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Ryan
White HIV/AIDS Program, Part B HIV Care Grants
to States
|
FY
2007
Actual |
FY
2008
Enacted |
FY
2009
Request |
FY
2009 +/-
FY 2008 |
BA
|
$1,195,500,000
|
$1,195,248,000
|
$1,209,487,000
|
+$14,239,000
|
State
$ |
405,954,000
$ |
386,748,000
$ |
394,941,000 |
+$ 8,193,000 |
ADAP $ |
789,546,000
|
$
808,500,000 |
$ 814,546,000 |
+$
6,046,000 |
Authorizing
Legislation: Title XXVI, Sections 2611-2631
of the Public Health Service Act, as amended.
FY
2009 Authorization |
$1,285,200,000
|
Allocation
Method |
Competitive
and Formula Grants, Cooperative Agreements
and Contracts |
Program Description and Accomplishments
Part B of the Ryan White HIV/AIDS Program provides
grants to all 50 states, the District of Columbia,
Puerto Rico and the U.S. territories to provide
services for people living with HIV/AIDS, including
outpatient medical care, oral health care, home-
and community-based services, continuation of
health insurance coverage, prescription drugs,
HIV care consortia, and supportive services.
Part B includes the AIDS Drug Assistance Program
(ADAP), which supports the provision of HIV
medications and related services. Seventy-five
percent of Part B funds must be used to support
core medical services. Part B funds are distributed
through base and supplemental grants, ADAP and
ADAP supplemental grants, and Emerging Communities
(ECs) grants. The base awards are distributed
by a formula based on a state or territory’s
living HIV/AIDS cases weighted for cases outside
of Part A-funded jurisdictions. Supplemental
awards are available to states with demonstrated
need. Congress designates a portion of the Part
B award to support ADAP. The majority of ADAP
funds are also distributed by a formula based
on living HIV/AIDS cases, though 5% of the funds
are set aside for states with severe need. A
state’s combined Part B base award and
ADAP allocation cannot decrease by more than
five percent per year. Most states provide some
services directly, while 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/AIDS. Emerging communities are metropolitan
areas that do not qualify as EMAs or TGAs but
have 500-999 cumulative reported AIDS cases
over the last five years and apply for supplemental
funding through a grant application. The AIDS
Drug Assistance Programs (ADAPs) provides FDA-approved
prescription medications for people with HIV/AIDS
with limited or no prescription drug coverage.
ADAP funds also may be used to purchase health
insurance for eligible clients or to pay for
services that enhance access, adherence, and
monitoring of drug treatments.
The Part B programs have been successful in
helping to ensure that people living with HIV/AIDS
can get the care and services they need to stay
healthy longer. The number of visits for health-related
services demonstrates the effectiveness of the
Part B program in delivering primary care and
related services for individuals infected with
HIV/AIDS by increasing the availability and
accessibility of care. Part B programs provided
2.28 million visits in 2004 and 2.34 million
visits in 2005. In FY 2006, Part B provided
1.88 million visits. The actual performance
for FY 2006 exceeded the target by 320,000 visits.
This however was a decrease from FY 2005. This
is most likely a result of the decline in Program
resources available for funding service provision,
which resulted in fewer providers and clients,
and the impact of healthcare inflation. ADAP
served 147,187 clients in 2005. In FY 2006,
157,988 clients were served annually through
State ADAPs exceeding the target. Sixty-five
percent of those served by ADAPS are people
of color. Nationally, more than 78 percent of
ADAP clients have incomes at 200 percent or
less of the federal poverty level (FPL). Individual
ADAPs operate in all 50 states, the District
of Columbia, Puerto Rico, the U.S. Virgin Islands,
Guam, American Samoa, Commonwealth of the Northern
Mariana Islands, and the Republic of the Marshall
Islands.
Program Assessment Rating Tool:
Part B 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: The Part B program
is regularly evaluated by independent agencies,
such as OIG and GAO. In the past year an OIG
Audit was conducted entitled “Review of
the Management of Unobligated Funds Provided
by Part B of the Ryan White Comprehensive AIDS
Resources Emergency Act” (A-06-04-00060)
(Final Report - May 2007). The findings of these
Audits indicate 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 were instead 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 B (Title II) grantees. Additionally,
the Part B program examines the reasons for
some States’ large unobligated balances
and monitors compliance to obligate 75 percent
of grant award with in 120 days.
A GAO evaluation conducted in the past year
was entitled “Oversight of Drug Pricing
in Federal Programs” (GAO-07-481T) (Final
Report - February 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 changes
the distribution whereas; two-thirds of Part
A funds will be distributed as formula grants
and one-third as supplemental grants. The finding
showed how the proposed hold-harmless provision
from H.R. 3043 would impact funding for urban
areas under the proposed funding levels. The
Oversight of Drug Pricing in Federal Programs
provided information related to the oversight
of prescription drug pricing practices, especially
340B drug pricing programs which provide discounted
drug prices to some State ADAPs. HRSAs Healthcare
Systems Bureau, Office of Pharmacy Affairs administers
the 340B Program which GAO found lacks transparency
in 340B prices, lacks oversight, and provides
overpayments to drug manufactures.
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
|
ADAP-Non-Add
|
FY 1999 |
$737,765,000 |
($461,000,000) |
FY 2000 |
$823,838,000 |
($528,000,000) |
FY 2001 |
$910,969,000 |
($589,000,000) |
FY 2002 |
$977,240,000 |
($639,000,000) |
FY 2003 |
$1,053,393,000 |
($714,326,000) |
FY 2004 |
$1,085,900,000 |
($748,872,000) |
FY 2005 |
$1,121,836,000 |
($787,521,000) |
FY 2006 |
$1,119,744,000 |
($789,005,000) |
FY 2007 |
$1,195,500,000 |
($789,546,000) |
FY 2008 |
$1,195,248,000 |
($808,500,000) |
Excludes
comparable amounts for SPNS
Budget Request
The FY 2009 Request of $1,209,487,000 is an
increase of $14,239,000 over the FY 2008 Enacted
level. The request supports current program
activities and includes an increase to provide
life-saving medications to people living with
HIV. Of this amount $394,941,000 which is $8,193,000
above the FY 2008 Enacted level will be used
for base formula HIV grants for the provision
of services in the fifty States, the District
of Columbia, Puerto Rico, the Virgin Islands
and six Pacific jurisdictions. This request
also includes $814,546,000 for State ADAP which
is $6,046,000 above the FY 2008 Enacted level.
HRSA has developed a model for estimating the
marginal cost of serving ADAP clients. The model
takes into account many of the factors affecting
purchasing power, such as increases in cost
of HIV/AIDS drugs; the legislative requirement
that all State ADAPs maintain a minimum drug
formulary, including new drug classes; and the
impact of Medicare Part D, rebates, and insurance
coverage. The FY 2009 ADAP Request of $814,546,000
will support providing ADAP services to 158,887
persons. This represents an increase of 148
individuals over the estimated number that might
be served at the FY 2008 level. The marginal
cost model corroborates the Program’s
projected target for number of ADAP clients
is by 2009. Part B funding will also contribute
to achieving the FY 2009 targets for the Ryan
White Program’s over-arching performance
measures, including proportion of racial/ethnic
minorities and women served, number of ADAP
clients, persons tested for CD4 count and viral
load, and providers implementing a quality management
program. (See Summary of Request for targets
and for strategies and challenges.)
# |
Key
Outputs |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Enacted |
FY
2009 Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long – Term Objective:
Expand the Capacity of the Health Care Safety
Net |
18.I.A.1. |
Number of visits for health-related
care (primary medical, dental, mental health,
substance abuse, rehabilitative, and home
health) to a level that approximates inclusion
of new clients. |
2.28M |
2.34M |
1.56M |
1.88M |
1.56M |
Jan-09 |
2.14
Ma |
2.28
M |
|
Grantees Funded |
59 |
59 |
|
59 |
|
59 |
59 |
59 |
|
Part B Emerging Communities |
29 |
28 |
|
26 |
|
19 |
19 |
TBDb |
|
Appropriated Amount ($
Million) |
$1,085.90
|
$1,121.80
|
|
$1,119.70 |
|
$1,195.50
|
$1,195.20
|
$1,209.50
|
Notes:
a. |
This
FY 2008 target was changed from that shown
in the FY 2008 Congressional Justification
to be consistent with recent performance.
|
b. |
Emerging
Communities are metropolitan areas that
do not yet qualify as EMAs or TGAs but have
500 - 999 cumulative AIDS cases over the
last five years. The number of Part B Emerging
Communities for 2009 is determined by the
reported AIDS cases from 1/2003 - 12/2007.
The Program expects to receive the 2007
AIDS case data from CDC that is required
for this calculation around the Summer or
Fall of 2008. |
State Table
FY 2009 Ryan White HIV/AIDS Treatment Modernization
Act Part B CARE Grants
State/Territory
|
FY
2007 Total* |
FY
2008** Estimate |
FY
2009*** Estimate |
Difference
+/- 2008 |
Alabama |
$19,791,847 |
|
|
|
Alaska |
1,129,894 |
|
|
|
Arizona |
13,543,748 |
|
|
|
Arkansas |
7,901,902 |
|
|
|
California |
122,936,034 |
|
|
|
Colorado |
13,396,954 |
|
|
|
Connecticut |
15,044,081 |
|
|
|
Delaware |
5,270,515 |
|
|
|
District
of Columbia |
18,834,754 |
|
|
|
Florida |
117,413,102 |
|
|
|
Georgia |
40,350,086 |
|
|
|
Hawaii |
3,237,348 |
|
|
|
Idaho |
1,105,364 |
|
|
|
Illinois |
36,392,873 |
|
|
|
Indiana |
12,996,706 |
|
|
|
Iowa |
2,874,145 |
|
|
|
Kansas |
3,434,675 |
|
|
|
Kentucky |
7,608,908 |
|
|
|
Louisiana |
21,542,485 |
|
|
|
Maine |
1,399,166 |
|
|
|
Maryland |
35,050,493 |
|
|
|
Massachusetts |
19,567,006 |
|
|
|
Michigan |
16,950,334 |
|
|
|
Minnesota |
7,088,148 |
|
|
|
Mississippi |
13,997,861 |
|
|
|
Missouri |
13,786,156 |
|
|
|
Montana |
866,238 |
|
|
|
Nebraska |
2,381,505 |
|
|
|
Nevada |
8,010,232 |
|
|
|
New
Hampshire |
1,502,980 |
|
|
|
New
Jersey |
45,995,066 |
|
|
|
New
Mexico |
4,065,724 |
|
|
|
New
York |
169,488,721 |
|
|
|
North
Carolina |
34,000,911 |
|
|
|
North
Dakota |
343,556 |
|
|
|
Ohio |
23,352,802 |
|
|
|
Oklahoma |
9,110,963 |
|
|
|
Oregon |
6,709,281 |
|
|
|
Pennsylvania |
38,649,989 |
|
|
|
Rhode
Island |
3,348,666 |
|
|
|
South
Carolina |
29,068,516 |
|
|
|
South
Dakota |
805,924 |
|
|
|
Tennessee |
18,374,749 |
|
|
|
Texas |
89,342,110 |
|
|
|
Utah |
4,275,389 |
|
|
|
Vermont |
902,212 |
|
|
|
Virginia |
28,922,603 |
|
|
|
Washington |
11,757,722 |
|
|
|
West
Virginia |
2,457,104 |
|
|
|
Wisconsin |
9,475,779 |
|
|
|
Wyoming |
680,188 |
|
|
|
Subtotal
|
1,116,533,515 |
|
|
|
Guam |
291,084 |
|
|
|
American
Samoa |
51,979 |
|
|
|
Marshall
Islands |
52,968 |
|
|
|
N.
Marianas |
53,958 |
|
|
|
F.
States Micronesia |
57,447 |
|
|
|
Republic
Of Palau |
50,000 |
|
|
|
Puerto
Rico |
32,563,575 |
|
|
|
Virgin
Islands |
1,272,874 |
|
|
|
Subtotal |
34,393,885 |
|
|
|
Total
States/Territories |
$1,150,927,400
|
|
|
|
Technical Assistance |
|
|
|
Other Adjustments***** |
41,000,176 |
|
|
|
Subtotal Adjustments |
41,000,176 |
|
|
|
Total
|
$1,191,927,576
|
1,195,248,000 |
1,209,487,000 |
|
*Total includes AIDS Drug Assistance Program
(ADAP) and Base Formula awards, and Competitive
ADAP Supplemental and Minority AIDS Initiative
(MAI) award amounts
**Fiscal Year 2008 grant amounts pending award
calculations in March 2008
***Fiscal Year 2009 grant amounts pending award
calculations in March 2009
****Total State Grants include or would include
amounts for AIDS Drug Assistance Programs as
follows:
FY
2007 $789,546,000 (excludes 5% setaside for
severe need supplemental)
FY 2008 $808,500,000 (excludes 5% setaside for
severe need supplemental)
*****Includes
amount for technical assistance to Ryan White
Program grantees and program evaluation
|