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The HIV/AIDS Program: Part B

Part B of the Ryan White HIV/AIDS Treatment Modernization Act of 2006 provides grants to all 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and five U.S. Pacific Territories or Associated Jurisdictions. Part B grants include a base grant, the AIDS Drug Assistance Program (ADAP) award, ADAP Supplemental grants and grants to States for Emerging Communities-those reporting between 500 and 999 cumulative reported AIDS cases over the most recent 5 years. All funding is distributed via formula and other criteria.

Part B funds may be used to fund 75% core medical services which include: outpatient and ambulatory health services, ADAP, AIDS pharmaceutical assistance, oral health care, early intervention services, health insurance premium and cost sharing assistance, home health care, medical nutrition therapy, hospice care, community-based health services, substance abuse outpatient care, medical case management, include treatment adherence services.

The remaining 25% must fund support services that are needed for individuals with HIV/AIDS to achieve their medical outcomes (such as respite care for persons caring for persons caring for individuals with HIV/AIDS, outreach services, medical transportation, linguistic services, and referrals for health care and support services.

In FY07, a total of $1.195 billion was appropriated to Part B programs, of which $789,546 million was earmarked for ADAP. Read more about the ADAP Program below.

  • Base Part B grants are awarded to States and Territories using a formula that, based on living cases of HIV/AIDS reported data. Also States with more than 1% of total AIDS cases reported in the United States during the previous 2 years must provide matching funds with their own resources using a formula outlined in the legislation.
  • Additional Part B funds are "earmarked" for ADAP, which primarily provide medications. Fundable services also include treatment adherence and support as well as health insurance coverage with prescription drug benefits. 5% of the ADAP earmark is reserved for grants to States and Territories that have a severe need for medication assistance.
  • A new Supplemental competitive programs is now available to States and Territories based on demonstrated need criteria. This program has not been funded to date.
  • Part B provides $5.0 million in supplemental grants to States for Emerging Communities-cities with between 500 and 999 reported AIDS cases in the most recent 5 years.
  • Part B provides a competitive grant of $7 million for the Minority AIDS Initiative to provide education and outreach services to increase the number of eligible racial and ethnic minorities who have access to treatment through Part B.
Part B providers may include public or nonprofit entities. For-profit entities are eligible only if they are the sole available providers of quality HIV care in the area.

Most States provide some services directly, but others work through subcontracts with Part B HIV Care Consortia. A consortium is an association of public and nonprofit health care and support service providers and community-based organizations that plans, develops, and delivers services for people living with HIV disease. Services provided through a consortium is considered support services.


The ADAP provides medications for the treatment of HIV disease. Program funds may also be used to purchase health insurance for eligible clients and for services that enhance access to, adherence to, and monitoring of drug treatments.


  • Grants are awarded to all 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and the Pacific jurisdictions
  • Congress "earmarks" funds that must be used for the ADAP, an important distinction because other Part B spending decisions are made locally. The ADAP earmark grew from $52 million in 1996 to $789,005 million in 2006 and $789,546 million in 2007. In FY08 the appropriation is $808,500 million. However, total ADAP spending is even higher, because State ADAPs also receive money from their respective States, from other Ryan White HIV/AIDS Program compenents, and through cost-saving strategies.
  • A formula based on the most recent calendar year of living HIV/AIDS cases is used to award ADAP funds to States and Territories. However, 5% of the total earmark is reserved for supplemental grants to States and Territories with demonstrated severe need that prevents them from providing medications consistent with Public Health Service guidelines. In previous years, estimated living cases of AIDS was used in determining the formula and 3% was reserved for supplemental grants.


The ADAP in each State and Territory is unique in that it decides which medications will be included in its formulary and how those medications will be distributed. New legislation requires that each State/Territory establish of a list of drug classes under which ADAPs must provide therapeutics.

  • Many States and Territories provide medications through a pharmacy reimbursement model. Patients show enrollment cards at participating pharmacies to receive their medications, and the pharmacy invoices the ADAP for payment.
  • Some ADAPs use pharmacies located within public health clinics to distribute drugs.
  • A few ADAPs purchase drugs and mail them to clients directly.


Each State and Territory establishes its own eligibility criteria. However, all States/Territories are required to implement an ADAP recertification process every six months to ensure only eligible clients are served. All require that program participants document their HIV status.

Increasing Demand

Pressure on ADAP resources has increased substantially.

  • Highly active antiretroviral therapy (HAART) is the standard of care for the majority of people living with HIV disease. Its cost may be $12,000 or more per year, in addition to the costs of addressing opportunistic infections, side effects, and other treatment issues.
  • AIDS mortality has decreased dramatically in the United States since 1995, and HIV incidence remains constant at approximately 40,000 new infections annually. Therefore, the total number of people living with HIV disease continues to climb.
  • The epidemic is growing rapidly among minorities, who have historically experienced higher risk for poverty, lack of health insurance, comorbidity, and disenfranchisement from the health care system. The result is a growing number of people living with HIV disease who require public support.