Ryan White CARE Act – Reauthorization –

Ryan White CARE Act – Reauthorization –

‘What you can do!’

Sue Rowland -- VORASeptember 20, 2005

‘What you can do!’

Sue Rowland -- VORASeptember 20, 2005

The Problem

What’s the future for HIV/AIDS Treatment funding?

Or

“The canary is awfully sick …”

Or …

The Ryan White C.A.R.E. Act provides significant levels of public funding for HIV/AIDS treatment services

It is authorized by Congress for 5 years at a time

The current authority for Ryan White funds expires on Sept 30, 2005

History

Of theRyan White C.A.R.E. Act

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•First passed as “the Ryan White CARE Act of 1990” [Public law 101-381]

•Amended as the Ryan White CARE Act of 1996

•Again amended as the Ryan White CARE Act of 2000

The primary purpose of the Act is established by Congress -- in the Law.

The details (the rules) are established by the federal agency assigned …

Administered by the Health Resources and Services Administration (HRSA)

The Act is complex …

• Title I -- Eligible Metro Areas (EMA’s)

• Title II -- the States– ADAP

• Title III -- Community-based care

• Title IV -- Family-centered care

… there’s more

• Part F -- AETC’s

• Part F -- Dental Reimbursement Program

• SPNS -- Special Projects of National Significance

• Community-Based Dental Partnership Program

Total RWCA Funds

$0

$500,000,000

$1,000,000,000

$1,500,000,000

$2,000,000,000

$2,500,000,000

FY 1991FY 1992FY 1993FY 1994FY 1995FY 1996FY 1997FY 1998FY 1999FY 2000FY 2001FY 2002FY 2003*FY 2004*FY 2005*

Title I Funds

$0

$100,000,000

$200,000,000

$300,000,000

$400,000,000

$500,000,000

$600,000,000

$700,000,000

FY1991

FY1993

FY1995

FY1997

FY1999

FY2001

FY2003*

FY2005*

Title II Funds

0

100,000,000

200,000,000

300,000,000

400,000,000

500,000,000

600,000,000

700,000,000

800,000,000

FY1991

FY1994

FY1997

FY2000

FY2003*

(STATE)(ADAP)

Title III Funds

0

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

FY1991

FY1993

FY1995

FY1997

FY1999

FY2001

FY2003*

FY2005*

Title IV Funds

0

10000000

20000000

30000000

40000000

50000000

60000000

70000000

80000000

FY1991

FY1993

FY1995

FY1997

FY1999

FY2001

FY2003*

FY2005*

AETC & Dental Funds

0

5000000

10000000

15000000

20000000

25000000

30000000

35000000

40000000

FY1991

FY1994

FY1997

FY2000

FY2003*

Part F: AETC

Part F: DentalReimbursements

Virginia’s awards• Title I

– Washington DC EMA - $29,431,967 **– Norfolk EMA - $4,726,063– Richmond EMA - $241,396

• Title II– State - $5,543,229– ADAP - $15,188,795– Minority AIDS Initiative - $112,908– Emerging Communities - $241,396

Virginia Awards

• Title III– University of Virginia - $430,537 (05)– Carilion Medical Center - $107,634 (05)– Centra Health, Inc. - $55,170 (04)

• Title IV– VCU/MCV - $309,777 (04)

• AETC– Based in Richmond

• Dental– None

RWCA: Problems … Structure of the titles results in “double

counting” PLWH/A “Hold harmless” - 90% provided to San

Francisco Southern states receiving less funding

Disproportionate distribution of funds

President Bush’s Principles

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The President’s Principles

• Eliminate “hold harmless”

• Eliminate double-counting

• Develop “severity of need for core services index” (SNCSI)

• National ADAP core meds

President’s Principles (con’t)

• 75% of Titles I - IV directed to essential cores services

• Change role/make-up of Title I Councils

• Use HIV data in distribution formula

• New routine voluntary HIV testing

Sen. Tom Coburn leading the Reauthorization review

• Held Hearing in June 2005

• GAO Report on “RWCA: Factors that Impact HIV and AIDS Funding and Client Coverage”

• Testimony provided to respond to GAO Report implications; supports President

Current Status of Reauthorization

No bill yet introduced to Amend One bill continues the Title IV

portion

The Problem Every day, 4 new cases of HIV are

found in Virginia every day One third of Va. PLWH/A are women Two thirds are African American Treating HIV/AIDS costs about $20,000

per person per year

The Problem Funding has not kept pace with the

growing number of persons living with HIV/AIDS in Virginia

Waiting lists have developed in Virginia Funding is not even distributed where

PLWH/A live

The Problem During AIDS Watch, we learned that

Virginia’s delegation not well aware of needs

In Richmond, Virginia’s State Legislators are unaware of what’s happening with federal funding for HIV/AIDS prevention & treatment

“I Can’t Lobby ….

…. Can I?”

“I Can’t Lobby ….

…. Can I?”

You, the Agency …

• Your leadership decides

• “Lobbying” IS allowable -- and limited.

You, the Individual …

• Does the source of your livelihood explicitly prohibit you from lobbying?–Very few do …

• How about “implicit” prohibitions?• Know your Rights as an American

Citizen.

What are the Rules?

“Yes, You can …” Two Senators One Congressperson

One State Senator One State Delegate

“What do I say?”

Sources of Help

• www.VORAonline.org

• www.NASTAD.org

• www.NMAC.org

• www.NAPWA.org

• www.C2EA.org

And many more ….

Efforts in VirginiaJoint Commission on Health

Care Study of Federal Funding for HIV/AIDS

prevention and treatment