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Public Financing and Delivery of Hiv/Aids Care: Securing the Legacy of Ryan White
cases of AIDS during the most recent five calendar years for which data are available from the CDC (HRSA, 2002a). A type of hold-harmless provision applies to Eligible Metropolitan Areas (EMAs) in that once a metropolitan area’s eligibility is established, the area remains eligible even if the number of cases drops below the threshold in later years.
An EMA’s base award is determined by a formula based on its proportion of the total number of estimated living cases in all EMAs. The formula also includes a hold-harmless provision that limits the amount an EMA’s funding can fall from year to year, according to a schedule specified in the legislation.3 San Francisco is the only EMA that now benefits from the hold-harmless provision (HRSA, 2002c).
Supplemental awards are determined by a competitive application process, rather than by a formula. Reviewers score the application according to criteria laid out by HRSA. Either HRSA staff or external reviewers score applications. The supplemental award is divided among all EMAs, taking into account the score as well as the proportion of all ELCs that an EMA has. Three different “smoothing” algorithms are applied to see which distributes the money most appropriately. In general, no grantee is given less than 80 percent of its base formula award (HRSA, 2001).
Title I Minority AIDS Initiative
Minority AIDS Initiative (MAI) grant awards are divided among all EMAs according to a formula based on their proportion of racial and ethnic minorities AIDS cases—including African Americans, Hispanics, Asian/Pacific Islanders, and Native Americans/Alaska Natives—diagnosed during the most recent two years for which data are available, and adjusted for reporting delays. For instance, data from 1998 and 1999 were used to calculate the Fiscal Year 2001 MAI award (HRSA, 2001).
The hold-harmless award is subtracted from the total Title I supplemental funds before the latter are divided.