / / www.kf f .or g/ hi va i d s/ hi v040808pkg. cf m] .
Part C (Title III) — Early Intervention Services
Part C provides early intervention grants to public and private nonprofit entities
already providing primary care services to low-income and medically underserved
people at risk for HIV.17 Under P.L. 109-415, 75% of the Part C grant must be used
for core medical services, and not less than 50% of the grant must be used for early
intervention services. Part C grants are awarded to federally-qualified health centers,
family planning clinics, hemophilia centers, rural health clinics, Indian Health
Service facilities, and certain health facilities and community-based organizations
that provide early intervention services to people infected with HIV/AIDS through
intravenous drug use. Part C services include counseling, HIV testing, referrals,
clinical and diagnostic services regarding HIV/AIDS, and drug treatments under
Part D (Title IV) — General Provisions
Under P.L. 109-415, Part D provides grants to public and nonprofit entities for18
family centered care for women, infants, children, and youth with HIV/AIDS. Such
individuals are provided health care on an outpatient basis, case management,
referrals, other services to enable participation in the program, including services
designed to recruit and retain youth with HIV. Grantees must coordinate with
programs promoting the reduction and elimination of risk of HIV/AIDS for youth.
P.L. 109-415 requires that GAO conduct an evaluation of funding under Part D
that is used to (1) provide administrative expenses and indirect costs, outpatient or
ambulatory family-centered care, and additional services; and (2) to identify and
connect HIV-positive pregnant women and their children with health care to improve
health and prevent perinatal transmission of HIV.
Under prior law, Part E authorized grants for emergency response employees
and established procedures for notifications of infectious diseases exposure; Part E
was never funded. P.L. 109-415 deletes all the old Part E sections and inserts several
old sections (with some text changes) from Part D (on coordination, audits,
definitions, and a prohibition on promotion of intravenous drug use or sexual
activity) and two new sections on public health emergencies and certain privacy
17 FY2008 Part C grants will be announced in September 2008. FY2007 Part C grants were
released in April 2007 [http://newsroom.hrsa.gov/releases/2007/PartCgrantsApril2007.htm]
and in July 2007 [http://newsroom.hrsa.gov/releases/2007/PartCgrantsJuly2007.htm]. On
September 18, 2007, the Bush Administration announced $1.3 million in Part C grants
focused on building infrastructure rather than service delivery or patient care
18 FY2008 Part D grants will be announced in September 2008. FY2007 Part D grants were
released in August 2007 [http://newsroom.hrsa.gov/releases/2007/RyanWhiteAugust.htm].
On September 18, 2007, the Bush Administration announced $1 million in Part D expansion
GAO will submit a report every two years to Congress that includes (1) a
description of federal, state and local barriers to program integration, particularly for
racial and ethnic minorities, including activities carried out under the Minority AIDS
Initiative (MAI); and, (2) recommendations for enhancing the continuity of care and
the provision of prevention services for those with HIV/AIDS or at risk for
HIV/AIDS. The report will include a demonstration of the manner in which funds
under the MAI are being expended and to what extent the services provided with
such funds increase access to prevention and care services for individuals with
HIV/AIDS and build stronger community linkages to address HIV prevention and
care for racial and ethnic minority communities.
The Secretary of HHS must develop a severity of need index by September 30,
2008. As defined in P.L. 109-415, a severity of need index means “the index of the
relative needs of individuals within a State or area, as identified by a number of
different factors, and is a factor or set of factors that is multiplied by the number of
living HIV/AIDS cases in a State or area, providing different weights to those cases
based on needs. Such factors or set of factors may be different for different
components of the provisions under this title.” If the severity of need index is not
completed by the deadline, then a report must be prepared for Congress that provides
information on obtaining client level data, the progress toward developing the index
and whether the index will be ready before FY2009.
Part F — Demonstration and Training
Part F provides support for the AIDS Dental Reimbursement (ADR) Program,
the AIDS Education and Training Centers (AETCs), and the Special Projects of
National Significance (SPNS) Program. P.L. 109-415 codifies the Minority AIDS
Initiative (MAI) as part of the Ryan White program under Part F.19 MAI provides
funding for grants under the Ryan White program that evaluate and address the
disproportionate impact of HIV/AIDS on racial and ethnic minorities.20
The ADR program reimburses dental schools for their treatment of AIDS
patients. The AETC program provides training for health providers in the prevention
of perinatal HIV transmission and the prevention and treatment of opportunistic
infections. Both the dental and the AETC programs were transferred legislatively
from Title VII of the PHS Act.
19 In 1998 the White House announced a series of initiatives targeting appropriated funds
for HIV/AIDS prevention and treatment programs in minority communities. The
Congressional Black Caucus worked with the Clinton Administration to formulate the
approach. For FY2007, a total of $399 million was provided to continue these activities at
the following agencies and offices: HRSA; CDC; National Institutes of Health; Substance
Abuse and Mental Health Services Administration; Minority Communities Fund; Office of
Minority Health; Office of Women’s Health.
20 FY2008 MAI awards will be announced in August 2008. FY2007 MAI awards for Part
A and Part B were announced in August 2007 [http://newsroom.hrsa.gov/releases/2007/
Under P.L. 109-415, the SPNS program awards grants to entities eligible for
funding under Parts A, B, C, and D to: (1) quickly respond to emerging needs of
persons receiving assistance under this title; and (2) develop a standard electronic
client information data system to improve grantee reporting of client-level data to the
Secretary. P.L. 109-415 provides new criteria for making grant awards that are
focused on: obtaining client-level data to create a severity of need index; creating and
maintaining a safe, secure, reliable qualified health information technology system;
or, newly emerging needs of persons receiving assistance under this title. Under
statute, the SPNS program is to be funded, up to $25 million, from amounts
appropriated for Parts A, B, C, and D; this was not changed by P.L. 109-415.
However, beginning in FY2003, each Labor-HHS appropriation bill has provided
$25 million for the SPNS program via a funding mechanism known as the “PHS
evaluation tap.”21 The $25 million is divided, roughly proportionately, between the
four Ryan White Parts (A, B, C, D), which then make the individual SPNS grant
21 The tap, authorized under section 241 of the PHS Act, transfers money among PHS
agencies for particular activities as specified by the appropriators. Although section 241 [42
USC 238j] states that the evaluation tap should be no more than 1% of PHS program
appropriations, the conference reports for the L-HHS Appropriation acts have set the tap at
not more than 2.1% in FY2003 (H.Rept.108-10), 2.2% in FY2004 (H.Rept.108-401), 2.4%
in FY2005 (H.Rept.108-792), and 2.4% in FY2006 (H.Rept. 109-337).
Table 1. Federal Funding for the Ryan White Program
($ in millions)
(ADAP)Part FPart F
Part APart B(non-add)Part CPart DPart EAETCADRTotal
FY199187.887.8 — 44.919.5017.0 — 257.0
FY1992121.6107.6 — 48.719.3016.9 — 314.1
FY1993184.8115.3 — 48.020.9016.4 — 385.4
FY1994325.5183.9 — 48.022.0016.47.0602.8
FY1995356.5198.1 — 52.026.0016.36.9655.8
FY1996 391.7 260.8 (52) 57.0 29.0 0 12.0 6 .9 757.4
FY1997 449.8 417.0 (167) 69.6 36.0 0 16.3 7 .5 996.3
FY1998 464.7 542.8 (285.5) 76.2 40.8 0 17.2 7 .8 1,150.2
FY1999 505.0 737.8 (461.0) 94.3 46.0 0 20.0 7 .8 1,410.9
FY2000 546.3 823.8 (528.0) 138.4 51.0 0 26.6 8 .0 1,594.2
FY2001 604.2 910.9 (589.0) 185.9 65.0 0 31.6 10.0 1 ,807.6
FY2002 619.4 977.2 (639.0) 193.8 71.0 0 35.3 13.5 1 ,902.2
FY2003 a 618.7 1 ,053.4 (714.3) 198.4 73.6 0 35.6 13.4 1 ,993.0
FY2004 a 615.0 1 ,085.9 (748.9) 197.2 73.1 0 35.3 13.3 2 ,019.9a
FY2005 610.1 1 ,121.8 (787.5) 195.6 72.5 0 35.1 13.2 2 ,048.3
FY2006 a 603.6 1 ,119.7 (789.0) 193.5 71.7 0 34.6 13.1 2 ,036.3a
FY2007 604.0 1 ,195.5 (789.5) 193.7 71.8 0 34.7 13.1 2 ,112.8
FY2008 a 627.1 1 ,195.2 (808.5) 198.8 73.7 0 34.1 12.9 2 ,141.8a
Request 619.4 1 ,209.5 (814.5) 198.8 73.7 0 28.7 12.9 2 ,142.9
Sources: HRSA FY2009 Justification of Estimates for Appropriations Committees. May not add
due to rounding.
a. The total does not include $25 million for SPNS provided via the PHS program evaluation tap
(section 241 of the PHS Act).