Funding Mechanism: Grants to local agencies
Total Available Funding: The Ryan White HIV/AIDS Program is authorized and funded under Title XXVI of the Public Health Services Acts, as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009. The FY 2010 appropriation for all Ryan White HIV/AIDS Program activities was $2.29 billion.
Number of Awards: 2081 providers received awards in FY 2009
Average Award Amount per Year: Range: $15,587 (a Part C grantee) to $164,425,258 (a Part B grantee)
Length of Project Period: Annual Congressional Appropriation by Fiscal Year
Federal Partners: HRSA works with other Federal agencies on the following partnerships to improve HIV care systems:
- US Department of Health and Human Services
- CDC/ HRSA Advisory Committee on HIV and STD Prevention and Treatment
- Centers for Medicare & Medicaid
- Centers for Disease Control and Prevention
- National Institutes of Health
- Agency for Healthcare Research and Quality
- Office of the Deputy Secretary for Health, Infectious Diseases
- US Department of Housing and Urban Development
- Housing Opportunities for People Living with AIDS
- Veterans Administration
Summary: HRSA’s Ryan White HIV/AIDS Program is the largest Federal program designed specifically for people living with and affected by HIV/AIDS. It provides healthcare and support services to individuals and families affected by HIV/AIDS, filling-in the gaps in care and treatment for the underinsured and uninsured. This program is administered by the HIV/AIDS Bureau within HRSA.
The Ryan While HIV/AIDS Program reaches more than 533,000 people each year. People living with HIV disease are, on average, poorer than the general population, and Program clients are poorer still. For them, the Program is the payer of last resort, because they are uninsured or have inadequate insurance and cannot cover the costs of care on their own and because no other source of payment for services, public or private, is available.
- Most Ryan White HIV/AIDS Program clients are from a racial or ethnic minority group. In 2008, more than 70 percent of Program clients self-identified as members of racial or ethnic minority groups.
- In 2008, 67 percent of Program clients were male, and 33 percent were female.
The Ryan White HIV/AIDS Program addresses the disproportionate impact of HIV/AIDS on the poorest and most disenfranchised Americans, and the program helps to remedy the overwhelming strain on local health and social service resources by promoting the creation of more affordable and responsive HIV/AIDS care options
The program funds:
- Care of individuals living with HIV disease;
- Care for HIV-positive mothers, children, and their families;
- Training for clinicians who treat HIV-positive individuals; and
- The development of innovative programs that improve treatment outcomes.
The Ryan White HIV/AIDS Program is divided into several “Parts,” following from the authorizing legislation.
Part A Part A provides grant funding for medical and support services to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs) — population centers that are most severely affected by the HIV/AIDS epidemic. EMA eligibility requires an area to report more than 2,000 AIDS cases in the most recent 5 years and to have a population of at least 50,000. To be eligible as a TGA, an area must have at least 1,000 reported but fewer than 2,000 new AIDS cases in the most recent 5 years. The FY 2010 Part A appropriation was approximately $679.1 million.
Part B Part B provides grants to States and Territories to improve the quality, availability, and organization of HIV/AIDS health care and support services. Part B grants include a base grant; the AIDS Drug Assistance Program (ADAP) award; ADAP Supplemental Drug Treatment Program funds; and supplemental grants to States with “emerging communities,” defined as jurisdictions reporting between 500 and 999 cumulative AIDS cases over the most recent 5 years. Congress designates, or “earmarks,’ a portion of the Part B appropriation for ADAP. With the dramatic increase in the cost of pharmaceutical treatment, the ADAP earmark is now the largest portion of Part B spending.
The FY 2010 Part B appropriation was approximately $1.25 billion of that, $835 million was for ADAP. Five percent on the ADAP earmark is set aside for the ADAP Supplemental Drug Treatment Program, which assists states needing additional ADAP funds.
Part B provides $5 million in supplemental grants to states for Emerging Communities. In 2009, $50,000 awards were made to two newly eligible U.S. Pacific Territories ( American Samoa and the Commonwealth of the Northern Mariana Islands) and three Associated Jurisdictions (the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau).
Part C Part C supports outpatient HIV early intervention services and ambulatory care. Unlike Part A and Part B grants, which are awarded to local and state governments that contract with organization to deliver services, Part C grants are awarded directly to service providers, such as ambulatory medical clinics. Part C also funds planning grants, which help organization more effectively deliver HIV/AIDS care and services. The FY 2010 Part C appropriation was approximately $206.8 million.
Part D Part D grants provide family-centered comprehensive care to children, youth, and women and their families and help t o improve access to clinical trials and research. In FY 2010, Part D programs received approximately $77.8 million in appropriations.
Part F Part F grants support several research, technical assistance, and access to care programs.
The Special Projects of National Significance (SPNS) Program supports the demonstration and evaluation of innovative models of HIV/AIDS care delivery to hard-to-reach populations. SPNS also funds special programs to support the development of standard electronic client information data systems by Ryan White HIV/AIDS Program grantees. A total of $25 million set aside for the SPNS Program in FY 2010.
The AIDS Education and Training Centers (AETC) Program supports education and training of health care providers through at network of 11 regional and 4 national centers. In FY 2010, the AETC appropriation was approximately $34.8 million.
Minority AIDS Initiative (MAI) was established in FY 1999 via the Congressional appropriations process to provide funding to improve access to HIV/AIDS care and health outcomes for disproportionately impacted minority populations, under Parts A, B, C, and D. The types of MAI-funded services provided under Parts A, C, and D were consistent with their 'base' programs while the Part B MAI focused on education and outreach to improve minority access to state ADAPs. The MAI was then codified with respect to each Part by the Ryan White HIV/AIDS Treatment Modernization Act of 2006, which also made the Part A and B MAI separated, competitive grant programs for EMA/TGAs and states respectively. However, under the Ryan White HIV/AIDS Treatment Extension Act of 2009, the Congress directed that both be returned to a formula grant basis and 'synchronized' with the Part A and B grant awards, similar to the Parts C and D MAI.
All grant programs of the Ryan White HIV/AIDS Treatment Extension Act of 2009 can support the provision of oral health services. Two Part F programs, however, specifically focus on funding oral health care for people with HIV:
- The HIV/AIDS Dental Reimbursement Program reimburses dental schools, hospitals with postdoctoral dental education programs, and community colleges with dental hygiene programs for a portion of uncompensated cost incurred in providing oral health treatment to patients with HIV disease
- The Community — Based Dental Partnership Program supports increased access to oral health care services for people who are HIV positive while providing education and clinical training for dental care providers, especially those practicing in community-based settings.
In total, the Dental Program receives a combined $13.6 million in appropriations in FY 2010.
The Ryan White HIV/AIDS Program has a “Living History” project ( URL: http://hab.hrsa.gov/livinghistory/index.htm). The main purpose of this project is to document and honor, in a creative way, the history, knowledge, and experiences of those who have contributed much to the Nation’s response to providing HIV/AIDS care and treatment services to those living with the disease and their families. One experience that is chronicled is the voice of Curtis (URL: http://hab.hrsa.gov/livinghistory/voices/curtis.htm). In this narrative, we learn of the experience of a man named Curtis who learned of his diagnosis with AIDS just prior to entering prison and the role the Ryan White HIV/AIDS Programs played in helping him re-enter the community as a person living with HIV/AIDS after he had paid his debt to society.
Background: The AIDS epidemic has taken an enormous toll since its onset in the early 1980s. Approximately 583,000 Americans have died from the disease, and many others are living with HIV-related illness and disability of caring for people with the disease. An estimated 56,000 Americans become infected with HIV each year, and more that 1.1 million Americas are living with HIV disease. The epidemic has hit hardest among populations who are poor, lack health insurance, and are disenfranchised from the health care system, and are from communities of color.
In response, Congress enacted the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in August 1990 to improve the quality and availability of care for low-income, uninsured, and underinsured individuals and families affected by HIV disease. The CARE Act was amended and reauthorized in 1996, 2000, and 2006; in 2009 it was reauthorized as the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87).
Grantees: The Ryan White HIV/AIDS Program has at least one grantee in every state in the Nation, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands, and the U.S. territories.
Evaluation Activities: The Division of Science and Policy (DSP) of the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), is HAB’s focal point for program data collection and evaluation, development of innovative models of HIV care, and coordination of program performance activities and development of policy guidance.
The three branches within the DSP have distinct roles that support evaluation activities:
- The Demonstration and Evaluation Branch manages the Special Projects of National Significance (SPNS) program. SPNS activities are described in greater detail in a separate inventory entry.
- The Epidemiology and Data Branch directs all program data collection and analysis activities. The branch is responsible for coordinating, conducting and documenting all HIV/AIDS science and evaluation studies and related scientific research, program evaluation, and epidemiology. One of the many activities of this branch includes analyzing health care data (including trends in health care availability, organization, and financing) to assess whether HAB’s activities address the needs of people living with HIV/AIDS in an effective, efficient manner.
- The Policy Development Branch develops and coordinates program policies and supports HAB policy development and implementation. Additionally, the branch monitors, analyzes, and assesses HIV/AIDS-related policy development activities, both within and outside of HHS, for potential impact on the Ryan White HIV/AIDS Program, and it develops recommendations for HAB’s response.
Future Prospects: The Ryan White HIV/AIDS Program is authorized through FY 2013.
RADM Deborah Parham-Hopson, PhD, RN, FAAN
Assistant Surgeon General, US Public Health Service and
Associate Administrator, HIV/AIDS Bureau, Health Resources and Services Administration