Ryan White CARE Act:

Estimated Effect of Proposed Stop-Loss Provision in H.R. 3293 on Urban Areas

GAO-09-947R: Published: Aug 3, 2009. Publicly Released: Aug 3, 2009.

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Congress asked us to estimate the effect on Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) funding to urban areas if a certain stop-loss provision is enacted. The CARE Act, administered by the Department of Health and Human Services's (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). In December 2006, the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (RWTMA) reauthorized CARE Act programs for fiscal years 2007 through 2009. In July 2009, the House of Representatives passed H.R. 3293, the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriation Act, 2010, which contains a stop-loss provision covering CARE Act funding for urban areas that receive funding under the CARE Act. This bill has not been passed by the Senate. Under the CARE Act, funding for urban areas--Eligible Metropolitan Areas (EMA) and Transitional Grant Areas (TGA)--is primarily provided through three categories of grants: (1) formula grants that are awarded based on the case counts of people with HIV/AIDS 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. Changes in grantees' characteristics and funding formulas can cause increases or decreases in grantees' funding.

To provide Congress with technical assistance, we developed an estimate of fiscal year 2010 Part A CARE Act funding for EMAs and TGAs with the stop-loss provision in H.R. 3293. We also developed an estimate of such funding without that provision. We used data from HHS, H.R. 3293, and the report of the House Committee on Appropriations accompanying H.R. 3293 to estimate these amounts. In order to conduct these analyses, we made a number of assumptions.

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