Ryan White CARE Act of 1990: Opportunities Are Available to Improve Funding Equity

GAO discussed the distribution of funds to states and eligible metropolitan areas (EMA) under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. GAO noted that: (1) the CARE Act is the only federal program that makes funds available specifically for medical and support services to individuals with acquired immunodeficiency syndrome (AIDS); (2) during fiscal year 1994, over $500 million in title I and II funds were distributed to states and EMA; (3) grant allocation formulas should reflect the number of people needing services and the cost of providing those services; (4) the CARE Act funding formulas result in funding disparities that are, to a large extent, unrelated to service costs or the states' ability to fund services from local sources; (5) greater funding equity could be achieved by eliminating the inappropriate double counting of AIDS cases and by using more appropriate measures of EMA and state funding needs; (6) although the costs of providing AIDS services vary among EMA and states, the title I and title II formulas do not measure those differences; (7) the cost of providing medical services in New York, Oakland, and San Francisco is about 30 percent above the national average; and (8) modifying the formulas to achieve more equitable funds distribution will involve significant changes in grants to some EMA and states.