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Public Financing and Delivery of Hiv/Aids Care: Securing the Legacy of Ryan White
needs of low-income individuals who are not eligible to be served by the new program.7
The Committee emphasizes that the creation of a new federal HIV program for low-income individuals with HIV would not eliminate the need for the Ryan White CARE Act. It would, however, alter the role of the CARE Act, particularly with respect to funding drug therapies and other services that would be covered by the new federal program. Many of the individuals with HIV who are now served by the CARE Act would be eligible for the new federal program. As an entitlement, the new federal program would have more funds with which to address the treatment needs of these individuals than the CARE Act programs, which are subject to the annual appropriations process. In the case of individuals eligible for both programs, the new federal program should be the first dollar payer for the services that it covers. This would free up remaining CARE Act funds for other purposes, such as assisting individuals in enrolling in the new federal program, filling in any remaining service gaps, and supporting delivery system improvements.
The proposed program has significant implications for a number of CARE Act sub-programs, notably Title II and ADAP. As noted before, ADAP represents the majority of Title II expenditures. Under the new program, the majority of these expenditures would be covered. However, the Committee recognizes that low-income immigrants with HIV infection will not be eligible for the federal program. Thus, a percentage of current ADAP funds should continue to be available to address the needs of this population and the public health imperative to control the spread of this infectious disease.
Title I under the CARE Act would also be notably impacted by the new program. If implemented as recommended by the Committee, the new program would lessen the need for Title I. Title I funds are primarily, but not entirely, devoted to services included in the Committee’s benefit package and, as an entitlement program, eligibility is triggered by HIV infection; thus, funds follow the individual. Under this scenario, planning bodies would be refocused, and Title I funding savings could be used to offset federal spending on the HIV-CCP or some portion of the funds shifted to Title III.
The Committee gave considerable attention to the need for continuing to allocate funds for Title III, Early Intervention Services discretionary grants. Current grantees include community and migrant health centers, hospitals or university-based medical centers, and city and county health
For a discussion on the new program’s budget impact on the Ryan White CARE Act, please see the earlier section of this chapter.