Ryan White CARE Act:

Estimated Effect of Continued Application of the Fiscal Year 2010 Stop-Loss Provision on 2011 Funding for Urban Areas

GAO-11-405R: Published: Feb 18, 2011. Publicly Released: Feb 18, 2011.

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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 the stop-loss provision applicable in fiscal year 2010 was applied to funding for 2011 under a continuing resolution. The 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). In October 2009, the Ryan White HIV/AIDS Treatment Extension Act of 2009 (RWTEA) reauthorized CARE Act programs for fiscal years 2010 through 2013. 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 awarded for urban areas to address disparities in access, treatment, care, and health outcomes.

The Consolidated Appropriations Act, 2010, contained a provision to ensure that decreases in total Part A funding for fiscal year 2009 for each EMA and TGA did not exceed specified levels. Specifically, it limited the total funding decrease for fiscal year 2009 to no more than 7.6 percent of what the EMA or TGA received for fiscal year 2006. The funds necessary to limit the decreases to urban areas were given as increases to supplemental grants for fiscal year 2010. To provide Congress with technical assistance, we developed an estimate of fiscal year 2011 CARE Act funding for EMAs and TGAs assuming 2010 funding levels and that the stop-loss provision applicable in fiscal year 2010 is applied. We also developed an estimate of such funding without the stop-loss provision. We used data from HHS and the Consolidated Appropriations Act, 2010, to estimate these amounts. In order to conduct these analyses, we made a number of assumptions. This document includes estimates of CARE Act funding for EMAs with and without the stop-loss provision. It also includes estimates of CARE Act funding for TGAs with and without the stop-loss provision.

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