Transcript Ryan White Reauthorization

Ryan White
Reauthorization
New York City HIV Health and Human Services
Planning Council
April 16, 2009
Humberto Cruz, Director
AIDS Institute
The 2006 Reauthorization
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Ryan White HIV/AIDS Treatment
Modernization Act is a three-year law that
expires on 9/30/09.
The law changed funding formulas and the
manner in which funds are allocated.
New York’s proportion of cases/funding was
reduced.
New York has lost $16.7 million in Part A and
Part B funds under the reauthorized law.
The 2006 Reauthorization
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If unobligated funds exceed two percent of the grant,
grantees are not eligible for supplemental funds, and the
subsequent year’s grant will be cut by the amount of
unobligated funds.
Law requires the development of a Severity of Need Index
(SONI).
 An index that takes into account other available resources
in determining need will penalize jurisdictions that have
devoted their own resources to HIV services.
Dutchess County is a “transitional grant area” but was
covered in for the three years of the law and will not qualify
under current Part A provisions.
Seventy-five percent of funds must be used for core services,
and support services must be linked to outcomes affecting
HIV-related clinical status.
The 2006 Reauthorization
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The Minority AIDS Initiative was changed from a formula grant
to a competitive grant.
A new Part B base supplemental was created and carves away
one-third of new base funding for competitive Part B grants.
There was pressure to eliminate hold harmless provisions that
prevent precipitous losses to jurisdictions.
Impact:
 New York has lost resources.
 We had to eliminate some contracts and modify numerous
contracts to meet the definition of support services.
 We have to compete for funds that were previously awarded
via formula.
 We used to write one application; now we write three.
2009 Reauthorization Recommendations
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Federal AIDS Policy Partnership Ryan White Work
Group is a coalition of national HIV/AIDS
organizations, providers, advocates, and persons
living with HIV/AIDS.
Participants include NASTAD, CAEAR Coalition,
NAPWA, NMAC, HIVMA, AAHIVM.
The Work Group has developed a community
consensus on the future of the Ryan White Law. The
consensus statement has been signed by 154
organizations as of April 1, 2009.
2009 Reauthorization Recommendations
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Rationale for consensus recommendations:
 The 2006 reauthorization included many significant changes.
The impact of the changes has not been fully assessed. For
example:
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distribution formulas
case data
core services requirement
requirements related to unobligated funds
Part B supplemental
Policy discussions that are underway could affect the Ryan
White program. For example:
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New
New
New
New
New
National AIDS strategy
Health care reform
CDC estimates that there will not be mature HIV data for all
states until 2012.
2009 Reauthorization Recommendations
Consensus Recommendations:
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Extend the RWHATMA for three years (i.e., re-start
the clock on the current three-year authorization).
Continued protection for states with maturing HIV case
data.
Extension of TGA eligibility.
Extension of hold harmless provisions.
Confirm that Part A and Part B funds will continue to be
allocated through existing mechanisms, rather than
through a SONI.
2009 Reauthorization Recommendations
Consensus Recommendations (continued):
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Recommended modifications:
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Increase the penalty threshold for unobligated funds from
two percent to five percent, and suspend penalties to enable
grantees to access supplemental funding and avoid
reductions in awards.
Remove the qualifier “medical” from transportation in the
support services category. Include “medical transportation”
as a core medical service.
Allow the provision of food pursuant to a doctor’s
prescription as a core medical service.
Eliminate requirement for Part D grantees to include medical
expenses in their program budgets.
2009 Reauthorization
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NY Representatives on House Energy and Commerce
Committee are encouraged by the community
consensus and hope that it will lead to a smooth
reauthorization.
Congress is prioritizing health care reform and food
safety.
Need to remind representatives that the Ryan White
law has a sunset clause, and without action, the
program expires on 9/30/09.