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entitled 'Ryan White Care Act: Impact of Legislative Funding Proposal 
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Subject: Ryan White Care Act: Impact of Legislative Funding Proposal on 
Urban Areas: 

The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE 
Act), administered by the Department of Health and Human Services' 
(HHS) Health Resources and Services Administration (HRSA), was enacted 
to address the needs of jurisdictions, health care providers, and 
people with human immunodeficiency virus/acquired immunodeficiency 
syndrome (HIV/AIDS) and their family members.[Footnote 1] In December 
2006 the Ryan White HIV/AIDS Treatment Modernization Act of 2006 
reauthorized CARE Act programs for fiscal years 2007 through 
2009.[Footnote 2] In July 2007, the House of Representatives passed 
H.R. 3043, the Departments of Labor, Health and Human Services, and 
Education and Related Agencies Appropriations Act for fiscal year 2008, 
which contains a hold-harmless provision covering funding for urban 
areas that receive funding under the CARE Act.[Footnote 3] This bill 
has not been passed by the Senate. 

Under the CARE Act, funding for Eligible Metropolitan Areas (EMA) and 
Transitional Grant Areas (TGA) is primarily provided through three 
categories of grants:[Footnote 4] (1) formula grants that are awarded 
based on the case counts of people with HIV/AIDS living in an urban 
area; (2) supplemental grants that are awarded on a competitive basis 
based on an urban area's demonstration of need, including criteria such 
as HIV/AIDS prevalence; and (3) Minority AIDS Initiative (MAI) grants, 
which are supplemental grants awarded on a competitive basis for urban 
areas to address disparities in access, treatment, care, and health 
outcomes. The CARE Act includes a hold-harmless provision that limited 
the decrease that an EMA could receive in its formula funding for 
fiscal year 2007 to 5 percent of the fiscal year 2006 formula funding 
it would have received if the revised urban area allocations required 
by the Modernization Act of 2006 had been in place in fiscal year 
2006.[Footnote 5] For fiscal years 2008 and 2009, the hold- harmless 
provision provides that an EMA will receive at least 100 percent of the 
amount of its formula funding for fiscal year 2007. However, no 
limitation applies to the decrease in total formula, supplemental, and 
MAI funding that an EMA can receive. The hold- harmless provision does 
not apply to TGAs. 

H.R. 3043, which was passed by the House of Representatives on July 19, 
2007, would include funds for fiscal year 2008 to ensure that decreases 
in total 2007 Part A funding for EMAs and TGAs would not exceed levels 
specified in the bill.[Footnote 6] It would limit the total funding 
decrease for an EMA for the 2007 program year to no more than 8.4 
percent of what the EMA received for the 2006 program year. Decreases 
for TGAs for the program year 2007 would be limited to 13.4 percent of 
their total funding from program year 2006.[Footnote 7] This hold- 
harmless provision would not apply to funding for any program year 
other than 2007. The bill does not characterize the hold-harmless 
funding as formula, supplemental, or MAI funding for purposes of the 
CARE Act nor does it indicate when such funds would be provided to EMAs 
and TGAs entitled to receive it. Finally, it does not state how long 
the eligible EMAs and TGAs would have to spend the funds they would 
receive. 

As Congress considers appropriations for CARE Act programs for fiscal 
year 2008, on July 27, 2007, and September 11, 2007, you asked us to 
(1) provide historical information on the funding levels identified 
during the appropriations process for CARE Act grants to urban areas as 
compared to fiscal year 2008 CARE Act funding levels proposed as part 
of the fiscal year 2008 appropriations process in the House of 
Representatives; (2) examine how the proposed hold-harmless provision 
from H.R. 3043 would impact funding for urban areas under the proposed 
funding levels; (3) determine whether any urban areas receive funding 
based on the number of both living and deceased HIV/AIDS cases; (4) 
provide sources that address the amount of CARE Act funding unobligated 
by urban areas, states, and territories; and (5) provide sources that 
address the number of people on AIDS Drug Assistance Program (ADAP) 
waiting lists.[Footnote 8] 

To provide information on the funding levels for CARE Act grants to 
urban areas identified during the appropriations process, we examined 
appropriations acts and related reports and HHS data for fiscal years 
2001 through 2007, the proposed funding for fiscal year 2008 contained 
in H.R. 3043, and the report of the House Committee on Appropriations 
on that bill.[Footnote 9] To assess the impact of the proposed hold- 
harmless provision on urban areas, we examined funding for fiscal years 
2006 and 2007, determined the amounts needed to fund the proposed hold- 
harmless provision, and estimated funding for fiscal year 2008 for EMAs 
and TGAs. To conduct this work, we reviewed data provided by HHS on 
fiscal years 2006 and 2007 CARE Act funding and case counts of people 
living with HIV/AIDS. We used this information to determine which urban 
areas would receive the hold-harmless funding, the amount each would 
receive, and the total needed to fund the hold-harmless provision. We 
also used the HHS data to estimate the fiscal year 2008 funding levels 
for urban areas with and without the proposed hold-harmless provision; 
that is, we determined (1) the projected funding levels for urban areas 
if all fiscal year 2008 funding for urban areas were used for program 
year 2008 formula, supplemental, and MAI grants and (2) the projected 
funding levels for urban areas if the amounts needed to fund the hold- 
harmless provision contained in H.R. 3043 were taken out of the funding 
to be used for program year 2008 grants.[Footnote 10] 

We conducted analyses with different funding levels to examine the 
impact of the proposed hold-harmless provision because the amount in 
H.R. 3043 and the amount in the report of the House Committee on 
Appropriations differ. At the time we conducted our analyses, fiscal 
year 2008 appropriations for CARE Act programs had not been enacted 
and, consequently, we used the amounts in H.R. 3043 and the report of 
the House Committee on Appropriations. However, the amount for urban 
areas and states and territories in H.R. 3043, that is Parts A and B, 
as passed by the House of Representatives is $10 million less than the 
amount obtained by adding together the amounts identified for urban 
areas and states and territories in the report of the House Committee 
on Appropriations. We have therefore conducted separate analyses using 
each amount. Each analysis requires different assumptions. 

The amount specified in H.R. 3043 for urban areas and states and 
territories as passed by the House of Representatives is 
$1,865,800,000, which according to HRSA is approximately a 3.68 percent 
increase over the fiscal year 2007 total funding for Parts A and B. We 
had to make several assumptions to estimate the fiscal year 2008 
funding for urban areas. First, we assumed that the percentage of 
funding for Part A (approximately 33.56 percent) out of the total 
funding for Parts A and B would be the same in fiscal year 2008 as it 
was in fiscal year 2007. By applying this percentage to the 
$1,865,800,000 specified in H.R. 3043, we estimated that approximately 
$626,248,693 would be the total funding for Part A in fiscal year 2008. 
Second, we assumed that MAI funding for each urban area would increase 
by the same percentage that total MAI funding allocated to urban areas 
is scheduled to increase under the CARE Act, which is approximately 
3.65 percent. Third, we assumed that the amount of funds set aside by 
HRSA prior to awarding grants to urban areas would be the same in 
fiscal year 2008 as it was in fiscal year 2007.[Footnote 11] Fourth, we 
subtracted the funding for MAI and set asides from the estimated Part A 
funding for fiscal year 2008, $626,248,693. The resulting funding, 
$557,300,597 would therefore be used for formula and supplemental 
grants. This represents an estimated increase of 3.8 percent in overall 
formula and supplemental funding for urban areas. Fifth, because 
updated HIV/AIDS case counts were not available, we used the HIV/AIDS 
case counts that HRSA used to determine fiscal year 2007 funding. We 
estimated the fiscal year 2008 formula funding for each urban area 
using these case counts. Sixth, we assumed that each urban area would 
receive the same percentage of the available supplemental funding in 
fiscal year 2008 that it received in fiscal year 2007. 

For the alternative analysis on the proposed hold-harmless provision 
based on the report of the House Committee on Appropriations, we used 
the amount specified in the report for urban areas, 
$636,300,000.[Footnote 12] We then made the same assumptions as for the 
previous analysis regarding MAI grants, amounts set aside by HRSA prior 
to awarding grants to urban areas, case counts, and supplemental 
grants. 

To determine whether any urban areas received funding based on both 
living and deceased HIV/AIDS cases, we used the funding formula data 
for fiscal years 2006 and 2007.[Footnote 13] In addition, we identified 
sources where information is available on the unobligated funding and 
waiting list issues by discussing these issues respectively with the 
HHS Office of Inspector General and the National Alliance of State & 
Territorial AIDS Directors. 

The objective of this work was to provide pertinent and timely 
information from readily available sources that Congress can use in 
determining funding for CARE Act programs. Because of time constraints, 
we did not conduct extensive testing and analysis of the reliability 
and validity of the data that were used for the analyses, nor did we 
conduct any additional analysis of the proposed provision. We performed 
our work from August 2007 through September 2007. 

CARE Act Funding for Urban Areas: 

CARE Act funding for urban areas would increase under the funding level 
identified in the report of the House Committee on Appropriations for 
CARE Act grants to these areas.[Footnote 14] Since fiscal year 2001, 
CARE Act funding for urban areas specified in conference reports 
accompanying the appropriations acts has ranged from a high of 
$622,741,000 in fiscal year 2003 to a low of $604,200,000 in fiscal 
year 2001.[Footnote 15] For fiscal year 2008, the report of the House 
Committee on Appropriations specifies $636,300,000 for urban 
areas,[Footnote 16] an increase of approximately 4.3 percent over the 
amount specified in the conference report for fiscal year 2006 
funding.[Footnote 17] However, this amount includes the funding that 
would be used to address the funding decreases that certain EMAs and 
TGAs experienced in fiscal year 2007, a total of approximately $9.4 
million.[Footnote 18] This would reduce the amount available for fiscal 
year 2008 grants as described by the Committee to approximately 
$626,900,000. This represents an increase of approximately 2.8 percent 
over the amount specified in the conference report for fiscal year 
2006.[Footnote 19] Table 1 shows the funding specified in congressional 
reports and the actual amounts awarded to urban areas for fiscal years 
2001 through 2007 and the proposed funding for fiscal year 2008 in the 
report of the House Committee on Appropriations. 

Table 1: CARE Act Funding for Urban Areas: 

Fiscal year: 2001; 
Funding identified in congressional report: $604,200,000[B]; 
Actual funding awarded[A]: $582,727,700. 

Fiscal year: 2002; 
Funding identified in congressional report: 619,585,000[B]; 
Actual funding awarded[A]: 597,256,000. 

Fiscal year: 2003; 
Funding identified in congressional report: 622,741,000[B]; 
Actual funding awarded[A]: 599,513,000. 

Fiscal year: 2004; 
Funding identified in congressional report: 618,693,000[B]; 
Actual funding awarded[A]: 595,342,000. 

Fiscal year: 2005; 
Funding identified in congressional report: 615,023,000[B]; 
Actual funding awarded[A]: 587,425,500. 

Fiscal year: 2006; 
Funding identified in congressional report: 610,094,000[B]; 
Actual funding awarded[A]: 579,686,392. 

Fiscal year: 2007; 
Funding identified in congressional report: [C]; 
Actual funding awarded[A]: 578,686,334. 

Fiscal year: 2008; 
Funding identified in congressional report: 636,300,000[D]; 
Actual funding awarded[A]: [E]. 

Sources: Conference reports accompanying annual appropriations laws, 
report of the House Committee on Appropriations (110-231), and HHS. 

[A] The actual funding awarded to urban areas differs from the amounts 
specified in the congressional reports for a variety of reasons. For 
example, rescissions may have reduced the total appropriations 
available for CARE Act programs. 

[B] Each appropriations act provided a lump sum covering the CARE Act 
and other programs and did not specify funding amounts for urban areas. 
The conference reports accompanying each act, while not legally 
binding, specified a separate amount to be used for grants to urban 
areas. 

[C] Fiscal year 2007 funds were appropriated for HRSA in a continuing 
resolution which contained a lump sum amount for all HRSA programs and 
did not specify a particular amount for grants to urban areas. See Pub. 
L. No. 110-5, 121 Stat. 8, 31-32. There were no conference or committee 
reports for this law. According to HHS, $603,993,000 was the funding 
level for grants to urban areas; that is, the amount available before 
subtracting for annual set asides. HRSA refers to this amount as the 
"final appropriation amount" for fiscal year 2007. 

[D] The $636,300,000 amount for urban areas is taken from the report of 
House Committee on Appropriations (No. 110-231) for H.R. 3043. 
According to the committee report, this amount is $32,307,000 above the 
fiscal year 2007 funding level and the administration's budget request 
for fiscal year 2007. If the proposed hold-harmless provision is 
enacted, the amount available to fund fiscal year 2008 grants would be 
reduced by approximately $9.4 million to $626,900,000. In addition, 
H.R. 3043 as reported by the Committee and passed by the House 
identifies an amount for CARE Act grants for urban areas and states and 
territories. However, this amount is $10 million less than the amount 
obtained by adding the amount identified in the House report for urban 
areas to the amount identified in the House report for states and 
territories. 

[E] No funding for fiscal year 2008 has been awarded yet. 

[End of table] 

CARE Act funding for urban areas is awarded to EMAs and TGAs through 
formula, supplemental, and MAI grants. Table 2 shows the grants awarded 
in fiscal years 2006 and 2007 to each EMA categorized by funding type. 
Table 3 shows the grants awarded in fiscal years 2006 and 2007 to each 
TGA categorized by funding type. 

Table 2: Grants Awarded to EMAs, Fiscal Years 2006 and 2007: 

EMA: Atlanta, Ga; 
Fiscal year 2006 grants: Formula: $9,634,687; 
Fiscal year 2006 grants: Supplemental: $7,625,341; 
Fiscal year 2006 grants: MAI: $1,609,533; 
Fiscal year 2006 grants: Total: $18,869,561; 
Fiscal year 2007 grants: Formula: $12,223,780; Fiscal year 2007 grants: 
Supplemental: $3,850,505; Fiscal year 2007 grants: MAI: $1,050,229; 
Fiscal year 2007 grants: Total: $17,124,514. 

EMA: Baltimore, Md; 
Fiscal year 2006 grants: Formula: 10,125,086; 
Fiscal year 2006 grants: Supplemental: 8,850,824; 
Fiscal year 2006 grants: MAI: 1,652,985; 
Fiscal year 2006 grants: Total: 20,628,895; 
Fiscal year 2007 grants: Formula: 13,101,233; 
Fiscal year 2007 grants: Supplemental: 5,186,790; 
Fiscal year 2007 grants: MAI: 2,100,038; 
Fiscal year 2007 grants: Total: 20,388,061. 

EMA: Boston, Mass; 
Fiscal year 2006 grants: Formula: 6,979,687; 
Fiscal year 2006 grants: Supplemental: 5,814,962; 
Fiscal year 2006 grants: MAI: 544,492; 
Fiscal year 2006 grants: Total: 13,339,141; 
Fiscal year 2007 grants: Formula: 9,091,554; 
Fiscal year 2007 grants: Supplemental: 3,769,583; 
Fiscal year 2007 grants: MAI: 814,862; 
Fiscal year 2007 grants: Total: 13,675,999. 

EMA: Chicago, Ill; 
Fiscal year 2006 grants: Formula: 12,891,725; 
Fiscal year 2006 grants: Supplemental: 10,274,677; 
Fiscal year 2006 grants: MAI: 1,878,231; 
Fiscal year 2006 grants: Total: 25,044,633; 
Fiscal year 2007 grants: Formula: 16,477,405; 
Fiscal year 2007 grants: Supplemental: 6,888,727; 
Fiscal year 2007 grants: MAI: 1,787,310; 
Fiscal year 2007 grants: Total: 25,153,442. 

EMA: Dallas, Tex; 
Fiscal year 2006 grants: Formula: 6,509,160; 
Fiscal year 2006 grants: Supplemental: 5,615,969; 
Fiscal year 2006 grants: MAI: 1,071,248; 
Fiscal year 2006 grants: Total: 13,196,377; 
Fiscal year 2007 grants: Formula: 9,137,396; 
Fiscal year 2007 grants: Supplemental: 3,640,608; 
Fiscal year 2007 grants: MAI: 772,577; 
Fiscal year 2007 grants: Total: 13,550,581. 

EMA: Detroit, Mich; 
Fiscal year 2006 grants: Formula: 4,450,466; 
Fiscal year 2006 grants: Supplemental: 3,380,311; 
Fiscal year 2006 grants: MAI: 597,700; 
Fiscal year 2006 grants: Total: 8,428,477; 
Fiscal year 2007 grants: Formula: 5,648,743; 
Fiscal year 2007 grants: Supplemental: 2,073,152; 
Fiscal year 2007 grants: MAI: 644,567; 
Fiscal year 2007 grants: Total: 8,366,462. 

EMA: Fort Lauderdale, Fla; 
Fiscal year 2006 grants: Formula: 7,390,404; 
Fiscal year 2006 grants: Supplemental: 6,514,401; 
Fiscal year 2006 grants: MAI: 1,058,833; 
Fiscal year 2006 grants: Total: 14,963,638; 
Fiscal year 2007 grants: Formula: 9,444,098; 
Fiscal year 2007 grants: Supplemental: 3,727,245; 
Fiscal year 2007 grants: MAI: 1,113,452; 
Fiscal year 2007 grants: Total: 14,284,795. 

EMA: Houston, Tex; 
Fiscal year 2006 grants: Formula: 10,069,778; 
Fiscal year 2006 grants: Supplemental: 8,252,040; 
Fiscal year 2006 grants: MAI: 1,631,702; 
Fiscal year 2006 grants: Total: 19,953,520; 
Fiscal year 2007 grants: Formula: 12,780,890; 
Fiscal year 2007 grants: Supplemental: 5,120,182; 
Fiscal year 2007 grants: MAI: 1,571,727; 
Fiscal year 2007 grants: Total: 19,472,799. 

EMA: Los Angeles, Calif; 
Fiscal year 2006 grants: Formula: 18,302,095; 
Fiscal year 2006 grants: Supplemental: 14,085,426; 
Fiscal year 2006 grants: MAI: 2,507,856; 
Fiscal year 2006 grants: Total: 34,895,377; 
Fiscal year 2007 grants: Formula: 23,182,654; 
Fiscal year 2007 grants: Supplemental: 9,552,345; 
Fiscal year 2007 grants: MAI: 2,528,561; 
Fiscal year 2007 grants: Total: 35,263,560. 

EMA: Miami, Fla; 
Fiscal year 2006 grants: Formula: 12,178,882; 
Fiscal year 2006 grants: Supplemental: 9,772,536; 
Fiscal year 2006 grants: MAI: 2,048,496; 
Fiscal year 2006 grants: Total: 23,999,914; 
Fiscal year 2007 grants: Formula: 16,014,327; 
Fiscal year 2007 grants: Supplemental: 6,481,882; 
Fiscal year 2007 grants: MAI: 2,565,107; 
Fiscal year 2007 grants: Total: 25,061,316. 

EMA: New Orleans, La; 
Fiscal year 2006 grants: Formula: 3,894,926; 
Fiscal year 2006 grants: Supplemental: 2,946,620; 
Fiscal year 2006 grants: MAI: 593,266; 
Fiscal year 2006 grants: Total: 7,434,812; 
Fiscal year 2007 grants: Formula: 4,944,054; 
Fiscal year 2007 grants: Supplemental: 1,770,338; 
Fiscal year 2007 grants: MAI: 541,807; 
Fiscal year 2007 grants: Total: 7,256,199. 

EMA: New York, N.Y; 
Fiscal year 2006 grants: Formula: 59,000,321; 
Fiscal year 2006 grants: Supplemental: 49,486,747; 
Fiscal year 2006 grants: MAI: 11,936,258; 
Fiscal year 2006 grants: Total: 120,423,326; 
Fiscal year 2007 grants: Formula: 74,867,223; 
Fiscal year 2007 grants: Supplemental: 25,998,357; 
Fiscal year 2007 grants: MAI: 9,347,777; 
Fiscal year 2007 grants: Total: 110,213,357. 

EMA: Newark, N.J; 
Fiscal year 2006 grants: Formula: 7,636,547; 
Fiscal year 2006 grants: Supplemental: 6,304,290; 
Fiscal year 2006 grants: MAI: 811,417; 
Fiscal year 2006 grants: Total: 14,752,254; 
Fiscal year 2007 grants: Formula: 9,089,812; 
Fiscal year 2007 grants: Supplemental: 3,552,687; 
Fiscal year 2007 grants: MAI: 1,284,886; 
Fiscal year 2007 grants: Total: 13,927,385. 

EMA: Orlando, Fla; 
Fiscal year 2006 grants: Formula: 4,336,162; 
Fiscal year 2006 grants: Supplemental: 3,555,581; 
Fiscal year 2006 grants: MAI: 669,530; 
Fiscal year 2006 grants: Total: 8,561,273; 
Fiscal year 2007 grants: Formula: 5,503,524; 
Fiscal year 2007 grants: Supplemental: 1,980,246; 
Fiscal year 2007 grants: MAI: 578,713; 
Fiscal year 2007 grants: Total: 8,062,483. 

EMA: Philadelphia, Pa; 
Fiscal year 2006 grants: Formula: 11,798,212; 
Fiscal year 2006 grants: Supplemental: 9,000,750; 
Fiscal year 2006 grants: MAI: 1,585,589; 
Fiscal year 2006 grants: Total: 22,384,551; 
Fiscal year 2007 grants: Formula: 14,920,594; 
Fiscal year 2007 grants: Supplemental: 5,037,001; 
Fiscal year 2007 grants: MAI: 1,682,127; 
Fiscal year 2007 grants: Total: 21,639,722. 

EMA: Phoenix, Ariz; 
Fiscal year 2006 grants: Formula: 3,701,962; 
Fiscal year 2006 grants: Supplemental: 2,489,262; 
Fiscal year 2006 grants: MAI: 328,114; 
Fiscal year 2006 grants: Total: 6,519,338; 
Fiscal year 2007 grants: Formula: 4,970,250; 
Fiscal year 2007 grants: Supplemental: 1,811,234; 
Fiscal year 2007 grants: MAI: 193,368; 
Fiscal year 2007 grants: Total: 6,974,852. 

EMA: San Diego, Calif; 
Fiscal year 2006 grants: Formula: 4,917,200; 
Fiscal year 2006 grants: Supplemental: 3,901,564; 
Fiscal year 2006 grants: MAI: 450,492; 
Fiscal year 2006 grants: Total: 9,269,256; 
Fiscal year 2007 grants: Formula: 6,769,231; 
Fiscal year 2007 grants: Supplemental: 2,912,131; 
Fiscal year 2007 grants: MAI: 543,389; 
Fiscal year 2007 grants: Total: 10,224,751. 

EMA: San Francisco, Calif; 
Fiscal year 2006 grants: Formula: 15,444,793; 
Fiscal year 2006 grants: Supplemental: 11,985,334; 
Fiscal year 2006 grants: MAI: 534,737; 
Fiscal year 2006 grants: Total: 27,964,864; 
Fiscal year 2007 grants: Formula: 14,672,553; 
Fiscal year 2007 grants: Supplemental: 4,134,300; 
Fiscal year 2007 grants: MAI: 652,491; 
Fiscal year 2007 grants: Total: 19,459,344. 

EMA: San Juan, P.R; 
Fiscal year 2006 grants: Formula: 7,641,520; 
Fiscal year 2006 grants: Supplemental: 4,636,975; 
Fiscal year 2006 grants: MAI: 1,191,852; 
Fiscal year 2006 grants: Total: 13,470,347; 
Fiscal year 2007 grants: Formula: 9,415,282; 
Fiscal year 2007 grants: Supplemental: 2,553,297; 
Fiscal year 2007 grants: MAI: 741,100; 
Fiscal year 2007 grants: Total: 12,709,679. 

EMA: Tampa-St. Petersburg, Fla; 
Fiscal year 2006 grants: Formula: 4,987,570; 
Fiscal year 2006 grants: Supplemental: 4,016,711; 
Fiscal year 2006 grants: MAI: 567,549; 
Fiscal year 2006 grants: Total: 9,571,830; 
Fiscal year 2007 grants: Formula: 6,330,047; 
Fiscal year 2007 grants: Supplemental: 2,345,441; 
Fiscal year 2007 grants: MAI: 525,592; 
Fiscal year 2007 grants: Total: 9,201,080. 

EMA: Washington, D.C; 
Fiscal year 2006 grants: Formula: 14,810,305; 
Fiscal year 2006 grants: Supplemental: 9,445,282; 
Fiscal year 2006 grants: MAI: 2,667,479; 
Fiscal year 2006 grants: Total: 26,923,066; 
Fiscal year 2007 grants: Formula: 18,759,719; 
Fiscal year 2007 grants: Supplemental: 6,895,292; 
Fiscal year 2007 grants: MAI: 1,976,712; 
Fiscal year 2007 grants: Total: 27,631,723. 

EMA: West Palm Beach, Fla; 
Fiscal year 2006 grants: Formula: 4,546,333; 
Fiscal year 2006 grants: Supplemental: 3,055,721; 
Fiscal year 2006 grants: MAI: 673,964; 
Fiscal year 2006 grants: Total: 8,276,018; 
Fiscal year 2007 grants: Formula: 5,769,416; 
Fiscal year 2007 grants: Supplemental: 1,949,450; 
Fiscal year 2007 grants: MAI: 576,631; 
Fiscal year 2007 grants: Total: 8,295,497. 

EMA: Total; 
Fiscal year 2006 grants: Formula: $241,247,821; 
Fiscal year 2006 grants: Supplemental: $191,011,324; 
Fiscal year 2006 grants: MAI: $36,611,323; 
Fiscal year 2006 grants: Total: $468,870,468; 
Fiscal year 2007 grants: Formula: $303,113,785; 
Fiscal year 2007 grants: Supplemental: $111,230,793; 
Fiscal year 2007 grants: MAI: $33,593,023; 
Fiscal year 2007 grants: Total: $447,937,601. 

Source: HHS. 

[End of table] 

Table 3: Grants Awarded to TGAs, Fiscal Years 2006 and 2007: 

TGA: Austin, Tex; 
Fiscal year 2006 grants: Formula: $1,932,460; 
Fiscal year 2006 grants: Supplemental: $1,572,898; 
Fiscal year 2006 grants: MAI: $213,718; 
Fiscal year 2006 grants: Total: $3,719,076; 
Fiscal year 2007 grants: Formula: $2,311,513; 
Fiscal year 2007 grants: Supplemental: $1,073,557; 
Fiscal year 2007 grants: MAI: $229,065; 
Fiscal year 2007 grants: Total: $3,614,135. 

TGA: Baton Rouge, La; 
Fiscal year 2006 grants: Formula: 0; 
Fiscal year 2006 grants: Supplemental: 0; 
Fiscal year 2006 grants: MAI: 0; 
Fiscal year 2006 grants: Total: 0; 
Fiscal year 2007 grants: Formula: 2,179,184; 
Fiscal year 2007 grants: Supplemental: 831,337; 
Fiscal year 2007 grants: MAI: 249,059; 
Fiscal year 2007 grants: Total: 3,259,580. 

TGA: Bergen-Passaic, N.J; 
Fiscal year 2006 grants: Formula: 2,440,939; 
Fiscal year 2006 grants: Supplemental: 1,834,541; 
Fiscal year 2006 grants: MAI: 210,170; 
Fiscal year 2006 grants: Total: 4,485,650; 
Fiscal year 2007 grants: Formula: 2,480,997; 
Fiscal year 2007 grants: Supplemental: 1,101,476; 
Fiscal year 2007 grants: MAI: 287,493; 
Fiscal year 2007 grants: Total: 3,869,966. 

TGA: Caguas, P.R; 
Fiscal year 2006 grants: Formula: 872,640; 
Fiscal year 2006 grants: Supplemental: 567,319; 
Fiscal year 2006 grants: MAI: 208,397; 
Fiscal year 2006 grants: Total: 1,648,356; 
Fiscal year 2007 grants: Formula: 690,977; 
Fiscal year 2007 grants: Supplemental: 269,503; 
Fiscal year 2007 grants: MAI: 121,984; 
Fiscal year 2007 grants: Total: 1,082,464. 

TGA: Charlotte-Gastonia, N.C.-S.C; 
Fiscal year 2006 grants: Formula: 0; 
Fiscal year 2006 grants: Supplemental: 0; 
Fiscal year 2006 grants: MAI: 0; 
Fiscal year 2006 grants: Total: 0; 
Fiscal year 2007 grants: Formula: 2,854,516; 
Fiscal year 2007 grants: Supplemental: 974,327; 
Fiscal year 2007 grants: MAI: 371,535; 
Fiscal year 2007 grants: Total: 4,200,378. 

TGA: Cleveland, Ohio; 
Fiscal year 2006 grants: Formula: 1,793,462; 
Fiscal year 2006 grants: Supplemental: 1,314,426; 
Fiscal year 2006 grants: MAI: 241,208; 
Fiscal year 2006 grants: Total: 3,349,096; 
Fiscal year 2007 grants: Formula: 2,606,155; 
Fiscal year 2007 grants: Supplemental: 1,060,413; 
Fiscal year 2007 grants: MAI: 316,520; 
Fiscal year 2007 grants: Total: 3,983,088. 

TGA: Denver, Colo; 
Fiscal year 2006 grants: Formula: 2,286,509; 
Fiscal year 2006 grants: Supplemental: 1,810,306; 
Fiscal year 2006 grants: MAI: 186,227; 
Fiscal year 2006 grants: Total: 4,283,042; 
Fiscal year 2007 grants: Formula: 4,860,304; 
Fiscal year 2007 grants: Supplemental: 1,925,546; 
Fiscal year 2007 grants: MAI: 275,492; 
Fiscal year 2007 grants: Total: 7,061,342. 

TGA: Dutchess County, N.Y; 
Fiscal year 2006 grants: Formula: 698,112; 
Fiscal year 2006 grants: Supplemental: 556,849; 
Fiscal year 2006 grants: MAI: 112,623; 
Fiscal year 2006 grants: Total: 1,367,584; 
Fiscal year 2007 grants: Formula: 719,007; 
Fiscal year 2007 grants: Supplemental: 339,616; 
Fiscal year 2007 grants: MAI: 103,571; 
Fiscal year 2007 grants: Total: 1,162,194. 

TGA: Fort Worth, Tex; 
Fiscal year 2006 grants: Formula: 1,726,845; 
Fiscal year 2006 grants: Supplemental: 1,463,049; 
Fiscal year 2006 grants: MAI: 219,925; 
Fiscal year 2006 grants: Total: 3,409,819; 
Fiscal year 2007 grants: Formula: 2,298,475; 
Fiscal year 2007 grants: Supplemental: 940,508; 
Fiscal year 2007 grants: MAI: 204,310; 
Fiscal year 2007 grants: Total: 3,443,293. 

TGA: Hartford, Conn; 
Fiscal year 2006 grants: Formula: 2,374,565; 
Fiscal year 2006 grants: Supplemental: 2,024,791; 
Fiscal year 2006 grants: MAI: 266,925; 
Fiscal year 2006 grants: Total: 4,666,281; 
Fiscal year 2007 grants: Formula: 2,003,833; 
Fiscal year 2007 grants: Supplemental: 913,750; 
Fiscal year 2007 grants: MAI: 252,944; 
Fiscal year 2007 grants: Total: 3,170,527. 

TGA: Indianapolis, Ind; 
Fiscal year 2006 grants: Formula: 0; 
Fiscal year 2006 grants: Supplemental: 0; 
Fiscal year 2006 grants: MAI: 0; 
Fiscal year 2006 grants: Total: 0; 
Fiscal year 2007 grants: Formula: 2,277,616; 
Fiscal year 2007 grants: Supplemental: 763,694; 
Fiscal year 2007 grants: MAI: 189,079; 
Fiscal year 2007 grants: Total: 3,230,389. 

TGA: Jacksonville, Fla; 
Fiscal year 2006 grants: Formula: 2,631,441; 
Fiscal year 2006 grants: Supplemental: 1,872,676; 
Fiscal year 2006 grants: MAI: 409,699; 
Fiscal year 2006 grants: Total: 4,913,816; 
Fiscal year 2007 grants: Formula: 3,078,757; 
Fiscal year 2007 grants: Supplemental: 1,414,071; 
Fiscal year 2007 grants: MAI: 393,745; 
Fiscal year 2007 grants: Total: 4,886,573. 

TGA: Jersey City, N.J; 
Fiscal year 2006 grants: Formula: 2,831,663; 
Fiscal year 2006 grants: Supplemental: 2,048,327; 
Fiscal year 2006 grants: MAI: 265,152; 
Fiscal year 2006 grants: Total: 5,145,142; 
Fiscal year 2007 grants: Formula: 2,831,049; 
Fiscal year 2007 grants: Supplemental: 1,286,939; 
Fiscal year 2007 grants: MAI: 417,858; 
Fiscal year 2007 grants: Total: 4,535,846. 

TGA: Kansas City, Mo; 
Fiscal year 2006 grants: Formula: 1,607,764; 
Fiscal year 2006 grants: Supplemental: 1,183,683; 
Fiscal year 2006 grants: MAI: 125,038; 
Fiscal year 2006 grants: Total: 2,916,485; 
Fiscal year 2007 grants: Formula: 2,524,021; 
Fiscal year 2007 grants: Supplemental: 1,013,510; 
Fiscal year 2007 grants: MAI: 187,284; 
Fiscal year 2007 grants: Total: 3,724,815. 

TGA: Las Vegas, Nev; 
Fiscal year 2006 grants: Formula: 2,422,499; 
Fiscal year 2006 grants: Supplemental: 1,647,505; 
Fiscal year 2006 grants: MAI: 253,623; 
Fiscal year 2006 grants: Total: 4,323,627; 
Fiscal year 2007 grants: Formula: 3,251,501; 
Fiscal year 2007 grants: Supplemental: 1,193,110; 
Fiscal year 2007 grants: MAI: 225,918; 
Fiscal year 2007 grants: Total: 4,670,529. 

TGA: Memphis, Tenn; 
Fiscal year 2006 grants: Formula: 0; 
Fiscal year 2006 grants: Supplemental: 0; 
Fiscal year 2006 grants: MAI: 0; 
Fiscal year 2006 grants: Total: 0; 
Fiscal year 2007 grants: Formula: 3,585,906; 
Fiscal year 2007 grants: Supplemental: 1,432,797; 
Fiscal year 2007 grants: MAI: 556,225; 
Fiscal year 2007 grants: Total: 5,574,928. 

TGA: Middlesex-Somerset-Hunterdon, N.J; 
Fiscal year 2006 grants: Formula: 1,427,281; 
Fiscal year 2006 grants: Supplemental: 1,032,702; 
Fiscal year 2006 grants: MAI: 135,680; 
Fiscal year 2006 grants: Total: 2,595,663; 
Fiscal year 2007 grants: Formula: 1,599,025; 
Fiscal year 2007 grants: Supplemental: 701,085; 
Fiscal year 2007 grants: MAI: 165,169; 
Fiscal year 2007 grants: Total: 2,465,279. 

TGA: Minneapolis-St. Paul, Minn; 
Fiscal year 2006 grants: Formula: 1,569,524; 
Fiscal year 2006 grants: Supplemental: 1,279,233; 
Fiscal year 2006 grants: MAI: 197,755; 
Fiscal year 2006 grants: Total: 3,046,512; 
Fiscal year 2007 grants: Formula: 2,963,378; 
Fiscal year 2007 grants: Supplemental: 1,240,032; 
Fiscal year 2007 grants: MAI: 264,702; 
Fiscal year 2007 grants: Total: 4,468,112. 

TGA: Nashville, Tenn; 
Fiscal year 2006 grants: Formula: 0; 
Fiscal year 2006 grants: Supplemental: 0; 
Fiscal year 2006 grants: MAI: 0; 
Fiscal year 2006 grants: Total: 0; 
Fiscal year 2007 grants: Formula: 2,541,621; 
Fiscal year 2007 grants: Supplemental: 938,981; 
Fiscal year 2007 grants: MAI: 207,441; 
Fiscal year 2007 grants: Total: 3,688,043. 

TGA: Nassau-Suffolk, N.Y; 
Fiscal year 2006 grants: Formula: 3,227,540; 
Fiscal year 2006 grants: Supplemental: 2,456,087; 
Fiscal year 2006 grants: MAI: 464,680; 
Fiscal year 2006 grants: Total: 6,148,307; 
Fiscal year 2007 grants: Formula: 3,130,907; 
Fiscal year 2007 grants: Supplemental: 1,358,744; 
Fiscal year 2007 grants: MAI: 325,286; 
Fiscal year 2007 grants: Total: 4,814,937. 

TGA: New Haven, Conn; 
Fiscal year 2006 grants: Formula: 3,631,905; 
Fiscal year 2006 grants: Supplemental: 2,710,386; 
Fiscal year 2006 grants: MAI: 342,303; 
Fiscal year 2006 grants: Total: 6,684,594; 
Fiscal year 2007 grants: Formula: 3,278,228; 
Fiscal year 2007 grants: Supplemental: 1,501,862; 
Fiscal year 2007 grants: MAI: 321,657; 
Fiscal year 2007 grants: Total: 5,101,747. 

TGA: Norfolk, Va; 
Fiscal year 2006 grants: Formula: 2,543,672; 
Fiscal year 2006 grants: Supplemental: 1,635,201; 
Fiscal year 2006 grants: MAI: 235,887; 
Fiscal year 2006 grants: Total: 4,414,760; 
Fiscal year 2007 grants: Formula: 3,390,349; 
Fiscal year 2007 grants: Supplemental: 1,284,883; 
Fiscal year 2007 grants: MAI: 379,699; 
Fiscal year 2007 grants: Total: 5,054,931. 

TGA: Oakland, Calif; 
Fiscal year 2006 grants: Formula: 3,310,871; 
Fiscal year 2006 grants: Supplemental: 2,072,022; 
Fiscal year 2006 grants: MAI: 352,944; 
Fiscal year 2006 grants: Total: 5,735,837; 
Fiscal year 2007 grants: Formula: 3,781,868; 
Fiscal year 2007 grants: Supplemental: 1,663,113; 
Fiscal year 2007 grants: MAI: 392,080; 
Fiscal year 2007 grants: Total: 5,837,061. 

TGA: Orange County, Calif; 
Fiscal year 2006 grants: Formula: 2,552,176; 
Fiscal year 2006 grants: Supplemental: 2,091,799; 
Fiscal year 2006 grants: MAI: 214,604; 
Fiscal year 2006 grants: Total: 4,858,579; 
Fiscal year 2007 grants: Formula: 3,328,279; 
Fiscal year 2007 grants: Supplemental: 1,345,454; 
Fiscal year 2007 grants: MAI: 292,945; 
Fiscal year 2007 grants: Total: 4,966,678. 

TGA: Ponce, P.R; 
Fiscal year 2006 grants: Formula: 1,338,048; 
Fiscal year 2006 grants: Supplemental: 806,867; 
Fiscal year 2006 grants: MAI: 246,529; 
Fiscal year 2006 grants: Total: 2,391,444; 
Fiscal year 2007 grants: Formula: 1,101,000; 
Fiscal year 2007 grants: Supplemental: 445,740; 
Fiscal year 2007 grants: MAI: 153,098; 
Fiscal year 2007 grants: Total: 1,699,838. 

TGA: Portland, Oreg; 
Fiscal year 2006 grants: Formula: 1,790,756; 
Fiscal year 2006 grants: Supplemental: 1,516,313; 
Fiscal year 2006 grants: MAI: 94,887; 
Fiscal year 2006 grants: Total: 3,401,956; 
Fiscal year 2007 grants: Formula: 2,120,010; 
Fiscal year 2007 grants: Supplemental: 957,919; 
Fiscal year 2007 grants: MAI: 78,536; 
Fiscal year 2007 grants: Total: 3,156,465. 

TGA: Riverside-San Bernadino, Calif; 
Fiscal year 2006 grants: Formula: 3,643,238; 
Fiscal year 2006 grants: Supplemental: 3,156,377; 
Fiscal year 2006 grants: MAI: 274,906; 
Fiscal year 2006 grants: Total: 7,074,521; 
Fiscal year 2007 grants: Formula: 4,389,913; 
Fiscal year 2007 grants: Supplemental: 2,074,448; 
Fiscal year 2007 grants: MAI: 255,733; 
Fiscal year 2007 grants: Total: 6,720,094. 

TGA: Sacramento, Calif; 
Fiscal year 2006 grants: Formula: 1,459,858; 
Fiscal year 2006 grants: Supplemental: 1,263,003; 
Fiscal year 2006 grants: MAI: 55,868; 
Fiscal year 2006 grants: Total: 2,778,729; 
Fiscal year 2007 grants: Formula: 1,472,863; 
Fiscal year 2007 grants: Supplemental: 689,474; 
Fiscal year 2007 grants: MAI: 97,469; 
Fiscal year 2007 grants: Total: 2,259,806. 

TGA: St. Louis. Mo; 
Fiscal year 2006 grants: Formula: 2,377,264; 
Fiscal year 2006 grants: Supplemental: 1,875,232; 
Fiscal year 2006 grants: MAI: 250,076; 
Fiscal year 2006 grants: Total: 4,502,572; 
Fiscal year 2007 grants: Formula: 3,471,180; 
Fiscal year 2007 grants: Supplemental: 1,424,275; 
Fiscal year 2007 grants: MAI: 378,174; 
Fiscal year 2007 grants: Total: 5,273,629. 

TGA: San Antonio, Tex; 
Fiscal year 2006 grants: Formula: 1,952,384; 
Fiscal year 2006 grants: Supplemental: 1,068,440; 
Fiscal year 2006 grants: MAI: 305,057; 
Fiscal year 2006 grants: Total: 3,325,881; 
Fiscal year 2007 grants: Formula: 2,441,234; 
Fiscal year 2007 grants: Supplemental: 949,837; 
Fiscal year 2007 grants: MAI: 264,661; 
Fiscal year 2007 grants: Total: 3,655,732. 

TGA: San Jose, Calif; 
Fiscal year 2006 grants: Formula: 1,322,616; 
Fiscal year 2006 grants: Supplemental: 871,297; 
Fiscal year 2006 grants: MAI: 110,849; 
Fiscal year 2006 grants: Total: 2,304,762; 
Fiscal year 2007 grants: Formula: 1,596,809; 
Fiscal year 2007 grants: Supplemental: 604,404; 
Fiscal year 2007 grants: MAI: 137,156; 
Fiscal year 2007 grants: Total: 2,338,369. 

TGA: Santa Rosa, Calif; 
Fiscal year 2006 grants: Formula: 572,703; 
Fiscal year 2006 grants: Supplemental: 426,667; 
Fiscal year 2006 grants: MAI: 29,264; 
Fiscal year 2006 grants: Total: 1,028,634; 
Fiscal year 2007 grants: Formula: 725,352; 
Fiscal year 2007 grants: Supplemental: 265,582; 
Fiscal year 2007 grants: MAI: 50,000; 
Fiscal year 2007 grants: Total: 1,040,934. 

TGA: Seattle, Wash; 
Fiscal year 2006 grants: Formula: 2,931,596; 
Fiscal year 2006 grants: Supplemental: 2,309,038; 
Fiscal year 2006 grants: MAI: 204,850; 
Fiscal year 2006 grants: Total: 5,445,484; 
Fiscal year 2007 grants: Formula: 4,051,676; 
Fiscal year 2007 grants: Supplemental: 1,667,482; 
Fiscal year 2007 grants: MAI: 234,009; 
Fiscal year 2007 grants: Total: 5,953,167. 

TGA: Vineland-Millville-Bridgeton, N.J; 
Fiscal year 2006 grants: Formula: 464,590; 
Fiscal year 2006 grants: Supplemental: 313,292; 
Fiscal year 2006 grants: MAI: 71,833; 
Fiscal year 2006 grants: Total: 849,715; 
Fiscal year 2007 grants: Formula: 518,884; 
Fiscal year 2007 grants: Supplemental: 196,470; 
Fiscal year 2007 grants: MAI: 68,510; 
Fiscal year 2007 grants: Total: 783,864. 

TGA: Total; 
Fiscal year 2006 grants: Formula: $59,734,921; 
Fiscal year 2006 grants: Supplemental: $44,780,326; 
Fiscal year 2006 grants: MAI: $6,300,677; 
Fiscal year 2006 grants: Total: $110,815,924; 
Fiscal year 2007 grants: Formula: $86,456,387; 
Fiscal year 2007 grants: Supplemental: $35,843,939; 
Fiscal year 2007 grants: MAI: $8,448,407; 
Fiscal year 2007 grants: Total: $130,748,733. 

Source: HHS. 

Note: The 2006 Modernization Act created a new category of urban areas 
called TGAs. TGAs that received Part A funding in 2006 were classified 
at that time as EMAs. 

[End of table] 

Projected CARE Act Funding for Urban Areas Would be Impacted by the 
Proposed Hold-Harmless Provision: 

The funding for both EMAs and TGAs would be impacted by the proposed 
hold-harmless provision in H.R. 3043. Some EMAs and TGAs would receive 
additional funding for the 2007 program year under the provision, but 
the amounts needed to fund the hold-harmless provision would be taken 
from the amount that could otherwise be available for fiscal year 2008 
funding. A total of $9,377,444 would be needed to fund the proposed 
hold-harmless provision, with $6,410,885 needed for EMAs and $2,966,559 
for TGAs. 

Projected EMA Funding: 

We found that the impact of the proposed hold-harmless provision in 
H.R. 3043 on EMAs would be to increase funding for 3 of 22 EMAs by a 
total of $6,410,885 for the 2007 program year, which runs from April 1, 
2007, to March 31, 2008. The San Francisco EMA would receive the 
largest increase, $6,156,471, while the Atlanta and New York EMAs would 
receive an additional $160,004 and $94,410, respectively. 

We found that under funding as identified in the report of the House 
Committee on Appropriations and under our assumptions, funding would be 
impacted for all EMAs. Sixteen of 22 EMAs would receive an increase in 
funding over fiscal year 2007 if the proposed hold-harmless provision 
is enacted. However, regardless of whether an EMA would receive an 
increase over fiscal year 2007 or not, all EMAs would be awarded less 
fiscal year 2008 funding with the hold-harmless provision in place than 
if the entire amount was awarded as fiscal year 2008 funding without 
the hold harmless because less funding would be available to be 
awarded. Less funding would be available for fiscal year 2008 because 
funds would be taken from fiscal year 2008 funding to cover the 
proposed hold-harmless provision in H.R. 3043 that protects funds for 
the 2007 program year, which ends March 31, 2008. The size of the 
difference in the amount of funding with and without the proposed hold- 
harmless provision would vary by EMA with differences ranging from 
approximately 0.7 percent to 2.1 percent.[Footnote 20] However, it is 
not possible to determine exactly how each EMA would be affected by the 
proposed 8.4 percent hold-harmless provision because it is not known 
how HRSA will award fiscal year 2008 funding. Table 4 lists EMA funding 
for fiscal years 2006 and 2007, and the projected funding for fiscal 
year 2008 with and without the proposed hold-harmless provision, 
assuming funding amounts as identified in the report of the House 
Committee on Appropriations. 

Table 4: Total EMA Formula, Supplemental, and MAI Grants for Fiscal 
Years 2006 and 2007 and Projected Funding for Fiscal Year 2008 Under 
Funding Levels as Identified in the Report of the House Committee on 
Appropriations: 

EMA: Atlanta, Ga; 
Fiscal year 2006 grants: $18,869,561; 
Fiscal year 2007 grants: $17,124,514; 
Estimated hold-harmless funding under H.R. 3043: $160,004; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: $17,112,815; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: $16,982,259. 

EMA: Baltimore, Md; 
Fiscal year 2006 grants: 20,628,895; 
Fiscal year 2007 grants: 20,388,061; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 22,732,883; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 22,301,873. 

EMA: Boston, Mass; 
Fiscal year 2006 grants: 13,339,141; 
Fiscal year 2007 grants: 13,675,999; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 15,277,498; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,972,628. 

EMA: Chicago, Ill; 
Fiscal year 2006 grants: 25,044,633; 
Fiscal year 2007 grants: 25,153,442; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 28,066,579; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 27,512,113. 

EMA: Dallas, Tex; 
Fiscal year 2006 grants: 13,196,377; 
Fiscal year 2007 grants: 13,550,581; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 15,137,303; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,836,295. 

EMA: Detroit, Mich; 
Fiscal year 2006 grants: 8,428,477; 
Fiscal year 2007 grants: 8,366,462; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 9,013,890; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,839,476. 

EMA: Fort Lauderdale, Fla; 
Fiscal year 2006 grants: 14,963,638; 
Fiscal year 2007 grants: 14,284,795; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 15,936,744; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 15,626,839. 

EMA: Houston, Tex; 
Fiscal year 2006 grants: 19,953,520; 
Fiscal year 2007 grants: 19,472,799; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 20,852,940; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 20,445,124. 

EMA: Los Angeles, Calif; 
Fiscal year 2006 grants: 34,895,377; 
Fiscal year 2007 grants: 35,263,560; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 38,631,203; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 37,867,959. 

EMA: Miami, Fla; 
Fiscal year 2006 grants: 23,999,914; 
Fiscal year 2007 grants: 25,061,316; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 27,885,150; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 27,354,166. 

EMA: New Orleans, La; 
Fiscal year 2006 grants: 7,434,812; 
Fiscal year 2007 grants: 7,256,199; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,056,604; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 7,901,579. 

EMA: New York, N.Y; 
Fiscal year 2006 grants: 120,423,326; 
Fiscal year 2007 grants: 110,213,357; 
Estimated hold-harmless funding under H.R. 3043: 94,410; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 110,216,803; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 109,335,299. 

EMA: Newark, N.J; 
Fiscal year 2006 grants: 14,752,254; 
Fiscal year 2007 grants: 13,927,385; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 14,821,268; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,535,807. 

EMA: Orlando, Fla; 
Fiscal year 2006 grants: 8,561,273; 
Fiscal year 2007 grants: 8,062,483; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,614,615; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,447,306. 

EMA: Philadelphia, Pa; 
Fiscal year 2006 grants: 22,384,551; 
Fiscal year 2007 grants: 21,639,722; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 21,765,212; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 21,464,894. 

EMA: Phoenix, Ariz; 
Fiscal year 2006 grants: 6,519,338; 
Fiscal year 2007 grants: 6,974,852; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 7,831,853; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 7,673,854. 

EMA: San Diego, Calif; 
Fiscal year 2006 grants: 9,269,256; 
Fiscal year 2007 grants: 10,224,751; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 11,828,264; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 11,590,839. 

EMA: San Francisco, Calif; 
Fiscal year 2006 grants: 27,964,864; 
Fiscal year 2007 grants: 19,459,344; 
Estimated hold-harmless funding under H.R. 3043: 6,156,471; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 19,429,426; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 19,289,248. 

EMA: San Juan, P.R; 
Fiscal year 2006 grants: 13,470,347; 
Fiscal year 2007 grants: 12,709,679; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 12,703,554; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 12,616,981. 

EMA: Tampa-St. Petersburg, Fla; 
Fiscal year 2006 grants: 9,571,830; 
Fiscal year 2007 grants: 9,201,080; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 9,692,491; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 9,500,031. 

EMA: Washington, D.C; 
Fiscal year 2006 grants: 26,923,066; 
Fiscal year 2007 grants: 27,631,723; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 28,861,975; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 28,297,491. 

EMA: West Palm Beach, Fla; 
Fiscal year 2006 grants: 8,276,018; 
Fiscal year 2007 grants: 8,295,497; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,404,609; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,241,277. 

EMA: Total; 
Fiscal year 2006 grants: $468,870,468; 
Fiscal year 2007 grants: $447,937,601; 
Estimated hold-harmless funding under H.R. 3043: $6,410,885; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: $472,873,680; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: $465,633,338. 

Sources: GAO analysis of HHS data, H.R. 3043, and report of the House 
of Committee on Appropriations (110-231). 

Notes: The projected fiscal year 2008 funding in this table is based on 
the funding amount for urban areas identified in the report of the 
House Committee on Appropriations (110-231). Before estimating the 
funding allocations, we reduced the amount to be allocated by 
subtracting out the amounts set aside by HRSA before awarding grants to 
urban areas. We used the same amounts for these reductions as were used 
in fiscal year 2007, $23,548,096. 

We cannot determine the exact impact on total funding for each EMA for 
fiscal year 2008. It is not possible to determine exactly how each EMA 
would be affected by the proposed 8.4 percent hold-harmless provision 
for EMAs because it is not known how HRSA will award fiscal year 2008 
supplemental and MAI grants and because the case counts on which 
formula grants will be based are not yet available. 

[A] The projected funding amounts in this column include the CARE Act 
hold-harmless provision that protects formula funding for EMAs. 

[B] Under the proposed hold-harmless provision in H.R. 3043, the 
maximum decrease in formula, supplemental, and MAI grants in total that 
an EMA could receive for program year 2007 would be no more than 8.4 
percent of what it received for program year 2006. Funds would be taken 
from fiscal year 2008 funding to cover this proposed hold-harmless 
provision. The projected funding amounts in this column include the 
CARE Act hold-harmless provision that protects formula funding for 
EMAs. 

[End of table] 

Under funding identified in H.R. 3043 and under our assumptions, 
funding for each EMA would be similarly impacted if the proposed hold- 
harmless provision is enacted. Sixteen of 22 EMAs would receive an 
increase in funding over fiscal year 2007 if the proposed hold-harmless 
provision is enacted. However, regardless of whether an EMA would 
receive an increase over fiscal year 2007 or not, all EMAs would 
receive less funding awarded as fiscal year 2008 funding with the hold- 
harmless provision in place than if the entire amount was awarded as 
fiscal year 2008 funding without the hold harmless because less funding 
would be available to be awarded. Less funding would be available for 
fiscal year 2008 because funds would be taken from fiscal year 2008 
funding to cover the proposed hold-harmless provision in H.R. 3043 that 
protects funds for the 2007 program year, which ends March 31, 2008. 
The size of the difference in the amount of funding with and without 
the hold-harmless provision would vary by EMA with differences ranging 
from approximately 0.7 percent to 2.2 percent. However, it is not 
possible to determine exactly how each EMA would be affected by the 
proposed 8.4 percent hold-harmless provision because it is not known 
how HRSA will award fiscal year 2008 funding. Table 5 lists EMA funding 
for fiscal years 2006 and 2007, and the projected funding for fiscal 
year 2008 with and without the proposed hold-harmless provision, 
assuming funding levels identified in H.R. 3043. 

Table 5: Total EMA Formula, Supplemental, and MAI Funding for Fiscal 
Years 2006 and 2007 and Projected Funding for Fiscal Year 2008 Under 
Funding Levels as Identified in H.R. 3043: 

EMA: Atlanta, Ga; 
Fiscal year 2006 grants: $18,869,561; 
Fiscal year 2007 grants: $17,124,514; 
Estimated hold-harmless funding under H.R. 3043: $160,004; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: $16,972,555; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: $16,834,467. 

EMA: Baltimore, Md; 
Fiscal year 2006 grants: 20,628,895; 
Fiscal year 2007 grants: 20,388,061; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 22,270,467; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 21,829,310. 

EMA: Boston, Mass; 
Fiscal year 2006 grants: 13,339,141; 
Fiscal year 2007 grants: 13,675,999; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 14,950,405; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,638,161. 

EMA: Chicago, Ill; 
Fiscal year 2006 grants: 25,044,633; 
Fiscal year 2007 grants: 25,153,442; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 27,471,692; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 26,903,749. 

EMA: Dallas, Tex; 
Fiscal year 2006 grants: 13,196,377; 
Fiscal year 2007 grants: 13,550,581; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 14,814,360; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,506,230. 

EMA: Detroit, Mich; 
Fiscal year 2006 grants: 8,428,477; 
Fiscal year 2007 grants: 8,366,462; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,826,768; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,648,298. 

EMA: Fort Lauderdale, Fla; 
Fiscal year 2006 grants: 14,963,638; 
Fiscal year 2007 grants: 14,284,795; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 15,604,256; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 15,287,060. 

EMA: Houston, Tex; 
Fiscal year 2006 grants: 19,953,520; 
Fiscal year 2007 grants: 19,472,799; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 20,415,390; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 19,997,556. 

EMA: Los Angeles, Calif; 
Fiscal year 2006 grants: 34,895,377; 
Fiscal year 2007 grants: 35,263,560; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 37,812,312; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 37,030,382. 

EMA: Miami, Fla; 
Fiscal year 2006 grants: 23,999,914; 
Fiscal year 2007 grants: 25,061,316; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 27,315,466; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 26,771,801. 

EMA: New Orleans, La; 
Fiscal year 2006 grants: 7,434,812; 
Fiscal year 2007 grants: 7,256,199; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 7,890,291; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 7,731,802. 

EMA: New York, N.Y; 
Fiscal year 2006 grants: 120,423,326; 
Fiscal year 2007 grants: 110,213,357; 
Estimated hold-harmless funding under H.R. 3043: 94,410; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 109,269,779; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 108,337,417. 

EMA: Newark, N.J; 
Fiscal year 2006 grants: 14,752,254; 
Fiscal year 2007 grants: 13,927,385; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 14,514,997; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,222,586. 

EMA: Orlando, Fla; 
Fiscal year 2006 grants: 8,561,273; 
Fiscal year 2007 grants: 8,062,483; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,435,117; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,263,934. 

EMA: Philadelphia, Pa; 
Fiscal year 2006 grants: 22,384,551; 
Fiscal year 2007 grants: 21,639,722; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 21,452,200; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 21,271,561. 

EMA: Phoenix, Ariz; 
Fiscal year 2006 grants: 6,519,338; 
Fiscal year 2007 grants: 6,974,852; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 7,662,349; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 7,500,806. 

EMA: San Diego, Calif; 
Fiscal year 2006 grants: 9,269,256; 
Fiscal year 2007 grants: 10,224,751; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 11,573,534; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 11,330,412. 

EMA: San Francisco, Calif; 
Fiscal year 2006 grants: 27,964,864; 
Fiscal year 2007 grants: 19,459,344; 
Estimated hold-harmless funding under H.R. 3043: 6,156,471; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 19,278,829; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 19,130,563. 

EMA: San Juan, P.R; 
Fiscal year 2006 grants: 13,470,347; 
Fiscal year 2007 grants: 12,709,679; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 12,610,547; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 12,518,979. 

EMA: Tampa-St. Petersburg, Fla; 
Fiscal year 2006 grants: 9,571,830; 
Fiscal year 2007 grants: 9,201,080; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 9,486,004; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 9,288,957. 

EMA: Washington, D.C; 
Fiscal year 2006 grants: 26,923,066; 
Fiscal year 2007 grants: 27,631,723; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 28,256,351; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 27,678,377. 

EMA: West Palm Beach, Fla; 
Fiscal year 2006 grants: 8,276,018; 
Fiscal year 2007 grants: 8,295,497; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,229,377; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,150,292. 

EMA: Total; 
Fiscal year 2006 grants: $468,870,468; 
Fiscal year 2007 grants: $447,937,601; 
Estimated hold-harmless funding under H.R. 3043: $6,410,885; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: $465,113,045; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: $457,872,699. 

Sources: GAO analysis of HHS data and H.R. 3043. 

Notes: The projected fiscal year 2008 funding in this table is based on 
the funding amount identified in H.R. 3043 and our assumption that the 
percentage of funding for Part A out of the total funding for Parts A 
and B will be the same in fiscal year 2008 as it was in fiscal year 
2007. Before estimating the funding allocations, we reduced the amount 
to be allocated by subtracting out the amounts set aside by HRSA before 
awarding grants to urban areas. We used the same amounts for these 
reductions as were used in fiscal year 2007, $23,548,096. 

We cannot determine the exact impact on total funding for each EMA for 
fiscal year 2008. It is not possible to determine exactly how each EMA 
would be affected by the proposed 8.4 percent hold-harmless provision 
for EMAs because it is not known how HRSA will award fiscal year 2008 
supplemental and MAI grants and because the case counts on which 
formula grants will be based are not yet available. 

[A] The projected funding amounts in this column include the CARE Act 
hold-harmless provision that protects formula funding for EMAs. 

[B] Under the proposed hold-harmless provision in H.R. 3043, the 
maximum decrease in formula, supplemental, and MAI grants in total that 
an EMA could receive for program year 2007 would be no more than 8.4 
percent of what it received for program year 2006. Funds would be taken 
from fiscal year 2008 funding to cover this proposed hold-harmless 
provision. The projected funding amounts in this column include the 
CARE Act hold-harmless provision that protects formula funding for 
EMAs. 

[End of table] 

Projected TGA Funding: 

We found that the impact of the proposed hold-harmless provision in 
H.R. 3043 on TGAs would be to increase the 2007 program year funding 
for 8 of 34 TGAs--Bergen-Passaic, New Jersey; Caguas, Puerto Rico; 
Dutchess County, New York; Hartford, Connecticut; Nassau-Suffolk, New 
York; New Haven, Connecticut; Ponce, Puerto Rico; and Sacramento, 
California--by a total of $2,966,559.[Footnote 21] 

We found that under funding identified in the report of the House 
Committee on Appropriations and under our assumptions, funding would be 
impacted for all TGAs. If the proposed hold-harmless provision is 
enacted, each TGA would receive an increase in funding over fiscal year 
2007, but the increase would be less than if the entire amount was 
awarded as fiscal year 2008 funding without the hold harmless because 
less funding would be available to be awarded. Less funding would be 
available for fiscal year 2008 because funds would be taken from fiscal 
year 2008 funding to cover the proposed hold-harmless provision in H.R. 
3043 that protects funds for the 2007 program year, which ends March 
31, 2008. The size of the difference in the amount of funding with and 
without the proposed hold-harmless provision would vary by TGA with 
differences ranging from approximately 1.5 to 1.6 percent.[Footnote 22] 
However, it is not possible to determine exactly how each TGA would be 
affected by the proposed 13.4 percent hold-harmless provision because 
it is not known how HRSA will award fiscal year 2008 funding. Table 6 
lists TGA funding for fiscal years 2006 and 2007, and the projected 
funding for fiscal year 2008 with and without the proposed hold- 
harmless provision, assuming funding amounts identified in the report 
of the House Committee on Appropriations. 

Table 6: Total TGA Formula, Supplemental, and MAI Funding for Fiscal 
Years 2006 and 2007 and Projected Funding for Fiscal Year 2008 Under 
Funding Levels as Identified in the Report of the House Committee on 
Appropriations: 

TGA: Austin, Tex; 
Fiscal year 2006 grants: $3,719,076; 
Fiscal year 2007 grants: $3,614,135; 
Estimated hold-harmless funding under H.R. 3043: $0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: $3,815,614; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: $3,756,472. 

TGA: Baton Rouge, La; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,259,580; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,440,391; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,387,794. 

TGA: Bergen-Passaic, N.J; 
Fiscal year 2006 grants: 4,485,650; 
Fiscal year 2007 grants: 3,869,966; 
Estimated hold-harmless funding under H.R. 3043: 14,607; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,084,832; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,022,242. 

TGA: Caguas, P.R; 
Fiscal year 2006 grants: 1,648,356; 
Fiscal year 2007 grants: 1,082,464; 
Estimated hold-harmless funding under H.R. 3043: 345,012; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,141,704; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,124,924. 

TGA: Charlotte-Gastonia, N.C.-S.C; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 4,200,378; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,432,317; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,365,423. 

TGA: Cleveland, Ohio; 
Fiscal year 2006 grants: 3,349,096; 
Fiscal year 2007 grants: 3,983,088; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,203,795; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,139,736. 

TGA: Denver, Colo; 
Fiscal year 2006 grants: 4,283,042; 
Fiscal year 2007 grants: 7,061,342; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 7,458,467; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 7,339,910. 

TGA: Dutchess County, N.Y; 
Fiscal year 2006 grants: 1,367,584; 
Fiscal year 2007 grants: 1,162,194; 
Estimated hold-harmless funding under H.R. 3043: 22,134; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,226,371; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,207,875. 

TGA: Fort Worth, Tex; 
Fiscal year 2006 grants: 3,409,819; 
Fiscal year 2007 grants: 3,443,293; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,635,512; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,578,923. 

TGA: Hartford, Conn; 
Fiscal year 2006 grants: 4,666,281; 
Fiscal year 2007 grants: 3,170,527; 
Estimated hold-harmless funding under H.R. 3043: 870,472; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,346,206; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,295,231. 

TGA: Indianapolis, Ind; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,230,389; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,410,745; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,357,610. 

TGA: Jacksonville, Fla; 
Fiscal year 2006 grants: 4,913,816; 
Fiscal year 2007 grants: 4,886,573; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,157,261; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,078,765. 

TGA: Jersey City, N.J; 
Fiscal year 2006 grants: 5,145,142; 
Fiscal year 2007 grants: 4,535,846; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,786,028; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,714,081. 

TGA: Kansas City, Mo; 
Fiscal year 2006 grants: 2,916,485; 
Fiscal year 2007 grants: 3,724,815; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,933,437; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,871,632. 

TGA: Las Vegas, Nev; 
Fiscal year 2006 grants: 4,323,627; 
Fiscal year 2007 grants: 4,670,529; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,932,284; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,854,631. 

TGA: Memphis, Tenn; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 5,574,928; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,881,516; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,793,833. 

TGA: Middlesex-Somerset-Hunterdon, N.J; 
Fiscal year 2006 grants: 2,595,663; 
Fiscal year 2007 grants: 2,465,279; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 2,602,521; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,562,335. 

TGA: Minneapolis-St. Paul, Minn; 
Fiscal year 2006 grants: 3,046,512; 
Fiscal year 2007 grants: 4,468,112; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 4,717,553; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,644,114. 

TGA: Nashville, Tenn; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,688,043; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,894,140; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,833,330. 

TGA: Nassau-Suffolk, N.Y; 
Fiscal year 2006 grants: 6,148,307; 
Fiscal year 2007 grants: 4,814,937; 
Estimated hold-harmless funding under H.R. 3043: 509,497; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,082,928; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,004,488. 

TGA: New Haven, Conn; 
Fiscal year 2006 grants: 6,684,594; 
Fiscal year 2007 grants: 5,101,747; 
Estimated hold-harmless funding under H.R. 3043: 687,111; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,386,188; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,302,673. 

TGA: Norfolk, Va; 
Fiscal year 2006 grants: 4,414,760; 
Fiscal year 2007 grants: 5,054,931; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,335,464; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,253,782. 

TGA: Oakland, Calif; 
Fiscal year 2006 grants: 5,735,837; 
Fiscal year 2007 grants: 5,837,061; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 6,162,947; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 6,067,801. 

TGA: Orange County, Calif; 
Fiscal year 2006 grants: 4,858,579; 
Fiscal year 2007 grants: 4,966,678; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,244,811; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,163,142. 

TGA: Ponce, P.R; 
Fiscal year 2006 grants: 2,391,444; 
Fiscal year 2007 grants: 1,699,838; 
Estimated hold-harmless funding under H.R. 3043: 371,153; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,793,657; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,766,634. 

TGA: Portland, Oreg; 
Fiscal year 2006 grants: 3,401,956; 
Fiscal year 2007 grants: 3,156,465; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,335,454; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,281,669. 

TGA: Riverside-San Bernadino, Calif; 
Fiscal year 2006 grants: 7,074,521; 
Fiscal year 2007 grants: 6,720,094; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 7,099,329; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 6,986,369. 

TGA: Sacramento, Calif; 
Fiscal year 2006 grants: 2,778,729; 
Fiscal year 2007 grants: 2,259,806; 
Estimated hold-harmless funding under H.R. 3043: 146,573; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 2,387,096; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,349,311. 

TGA: St. Louis. Mo; 
Fiscal year 2006 grants: 4,502,572; 
Fiscal year 2007 grants: 5,273,629; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,566,687; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,481,157. 

TGA: San Antonio, Tex; 
Fiscal year 2006 grants: 3,325,881; 
Fiscal year 2007 grants: 3,655,732; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,858,822; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,799,575. 

TGA: San Jose, Calif; 
Fiscal year 2006 grants: 2,304,762; 
Fiscal year 2007 grants: 2,338,369; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 2,485,741; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,447,005. 

TGA: Santa Rosa, Calif; 
Fiscal year 2006 grants: 1,028,634; 
Fiscal year 2007 grants: 1,040,934; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,099,462; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,082,147. 

TGA: Seattle, Wash; 
Fiscal year 2006 grants: 5,445,484; 
Fiscal year 2007 grants: 5,953,167; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 6,288,967; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 6,189,029. 

TGA: Vineland-Millville-Bridgeton, N.J; 
Fiscal year 2006 grants: 849,715; 
Fiscal year 2007 grants: 783,864; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 827,169; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 814,671. 

TGA: Total; 
Fiscal year 2006 grants: $110,815,924; 
Fiscal year 2007 grants: $130,748,733; 
Estimated hold-harmless funding under H.R. 3043: $2,966,559; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: $138,055,416; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: $135,918,315. 

Sources: GAO analysis of HHS data, H.R. 3043, and report of the House 
of Committee on Appropriations (110-231). 

Notes: The projected fiscal year 2008 funding in this table is based on 
the funding amount for urban areas identified in the report of the 
House Committee on Appropriations (110-231). Before estimating the 
funding allocations, we reduced the amount to be allocated by 
subtracting out the amounts set aside by HRSA before awarding grants to 
urban areas. We used the same amounts for these reductions as were used 
in fiscal year 2007, $23,548,096. 

We cannot determine the exact impact on total funding for each TGA for 
fiscal year 2008. It is not possible to determine exactly how each TGA 
would be affected by the proposed 13.4 percent hold-harmless provision 
for TGAs because it is not known how HRSA will award fiscal year 2008 
supplemental and MAI grants and because the case counts on which 
formula grants will be based are not yet available. 

[A] Under the proposed hold-harmless provision in H.R. 3043, the 
maximum decrease in formula, supplemental, and MAI grants in total that 
a TGA could receive for program year 2007 would be no more than 13.4 
percent of what it received for program year 2006. Funds would be taken 
from fiscal year 2008 funding to cover this proposed hold-harmless 
provision. 

[End of table] 

Under funding identified in H.R. 3043 and under our assumptions, 
funding for each TGA would be impacted if the proposed hold-harmless 
provision is enacted. Each TGA would receive an increase in funding 
over fiscal year 2007 if the proposed hold-harmless provision is 
enacted, but the amount would be less than if the entire amount was 
awarded as fiscal year 2008 funding without the hold harmless because 
less funding would be available to be awarded. Less funding would be 
available for fiscal year 2008 because funds would be taken from fiscal 
year 2008 funding to cover the proposed hold-harmless provision in H.R. 
3043 that protects funds for the 2007 program year, which ends March 
31, 2008. The size of the difference in the amount of funding with and 
without the hold-harmless provision would vary by TGA with differences 
ranging from approximately 1.5 percent to 1.7 percent. However, it is 
not possible to determine exactly how each TGA would be affected by the 
proposed 13.4 percent hold-harmless provision because it is not known 
how HRSA will award fiscal year 2008 funding. Table 7 lists TGA funding 
for fiscal years 2006 and 2007, and the projected funding for fiscal 
year 2008 with and without the proposed hold-harmless provision, 
assuming funding amounts identified in H.R. 3043. 

Table 7: Total TGA Formula, Supplemental, and MAI Funding for Fiscal 
Years 2006 and 2007 and Projected Funding for Fiscal Year 2008 Under 
Funding Levels as Identified in the H.R. 3043: 

TGA: Austin, Tex; 
Fiscal year 2006 grants: $3,719,076; 
Fiscal year 2007 grants: $3,614,135; 
Estimated hold-harmless funding under H.R. 3043: $0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: $3,752,222; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: $3,693,080. 

TGA: Baton Rouge, La; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,259,580; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,384,014; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,331,417. 

TGA: Bergen-Passaic, N.J; 
Fiscal year 2006 grants: 4,485,650; 
Fiscal year 2007 grants: 3,869,966; 
Estimated hold-harmless funding under H.R. 3043: 14,607; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,017,744; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,955,154. 

TGA: Caguas, P.R; 
Fiscal year 2006 grants: 1,648,356; 
Fiscal year 2007 grants: 1,082,464; 
Estimated hold-harmless funding under H.R. 3043: 345,012; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,123,718; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,106,937. 

TGA: Charlotte-Gastonia, N.C.-S.C; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 4,200,378; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,360,616; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,293,722. 

TGA: Cleveland, Ohio; 
Fiscal year 2006 grants: 3,349,096; 
Fiscal year 2007 grants: 3,983,088; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,135,132; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,071,073. 

TGA: Denver, Colo; 
Fiscal year 2006 grants: 4,283,042; 
Fiscal year 2007 grants: 7,061,342; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 7,331,391; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 7,212,834. 

TGA: Dutchess County, N.Y; 
Fiscal year 2006 grants: 1,367,584; 
Fiscal year 2007 grants: 1,162,194; 
Estimated hold-harmless funding under H.R. 3043: 22,134; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,206,546; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,188,050. 

TGA: Fort Worth, Tex; 
Fiscal year 2006 grants: 3,409,819; 
Fiscal year 2007 grants: 3,443,293; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,574,857; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,518,267. 

TGA: Hartford, Conn; 
Fiscal year 2006 grants: 4,666,281; 
Fiscal year 2007 grants: 3,170,527; 
Estimated hold-harmless funding under H.R. 3043: 870,472; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,291,568; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,240,594. 

TGA: Indianapolis, Ind; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,230,389; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,353,792; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,300,657. 

TGA: Jacksonville, Fla; 
Fiscal year 2006 grants: 4,913,816; 
Fiscal year 2007 grants: 4,886,573; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,073,124; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,994,629. 

TGA: Jersey City, N.J; 
Fiscal year 2006 grants: 5,145,142; 
Fiscal year 2007 grants: 4,535,846; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,708,911; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,636,964. 

TGA: Kansas City, Mo; 
Fiscal year 2006 grants: 2,916,485; 
Fiscal year 2007 grants: 3,724,815; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,867,191; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,805,386. 

TGA: Las Vegas, Nev; 
Fiscal year 2006 grants: 4,323,627; 
Fiscal year 2007 grants: 4,670,529; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,849,051; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,771,399. 

TGA: Memphis, Tenn; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 5,574,928; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,787,532; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,699,849. 

TGA: Middlesex-Somerset-Hunterdon, N.J; 
Fiscal year 2006 grants: 2,595,663; 
Fiscal year 2007 grants: 2,465,279; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 2,559,448; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,519,262. 

TGA: Minneapolis-St. Paul, Minn; 
Fiscal year 2006 grants: 3,046,512; 
Fiscal year 2007 grants: 4,468,112; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 4,638,837; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,565,398. 

TGA: Nashville, Tenn; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,688,043; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,828,960; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,768,150. 

TGA: Nassau-Suffolk, N.Y; 
Fiscal year 2006 grants: 6,148,307; 
Fiscal year 2007 grants: 4,814,937; 
Estimated hold-harmless funding under H.R. 3043: 509,497; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 4,998,851; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,920,411. 

TGA: New Haven, Conn; 
Fiscal year 2006 grants: 6,684,594; 
Fiscal year 2007 grants: 5,101,747; 
Estimated hold-harmless funding under H.R. 3043: 687,111; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,296,672; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,213,157. 

TGA: Norfolk, Va; 
Fiscal year 2006 grants: 4,414,760; 
Fiscal year 2007 grants: 5,054,931; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,247,912; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,166,230. 

TGA: Oakland, Calif; 
Fiscal year 2006 grants: 5,735,837; 
Fiscal year 2007 grants: 5,837,061; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 6,060,963; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,965,817. 

TGA: Orange County, Calif; 
Fiscal year 2006 grants: 4,858,579; 
Fiscal year 2007 grants: 4,966,678; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,157,273; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,075,603. 

TGA: Ponce, P.R; 
Fiscal year 2006 grants: 2,391,444; 
Fiscal year 2007 grants: 1,699,838; 
Estimated hold-harmless funding under H.R. 3043: 371,153; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,764,692; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,737,668. 

TGA: Portland, Oreg; 
Fiscal year 2006 grants: 3,401,956; 
Fiscal year 2007 grants: 3,156,465; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,277,805; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,224,020. 

TGA: Riverside-San Bernadino, Calif; 
Fiscal year 2006 grants: 7,074,521; 
Fiscal year 2007 grants: 6,720,094; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 6,978,252; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 6,865,292. 

TGA: Sacramento, Calif; 
Fiscal year 2006 grants: 2,778,729; 
Fiscal year 2007 grants: 2,259,806; 
Estimated hold-harmless funding under H.R. 3043: 146,573; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 2,346,595; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,308,810. 

TGA: St. Louis. Mo; 
Fiscal year 2006 grants: 4,502,572; 
Fiscal year 2007 grants: 5,273,629; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,475,011; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,389,481. 

TGA: San Antonio, Tex; 
Fiscal year 2006 grants: 3,325,881; 
Fiscal year 2007 grants: 3,655,732; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,795,318; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,736,072. 

TGA: San Jose, Calif; 
Fiscal year 2006 grants: 2,304,762; 
Fiscal year 2007 grants: 2,338,369; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 2,444,222; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,405,486. 

TGA: Santa Rosa, Calif; 
Fiscal year 2006 grants: 1,028,634; 
Fiscal year 2007 grants: 1,040,934; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,080,902; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,063,586. 

TGA: Seattle, Wash; 
Fiscal year 2006 grants: 5,445,484; 
Fiscal year 2007 grants: 5,953,167; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 6,181,848; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 6,081,910. 

TGA: Vineland-Millville-Bridgeton, N.J; 
Fiscal year 2006 grants: 849,715; 
Fiscal year 2007 grants: 783,864; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 813,773; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 801,275. 

TGA: Total; 
Fiscal year 2006 grants: $110,815,924; 
Fiscal year 2007 grants: $130,748,733; 
Estimated hold-harmless funding under H.R. 3043: $2,966,559; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: $135,764,743; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: $133,627,642. 

Sources: GAO analysis of HHS data and H.R. 3043. 

Notes: The projected fiscal year 2008 funding in this table is based on 
the funding amount identified in H.R. 3043 and our assumption that the 
percentage of funding for Part A out of the total funding for Parts A 
and B will be the same in fiscal year 2008 as it was in fiscal year 
2007. Before estimating the funding allocations, we reduced the amount 
to be allocated by subtracting out the amounts set aside by HRSA before 
awarding grants to urban areas. We used the same amounts for these 
reductions as were used in fiscal year 2007, $23,548,096. 

We cannot determine the exact impact on total funding for each TGA for 
fiscal year 2008. It is not possible to determine exactly how each TGA 
would be affected by the proposed 13.4 percent hold-harmless provision 
for TGAs because it is not known how HRSA will award fiscal year 2008 
supplemental and MAI grants and because the case counts on which 
formula grants will be based are not yet available. 

[A] Under the proposed hold-harmless provision in H.R. 3043, the 
maximum decrease in formula, supplemental, and MAI grants in total that 
a TGA could receive for program year 2007 would be no more than 13.4 
percent of what it received for program year 2006. Funds would be taken 
from fiscal year 2008 funding to cover this proposed hold-harmless 
provision. 

[End of table] 

San Francisco EMA Continues to Have Deceased Cases Factored into Its 
Funding Allocation: 

The San Francisco EMA continues to be the only urban area whose formula 
funding is based on both living and deceased AIDS cases. In February 
2006, we reported that the San Francisco EMA was the only EMA still 
receiving CARE Act formula funding based on the number of living and 
deceased cases in a metropolitan area.[Footnote 23] All other EMAs 
received formula funding based on an estimate of the number of living 
AIDS cases. We showed that the fiscal year 2004 CARE Act formula 
funding for the San Francisco EMA was determined by its fiscal year 
1995 funding, which was based on both living and deceased AIDS cases. 
Since the San Francisco EMA also received hold-harmless funding in 
fiscal years 2005, 2006, and 2007, its CARE Act formula funding 
continues to be based, in part, on the number of deceased cases in the 
San Francisco EMA as of 1995.[Footnote 24] 

Information on Unobligated CARE Act Funding and ADAP Waiting Lists: 

Information on unobligated CARE Act funding can be found in two reports 
by the HHS Office of the Inspector General issued in February 2007 and 
May 2007.[Footnote 25] 

Information on the number of people on ADAP waiting lists can be found 
in the National ADAP Monitoring Project Annual Report and The ADAP 
Watch.[Footnote 26] ADAPs purchase and provide HIV/AIDS drugs to people 
with HIV/AIDS and pay for health insurance that includes HIV/AIDS 
treatments. 

We are sending copies of this report to the Secretary of Health and 
Human Services, the Administrator of the Health Resources and Services 
Administration, and to the Committee on Appropriations, United States 
Senate; the Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies, Committee on Appropriations, United 
States Senate; the Committee on Health, Education, Labor, and Pensions, 
United States Senate; the Committee on Appropriations, House of 
Representatives; the Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies, Committee on Appropriations, House of 
Representatives; and the Committee on Energy and Commerce, House of 
Representatives. We will also make copies available to others upon 
request. In addition, the report will be available on GAO's Web site at 
[hyperlink, http://www.gao.gov]. 

If you or your staff have any questions about this report, please 
contact me at (202) 512-7114 or crossem@gao.gov. Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this report. Major contributors to this report were 
Martha Kelly, Assistant Director; Robert Copeland; Helen Desaulniers; 
Adrienne Griffin; Cathy Hamann; and Suzanne Worth. 

Signed by: 

Marcia Crosse Director, Health Care: 

List of Requesters: 

The Honorable Nancy Pelosi: 
The Speaker of the House of Representatives: 

The Honorable Michael B. Enzi: 
Ranking Member: 
Committee on Health, Education, Labor, and Pensions: 
United States Senate: 

The Honorable Barbara Boxer: 
The Honorable Richard Burr: 
The Honorable Tom A. Coburn: 
The Honorable Christopher J. Dodd: 
The Honorable Dianne Feinstein: 
The Honorable Jeff Sessions: 
United States Senate: 

The Honorable Rosa L. DeLauro: 
The Honorable Anna G. Eshoo: 
The Honorable Tom Lantos: 
The Honorable Lynn C. Woolsey: 
House of Representatives: 

Footnotes: 

[1] Pub. L. No. 101-381, 104 Stat. 576 (codified as amended at 42 
U.S.C.  300ff through 300ff-121). Unless otherwise indicated, 
references to the CARE Act refer to current law. 

[2] Pub. L. No. 109-415, 120 Stat. 2767. The CARE Act programs had 
previously been reauthorized by the Ryan White CARE Act Amendments of 
1996 (Pub. L. No. 104-146, 110 Stat. 1346) and the Ryan White CARE Act 
Amendments of 2000 (Pub. L. No. 106-345, 114 Stat. 1319). 

[3] H.R. 3043, 110th Cong. (2007). For purposes of this report, unless 
otherwise specified we use the term H.R. 3043 to refer to the bill as 
passed by the House of Representatives. 

[4] In this report, we use the term urban areas to refer to both EMAs 
and TGAs. An EMA is a metropolitan area with a population of 50,000 or 
more that had more than 2,000 AIDS cases reported in the most recent 5- 
year period. The 2,000 AIDS cases criterion does not include cases of 
HIV that have not progressed to AIDS. In fiscal year 2007, there were 
22 EMAs. The Modernization Act of 2006 created a new program for TGA. A 
TGA is a metropolitan area with a population of 50,000 or more, which 
had 1,000 to 1,999 AIDS cases reported in the most recent 5-year 
period. Under this program urban areas that were eligible for EMA 
funding in fiscal year 2006 but that no longer meet the eligibility 
criteria for either EMAs or TGAs maintain their eligibility for funding 
and are considered TGAs for fiscal year 2007. In fiscal year 2007, 
there were 34 TGAs. 

[5] Prior to enactment of the Modernization Act of 2006, amounts 
available for formula and supplemental grants were split evenly between 
the two. Under the Modernization Act of 2006, two-thirds of such 
funding is to be distributed as formula grants and one-third as 
supplemental grants. 

[6] Part A of the CARE Act (also referred to as Title I) covers funding 
to urban areas. Part B (also referred to as Title II) covers funding to 
states, territories, and the District of Columbia. 

[7] The 2007 CARE Act program year began on April 1, 2007, and grants 
for that year were made with fiscal year 2007 appropriations. The 
proposed legislation states that "within the amounts provided for Part 
A . . ., funds are included to ensure that the amount of any funding 
provided under [Part A to an EMA] for the program year beginning in 
2007 is not reduced by an amount that is more than 8.4 percent, and the 
amount of any funding provided under [Part A to a TGA] is not reduced 
by an amount that is more than 13.4 percent, relative to the amount of 
the total funding provided under such part to the [EMA or TGA] for the 
program year beginning in fiscal year 2006." Because the provision 
would apply to "any funding" provided to EMAs and TGAs under Part A, we 
consider the total amount subject to the hold-harmless to be formula, 
supplemental, and MAI grants made with Part A funds. MAI grants are 
authorized by 42 U.S.C.  300ff-121, which specifically directs HHS to 
provide funding under Part A. 

[8] Funding for ADAPs is provided under Part B of the CARE Act and goes 
to states, territories, and the District of Columbia. Funding for ADAPs 
provides medications, treatment adherence and support, and health 
insurance with prescription drug benefits to people with HIV/AIDS. 

[9] H. Rep. No. 110-231 (2007). 

[10] In this report, we treat the proposed hold-harmless funding as if 
it was an addition to fiscal year 2007 supplemental funding. While not 
addressed in this report, the treatment of the proposed hold-harmless 
funding could have ramifications for funding beyond 2007. For fiscal 
years 2008 and 2009, hold-harmless amounts for EMAs under the CARE Act 
are based on the amount of formula funding (including hold-harmless 
funding) provided under the act for 2007. If the additional funding 
provided under H.R. 3043 was treated as formula funding, it would be 
included when the formula funding hold-harmless amounts for EMAs for 
fiscal years 2008 and 2009 are calculated. However, if the funding is 
not treated as formula funding, it would not be counted for 
calculations of CARE Act hold-harmless funding in future years since 
there is no hold-harmless provision protecting other funding 
categories. 

[11] Before awarding grants, HRSA sets aside funds from the total 
amount available for urban areas. These amounts are set aside for 
various purposes, including for possible public health emergencies. 
According to HRSA, the amount set aside in fiscal year 2007 was 
$23,548,096. Therefore, we have used this same figure for fiscal year 
2008 calculations. 

[12] Although the difference in proposed fiscal year 2008 funding 
between H.R. 3043 and the report of the Committee on Appropriations for 
Parts A and B is $10 million, under our assumptions the difference for 
Part A alone would be $10,051,307. This results from our assumption 
that under H.R. 3043 the percentage of funding for Part A 
(approximately 33.56 percent) out of the total funding for Parts A and 
B would be the same in fiscal year 2008 as it was in fiscal year 2007. 
However, the amount proposed in the report of the House Committee on 
Appropriations for Part A ($636,300,000) is a larger percentage (33.92 
percent) of the total amount specified for Parts A and B 
($1,875,800,000). Therefore, the increase for Part A would actually be 
larger than the $10 million difference for Parts A and B combined. 

[13] In our February 2006 report, we found that as of fiscal year 2004, 
one EMA was receiving CARE Act formula funding based on both living and 
deceased cases. See GAO, HIV/AIDS: Changes Needed to Improve the 
Distribution of Ryan White CARE Act and Housing Funds, GAO-06-332 
(Washington, D.C.: Feb. 28, 2006). 

[14] This committee report is not binding on HHS. 

[15] The appropriations acts for fiscal years 2001 through 2007 
covering HHS have not specified an amount of funding to be used for 
Part A grants for urban areas. However, when available the conference 
report accompanying the appropriations act has identified a total 
amount to be used for Part A funding for urban areas. Although these 
reports are not legally binding on HHS, we have used the amounts 
specified in them for the purposes of our analysis. 

[16] See H.R. Rep. No. 110-231, at 78-79 (2007). According to the 
committee report, this amount is $32,307,000 above the fiscal year 2007 
funding level and the administration's budget request for fiscal year 
2008. According to HHS, $603,993,000 was the funding level for grants 
to urban areas; that is, the amount available before subtracting for 
annual set asides. HHS refers to this amount as the "final 
appropriation amount" for fiscal year 2007. 

[17] See H.R. Conf. Rep. No. 109-337, at 137 (2005). We use funding 
from fiscal year 2006 because this was the last year for which there 
was a conference report accompanying the appropriations act for HHS. 
Fiscal year 2007 funds were appropriated for HRSA in a continuing 
resolution which contained a lump sum amount for all HRSA programs and 
did not specify a particular amount for grants to urban areas. See 
Revised Continuing Appropriations Resolution, 2007, Pub. L. No. 110-5, 
121 Stat. 8, 31-32. There were no conference or committee reports for 
this law. 

[18] The analyses demonstrating that $9.4 million would be needed to 
fund the hold-harmless provision contained in H.R. 3043 as passed by 
the House are described later in this report. 

[19] The $636,300,000 funding level for urban areas is taken from the 
report of the House Committee on Appropriations (No. 110-231) for H.R. 
3043. H.R. 3043 as reported by the Committee and passed by the House 
identifies an amount for CARE Act grants for urban areas and states and 
territories. However, this amount is $10 million less than the amount 
obtained by adding the amount identified in the House report for urban 
areas to the amount identified in the House report for states and 
territories. 

[20] The size of the decrease would depend on whether an EMA's formula 
funding would be held harmless for fiscal year 2008 under the hold- 
harmless provision of the CARE Act and the size of its MAI funding. 
Under our assumptions, those EMAs whose formula funding was held 
harmless would receive smaller decreases in their total funding. This 
would occur because those EMAs that qualified for the formula funding 
hold harmless could only have their supplemental funding decreased, not 
both formula and supplemental funding. Since we assumed that each EMA 
would receive the same percentage of supplemental funding in fiscal 
year 2008 that it received in fiscal year 2007, those EMAs that also 
received formula funding decreases would have larger total funding 
decreases. Under our assumptions, MAI funding would not be used to fund 
the hold-harmless provision. We assumed that the total funding for MAI 
grants would increase to the amount specified in the CARE Act and that 
each EMA would receive the same percentage of MAI funding in fiscal 
year 2008 funding that it received in fiscal year 2007. Consequently, 
those EMAs that have a larger proportion of their funding provided 
through MAI have smaller amounts that could be used to fund the hold- 
harmless provision. This results in smaller funding differences between 
what they would receive with and without the proposed hold-harmless 
provision. 

[21] The hold-harmless amounts for the eight TGAs would be $14,607 for 
Bergen-Passaic; $345,012 for Caguas; $22,134 for Dutchess County; 
$870,472 for Hartford; $509,497 for Nassau-Suffolk; $687,111 for New 
Haven; $371,153 for Ponce; and $146,573 for Sacramento. 

[22] Under our assumptions, MAI funding would not be used to fund the 
hold-harmless provision. We assumed that the total funding for MAI 
grants would increase to the amount specified in the CARE Act and that 
each TGA would receive the same percentage of MAI funding in fiscal 
year 2008 funding that it received in fiscal year 2007. Consequently, 
those EMAs that have a larger proportion of their funding provided 
through MAI have smaller amounts that could be used to fund the hold- 
harmless provision. This results in smaller funding differences between 
what they would receive with and without the proposed hold-harmless 
provision. 

[23] GAO-06-332, pp. 34-35. 

[24] Fiscal year 2007 funding for the San Francisco EMA can be traced 
to its fiscal year 1995 funding due to the relationship between the 
amount it received in fiscal year 1995 and the amounts it was 
guaranteed by law to receive in fiscal years 2000, 2006, and 2007 due 
to the operation of the hold-harmless provisions. In fiscal year 2000, 
the San Francisco EMA received 95 percent of the amount it received 
from its grant in fiscal year 1995. In fiscal year 2006, it received 85 
percent of the amount it received from its grant in fiscal year 2000. 
In fiscal year 2007, it received 95 percent of the amount it received 
from its grant in fiscal year 2006. Taken together, the hold-harmless 
provisions meant that in fiscal year 2007 the San Francisco EMA 
received approximately 76.7 percent of its fiscal year 1995 grant of 
$19,126,679, or $14,672,553. We calculated the guaranteed percentage by 
multiplying the hold-harmless amounts (95, 85, and 95 percents) for 
each year together. See GAO-06-332 for more discussion on how the hold- 
harmless provision operates and how it has affected funding for the San 
Francisco EMA. 

[25] HHS, Review of the Management of Unobligated Funds Provided by 
Title I of the Ryan White Comprehensive AIDS Resources Emergency Act, A-
02-03-02006 (Washington, D.C.: Feb. 27, 2007), [hyperlink, 
http://www.oig.hhs.gov/oas/reports/region2/20302006.pdf] (downloaded 
September 6, 2007) and Review of the Management of Unobligated Funds 
Provided by Title II of the Ryan White Comprehensive AIDS Resources 
Emergency Act, A-06-04-00060 (Washington, D.C, May 15, 2007), 
[hyperlink, http://www.oig.hhs.gov/oas/reports/region6/60400060.htm] 
(downloaded September 6, 2007). 

[26] Henry J. Kaiser Family Foundation and the National Alliance of 
State & Territorial AIDS Directors, National ADAP Monitoring Project 
Annual Report (Washington, D.C.: April 2007), [hyperlink, 
http://www.nastad.org/Docs/highlight/2007411_2007NationalADAPMonitoringR
epFINAL.pdf] (downloaded September 6, 2007) and the National Alliance 
of State & Territorial AIDS Directors, The ADAP Watch (Washington, 
D.C.: Aug. 16, 2007), [hyperlink, 
http://www.nastad.org/infocus/infocusresults.aspx] (downloaded 
September 6, 2007). 

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