Ryan White CARE Act of 1990:

Opportunities to Enhance Funding Equity

HEHS-96-26: Published: Nov 13, 1995. Publicly Released: Nov 13, 1995.

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Pursuant to a congressional request, GAO reviewed the funding formulas established under the Ryan White Care Act, focusing on: (1) whether the existing formulas distribute funds equitably to states and eligible metropolitan areas (EMA); (2) the factors that inhibit greater funding equity; and (3) formula changes that are needed to improve funding equity.

GAO found that: (1) although Ryan White Care Act funding formulas include factors used in equity-based formulas, they result in per-case funding discrepancies because EMA cases are double counted; (2) states without EMA do not benefit from double counting and receive significantly less funding; (3) the indicators used to target funds to needy states and EMA fail to take geographic cost differences into consideration; (4) EMA funding levels are based on the cumulative number of reported acquired immunodeficiency syndrome (AIDS) cases, resulting in the oldest EMA receiving the most funding; (5) better cost indicators could be used to target more funds to states and EMA where resources are the most needed; and (6) funding equity could be improved by eliminating the inappropriate double counting of AIDS cases and by using more appropriate measures of EMA and state funding needs.

Matters for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Congress chose not to implement the recommendation when it reauthorized the program.

    Matter: If Congress wishes to target more aid to states and EMA with limited fiscal capacity, then it may wish to consider adopting an indicator that reflects the relative strength of local tax bases and concentrations of people with AIDS. Alternatively, Congress may wish to discontinue the use of AIDS incidence rates in the title I formula and per capita income in the title II formula because of the funding inequities that these components produce.

  2. Status: Closed - Not Implemented

    Comments: Congress chose not to implement this recommendation when it reauthorized the program.

    Matter: To achieve greater equity in the distribution of funds, Congress should modify the funding formulas to include an indicator that reflects the relative differences across states and EMA in the cost of serving people with AIDS.

  3. Status: Closed - Implemented

    Comments: Congress changed the law consistent with the recommendation.

    Matter: To achieve greater equity in the distribution of funds, Congress should modify the funding formulas to adopt a caseload indicator that better reflects the number of people living with AIDS who are in need of services.

  4. Status: Closed - Implemented

    Comments: Congress changed the law consistent with the recommendation.

    Matter: To achieve greater equity in the distribution of funds, Congress should modify the funding formulas to reduce the double counting of EMA cases so that comparable medical services funding is available for people with AIDS, regardless of where they live.

  5. Status: Closed - Implemented

    Comments: Congress enacted the recommendation.

    Matter: To avoid possible disruption of service delivery, Congress may wish to consider phasing in formula modifications which should minimize, if not avoid, disruption for the service delivery networks the CARE Act has made possible over the last 5 years.

 

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