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Ryan
White HIV/AIDS Program, Part A Emergency Relief Grants
|
FY
2007
Actual |
FY
2008
Enacted |
FY
2009
Request |
FY
2009 +/-
FY 2008 |
BA
|
$603,993,000
|
$627,149,000 |
$619,424,000 |
-$7,725,000 |
Authorizing
Legislation: Title XXVI, Sections 2601-2610 of the
Public Health Service Act, as amended.
FY
2009 Authorization |
$649,500,000
|
Allocation
Method |
Competitive
and Formula Grants, Cooperative Agreements and
Contracts |
Program Description and Accomplishments
Part A of the Ryan White HIV/AIDS Program prioritizes
primary medical care, access to anti-retroviral therapies,
and medical case management as the areas of greatest
need for persons with HIV disease. Part A funds may
be used to provide a continuum of care for people
living with HIV disease who are primarily low income,
underserved, uninsured and underinsured. The grants
fund systems of care to provide 13 core medical services
and other additional support services for individuals
with HIV/AIDS in 22 Eligible Metropolitan Areas (EMAs),
which are jurisdictions with over 2,000 living AIDS
cases over the last five years and 34 transitional
grant areas (TGAs) (jurisdictions with between 1,000
and 2,000 living AIDS cases over the last five years).
Two-thirds of the funds available are awarded according
to a formula based on the number of living cases of
HIV/AIDS in the EMAs and TGAs. The statute also includes
a hold harmless provision which limits a potential
loss in EMA’s formula award to a specific percentage
of the amount of the award in the previous year. The
remaining funds, less any hold harmless amounts, are
awarded as discretionary supplemental grants based
on the demonstration of additional need by the EMAs
and TGAs and as competitive Minority AIDS Initiative
grants.
More than 70 percent of all people living with HIV/AIDS
in the U.S. reside in a metropolitan area served by
Part A. Part A serves an estimated 300,000 people
living with HIV/AIDS each year. Seventy-five percent
of Part A clients are people of color and 30 percent
are women. In 2004 Part A provided 3.11 million visits
for health-related care (primary medical, dental,
mental health, substance abuse, rehabilitative, and
home health) and 3.18 million visits were provided
in 2005. In FY 2006, 2.47 million visits were provided
by 51 Part A grantees. This number is 440,000 below
the 2006 target. The decrease in visits for FY 2005
and FY 2006 is may be a result of the decline in Ryan
White HIV/AIDS Program resources available for funding
service provision, which resulted in fewer PART A
providers and clients, and the impact of healthcare
inflation.
Cervical Intraepithelial Neoplasia (CIN) refers to
cellular changes in the cervix, thought to be precursors
of cervical cancer that can be detected with PAP screening.
Researchers conclude that HIV+ women are three times
as likely as HIV negative women to have CIN. Part
A has continued to increase the proportion of women
that receive PAP screening. In 2005, 38% of women
received PAP screening and in 2004 35.8% of women
received such screening. In FY 2006, the Part A program
provided 40.8% of women served with PAP screening.
This fell short of the target by 6.6 percentage points.
Latent TB is much more likely to become active TB
in someone who is HIV infected. This is because HIV
weakens the immune system, allowing TB to flourish.
The CDC recommends HIV-infected persons get tested
for TB, with a TB Skin Test (TST). The Part A program
provided TB skin tests to 28% of clients in 2004,
and 54% of client in 2005. In FY 2006, the Part A
program provided 52.5% of clients with TB skin tests.
This exceeded the target by 18.5 percentage points.
Program Assessment Rating Tool: Part
A was included in the combined PART reassessment conducted
in 2007 for the Ryan White HIV/AIDS Program. The Program
received an Effective rating. See Summary of Request
for more details.
External Evaluation: Part A is regularly
evaluated by independent entities, such as Office
of the Inspector General and Government Accountability
Office. In the past year an OIG Audit was conducted
entitled “Review of the Management of Unobligated
Funds Provided by Part A of the Ryan White Comprehensive
AIDS Resources Emergency Act” (A-02-03-02006)
(Final Report - February 2007). The findings of these
Audits indicated that HRSA did not always comply with
Departmental policy that limit the carryover of unobligated
grant balances to the next budget year only. These
funds were originally awarded to provide services
during a specific budget year but were carried over
for use in subsequent budget periods. Departmental
policy guidance issued after the audit period now
permits the carryover of unobligated grant funds into
either of the next two budget periods. HAB has taken
appropriate steps and follows current Departmental
policy regarding the approval of carryover requests
from Part A grantees.
The GAO conducted an evaluation in the past year entitled
“Impact of Legislative Funding Proposal on Urban
Areas” (GAO-08-137R) (Final Report - October
2007). The Legislative Funding Proposal found that
prior to the Ryan White HIV/AIDS Treatment Modernization
Act of 2006 (enacted December 19, 2006), the Part
A funding amounts were evenly split between formula
and supplemental grants. The new legislation changed
the distribution such that two-thirds of Part A funds
are distributed as formula grants and one-third as
supplemental grants. The findings showed how the proposed
hold-harmless provision from H.R. 3043 would impact
funding for urban areas under the proposed funding
levels.
Funding includes costs associated with grant reviews,
processing of grants through the Grants Administration
Tracking and Evaluation System (GATES) and HRSA’s
electronic handbook, and follow-up performance reviews.
Funding History
FY |
Amount
|
FY
1999 |
$
505,039,000 |
FY
2000 |
$
546,392,000 |
FY
2001 |
$
604,169,000 |
FY
2002 |
$
619,381,000 |
FY
2003 |
$
618,693,000 |
FY
2004 |
$
615,023,000 |
FY
2005 |
$
610,094,000 |
FY
2006 |
$
603,576,000 |
FY
2007 |
$
603,993,000 |
FY
2008 |
$
627,149,000 |
Excludes
comparable amounts for SPNS
Budget Request
The FY 2009 Request of $619,424,000 is $7,725,000
below the FY 2008 Enacted level but does support authorized
program activities and services in the 22 Eligible
Metropolitan Areas and 34 Transition Grant Areas.
The FY 2009 target for the number of visits for health-related
care (primary medical, dental, mental health, substance
abuse, rehabilitative, and home health) to the level
that approximates inclusion of new clients is set
at 2.44 million visits. The proportion of women that
receive PAP screening has a FY 2009 target 45.9% (baseline
plus 1.5%). The FY 2009 target for the proportion
of clients that receive TB skin test will be to sustain
the FY 2008 result. Part A funding will also contribute
to achieving the FY 2009 targets for the Ryan White
Program’s over-arching performance measures,
including proportion of racial/ethnic minorities and
women served, persons tested for CD4 count and viral
load, and providers implementing a quality management
program. (See Summary of Request for targets and for
strategies and challenges.)
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Target |
Actual |
Target |
Actual |
Long
– Term Objective: Promote Effectiveness of Health
Care Services |
17.III.A.1. |
Proportion of women that receive
PAP screening. |
35.80% |
38% |
Baseline plus 1.5% |
40.80% |
Baseline plus 1.5% |
Oct-08 |
Baseline plus 1.5% |
Baseline plus 1.5% |
17.III.A.2. |
Proportion of clients that receive
TB skin tests. |
28% |
54% |
1.5% over
FY 05 |
52.50% |
Sustain FY 06 |
Oct-08 |
Sustain FY 07 |
Sustain FY 08 |
# |
Key
Outputs |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Enacted |
FY
2009 Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long
– Term Objective: Expand the Capacity of the Health
Care Safety Net |
17.I.A.1. |
Number of visits for health-related care (primary
medical, dental, mental health, substance abuse,
rehabilitative, and home health) to a level that
approximates inclusion of new clients. |
3.11 M |
3.18 M |
2.91 M |
2.47 M |
2.91 M |
Jan-09 |
2.47 Ma |
2.44 M |
|
EMAs |
51 |
51 |
|
51 |
|
|
|
|
|
EMAs and Transitional areas |
|
|
|
|
|
56 |
56 |
56 |
|
Appropriated Amount ($ Million) |
$615.02 |
$610.09 |
|
$603.58 |
|
$603.99 |
$627.15 |
$619.42 |
Notes:
a This FY 2008 target was changed from that shown
in the FY 2008 Congressional Justification to be consistent
with recent performance.
FY 2007 Ryan White HIV/AIDS Treatment Modernization
Act of 2006
Part A - Formula & Supplemental Grants
EMAs |
Formula |
Supplemental |
Total |
Atlanta, GA |
$ 12,223,780 |
$ 3,850,505 |
$ 16,074,285 |
Baltimore, MD |
13,101,233 |
5,186,790 |
18,288,023 |
Boston, MA |
9,091,554 |
3,769,583 |
12,861,137 |
Chicago, IL |
16,477,405 |
6,888,727 |
23,366,132 |
Dallas, TX |
9,137,396 |
3,640,608 |
12,778,004 |
Detroit, MI |
5,648,743 |
2,073,152 |
7,721,895 |
Ft. Lauderdale, FL |
9,444,098 |
3,727,245 |
13,171,343 |
Houston, TX |
12,780,890 |
5,120,182 |
17,901,072 |
Los Angeles, CA |
23,182,654 |
9,552,345 |
32,734,999 |
Miami, FL |
16,014,327 |
6,481,882 |
22,496,209 |
New Orleans, LA |
4,944,054 |
1,770,338 |
6,714,392 |
New York, NY |
74,867,223 |
25,998,357 |
100,865,580 |
Newark, NJ |
9,089,812 |
3,552,687 |
12,642,499 |
Orlando, FL |
5,503,524 |
1,980,246 |
7,483,770 |
Philadelphia, PA |
14,920,594 |
5,037,001 |
19,957,595 |
Phoenix, AZ |
4,970,250 |
1,811,234 |
6,781,484 |
San Diego, CA |
6,769,231 |
2,912,131 |
9,681,362 |
San Francisco, CA |
14,672,553 |
4,134,300 |
18,806,853 |
San Juan, PR |
9,415,282 |
2,553,297 |
11,968,579 |
Tampa-St. Petersburg, FL |
6,330,047 |
2,345,441 |
8,675,488 |
Washington, DC |
18,759,719 |
6,895,292 |
25,655,011 |
West Palm Beach, FL |
5,769,416 |
1,949,450 |
7,718,866 |
|
$303,113,785 |
$111,230,793 |
$414,344,578 |
TGAs |
Formula |
Supplemental |
Total |
Austin, TX |
$2,311,513 |
$1,073,557 |
$3,385,070 |
Bergen-Passaic, NJ |
2,480,997 |
1,101,476 |
3,582,473 |
Caguas, PR |
690,977 |
269,503 |
960,480 |
Cleveland, OH |
2,606,155 |
1,060,413 |
3,666,568 |
Denver, CO |
4,860,304 |
1,925,546 |
6,785,850 |
Dutchess County, NY |
719,007 |
339,616 |
1,058,623 |
Ft. Worth, TX |
2,298,475 |
940,508 |
3,238,983 |
Hartford, CT |
2,003,833 |
913,750 |
2,917,583 |
Jacksonville, FL |
3,078,757 |
1,414,071 |
4,492,828 |
Jersey City, NJ |
2,831,049 |
1,286,939 |
4,117,988 |
Kansas City, MO |
2,524,021 |
1,013,510 |
3,537,531 |
Las Vegas, NV |
3,251,501 |
1,193,110 |
4,444,611 |
Middlesex-Somerset-Hunterdon, NJ |
1,599,025 |
701,085 |
2,300,110 |
Minneapolis-St. Paul, MN |
2,963,378 |
1,240,032 |
4,203,410 |
Nassau-Suffolk, NY |
3,130,907 |
1,358,744 |
4,489,651 |
New Haven, CT |
3,278,228 |
1,501,862 |
4,780,090 |
Norfolk, VA |
3,390,349 |
1,284,883 |
4,675,232 |
Oakland, CA |
3,781,868 |
1,663,113 |
5,444,981 |
Orange County, CA |
3,328,279 |
1,345,454 |
4,673,733 |
Ponce, PR |
1,101,000 |
445,740 |
1,546,740 |
Portland, OR |
2,120,010 |
957,919 |
3,077,929 |
Riverside-San Bernardino, CA |
4,389,913 |
2,074,448 |
6,464,361 |
Sacramento, CA |
1,472,863 |
689,474 |
2,162,337 |
St. Louis, MO |
3,471,180 |
1,424,275 |
4,895,455 |
San Antonio, TX |
2,441,234 |
949,837 |
3,391,071 |
San Jose, CA |
1,596,809 |
604,404 |
2,201,213 |
Santa Rosa, CA |
725,352 |
265,582 |
990,934 |
Seattle, WA |
4,051,676 |
1,667,482 |
5,719,158 |
Vineland-Millville-Bridgeton, NJ |
518,884 |
196,470 |
715,354 |
Baton Rouge, LA |
2,179,184 |
831,337 |
3,010,521 |
Charlotte-Gastonia, NC-SC |
2,854,516 |
974,327 |
3,828,843 |
Indianapolis, IN |
2,277,616 |
763,694 |
3,041,310 |
Memphis, TN |
3,585,906 |
1,432,797 |
5,018,703 |
Nashville, TN |
2,541,621 |
938,981 |
3,480,602 |
|
$86,456,387 |
$35,843,939 |
$122,300,326 |
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