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GAO discussed the distribution of funds to states and existing metropolitan areas (EMA) under the Ryan White Care Act. GAO noted that: (1) the title I and II funding formulas do not meet the beneficiary or taxpayer equity criteria for funds distribution; (2) the funding formulas result in per case funding disparities that are mostly unrelated to service costs or the ability of states and EMA to fund services from local sources; (3) EMA cases are inappropriately double counted in both title I and title II formulas because there is no indicator that reflects cost differences in providing services in both states and EMA; (4) formula factors that incorrectly measure caseloads and funding capacity result in funding disparities; and (5) greater funding equity could be achieved by changing the structure of the funding formulas to correct the bias introduced by double counting EMA AIDS cases and by using more appropriate measures of EMA and state funding needs.

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