States that choose to expand their Medicaid program must provide the same benefits under CHIP. States that do not expand Medicaid can either choose popular benefit packages or develop equivalent ones. In response to the information that 11 million infants, children, and adolescents were uninsured last year, 3 million of whom were estimated to be eligible for Medicaid, CHIP requires and supports outreach to Medicaid-eligible children.

There are important implementation issues that will affect eligibility and services for the HIV-infected population. If a state chooses to expand Medicaid with CHIP funds, the comprehensive Medicaid benefit package would be available to children and become an entitlement. Choosing a separate health insurance program that uses commercial plan packages may not meet the multiple special needs of a child with HIV/AIDS and the benefits can be capped by the state's allocation. A separate plan would also allow for premiums and cost sharing, while a Medicaid expansion would preclude passing on costs to families in the form of cost sharing. Some state Medicaid plans, however, have received waivers for cost sharing. No matter which plan a state chooses, it has considerable flexibility in determining family incomes and which groups of children to cover.

Health Resources and Services Administration17

Health Resources and Services Administration (HRSA) is located within the DHHS and contains four bureaus, three of which directly support services that benefit individuals and families affected by HIV/AIDS—the HIV/AIDS Bureau, the Bureau of Primary Health Care, and the Bureau of Maternal and Child Health. The following are the major HRSA programs supporting service delivery on the community level.

Ryan White Programs (Titles I, II, III, IV, and Part F)

The Ryan White CARE Act, administered by the HIV/AIDS Bureau, funds the delivery of HIV/AIDS care, services, and training. The purpose of the act was to improve the quality and availability of care for people with HIV/AIDS and their families. Total appropriations for the CARE Act for FY 1998 were $1.15 billion. Amendments to the Ryan White CARE Act in 1996 intensified the focus on prevention of perinatal HIV transmission and provided additional funding to states adopting the new CDC guidelines for offsetting costs related to such activities as outreach, voluntary testing for HIV, and mandatory testing of newborns.

Title I: HIV Emergency Relief Grant Program for Eligible Metropolitan Areas

Formula and supplemental grants to Eligible Metropolitan Areas (EMAs)


Information on Ryan White titles from HRSA (1997a,b). Data provided by the HIV/AIDS Bureau.

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