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Tuesday, January 18, 2011

The Ryan White HIV/AIDS Program

Judith A. Johnson
Specialist in Biomedical Policy

The Ryan White HIV/AIDS Program makes federal funds available to metropolitan areas and states to assist in health care costs and support services for individuals and families affected by the human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). The Ryan White program currently serves more than half a million low-income people with HIV/AIDS in the United States; 33% of those served are uninsured, and an additional 56% are underinsured. The program is administered by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS). Its statutory authority is Title XXVI of the Public Health Service (PHS) Act, originally enacted in 1990.

The Ryan White program is composed of four major parts and several other components. Part A provides grants to urban areas and mid-sized cities. Part B provides grants to states and territories; it also provides funds for the AIDS Drug Assistance Program (ADAP). Part C provides early intervention grants to public and private nonprofit entities. Part D provides grants to public and private nonprofit entities for family-centered care for women, infants, children, and youth with HIV/AIDS. The other components, sometimes referred to as Part F, include the AIDS Dental Reimbursement (ADR) Program, the Community-Based Dental Partnership Program, the AIDS Education and Training Centers (AETCs), the Special Projects of National Significance (SPNS) Program, and the Minority AIDS Initiative (MAI).

In October 2009, the 111
th Congress passed and President Obama signed the Ryan White HIV/AIDS Treatment Extension Act of 2009 (P.L. 111-87), which reauthorizes the Ryan White program through September 30, 2013. P.L. 111-87 maintains the hold-harmless provision for Part A and Part B and provides a continuation of the transition period for states that do not have a fully mature name-based HIV reporting system. The new law requires that the Secretary establish a national HIV/AIDS testing goal of 5 million tests annually through programs administered by HRSA and the Centers for Disease Control and Prevention (CDC). It requires the Part A Planning Councils to develop a strategy for identifying individuals with HIV/AIDS who do not know their HIV status, making them aware of their status and connecting them with health care and support services. It also requires the Part B grant application to provide a comprehensive plan for the identification of such individuals and enable their access to medical treatment.

The Patient Protection and Affordable Care Act (PPACA, P.L. 111-148) contains general provisions to increase access to health insurance and which, therefore, will increase coverage for people living with HIV/AIDS. PPACA includes prohibitions on the cancellation of coverage by an insurer due to a preexisting condition, elimination of lifetime caps on insurance benefits and annual limits on coverage, and eligibility for tax subsidies to assist low- and middle-income individuals in the purchase of coverage from state health insurance exchanges. In addition, Medicaid eligibility will be broadened to include single adults, and PPACA phases out the Medicare Part D doughnut hole for HIV/AIDS individuals who are Medicare eligible.

Ryan White programs received $2.266 billion for FY2010 in the Consolidated Appropriations Act, 2010 (P.L. 111-117). In July 2010 HHS announced the reallocation of $25 million in funds for ADAP from dozens of programs throughout HHS. The additional funds were targeted for states with ADAP waiting lists or other cost containment strategies.

The Obama Administration’s request for Ryan White programs in FY2011 is $2.305 billion, an increase of $39.513 million over the FY2010 appropriation. The House Labor-HHS-Education Appropriations Subcommittee held a markup session in July 2010, but the full committee did not report a bill. The Senate Committee on Appropriations reported S. 3686 (S.Rept. 111-243) in August 2010, but the bill did not receive any further action. The Continuing Appropriations Act, 2011 (P.L. 111-242), as amended, provides temporary FY2011 funding through March 4, 2011, at the FY2010 rate of operations.

Date of Report: January 5, 2011
Number of Pages: 21
Order Number: RL33279
Price: $29.95

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