The CARE Act has several titles and components, which are described in Box 1-1. In FY 2003, federal spending for the CARE Act totaled $2.0 billion; it represents the third largest source of federal funding for HIV care in the United States (HRSA, 2003a). Title I ($626.7 million) and Title II ($1 billion) of the CARE Act provided the largest amount of grant funding to areas, states, and territories in FY 2003. The majority of Title I funds go to health care services, case management, and social support services (HRSA, 2002a). The majority of Title II funding is directed as an earmark to the AIDS Drug Assistance Progam (ADAP) ($714.3 million, a program that provides medications but can also be used to purchase private insurance with drug coverage benefits) (HRSA, 2002b). The remainder of ADAP funds is directed to states ($352.6 million) for services (HRSA, 2002c, 2003a). In recognition of the varying nature of the HIV/AIDS epidemic across the country, CARE Act grantees, including states and cities, are given broad discretion in designing local programs. As a result, there is significant variation in state funding, eligibility, services, and other aspects of CARE Act programs across the country.
Although much smaller in scope, three additional CARE Act programs provide funding for care services: Title III-Early Intervention Services, Planning and Capacity Grants (Title III); Title IV-Women, Children, Infants, and Youth (Title IV); and the HIV/AIDS Dental Reimbursement Program (Dental Reimbursement Program). In FY 2003, these programs had a cumulative appropriation of $288.8 million.
Title III of the CARE Act funds early-intervention HIV services provided by public and non-profit groups. Early-intervention services include counseling, testing, medical evaluation, primary care, antiretroviral therapies, medical and mental health care, case management, and other services. A smaller proportion of the Title III funds help such groups plan for the development of early-intervention services (one-year grants of $50,000) or build their capacity to provide services (up to $150,000 over a three-year period (HRSA, 2002d). In FY 2003, $200.9 million was appropriated for this program (HRSA, 2003a).
Title IV of the CARE Act addresses the specific needs of women, infants, and children and youth living with HIV. Title IV evolved from the Pediatric AIDS Demonstration Program which was established in 1988. The funds cover primary and specialty medical care, psychosocial services, logistical support and coordination, outreach, and case management (HRSA, 2002e). Title IV also provides clients with increased access to HIV/AIDS clinical