there is currently substantial unmet demand for services, any adjustments in funding for the Ryan White CARE Act should allow for meeting some of the currently unmet needs. The following paragraphs estimate the upper bound of the potential reduction to the Ryan White CARE Act if the HIV-CCP were to be fully implemented. This upper bound represents the most that could be eliminated from the program, before allowing for meeting current unmet needs.
As discussed in Chapter 3 (Box 3-2), Titles I and II of the CARE Act cover a variety of support services, including housing and food assistance, transportation, and advocacy and outreach services. The need for these services among the populations served by the CARE Act would not be eliminated by the implementation of the HIV-CCP. The Committee also envisions that any overlap between the CARE Act and the HIV-CCP would almost certainly occur only with Titles I and II and the dental reimbursement program. Though the Committee does foresee a potential restructuring of Title III (discussed later in this chapter), Title IV, and the AIDS Education and Training Centers (AETC) and the Special Projects of National Significance (SPNS) programs, these funds are targeted toward unmet needs that would still exist even with the new program and are unlikely to be diminished.
Table 3-1 provides the percentage distribution of funds for Titles I and II through Fiscal Year (FY) 2001, the most recent year for which data is available. Using these percentages for FY 2001 and applying them to FY 2002 allocations, we were able to approximate what percentage of CARE Act funds would be spent on services covered by the HIV-CCP (Table 6-8).5
The amount of CARE Act funds spent in service categories covered by the HIV-CCP totals $1.261 billion. This does not mean, however, that all of these funds could be used to offset the cost of the HIV-CCP. Not all of those receiving services under the CARE Act will be eligible for the HIV-CCP. In the model the Committee estimates that only 53 percent of uninsured individuals in care will be eligible for the program, leaving 47 percent who would continue to rely on other payers to receive care. Of the 53 percent who are eligible for the program, the Committee estimates that 90 percent (48 percent of those eligible) will actually enroll due to barriers in switching programs and inefficiencies in outreach and enrollment mechanisms. Thus, we calculate that of services covered by the HIV-CCP no more than $602 million of the $1.261 billion in potential overlap may be realized
The percentage distribution of funds across service categories in Titles I and II does vary slightly from year to year; however, it has not varied by more than ±5 percent in any category since 1998. Therefore, the margin of error caused by applying the values from FY 2001 to FY 2002 is relatively small.