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Ryan White CARE Act Reauthorization Fact Sheet....what is in the works...



Ryan White CARE Act Reauthorization

Fact Sheet

June 14, 2006

This fact sheet is intended to update anyone interested on how the CARE Act reauthorization is proceeding with simple facts and information about where we are in the process and what to expect. This fact sheet will be updated and distributed roughly once a month until the CARE Act is reauthorized. 

Congressional Update

    * In May, the Congressional workgroup finally finished its bi-partisan, bi-cameral process of drafting reauthorization legislation. The workgroup had been made up of key staff of the Senate HELP and House E&C Committees.*  Their intent is to file the same bill in both the House and the Senate, averting any conference committee to settle differences between the two in order to get reauthorization done this summer.
    * On May 9th, the Committees** released an outline of their proposed legislation and met with community stakeholders to explain their proposal and respond to questions and concerns from the community.  A draft bill was released the next day.
    * On May 10th, the Congressional Black Caucus sent a letter to the authors of the bill asking that the portion of the Minority AIDS Initiative (MAI) in the CARE Act be codified as a separate Title of the CARE Act.
    * On May 17th, the Senate HELP Committee “marked up” the bill and filed it as S. 2823 – “The Ryan White HIV/AIDS Treatment Modernization Act of 2006”.  A “mark up” is a meeting to review and approve a bill. The vote was 19-1. Senator Hillary Clinton (D-NY) voted against the bill due to her concerns about possible New York State losses of funding under the proposal.
    * On May 19th, the bi-cameral, bi-partisan panel held another feedback session with the community to answer questions publicly on the draft bill that was released.
    * Fulfilling a promise to the HIV community, the House E&C Committee held an off-the-record “hearing” on May 24th.  At the session, Members of the Committee made statements about the bill and asked questions of specific stakeholders on various parts of the legislation.
    * The House E&C Committee is expected to “mark up” its version of the bill sometime in June. If it’s at all different from the Senate bill then a conference committee of a few delegates from each the House and Senate will hammer out a compromise.  The conferenced bill will then have to go back to the floor of both the House and the Senate for their final vote.


Major changes to the CARE Act in S. 2823

    * The information below is based on the bill that passed out of Senate HELP. You can read a side-by-side analysis of the bill, which compares current law to the proposed reauthorization legislation at
    * Three Tiers in Title I
          o Title I funds metropolitan areas that have been heavily impacted by HIV/AIDS (currently called “Eligible Metropolitan Areas” or EMAs)
          o Eligibility requirements to be a Title I funded area will expand. This will increase the number of Title I jurisdictions.
          o Three “tiers” will be created in Title I. The tier an area falls into will depend on its living AIDS cases reported in the last five years.
          o Tier one jurisdictions have 2,000 living AIDS cases reported in the previous five years.
          o Tier two jurisdictions have between 1,000 to 1,999 living AIDS cases reported in the previous five years. Tier two will also contain current “grandfathered” EMAs, which are those that have stopped meeting eligibility requirements, but remained EMAs. The grandfathered areas will stay in Tier two for three years. After that, their status will be based on their living AIDS counts.
          o Tier three jurisdictions have between 500 and 999 living AIDS cases in the previous five years.
    * Hold Harmless
          o The “hold harmless” provision, which protected Title I EMAs and states from being cut more than a certain percentage from year to year, is being phased out.
          o Hold harmless will remain for the next three years for Tier One jurisdictions in Title I and for states (Title II funding). After three years, there will be no more hold harmless
    * Funding Formula Changes
          o The way money is distributed through Title I and Title II would change under the new legislation.
          o For Tiers one and two of Title I, funding will be distributed based on two-thirds formula and one-third supplemental grant. Currently, Title I funds are distributed based on 50 percent formula and 50 percent supplemental.
          o All Tier three funding in Title I will be distributed based on formula.
          o Title I formula will be based on both living HIV and AIDS cases. Areas that are transitioning to a newer HIV reporting system will have a “proxy” of .9 times the number of AIDS cases until they have a complete data set.
    * Mandatory Spending on “Core Medical Services”
          o 75% of all Ryan White CARE Act funding (except for Title IV) must be spent on “Core Medical Services”. The remaining 25% may be used for “support services needed to achieve medical outcomes.”
          o Core Medical Services would be defined as:
                + outpatient and ambulatory health services
                + pharmaceuticals
                + oral health
                + early intervention services
                + health insurance premiums and cost-sharing assistance for low-income people;
                + home health care;
                + home and community-based health services
                + hospice services
                + mental health services
                + outpatient substance abuse care
                + medical case management, including treatment adherence services.
          o The 75% requirement shall be waived by the Secretary of Health and Human Services if the grantee can show that core medical services are available to all people living with HIV/AIDS, and that there is no AIDS Drug Assistance Program waiting list in the area.
    * Addressing the AIDS Drug Assistance Program (ADAP) Crisis

          o Each state will be required to provide a minimum list of antiretroviral drugs (ARVs) to be determined by HHS.
          o The amount of money set aside from ADAP funding for supplemental grants will increase from 3% to 5%. Supplemental grants give extra money to states that are having problems providing ADAP services to everyone who needs them.
          o There is a recommended one-time $40 million “ADAP booster”. This is money that would go to the Secretary of Health and Human Services to use at his discretion to help states that are struggling with their ADAPs.

      Funding Levels

          o The legislation authorizes funding levels for all Titles and Parts of the CARE Act. These are recommendations of how much money should be allocated to each section of the CARE Act per year in the appropriations process. Appropriators are not supposed to fund programs higher than authorized levels, although there are cases where this happens. Under S. 2823:
                + Title I funding would be increased by $10 million to absorb the existing Emerging Communities that would move to Title I.
                + Title II funding would be increased by $30 million in FY07, with $10 million of the funds for a new supplemental grant pool
                + Titles I, II, III can receive an annual funding increase of 3.7 percent, although ADAP could not receive any increase in FY07.
                + Title IV, AIDS Education and Training Centers and the Dental Program would be flat funded over the next five years.

Other updates

On April 25th, the Communities Advocating Emergency AIDS Relief (CAEAR) Coalition released an analysis of how much CARE Act funding each state receives per person living with AIDS. The analysis factors in funding from all Titles and components of the CARE Act. You can read it at 

On June 5th, members of the Senate HELP and House E&C Committees received a letter signed by over 50 local, state and national HIV/AIDS organizations urging them to increase the very low authorizing levels contained in S. 2823.  The groups wrote, “The modest increases that were included (on average 3.7 % or flat funding, depending on the Title) are not nearly enough to keep pace with the increases in health care costs alone, much less the increasing prevalence of HIV/AIDS in the United States and the growing need for Ryan White CARE Act Services.”  The letter was drafted and circulated by the Ryan White Reauthorization Workgroup of FAPP.  For a copy of the letter go to: 

This fact sheet was produced by the Ryan White Reauthorization Workgroup of the Federal AIDS Policy Partnership (FAPP).  Please adapt this form in any way you deem fit to send to your membership.     

      * To do all of the business before it, Congress divides up its work by committee, in which only a fraction of the members are involved.  On the Senate side, the Health, Education, Labor & Pensions (HELP) Committee is in charge of re-writing the Ryan White CARE Act.  On the House side, it is the Energy & Commerce (E&C) Committee, which has a subcommittee on health.   

      ** The Congressional workgroup drafting Ryan White legislations was led by the staff members of the top Republican (Chair) and top Democrat (Ranking Member) of the Senate and the House: Senators Mike Enzi (R-WY) and Edward Kennedy (D-MA) and Representatives Joe Barton (R-TX) and John Dingell (D-MI)

For questions on this Fact Sheet or on the Federal AIDS Policy Partnership Ryan White Reauthorization Workgroup, please contact any of the three co-chairs:

Ryan Clary, Project Inform

Carl Schmid, The AIDS Institute

Greg Smiley, American Academy of HIV Medicine:

Thank you very much, Trai.

This is very informative and the first real glimpse of what we might expect.

Thank you for this information. Many of us here in AZ depend on Ryan White. I'm not sure why Mrs. Clinton was the only one who voted against it. She couldn't be that greedy, or could she?

In my opinion, she voted what would be best for the people of New they stand to lose a lot of funding, as does several areas...such as California over the course of this legislation.

T Rai

The official word from the Joint Committees of the Nine Planning Counsils (of California) is... There is considerable problems with the language of the bill and if it is not on the Senate Floor by the end of this week, it will not be voted on by the Senate or the House this year, there is still time to write to the members of the Senate Budget Committee, Senate Committee on Health, Education, Labor and Pensions, the House Ways and Means Committee and the Sub-committee on Health.  The names and addresses of the members of those committees and sample letters are available under the SUPPORT tab of  Have the best day


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