• Contents
• Introduction
• Study 1: Ryan White CARE Act Reauthorization 2005: Title I and Title II Health Services Expenditure Patterns
• Study 2: Examination of Key Fiscal Issues Related to Grantees of the Ryan White Comprehensive AIDS Resources Emergency Act
• Study 3: Assessing the Impact of the Ryan White CARE Act Title II Emerging Communities Formula Grant Program

Contents

Study 1: Ryan White CARE Act Reauthorization 2005: Title I and Title II Health Services Expenditure Patterns 1

Study 2: Examination of Key Fiscal Issues Related to Grantees of the Ryan White Comprehensive AIDS Resources Emergency Act 9

Study 3: Assessing the Impact of the Ryan White CARE Act Title II Emerging Communities Formula Grant Program 35

Introduction

Since its initial passage in 1990, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act has been critical in ensuring access to HIV care and treatment for hundreds of thousands of persons living with HIV/AIDS and their families. Today, the CARE Act remains a cornerstone of the Federal effort to fight HIV/AIDS and continues to provide a critical safety net for over 571,000 individuals affected by HIV/AIDS who are uninsured or underinsured each year.

With approximately 40,000 new HIV infections each year in the United States, but fewer AIDS deaths (as the result of remarkable new treatments), more people than ever are living with HIV/AIDS—more people who need the care and services funded by the CARE Act. Increasingly, these are historically underserved populations, including racial and ethnic minorities. Responding to these individuals and families, who depend on the CARE Act for essential health and support services, involves a number of challenges:

• The ever-increasing cost of health care, particularly the cost of highly active aantiretroviral therapy (HAART)
• An increasing demand on the CARE Act as a primary source for long-term ambulatory and supportive care
• Changes in the underlying health care financing system that surrounds CARE Act programs.

Each CARE Act reauthorization offers the U.S. Department of Health and Human Services an opportunity to assess how it can make the CARE Act even more effective at responding to changes in the epidemic and appropriately targeting resources. These policy studies attempt to improve our understanding of how the above challenges affect CARE Act programs and the people they serve.

The Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau is responsible for implementing the CARE Act. It is in partial fulfillment of this responsibility that the monograph Examination of Fiscal Management and the Allocation of CARE Act Resources is published. The goals for the monograph are to expand on current knowledge; inform policy-related, administrative, and legislative decision making; and provide technical assistance to CARE Act grantees and providers that will enhance the quality and reach of their programs.

The monograph focuses on CARE Act spending. It identifies the services that major payers (such as Medicaid and Medicare) cover and describes who is eligible for those services. Geographic and funding factors that affect the shift in treatment patterns for HIV are also discussed. The ultimate goal is to ensure maximum return on CARE Act spending—and to ensure that CARE Act funds are used only when no other source of payment is available.

Three policy studies are included in this booklet:

1. Ryan White CARE Act Reauthorization 2005: Title I and Title II Health Services Expenditures Patterns
2. Examination of Key Fiscal Issues Related to Grantees of the Ryan White CARE Act
3. Assessing the Impact of the Ryan White CARE Act Title II Emerging Communities Formula Grant Program.

Findings and recommendations from these studies will help inform HRSA’s administrative procedures, technical assistance, and training activities; improve service delivery; and enhance intergovernmental relationships between Federal agencies and among Federal, State, and local jurisdictions. HRSA grantees are encouraged to read these reports and to incorporate findings and recommendations into their ongoing planning and program activities. HRSA welcomes feedback from readers on the usefulness of this monograph for their work.

 

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