Committee was tasked to evaluate. Past IOM Committees have made recommendations for universal health-care coverage, and for specific types of services that should be covered (e.g., primary care services and public and private insurance coverage of evidence-based mental health and substance abuse treatment services). What is new in this report is the tying together of those services for individuals with HIV under the umbrella of a federally-supported entitlement.

With respect to the financing of services, the Committee considered expanding Medicaid to include low-income individuals with HIV, but rejected that approach in favor of a new federally-funded entitlement. The Committee is not breaking new policy ground by recommending this entitlement, but rather is in concordance with current policies because the Congressional language that discusses “eligibility for medical assistance under such title [Medicaid]” refers, by definition, to an individual entitlement. Further, had the Committee decided to recommend an expansion of the Medicaid program to cover individuals with HIV, that recommendation would not have been free to either the federal government or the states; thus, the Committee’s recommendation for additional funding is consistent with the financial implications of that financing option. Finally, it is worth highlighting that the Committee’s cost–benefit analysis demonstrates that the program would be cost-effective.

The Committee emphasizes that it has not gone beyond its charge in its recommendations in this report. As requested by Congress the Committee focused on a specific population and disease: low-income, uninsured, and underinsured individuals with HIV. The Committee’s recommendation for a new entitlement at a cost of $7 billion is also within its purview given its charge to consider all financing options. The Committee is firm in its conviction that this nation can do more to treat individuals with HIV and to reduce the risk of HIV transmission. The HIV Comprehensive Care Program, if implemented, would secure the legacy of Ryan White and would indicate a continued federal commitment to address the financing and delivery of care for people with HIV/AIDS.

Front Matter (R1-R16)

Prologue and Executive Summary (1-26)

1 Introduction: Securing the Legacy of Ryan White (27-35)

2 HIV/AIDS Care in the Third Decade: Opportunities and Challenges in the Changing Epidemic (36-72)

3 Current Financing and Delivery of HIV Care (73-106)

4 Barriers to HIV Care (107-140)

5 Options for Financing and Delivering HIV Care (141-177)

6 Recommendations (178-212)

Appendix A: Technical Appendix Estimating the Impact and Cost of Expanded HIV Care Programs (213-245)

Appendix B: Overview of Care Act Allocation Formulas (246-249)

Appendix C: Mental Illness and HIV Comorbidity: A Large and Vulnerable HIV Subpopulation (250-267)

Appendix D: Financing HIV/AIDS Care: A Quilt With Many Holes (268-312)

Appendix E: Towards an Understanding of Meeting HIV-Infected Substance Users (313-339)

Appendix F: Committee on the Public Financing and Delivery of HIV Care (340-346)

Index (347-358)