Ryan White Care Act: Impact of Legislative Funding Proposal on	 
Urban Areas (05-OCT-07, GAO-08-137R).				 
                                                                 
The Ryan White Comprehensive AIDS Resources Emergency Act of 1990
(CARE Act), administered by the Department of Health and Human	 
Services' (HHS) Health Resources and Services Administration	 
(HRSA), was enacted to address the needs of jurisdictions, health
care providers, and people with human immunodeficiency		 
virus/acquired immunodeficiency syndrome (HIV/AIDS) and their	 
family members. In December 2006 the Ryan White HIV/AIDS	 
Treatment Modernization Act of 2006 reauthorized CARE Act	 
programs for fiscal years 2007 through 2009. In July 2007, the	 
House of Representatives passed H.R. 3043, the Departments of	 
Labor, Health and Human Services, and Education and Related	 
Agencies Appropriations Act for fiscal year 2008, which contains 
a hold-harmless provision covering funding for urban areas that  
receive funding under the CARE Act. This bill has not been passed
by the Senate. Under the CARE Act, funding for Eligible 	 
Metropolitan Areas (EMA) and Transitional Grant Areas (TGA) is	 
primarily provided through three categories of grants: (1)	 
formula grants that are awarded based on the case counts of	 
people with HIV/AIDS living in an urban area; (2) supplemental	 
grants that are awarded on a competitive basis based on an urban 
area's demonstration of need, including criteria such as HIV/AIDS
prevalence; and (3) Minority AIDS Initiative (MAI) grants, which 
are supplemental grants awarded on a competitive basis for urban 
areas to address disparities in access, treatment, care, and	 
health outcomes. The CARE Act includes a hold-harmless provision 
that limited the decrease that an EMA could receive in its	 
formula funding for fiscal year 2007 to 5 percent of the fiscal  
year 2006 formula funding it would have received if the revised  
urban area allocations required by the Modernization Act of 2006 
had been in place in fiscal year 2006. For fiscal years 2008 and 
2009, the hold-harmless provision provides that an EMA will	 
receive at least 100 percent of the amount of its formula funding
for fiscal year 2007. However, no limitation applies to the	 
decrease in total formula, supplemental, and MAI funding that an 
EMA can receive. As Congress considers appropriations for CARE	 
Act programs for fiscal year 2008, on July 27, 2007, and	 
September 11, 2007, Congress asked us to (1) provide historical  
information on the funding levels identified during the 	 
appropriations process for CARE Act grants to urban areas as	 
compared to fiscal year 2008 CARE Act funding levels proposed as 
part of the fiscal year 2008 appropriations process in the House 
of Representatives; (2) examine how the proposed hold-harmless	 
provision from H.R. 3043 would impact funding for urban areas	 
under the proposed funding levels; (3) determine whether any	 
urban areas receive funding based on the number of both living	 
and deceased HIV/AIDS cases; (4) provide sources that address the
amount of CARE Act funding unobligated by urban areas, states,	 
and territories; and (5) provide sources that address the number 
of people on AIDS Drug Assistance Program (ADAP) waiting lists.  
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-137R					        
    ACCNO:   A77147						        
  TITLE:     Ryan White Care Act: Impact of Legislative Funding       
Proposal on Urban Areas 					 
     DATE:   10/05/2007 
  SUBJECT:   Acquired immunodeficiency syndrome 		 
	     Appropriated funds 				 
	     Federal aid to localities				 
	     Federal funds					 
	     Federal grants					 
	     Formula grants					 
	     Health care programs				 
	     Health care services				 
	     Impacted area programs				 
	     Proposed legislation				 
	     Public health					 
	     Public health legislation				 
	     Program evaluation 				 
	     Urban areas					 
	     Eligible Metropolitan Areas			 
	     Transitional Grant Areas				 

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GAO-08-137R

   

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October 5, 2007

Congressional Requesters

Subject: Ryan White Care Act: Impact of Legislative Funding Proposal on
Urban Areas

The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE
Act), administered by the Department of Health and Human Services' (HHS)
Health Resources and Services Administration (HRSA), was enacted to
address the needs of jurisdictions, health care providers, and people with
human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
and their family members.^1 In December 2006 the Ryan White HIV/AIDS
Treatment Modernization Act of 2006 reauthorized CARE Act programs for
fiscal years 2007 through 2009.^2 In July 2007, the House of
Representatives passed H.R. 3043, the Departments of Labor, Health and
Human Services, and Education and Related Agencies Appropriations Act for
fiscal year 2008, which contains a hold-harmless provision covering
funding for urban areas that receive funding under the CARE Act.^3 This
bill has not been passed by the Senate.

Under the CARE Act, funding for Eligible Metropolitan Areas (EMA) and
Transitional Grant Areas (TGA) is primarily provided through three
categories of grants:^4 (1) formula grants that are awarded based on the
case counts of people with HIV/AIDS living in an urban area; (2)
supplemental grants that are awarded on a competitive basis based on an
urban area's demonstration of need, including criteria such as HIV/AIDS
prevalence; and (3) Minority AIDS Initiative (MAI) grants, which are
supplemental grants awarded on a competitive basis
for urban areas to address disparities in access, treatment, care, and
health outcomes. The CARE Act includes a hold-harmless provision that
limited the decrease that an EMA could receive in its formula funding for
fiscal year 2007 to 5 percent of the fiscal year 2006 formula funding it
would have received if the revised urban area allocations required by the
Modernization Act of 2006 had been in place in fiscal year 2006.^5 For
fiscal years 2008 and 2009, the hold-harmless provision provides that an
EMA will receive at least 100 percent of the amount of its formula funding
for fiscal year 2007. However, no limitation applies to the decrease in
total formula, supplemental, and MAI funding that an EMA can receive. The
hold-harmless provision does not apply to TGAs.

^1Pub. L. No. 101-381, 104 Stat. 576 (codified as amended at 42 U.S.C. SS
300ff through 300ff-121). Unless otherwise indicated, references to the
CARE Act refer to current law.

^2Pub. L. No. 109-415, 120 Stat. 2767. The CARE Act programs had
previously been reauthorized by the Ryan White CARE Act Amendments of 1996
(Pub. L. No. 104-146, 110 Stat. 1346) and the Ryan White CARE Act
Amendments of 2000 (Pub. L. No. 106-345, 114 Stat. 1319).

^3H.R. 3043, 110th Cong. (2007). For purposes of this report, unless
otherwise specified we use the term H.R. 3043 to refer to the bill as
passed by the House of Representatives.

^4In this report, we use the term urban areas to refer to both EMAs and
TGAs. An EMA is a metropolitan area with a population of 50,000 or more
that had more than 2,000 AIDS cases reported in the most recent 5-year
period. The 2,000 AIDS cases criterion does not include cases of HIV that
have not progressed to AIDS. In fiscal year 2007, there were 22 EMAs. The
Modernization Act of 2006 created a new program for TGA. A TGA is a
metropolitan area with a population of 50,000 or more, which had 1,000 to
1,999 AIDS cases reported in the most recent 5-year period. Under this
program urban areas that were eligible for EMA funding in fiscal year 2006
but that no longer meet the eligibility criteria for either EMAs or TGAs
maintain their eligibility for funding and are considered TGAs for fiscal
year 2007. In fiscal year 2007, there were 34 TGAs.

H.R. 3043, which was passed by the House of Representatives on July 19,
2007, would include funds for fiscal year 2008 to ensure that decreases in
total 2007 Part A funding for EMAs and TGAs would not exceed levels
specified in the bill.^6 It would limit the total funding decrease for an
EMA for the 2007 program year to no more than 8.4 percent of what the EMA
received for the 2006 program year. Decreases for TGAs for the program
year 2007 would be limited to 13.4 percent of their total funding from
program year 2006.^7 This hold-harmless provision would not apply to
funding for any program year other than 2007. The bill does not
characterize the hold-harmless funding as formula, supplemental, or MAI
funding for purposes of the CARE Act nor does it indicate when such funds
would be provided to EMAs and TGAs entitled to receive it. Finally, it
does not state how long the eligible EMAs and TGAs would have to spend the
funds they would receive.

As Congress considers appropriations for CARE Act programs for fiscal year
2008, on July 27, 2007, and September 11, 2007, you asked us to (1)
provide historical information on the funding levels identified during the
appropriations process for CARE Act grants to urban areas as compared to
fiscal year 2008 CARE Act funding levels proposed as part of the fiscal
year 2008 appropriations process in the House of Representatives; (2)
examine how the proposed hold-harmless provision from H.R. 3043 would
impact funding for urban areas under the proposed funding levels; (3)
determine whether any urban areas receive funding based on the number of
both living and deceased HIV/AIDS cases; (4) provide sources that address
the amount of CARE Act funding unobligated by urban areas, states, and
territories; and (5) provide sources that address the number of people on
AIDS Drug Assistance Program (ADAP) waiting lists.^8

^5Prior to enactment of the Modernization Act of 2006, amounts available
for formula and supplemental grants were split evenly between the two.
Under the Modernization Act of 2006, two-thirds of such funding is to be
distributed as formula grants and one-third as supplemental grants.

^6Part A of the CARE Act (also referred to as Title I) covers funding to
urban areas. Part B (also referred to as Title II) covers funding to
states, territories, and the District of Columbia.

^7The 2007 CARE Act program year began on April 1, 2007, and grants for
that year were made with fiscal year 2007 appropriations. The proposed
legislation states that "within the amounts provided for Part A . . .,
funds are included to ensure that the amount of any funding provided under
[Part A to an EMA] for the program year beginning in 2007 is not reduced
by an amount that is more than 8.4 percent, and the amount of any funding
provided under [Part A to a TGA] is not reduced by an amount that is more
than 13.4 percent, relative to the amount of the total funding provided
under such part to the [EMA or TGA] for the program year beginning in
fiscal year 2006." Because the provision would apply to "any funding"
provided to EMAs and TGAs under Part A, we consider the total amount
subject to the hold-harmless to be formula, supplemental, and MAI grants
made with Part A funds. MAI grants are authorized by 42 U.S.C. S
300ff-121, which specifically directs HHS to provide funding under Part A.

To provide information on the funding levels for CARE Act grants to urban
areas identified during the appropriations process, we examined
appropriations acts and related reports and HHS data for fiscal years 2001
through 2007, the proposed funding for fiscal year 2008 contained in H.R.
3043, and the report of the House Committee on Appropriations on that
bill.^9 To assess the impact of the proposed hold-harmless provision on
urban areas, we examined funding for fiscal years 2006 and 2007,
determined the amounts needed to fund the proposed hold-harmless
provision, and estimated funding for fiscal year 2008 for EMAs and TGAs.
To conduct this work, we reviewed data provided by HHS on fiscal years
2006 and 2007 CARE Act funding and case counts of people living with
HIV/AIDS. We used this information to determine which urban areas would
receive the hold-harmless funding, the amount each would receive, and the
total needed to fund the hold-harmless provision. We also used the HHS
data to estimate the fiscal year 2008 funding levels for urban areas with
and without the proposed hold-harmless provision; that is, we determined
(1) the projected funding levels for urban areas if all fiscal year 2008
funding for urban areas were used for program year 2008 formula,
supplemental, and MAI grants and (2) the projected funding levels for
urban areas if the amounts needed to fund the hold-harmless provision
contained in H.R. 3043 were taken out of the funding to be used for
program year 2008 grants.^10

We conducted analyses with different funding levels to examine the impact
of the proposed hold-harmless provision because the amount in H.R. 3043
and the amount in the report of the House Committee on Appropriations
differ. At the time we conducted our analyses, fiscal year 2008
appropriations for CARE Act programs had not been enacted and,
consequently, we used the amounts in H.R. 3043 and the report of the House
Committee on Appropriations. However, the amount for urban areas and
states and territories in H.R. 3043, that is Parts A and B, as passed by
the House of Representatives is $10 million less than the amount obtained
by adding together the amounts identified for urban areas and states and
territories in the report of the House Committee on Appropriations. We
have therefore conducted separate analyses using each amount. Each
analysis requires different assumptions.

^8Funding for ADAPs is provided under Part B of the CARE Act and goes to
states, territories, and the District of Columbia. Funding for ADAPs
provides medications, treatment adherence and support, and health
insurance with prescription drug benefits to people with HIV/AIDS.

^9H. Rep. No. 110-231 (2007).

^10In this report, we treat the proposed hold-harmless funding as if it
was an addition to fiscal year 2007 supplemental funding. While not
addressed in this report, the treatment of the proposed hold-harmless
funding could have ramifications for funding beyond 2007. For fiscal years
2008 and 2009, hold-harmless amounts for EMAs under the CARE Act are based
on the amount of formula funding (including hold-harmless funding)
provided under the act for 2007. If the additional funding provided under
H.R. 3043 was treated as formula funding, it would be included when the
formula funding hold-harmless amounts for EMAs for fiscal years 2008 and
2009 are calculated. However, if the funding is not treated as formula
funding, it would not be counted for calculations of CARE Act
hold-harmless funding in future years since there is no hold-harmless
provision protecting other funding categories.

The amount specified in H.R. 3043 for urban areas and states and
territories as passed by the House of Representatives is $1,865,800,000,
which according to HRSA is approximately a 3.68 percent increase over the
fiscal year 2007 total funding for Parts A and B. We had to make several
assumptions to estimate the fiscal year 2008 funding for urban areas.
First, we assumed that the percentage of funding for Part A (approximately
33.56 percent) out of the total funding for Parts A and B would be the
same in fiscal year 2008 as it was in fiscal year 2007. By applying this
percentage to the $1,865,800,000 specified in H.R. 3043, we estimated that
approximately $626,248,693 would be the total funding for Part A in fiscal
year 2008. Second, we assumed that MAI funding for each urban area would
increase by the same percentage that total MAI funding allocated to urban
areas is scheduled to increase under the CARE Act, which is approximately
3.65 percent. Third, we assumed that the amount of funds set aside by HRSA
prior to awarding grants to urban areas would be the same in fiscal year
2008 as it was in fiscal year 2007.^11 Fourth, we subtracted the funding
for MAI and set asides from the estimated Part A funding for fiscal year
2008, $626,248,693. The resulting funding, $557,300,597 would therefore be
used for formula and supplemental grants. This represents an estimated
increase of 3.8 percent in overall formula and supplemental funding for
urban areas. Fifth, because updated HIV/AIDS case counts were not
available, we used the HIV/AIDS case counts that HRSA used to determine
fiscal year 2007 funding. We estimated the fiscal year 2008 formula
funding for each urban area using these case counts. Sixth, we assumed
that each urban area would receive the same percentage of the available
supplemental funding in fiscal year 2008 that it received in fiscal year
2007.

For the alternative analysis on the proposed hold-harmless provision based
on the report of the House Committee on Appropriations, we used the amount
specified in the report for urban areas, $636,300,000.^12 We then made the
same assumptions as for the previous analysis regarding MAI grants,
amounts set aside by HRSA prior to awarding grants to urban areas, case
counts, and supplemental grants.

To determine whether any urban areas received funding based on both living
and deceased HIV/AIDS cases, we used the funding formula data for fiscal
years 2006 and 2007.^13 In addition, we identified sources where
information is available on the unobligated funding and waiting list
issues by discussing these issues respectively with the HHS Office of
Inspector General and the National Alliance of State & Territorial AIDS
Directors.

^11Before awarding grants, HRSA sets aside funds from the total amount
available for urban areas. These amounts are set aside for various
purposes, including for possible public health emergencies. According to
HRSA, the amount set aside in fiscal year 2007 was $23,548,096. Therefore,
we have used this same figure for fiscal year 2008 calculations.

^12Although the difference in proposed fiscal year 2008 funding between
H.R. 3043 and the report of the Committee on Appropriations for Parts A
and B is $10 million, under our assumptions the difference for Part A
alone would be $10,051,307. This results from our assumption that under
H.R. 3043 the percentage of funding for Part A (approximately 33.56
percent) out of the total funding for Parts A and B would be the same in
fiscal year 2008 as it was in fiscal year 2007. However, the amount
proposed in the report of the House Committee on Appropriations for Part A
($636,300,000) is a larger percentage (33.92 percent) of the total amount
specified for Parts A and B ($1,875,800,000). Therefore, the increase for
Part A would actually be larger than the $10 million difference for Parts
A and B combined.

^13In our February 2006 report, we found that as of fiscal year 2004, one
EMA was receiving CARE Act formula funding based on both living and
deceased cases. See GAO, HIV/AIDS: Changes Needed to Improve the
Distribution of Ryan White CARE Act and Housing Funds, GAO-06-332
(Washington, D.C.: Feb. 28, 2006).

The objective of this work was to provide pertinent and timely information
from readily available sources that Congress can use in determining
funding for CARE Act programs. Because of time constraints, we did not
conduct extensive testing and analysis of the reliability and validity of
the data that were used for the analyses, nor did we conduct any
additional analysis of the proposed provision. We performed our work from
August 2007 through September 2007.

CARE Act Funding for Urban Areas

CARE Act funding for urban areas would increase under the funding level
identified in the report of the House Committee on Appropriations for CARE
Act grants to these areas.^14 Since fiscal year 2001, CARE Act funding for
urban areas specified in conference reports accompanying the
appropriations acts has ranged from a high of $622,741,000 in fiscal year
2003 to a low of $604,200,000 in fiscal year 2001.^15 For fiscal year
2008, the report of the House Committee on Appropriations specifies
$636,300,000 for urban areas,^16 an increase of approximately 4.3 percent
over the amount specified in the conference report for fiscal year 2006
funding.^17 However, this amount includes the funding that would be used
to address the funding decreases that certain EMAs and TGAs experienced in
fiscal year 2007, a total of approximately $9.4 million.^18 This would
reduce the amount available for fiscal year 2008 grants as described by
the Committee to approximately $626,900,000. This represents an increase
of approximately 2.8 percent over the amount specified in the conference
report for fiscal year 2006.^19 Table 1 shows the funding specified in
congressional reports and the actual amounts awarded to urban areas for
fiscal years 2001 through 2007 and the proposed funding for fiscal year
2008 in the report of the House Committee on Appropriations.

^14This committee report is not binding on HHS.

^15The appropriations acts for fiscal years 2001 through 2007 covering HHS
have not specified an amount of funding to be used for Part A grants for
urban areas. However, when available the conference report accompanying
the appropriations act has identified a total amount to be used for Part A
funding for urban areas. Although these reports are not legally binding on
HHS, we have used the amounts specified in them for the purposes of our
analysis.

^16See H.R. Rep. No. 110-231, at 78-79 (2007). According to the committee
report, this amount is $32,307,000 above the fiscal year 2007 funding
level and the administration's budget request for fiscal year 2008.
According to HHS, $603,993,000 was the funding level for grants to urban
areas; that is, the amount available before subtracting for annual set
asides. HHS refers to this amount as the "final appropriation amount" for
fiscal year 2007.

^17See H.R. Conf. Rep. No. 109-337, at 137 (2005). We use funding from
fiscal year 2006 because this was the last year for which there was a
conference report accompanying the appropriations act for HHS. Fiscal year
2007 funds were appropriated for HRSA in a continuing resolution which
contained a lump sum amount for all HRSA programs and did not specify a
particular amount for grants to urban areas. See Revised Continuing
Appropriations Resolution, 2007, Pub. L. No. 110-5, 121 Stat. 8, 31-32.
There were no conference or committee reports for this law.

^18The analyses demonstrating that $9.4 million would be needed to fund
the hold-harmless provision contained in H.R. 3043 as passed by the House
are described later in this report.

^19The $636,300,000 funding level for urban areas is taken from the report
of the House Committee on Appropriations (No. 110-231) for H.R. 3043. H.R.
3043 as reported by the Committee and passed by the House identifies an
amount for CARE Act grants for urban areas and states and territories.
However, this amount is $10 million less than the amount obtained by
adding the amount identified in the House report for urban areas to the
amount identified in the House report for states and territories.

Table 1: CARE Act Funding for Urban Areas

Fiscal year: 2001; 
Funding identified in congressional report: $604,200,000[B]; 
Actual funding awarded[A]: $582,727,700. 

Fiscal year: 2002; 
Funding identified in congressional report: 619,585,000[B]; 
Actual funding awarded[A]: 597,256,000. 

Fiscal year: 2003; 
Funding identified in congressional report: 622,741,000[B]; 
Actual funding awarded[A]: 599,513,000. 

Fiscal year: 2004; 
Funding identified in congressional report: 618,693,000[B]; 
Actual funding awarded[A]: 595,342,000. 

Fiscal year: 2005; 
Funding identified in congressional report: 615,023,000[B]; 
Actual funding awarded[A]: 587,425,500. 

Fiscal year: 2006; 
Funding identified in congressional report: 610,094,000[B]; 
Actual funding awarded[A]: 579,686,392. 

Fiscal year: 2007; 
Funding identified in congressional report: [C]; 
Actual funding awarded[A]: 578,686,334. 

Fiscal year: 2008; 
Funding identified in congressional report: 636,300,000[D]; 
Actual funding awarded[A]: [E]. 

Sources: Conference reports accompanying annual appropriations laws,
report of the House Committee on Appropriations (110-231), and HHS.

[a]The actual funding awarded to urban areas differs from the amounts
specified in the congressional reports for a variety of reasons. For
example, rescissions may have reduced the total appropriations available
for CARE Act programs.

[b]Each appropriations act provided a lump sum covering the CARE Act and
other programs and did not specify funding amounts for urban areas. The
conference reports accompanying each act, while not legally binding,
specified a separate amount to be used for grants to urban areas.

[c]Fiscal year 2007 funds were appropriated for HRSA in a continuing
resolution which contained a lump sum amount for all HRSA programs and did
not specify a particular amount for grants to urban areas. See Pub. L. No.
110-5, 121 Stat. 8, 31-32. There were no conference or committee reports
for this law. According to HHS, $603,993,000 was the funding level for
grants to urban areas; that is, the amount available before subtracting
for annual set asides. HRSA refers to this amount as the "final
appropriation amount" for fiscal year 2007.

[d]The $636,300,000 amount for urban areas is taken from the report of House
Committee on Appropriations (No. 110-231) for H.R. 3043. According to the
committee report, this amount is $32,307,000 above the fiscal year 2007
funding level and the administration's budget request for fiscal year
2007. If the proposed hold-harmless provision is enacted, the amount
available to fund fiscal year 2008 grants would be reduced by
approximately $9.4 million to $626,900,000. In addition, H.R. 3043 as
reported by the Committee and passed by the House identifies an amount for
CARE Act grants for urban areas and states and territories. However, this
amount is $10 million less than the amount obtained by adding the amount
identified in the House report for urban areas to the amount identified in
the House report for states and territories.

[e]No funding for fiscal year 2008 has been awarded yet.

CARE Act funding for urban areas is awarded to EMAs and TGAs through
formula, supplemental, and MAI grants. Table 2 shows the grants awarded in
fiscal years 2006 and 2007 to each EMA categorized by funding type. Table
3 shows the grants awarded in fiscal years 2006 and 2007 to each TGA
categorized by funding type.

Table 2: Grants Awarded to EMAs, Fiscal Years 2006 and 2007

EMA: Atlanta, Ga; 
Fiscal year 2006 grants: Formula: $9,634,687; 
Fiscal year 2006 grants: Supplemental: $7,625,341; 
Fiscal year 2006 grants: MAI: $1,609,533; 
Fiscal year 2006 grants: Total: $18,869,561; 
Fiscal year 2007 grants: Formula: $12,223,780; Fiscal year 2007 grants: 
Supplemental: $3,850,505; Fiscal year 2007 grants: MAI: $1,050,229; 
Fiscal year 2007 grants: Total: $17,124,514. 

EMA: Baltimore, Md; 
Fiscal year 2006 grants: Formula: 10,125,086; 
Fiscal year 2006 grants: Supplemental: 8,850,824; 
Fiscal year 2006 grants: MAI: 1,652,985; 
Fiscal year 2006 grants: Total: 20,628,895; 
Fiscal year 2007 grants: Formula: 13,101,233; 
Fiscal year 2007 grants: Supplemental: 5,186,790; 
Fiscal year 2007 grants: MAI: 2,100,038; 
Fiscal year 2007 grants: Total: 20,388,061. 

EMA: Boston, Mass; 
Fiscal year 2006 grants: Formula: 6,979,687; 
Fiscal year 2006 grants: Supplemental: 5,814,962; 
Fiscal year 2006 grants: MAI: 544,492; 
Fiscal year 2006 grants: Total: 13,339,141; 
Fiscal year 2007 grants: Formula: 9,091,554; 
Fiscal year 2007 grants: Supplemental: 3,769,583; 
Fiscal year 2007 grants: MAI: 814,862; 
Fiscal year 2007 grants: Total: 13,675,999. 

EMA: Chicago, Ill; 
Fiscal year 2006 grants: Formula: 12,891,725; 
Fiscal year 2006 grants: Supplemental: 10,274,677; 
Fiscal year 2006 grants: MAI: 1,878,231; 
Fiscal year 2006 grants: Total: 25,044,633; 
Fiscal year 2007 grants: Formula: 16,477,405; 
Fiscal year 2007 grants: Supplemental: 6,888,727; 
Fiscal year 2007 grants: MAI: 1,787,310; 
Fiscal year 2007 grants: Total: 25,153,442. 

EMA: Dallas, Tex; 
Fiscal year 2006 grants: Formula: 6,509,160; 
Fiscal year 2006 grants: Supplemental: 5,615,969; 
Fiscal year 2006 grants: MAI: 1,071,248; 
Fiscal year 2006 grants: Total: 13,196,377; 
Fiscal year 2007 grants: Formula: 9,137,396; 
Fiscal year 2007 grants: Supplemental: 3,640,608; 
Fiscal year 2007 grants: MAI: 772,577; 
Fiscal year 2007 grants: Total: 13,550,581. 

EMA: Detroit, Mich; 
Fiscal year 2006 grants: Formula: 4,450,466; 
Fiscal year 2006 grants: Supplemental: 3,380,311; 
Fiscal year 2006 grants: MAI: 597,700; 
Fiscal year 2006 grants: Total: 8,428,477; 
Fiscal year 2007 grants: Formula: 5,648,743; 
Fiscal year 2007 grants: Supplemental: 2,073,152; 
Fiscal year 2007 grants: MAI: 644,567; 
Fiscal year 2007 grants: Total: 8,366,462. 

EMA: Fort Lauderdale, Fla; 
Fiscal year 2006 grants: Formula: 7,390,404; 
Fiscal year 2006 grants: Supplemental: 6,514,401; 
Fiscal year 2006 grants: MAI: 1,058,833; 
Fiscal year 2006 grants: Total: 14,963,638; 
Fiscal year 2007 grants: Formula: 9,444,098; 
Fiscal year 2007 grants: Supplemental: 3,727,245; 
Fiscal year 2007 grants: MAI: 1,113,452; 
Fiscal year 2007 grants: Total: 14,284,795. 

EMA: Houston, Tex; 
Fiscal year 2006 grants: Formula: 10,069,778; 
Fiscal year 2006 grants: Supplemental: 8,252,040; 
Fiscal year 2006 grants: MAI: 1,631,702; 
Fiscal year 2006 grants: Total: 19,953,520; 
Fiscal year 2007 grants: Formula: 12,780,890; 
Fiscal year 2007 grants: Supplemental: 5,120,182; 
Fiscal year 2007 grants: MAI: 1,571,727; 
Fiscal year 2007 grants: Total: 19,472,799. 

EMA: Los Angeles, Calif; 
Fiscal year 2006 grants: Formula: 18,302,095; 
Fiscal year 2006 grants: Supplemental: 14,085,426; 
Fiscal year 2006 grants: MAI: 2,507,856; 
Fiscal year 2006 grants: Total: 34,895,377; 
Fiscal year 2007 grants: Formula: 23,182,654; 
Fiscal year 2007 grants: Supplemental: 9,552,345; 
Fiscal year 2007 grants: MAI: 2,528,561; 
Fiscal year 2007 grants: Total: 35,263,560. 

EMA: Miami, Fla; 
Fiscal year 2006 grants: Formula: 12,178,882; 
Fiscal year 2006 grants: Supplemental: 9,772,536; 
Fiscal year 2006 grants: MAI: 2,048,496; 
Fiscal year 2006 grants: Total: 23,999,914; 
Fiscal year 2007 grants: Formula: 16,014,327; 
Fiscal year 2007 grants: Supplemental: 6,481,882; 
Fiscal year 2007 grants: MAI: 2,565,107; 
Fiscal year 2007 grants: Total: 25,061,316. 

EMA: New Orleans, La; 
Fiscal year 2006 grants: Formula: 3,894,926; 
Fiscal year 2006 grants: Supplemental: 2,946,620; 
Fiscal year 2006 grants: MAI: 593,266; 
Fiscal year 2006 grants: Total: 7,434,812; 
Fiscal year 2007 grants: Formula: 4,944,054; 
Fiscal year 2007 grants: Supplemental: 1,770,338; 
Fiscal year 2007 grants: MAI: 541,807; 
Fiscal year 2007 grants: Total: 7,256,199. 

EMA: New York, N.Y; 
Fiscal year 2006 grants: Formula: 59,000,321; 
Fiscal year 2006 grants: Supplemental: 49,486,747; 
Fiscal year 2006 grants: MAI: 11,936,258; 
Fiscal year 2006 grants: Total: 120,423,326; 
Fiscal year 2007 grants: Formula: 74,867,223; 
Fiscal year 2007 grants: Supplemental: 25,998,357; 
Fiscal year 2007 grants: MAI: 9,347,777; 
Fiscal year 2007 grants: Total: 110,213,357. 

EMA: Newark, N.J; 
Fiscal year 2006 grants: Formula: 7,636,547; 
Fiscal year 2006 grants: Supplemental: 6,304,290; 
Fiscal year 2006 grants: MAI: 811,417; 
Fiscal year 2006 grants: Total: 14,752,254; 
Fiscal year 2007 grants: Formula: 9,089,812; 
Fiscal year 2007 grants: Supplemental: 3,552,687; 
Fiscal year 2007 grants: MAI: 1,284,886; 
Fiscal year 2007 grants: Total: 13,927,385. 

EMA: Orlando, Fla; 
Fiscal year 2006 grants: Formula: 4,336,162; 
Fiscal year 2006 grants: Supplemental: 3,555,581; 
Fiscal year 2006 grants: MAI: 669,530; 
Fiscal year 2006 grants: Total: 8,561,273; 
Fiscal year 2007 grants: Formula: 5,503,524; 
Fiscal year 2007 grants: Supplemental: 1,980,246; 
Fiscal year 2007 grants: MAI: 578,713; 
Fiscal year 2007 grants: Total: 8,062,483. 

EMA: Philadelphia, Pa; 
Fiscal year 2006 grants: Formula: 11,798,212; 
Fiscal year 2006 grants: Supplemental: 9,000,750; 
Fiscal year 2006 grants: MAI: 1,585,589; 
Fiscal year 2006 grants: Total: 22,384,551; 
Fiscal year 2007 grants: Formula: 14,920,594; 
Fiscal year 2007 grants: Supplemental: 5,037,001; 
Fiscal year 2007 grants: MAI: 1,682,127; 
Fiscal year 2007 grants: Total: 21,639,722. 

EMA: Phoenix, Ariz; 
Fiscal year 2006 grants: Formula: 3,701,962; 
Fiscal year 2006 grants: Supplemental: 2,489,262; 
Fiscal year 2006 grants: MAI: 328,114; 
Fiscal year 2006 grants: Total: 6,519,338; 
Fiscal year 2007 grants: Formula: 4,970,250; 
Fiscal year 2007 grants: Supplemental: 1,811,234; 
Fiscal year 2007 grants: MAI: 193,368; 
Fiscal year 2007 grants: Total: 6,974,852. 

EMA: San Diego, Calif; 
Fiscal year 2006 grants: Formula: 4,917,200; 
Fiscal year 2006 grants: Supplemental: 3,901,564; 
Fiscal year 2006 grants: MAI: 450,492; 
Fiscal year 2006 grants: Total: 9,269,256; 
Fiscal year 2007 grants: Formula: 6,769,231; 
Fiscal year 2007 grants: Supplemental: 2,912,131; 
Fiscal year 2007 grants: MAI: 543,389; 
Fiscal year 2007 grants: Total: 10,224,751. 

EMA: San Francisco, Calif; 
Fiscal year 2006 grants: Formula: 15,444,793; 
Fiscal year 2006 grants: Supplemental: 11,985,334; 
Fiscal year 2006 grants: MAI: 534,737; 
Fiscal year 2006 grants: Total: 27,964,864; 
Fiscal year 2007 grants: Formula: 14,672,553; 
Fiscal year 2007 grants: Supplemental: 4,134,300; 
Fiscal year 2007 grants: MAI: 652,491; 
Fiscal year 2007 grants: Total: 19,459,344. 

EMA: San Juan, P.R; 
Fiscal year 2006 grants: Formula: 7,641,520; 
Fiscal year 2006 grants: Supplemental: 4,636,975; 
Fiscal year 2006 grants: MAI: 1,191,852; 
Fiscal year 2006 grants: Total: 13,470,347; 
Fiscal year 2007 grants: Formula: 9,415,282; 
Fiscal year 2007 grants: Supplemental: 2,553,297; 
Fiscal year 2007 grants: MAI: 741,100; 
Fiscal year 2007 grants: Total: 12,709,679. 

EMA: Tampa-St. Petersburg, Fla; 
Fiscal year 2006 grants: Formula: 4,987,570; 
Fiscal year 2006 grants: Supplemental: 4,016,711; 
Fiscal year 2006 grants: MAI: 567,549; 
Fiscal year 2006 grants: Total: 9,571,830; 
Fiscal year 2007 grants: Formula: 6,330,047; 
Fiscal year 2007 grants: Supplemental: 2,345,441; 
Fiscal year 2007 grants: MAI: 525,592; 
Fiscal year 2007 grants: Total: 9,201,080. 

EMA: Washington, D.C; 
Fiscal year 2006 grants: Formula: 14,810,305; 
Fiscal year 2006 grants: Supplemental: 9,445,282; 
Fiscal year 2006 grants: MAI: 2,667,479; 
Fiscal year 2006 grants: Total: 26,923,066; 
Fiscal year 2007 grants: Formula: 18,759,719; 
Fiscal year 2007 grants: Supplemental: 6,895,292; 
Fiscal year 2007 grants: MAI: 1,976,712; 
Fiscal year 2007 grants: Total: 27,631,723. 

EMA: West Palm Beach, Fla; 
Fiscal year 2006 grants: Formula: 4,546,333; 
Fiscal year 2006 grants: Supplemental: 3,055,721; 
Fiscal year 2006 grants: MAI: 673,964; 
Fiscal year 2006 grants: Total: 8,276,018; 
Fiscal year 2007 grants: Formula: 5,769,416; 
Fiscal year 2007 grants: Supplemental: 1,949,450; 
Fiscal year 2007 grants: MAI: 576,631; 
Fiscal year 2007 grants: Total: 8,295,497. 

EMA: Total; 
Fiscal year 2006 grants: Formula: $241,247,821; 
Fiscal year 2006 grants: Supplemental: $191,011,324; 
Fiscal year 2006 grants: MAI: $36,611,323; 
Fiscal year 2006 grants: Total: $468,870,468; 
Fiscal year 2007 grants: Formula: $303,113,785; 
Fiscal year 2007 grants: Supplemental: $111,230,793; 
Fiscal year 2007 grants: MAI: $33,593,023; 
Fiscal year 2007 grants: Total: $447,937,601. 

Source: HHS

Table 3: Grants Awarded to TGAs, Fiscal Years 2006 and 2007

TGA: Austin, Tex; 
Fiscal year 2006 grants: Formula: $1,932,460; 
Fiscal year 2006 grants: Supplemental: $1,572,898; 
Fiscal year 2006 grants: MAI: $213,718; 
Fiscal year 2006 grants: Total: $3,719,076; 
Fiscal year 2007 grants: Formula: $2,311,513; 
Fiscal year 2007 grants: Supplemental: $1,073,557; 
Fiscal year 2007 grants: MAI: $229,065; 
Fiscal year 2007 grants: Total: $3,614,135. 

TGA: Baton Rouge, La; 
Fiscal year 2006 grants: Formula: 0; 
Fiscal year 2006 grants: Supplemental: 0; 
Fiscal year 2006 grants: MAI: 0; 
Fiscal year 2006 grants: Total: 0; 
Fiscal year 2007 grants: Formula: 2,179,184; 
Fiscal year 2007 grants: Supplemental: 831,337; 
Fiscal year 2007 grants: MAI: 249,059; 
Fiscal year 2007 grants: Total: 3,259,580. 

TGA: Bergen-Passaic, N.J; 
Fiscal year 2006 grants: Formula: 2,440,939; 
Fiscal year 2006 grants: Supplemental: 1,834,541; 
Fiscal year 2006 grants: MAI: 210,170; 
Fiscal year 2006 grants: Total: 4,485,650; 
Fiscal year 2007 grants: Formula: 2,480,997; 
Fiscal year 2007 grants: Supplemental: 1,101,476; 
Fiscal year 2007 grants: MAI: 287,493; 
Fiscal year 2007 grants: Total: 3,869,966. 

TGA: Caguas, P.R; 
Fiscal year 2006 grants: Formula: 872,640; 
Fiscal year 2006 grants: Supplemental: 567,319; 
Fiscal year 2006 grants: MAI: 208,397; 
Fiscal year 2006 grants: Total: 1,648,356; 
Fiscal year 2007 grants: Formula: 690,977; 
Fiscal year 2007 grants: Supplemental: 269,503; 
Fiscal year 2007 grants: MAI: 121,984; 
Fiscal year 2007 grants: Total: 1,082,464. 

TGA: Charlotte-Gastonia, N.C.-S.C; 
Fiscal year 2006 grants: Formula: 0; 
Fiscal year 2006 grants: Supplemental: 0; 
Fiscal year 2006 grants: MAI: 0; 
Fiscal year 2006 grants: Total: 0; 
Fiscal year 2007 grants: Formula: 2,854,516; 
Fiscal year 2007 grants: Supplemental: 974,327; 
Fiscal year 2007 grants: MAI: 371,535; 
Fiscal year 2007 grants: Total: 4,200,378. 

TGA: Cleveland, Ohio; 
Fiscal year 2006 grants: Formula: 1,793,462; 
Fiscal year 2006 grants: Supplemental: 1,314,426; 
Fiscal year 2006 grants: MAI: 241,208; 
Fiscal year 2006 grants: Total: 3,349,096; 
Fiscal year 2007 grants: Formula: 2,606,155; 
Fiscal year 2007 grants: Supplemental: 1,060,413; 
Fiscal year 2007 grants: MAI: 316,520; 
Fiscal year 2007 grants: Total: 3,983,088. 

TGA: Denver, Colo; 
Fiscal year 2006 grants: Formula: 2,286,509; 
Fiscal year 2006 grants: Supplemental: 1,810,306; 
Fiscal year 2006 grants: MAI: 186,227; 
Fiscal year 2006 grants: Total: 4,283,042; 
Fiscal year 2007 grants: Formula: 4,860,304; 
Fiscal year 2007 grants: Supplemental: 1,925,546; 
Fiscal year 2007 grants: MAI: 275,492; 
Fiscal year 2007 grants: Total: 7,061,342. 

TGA: Dutchess County, N.Y; 
Fiscal year 2006 grants: Formula: 698,112; 
Fiscal year 2006 grants: Supplemental: 556,849; 
Fiscal year 2006 grants: MAI: 112,623; 
Fiscal year 2006 grants: Total: 1,367,584; 
Fiscal year 2007 grants: Formula: 719,007; 
Fiscal year 2007 grants: Supplemental: 339,616; 
Fiscal year 2007 grants: MAI: 103,571; 
Fiscal year 2007 grants: Total: 1,162,194. 

TGA: Fort Worth, Tex; 
Fiscal year 2006 grants: Formula: 1,726,845; 
Fiscal year 2006 grants: Supplemental: 1,463,049; 
Fiscal year 2006 grants: MAI: 219,925; 
Fiscal year 2006 grants: Total: 3,409,819; 
Fiscal year 2007 grants: Formula: 2,298,475; 
Fiscal year 2007 grants: Supplemental: 940,508; 
Fiscal year 2007 grants: MAI: 204,310; 
Fiscal year 2007 grants: Total: 3,443,293. 

TGA: Hartford, Conn; 
Fiscal year 2006 grants: Formula: 2,374,565; 
Fiscal year 2006 grants: Supplemental: 2,024,791; 
Fiscal year 2006 grants: MAI: 266,925; 
Fiscal year 2006 grants: Total: 4,666,281; 
Fiscal year 2007 grants: Formula: 2,003,833; 
Fiscal year 2007 grants: Supplemental: 913,750; 
Fiscal year 2007 grants: MAI: 252,944; 
Fiscal year 2007 grants: Total: 3,170,527. 

TGA: Indianapolis, Ind; 
Fiscal year 2006 grants: Formula: 0; 
Fiscal year 2006 grants: Supplemental: 0; 
Fiscal year 2006 grants: MAI: 0; 
Fiscal year 2006 grants: Total: 0; 
Fiscal year 2007 grants: Formula: 2,277,616; 
Fiscal year 2007 grants: Supplemental: 763,694; 
Fiscal year 2007 grants: MAI: 189,079; 
Fiscal year 2007 grants: Total: 3,230,389. 

TGA: Jacksonville, Fla; 
Fiscal year 2006 grants: Formula: 2,631,441; 
Fiscal year 2006 grants: Supplemental: 1,872,676; 
Fiscal year 2006 grants: MAI: 409,699; 
Fiscal year 2006 grants: Total: 4,913,816; 
Fiscal year 2007 grants: Formula: 3,078,757; 
Fiscal year 2007 grants: Supplemental: 1,414,071; 
Fiscal year 2007 grants: MAI: 393,745; 
Fiscal year 2007 grants: Total: 4,886,573. 

TGA: Jersey City, N.J; 
Fiscal year 2006 grants: Formula: 2,831,663; 
Fiscal year 2006 grants: Supplemental: 2,048,327; 
Fiscal year 2006 grants: MAI: 265,152; 
Fiscal year 2006 grants: Total: 5,145,142; 
Fiscal year 2007 grants: Formula: 2,831,049; 
Fiscal year 2007 grants: Supplemental: 1,286,939; 
Fiscal year 2007 grants: MAI: 417,858; 
Fiscal year 2007 grants: Total: 4,535,846. 

TGA: Kansas City, Mo; 
Fiscal year 2006 grants: Formula: 1,607,764; 
Fiscal year 2006 grants: Supplemental: 1,183,683; 
Fiscal year 2006 grants: MAI: 125,038; 
Fiscal year 2006 grants: Total: 2,916,485; 
Fiscal year 2007 grants: Formula: 2,524,021; 
Fiscal year 2007 grants: Supplemental: 1,013,510; 
Fiscal year 2007 grants: MAI: 187,284; 
Fiscal year 2007 grants: Total: 3,724,815. 

TGA: Las Vegas, Nev; 
Fiscal year 2006 grants: Formula: 2,422,499; 
Fiscal year 2006 grants: Supplemental: 1,647,505; 
Fiscal year 2006 grants: MAI: 253,623; 
Fiscal year 2006 grants: Total: 4,323,627; 
Fiscal year 2007 grants: Formula: 3,251,501; 
Fiscal year 2007 grants: Supplemental: 1,193,110; 
Fiscal year 2007 grants: MAI: 225,918; 
Fiscal year 2007 grants: Total: 4,670,529. 

TGA: Memphis, Tenn; 
Fiscal year 2006 grants: Formula: 0; 
Fiscal year 2006 grants: Supplemental: 0; 
Fiscal year 2006 grants: MAI: 0; 
Fiscal year 2006 grants: Total: 0; 
Fiscal year 2007 grants: Formula: 3,585,906; 
Fiscal year 2007 grants: Supplemental: 1,432,797; 
Fiscal year 2007 grants: MAI: 556,225; 
Fiscal year 2007 grants: Total: 5,574,928. 

TGA: Middlesex-Somerset-Hunterdon, N.J; 
Fiscal year 2006 grants: Formula: 1,427,281; 
Fiscal year 2006 grants: Supplemental: 1,032,702; 
Fiscal year 2006 grants: MAI: 135,680; 
Fiscal year 2006 grants: Total: 2,595,663; 
Fiscal year 2007 grants: Formula: 1,599,025; 
Fiscal year 2007 grants: Supplemental: 701,085; 
Fiscal year 2007 grants: MAI: 165,169; 
Fiscal year 2007 grants: Total: 2,465,279. 

TGA: Minneapolis-St. Paul, Minn; 
Fiscal year 2006 grants: Formula: 1,569,524; 
Fiscal year 2006 grants: Supplemental: 1,279,233; 
Fiscal year 2006 grants: MAI: 197,755; 
Fiscal year 2006 grants: Total: 3,046,512; 
Fiscal year 2007 grants: Formula: 2,963,378; 
Fiscal year 2007 grants: Supplemental: 1,240,032; 
Fiscal year 2007 grants: MAI: 264,702; 
Fiscal year 2007 grants: Total: 4,468,112. 

TGA: Nashville, Tenn; 
Fiscal year 2006 grants: Formula: 0; 
Fiscal year 2006 grants: Supplemental: 0; 
Fiscal year 2006 grants: MAI: 0; 
Fiscal year 2006 grants: Total: 0; 
Fiscal year 2007 grants: Formula: 2,541,621; 
Fiscal year 2007 grants: Supplemental: 938,981; 
Fiscal year 2007 grants: MAI: 207,441; 
Fiscal year 2007 grants: Total: 3,688,043. 

TGA: Nassau-Suffolk, N.Y; 
Fiscal year 2006 grants: Formula: 3,227,540; 
Fiscal year 2006 grants: Supplemental: 2,456,087; 
Fiscal year 2006 grants: MAI: 464,680; 
Fiscal year 2006 grants: Total: 6,148,307; 
Fiscal year 2007 grants: Formula: 3,130,907; 
Fiscal year 2007 grants: Supplemental: 1,358,744; 
Fiscal year 2007 grants: MAI: 325,286; 
Fiscal year 2007 grants: Total: 4,814,937. 

TGA: New Haven, Conn; 
Fiscal year 2006 grants: Formula: 3,631,905; 
Fiscal year 2006 grants: Supplemental: 2,710,386; 
Fiscal year 2006 grants: MAI: 342,303; 
Fiscal year 2006 grants: Total: 6,684,594; 
Fiscal year 2007 grants: Formula: 3,278,228; 
Fiscal year 2007 grants: Supplemental: 1,501,862; 
Fiscal year 2007 grants: MAI: 321,657; 
Fiscal year 2007 grants: Total: 5,101,747. 

TGA: Norfolk, Va; 
Fiscal year 2006 grants: Formula: 2,543,672; 
Fiscal year 2006 grants: Supplemental: 1,635,201; 
Fiscal year 2006 grants: MAI: 235,887; 
Fiscal year 2006 grants: Total: 4,414,760; 
Fiscal year 2007 grants: Formula: 3,390,349; 
Fiscal year 2007 grants: Supplemental: 1,284,883; 
Fiscal year 2007 grants: MAI: 379,699; 
Fiscal year 2007 grants: Total: 5,054,931. 

TGA: Oakland, Calif; 
Fiscal year 2006 grants: Formula: 3,310,871; 
Fiscal year 2006 grants: Supplemental: 2,072,022; 
Fiscal year 2006 grants: MAI: 352,944; 
Fiscal year 2006 grants: Total: 5,735,837; 
Fiscal year 2007 grants: Formula: 3,781,868; 
Fiscal year 2007 grants: Supplemental: 1,663,113; 
Fiscal year 2007 grants: MAI: 392,080; 
Fiscal year 2007 grants: Total: 5,837,061. 

TGA: Orange County, Calif; 
Fiscal year 2006 grants: Formula: 2,552,176; 
Fiscal year 2006 grants: Supplemental: 2,091,799; 
Fiscal year 2006 grants: MAI: 214,604; 
Fiscal year 2006 grants: Total: 4,858,579; 
Fiscal year 2007 grants: Formula: 3,328,279; 
Fiscal year 2007 grants: Supplemental: 1,345,454; 
Fiscal year 2007 grants: MAI: 292,945; 
Fiscal year 2007 grants: Total: 4,966,678. 

TGA: Ponce, P.R; 
Fiscal year 2006 grants: Formula: 1,338,048; 
Fiscal year 2006 grants: Supplemental: 806,867; 
Fiscal year 2006 grants: MAI: 246,529; 
Fiscal year 2006 grants: Total: 2,391,444; 
Fiscal year 2007 grants: Formula: 1,101,000; 
Fiscal year 2007 grants: Supplemental: 445,740; 
Fiscal year 2007 grants: MAI: 153,098; 
Fiscal year 2007 grants: Total: 1,699,838. 

TGA: Portland, Oreg; 
Fiscal year 2006 grants: Formula: 1,790,756; 
Fiscal year 2006 grants: Supplemental: 1,516,313; 
Fiscal year 2006 grants: MAI: 94,887; 
Fiscal year 2006 grants: Total: 3,401,956; 
Fiscal year 2007 grants: Formula: 2,120,010; 
Fiscal year 2007 grants: Supplemental: 957,919; 
Fiscal year 2007 grants: MAI: 78,536; 
Fiscal year 2007 grants: Total: 3,156,465. 

TGA: Riverside-San Bernadino, Calif; 
Fiscal year 2006 grants: Formula: 3,643,238; 
Fiscal year 2006 grants: Supplemental: 3,156,377; 
Fiscal year 2006 grants: MAI: 274,906; 
Fiscal year 2006 grants: Total: 7,074,521; 
Fiscal year 2007 grants: Formula: 4,389,913; 
Fiscal year 2007 grants: Supplemental: 2,074,448; 
Fiscal year 2007 grants: MAI: 255,733; 
Fiscal year 2007 grants: Total: 6,720,094. 

TGA: Sacramento, Calif; 
Fiscal year 2006 grants: Formula: 1,459,858; 
Fiscal year 2006 grants: Supplemental: 1,263,003; 
Fiscal year 2006 grants: MAI: 55,868; 
Fiscal year 2006 grants: Total: 2,778,729; 
Fiscal year 2007 grants: Formula: 1,472,863; 
Fiscal year 2007 grants: Supplemental: 689,474; 
Fiscal year 2007 grants: MAI: 97,469; 
Fiscal year 2007 grants: Total: 2,259,806. 

TGA: St. Louis. Mo; 
Fiscal year 2006 grants: Formula: 2,377,264; 
Fiscal year 2006 grants: Supplemental: 1,875,232; 
Fiscal year 2006 grants: MAI: 250,076; 
Fiscal year 2006 grants: Total: 4,502,572; 
Fiscal year 2007 grants: Formula: 3,471,180; 
Fiscal year 2007 grants: Supplemental: 1,424,275; 
Fiscal year 2007 grants: MAI: 378,174; 
Fiscal year 2007 grants: Total: 5,273,629. 

TGA: San Antonio, Tex; 
Fiscal year 2006 grants: Formula: 1,952,384; 
Fiscal year 2006 grants: Supplemental: 1,068,440; 
Fiscal year 2006 grants: MAI: 305,057; 
Fiscal year 2006 grants: Total: 3,325,881; 
Fiscal year 2007 grants: Formula: 2,441,234; 
Fiscal year 2007 grants: Supplemental: 949,837; 
Fiscal year 2007 grants: MAI: 264,661; 
Fiscal year 2007 grants: Total: 3,655,732. 

TGA: San Jose, Calif; 
Fiscal year 2006 grants: Formula: 1,322,616; 
Fiscal year 2006 grants: Supplemental: 871,297; 
Fiscal year 2006 grants: MAI: 110,849; 
Fiscal year 2006 grants: Total: 2,304,762; 
Fiscal year 2007 grants: Formula: 1,596,809; 
Fiscal year 2007 grants: Supplemental: 604,404; 
Fiscal year 2007 grants: MAI: 137,156; 
Fiscal year 2007 grants: Total: 2,338,369. 

TGA: Santa Rosa, Calif; 
Fiscal year 2006 grants: Formula: 572,703; 
Fiscal year 2006 grants: Supplemental: 426,667; 
Fiscal year 2006 grants: MAI: 29,264; 
Fiscal year 2006 grants: Total: 1,028,634; 
Fiscal year 2007 grants: Formula: 725,352; 
Fiscal year 2007 grants: Supplemental: 265,582; 
Fiscal year 2007 grants: MAI: 50,000; 
Fiscal year 2007 grants: Total: 1,040,934. 

TGA: Seattle, Wash; 
Fiscal year 2006 grants: Formula: 2,931,596; 
Fiscal year 2006 grants: Supplemental: 2,309,038; 
Fiscal year 2006 grants: MAI: 204,850; 
Fiscal year 2006 grants: Total: 5,445,484; 
Fiscal year 2007 grants: Formula: 4,051,676; 
Fiscal year 2007 grants: Supplemental: 1,667,482; 
Fiscal year 2007 grants: MAI: 234,009; 
Fiscal year 2007 grants: Total: 5,953,167. 

TGA: Vineland-Millville-Bridgeton, N.J; 
Fiscal year 2006 grants: Formula: 464,590; 
Fiscal year 2006 grants: Supplemental: 313,292; 
Fiscal year 2006 grants: MAI: 71,833; 
Fiscal year 2006 grants: Total: 849,715; 
Fiscal year 2007 grants: Formula: 518,884; 
Fiscal year 2007 grants: Supplemental: 196,470; 
Fiscal year 2007 grants: MAI: 68,510; 
Fiscal year 2007 grants: Total: 783,864. 

TGA: Total; 
Fiscal year 2006 grants: Formula: $59,734,921; 
Fiscal year 2006 grants: Supplemental: $44,780,326; 
Fiscal year 2006 grants: MAI: $6,300,677; 
Fiscal year 2006 grants: Total: $110,815,924; 
Fiscal year 2007 grants: Formula: $86,456,387; 
Fiscal year 2007 grants: Supplemental: $35,843,939; 
Fiscal year 2007 grants: MAI: $8,448,407; 
Fiscal year 2007 grants: Total: $130,748,733. 

Source: HHS

Note: The 2006 Modernization Act created a new category of urban areas
called TGAs. TGAs that received Part A funding in 2006 were classified at
that time as EMAs.

Projected CARE Act Funding for Urban Areas Would be Impacted by the
Proposed Hold-Harmless Provision

The funding for both EMAs and TGAs would be impacted by the proposed
hold-harmless provision in H.R. 3043. Some EMAs and TGAs would receive
additional funding for the 2007 program year under the provision, but the
amounts needed to fund the hold-harmless provision would be taken from the
amount that could otherwise be available for fiscal year 2008 funding. A
total of $9,377,444 would be needed to fund the proposed hold-harmless
provision, with $6,410,885 needed for EMAs and $2,966,559 for TGAs.

Projected EMA Funding

We found that the impact of the proposed hold-harmless provision in H.R.
3043 on EMAs would be to increase funding for 3 of 22 EMAs by a total of
$6,410,885 for the 2007 program year, which runs from April 1, 2007, to
March 31, 2008. The San Francisco EMA would receive the largest increase,
$6,156,471, while the Atlanta and New York EMAs would receive an
additional $160,004 and $94,410, respectively.

We found that under funding as identified in the report of the House
Committee on Appropriations and under our assumptions, funding would be
impacted for all EMAs. Sixteen of 22 EMAs would receive an increase in
funding over fiscal year 2007 if the proposed hold-harmless provision is
enacted. However, regardless of whether an EMA would receive an increase
over fiscal year 2007 or not, all EMAs would be awarded less fiscal year
2008 funding with the hold-harmless provision in place than if the entire
amount was awarded as fiscal year 2008 funding without the hold harmless
because less funding would be available to be awarded. Less funding would
be available for fiscal year 2008 because funds would be taken from fiscal
year 2008 funding to cover the proposed hold-harmless provision in H.R.
3043 that protects funds for the 2007 program year, which ends March 31,
2008. The size of the difference in the amount of funding with and without
the proposed hold-harmless provision would vary by EMA with differences
ranging from approximately 0.7 percent to 2.1 percent.^20 However, it is
not possible to determine exactly how each EMA would be affected by the
proposed 8.4 percent hold-harmless provision because it is not known how
HRSA will award fiscal year 2008 funding. Table 4 lists EMA funding for
fiscal years 2006 and 2007, and the projected funding for fiscal year 2008
with and without the proposed hold-harmless provision, assuming funding
amounts as identified in the report of the House Committee on
Appropriations.

^20The size of the decrease would depend on whether an EMA's formula
funding would be held harmless for fiscal year 2008 under the
hold-harmless provision of the CARE Act and the size of its MAI funding.
Under our assumptions, those EMAs whose formula funding was held harmless
would receive smaller decreases in their total funding. This would occur
because those EMAs that qualified for the formula funding hold harmless
could only have their supplemental funding decreased, not both formula and
supplemental funding. Since we assumed that each EMA would receive the
same percentage of supplemental funding in fiscal year 2008 that it
received in fiscal year 2007, those EMAs that also received formula
funding decreases would have larger total funding decreases. Under our
assumptions, MAI funding would not be used to fund the hold-harmless
provision. We assumed that the total funding for MAI grants would increase
to the amount specified in the CARE Act and that each EMA would receive
the same percentage of MAI funding in fiscal year 2008 funding that it
received in fiscal year 2007. Consequently, those EMAs that have a larger
proportion of their funding provided through MAI have smaller amounts that
could be used to fund the hold-harmless provision. This results in smaller
funding differences between what they would receive with and without the
proposed hold-harmless provision.

Table 4: Total EMA Formula, Supplemental, and MAI Grants for Fiscal Years
2006 and 2007 and Projected Funding for Fiscal Year 2008 Under Funding
Levels as Identified in the Report of the House Committee on
Appropriations

EMA: Atlanta, Ga; 
Fiscal year 2006 grants: $18,869,561; 
Fiscal year 2007 grants: $17,124,514; 
Estimated hold-harmless funding under H.R. 3043: $160,004; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: $17,112,815; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: $16,982,259. 

EMA: Baltimore, Md; 
Fiscal year 2006 grants: 20,628,895; 
Fiscal year 2007 grants: 20,388,061; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 22,732,883; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 22,301,873. 

EMA: Boston, Mass; 
Fiscal year 2006 grants: 13,339,141; 
Fiscal year 2007 grants: 13,675,999; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 15,277,498; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,972,628. 

EMA: Chicago, Ill; 
Fiscal year 2006 grants: 25,044,633; 
Fiscal year 2007 grants: 25,153,442; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 28,066,579; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 27,512,113. 

EMA: Dallas, Tex; 
Fiscal year 2006 grants: 13,196,377; 
Fiscal year 2007 grants: 13,550,581; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 15,137,303; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,836,295. 

EMA: Detroit, Mich; 
Fiscal year 2006 grants: 8,428,477; 
Fiscal year 2007 grants: 8,366,462; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 9,013,890; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,839,476. 

EMA: Fort Lauderdale, Fla; 
Fiscal year 2006 grants: 14,963,638; 
Fiscal year 2007 grants: 14,284,795; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 15,936,744; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 15,626,839. 

EMA: Houston, Tex; 
Fiscal year 2006 grants: 19,953,520; 
Fiscal year 2007 grants: 19,472,799; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 20,852,940; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 20,445,124. 

EMA: Los Angeles, Calif; 
Fiscal year 2006 grants: 34,895,377; 
Fiscal year 2007 grants: 35,263,560; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 38,631,203; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 37,867,959. 

EMA: Miami, Fla; 
Fiscal year 2006 grants: 23,999,914; 
Fiscal year 2007 grants: 25,061,316; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 27,885,150; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 27,354,166. 

EMA: New Orleans, La; 
Fiscal year 2006 grants: 7,434,812; 
Fiscal year 2007 grants: 7,256,199; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,056,604; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 7,901,579. 

EMA: New York, N.Y; 
Fiscal year 2006 grants: 120,423,326; 
Fiscal year 2007 grants: 110,213,357; 
Estimated hold-harmless funding under H.R. 3043: 94,410; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 110,216,803; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 109,335,299. 

EMA: Newark, N.J; 
Fiscal year 2006 grants: 14,752,254; 
Fiscal year 2007 grants: 13,927,385; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 14,821,268; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,535,807. 

EMA: Orlando, Fla; 
Fiscal year 2006 grants: 8,561,273; 
Fiscal year 2007 grants: 8,062,483; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,614,615; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,447,306. 

EMA: Philadelphia, Pa; 
Fiscal year 2006 grants: 22,384,551; 
Fiscal year 2007 grants: 21,639,722; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 21,765,212; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 21,464,894. 

EMA: Phoenix, Ariz; 
Fiscal year 2006 grants: 6,519,338; 
Fiscal year 2007 grants: 6,974,852; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 7,831,853; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 7,673,854. 

EMA: San Diego, Calif; 
Fiscal year 2006 grants: 9,269,256; 
Fiscal year 2007 grants: 10,224,751; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 11,828,264; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 11,590,839. 

EMA: San Francisco, Calif; 
Fiscal year 2006 grants: 27,964,864; 
Fiscal year 2007 grants: 19,459,344; 
Estimated hold-harmless funding under H.R. 3043: 6,156,471; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 19,429,426; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 19,289,248. 

EMA: San Juan, P.R; 
Fiscal year 2006 grants: 13,470,347; 
Fiscal year 2007 grants: 12,709,679; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 12,703,554; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 12,616,981. 

EMA: Tampa-St. Petersburg, Fla; 
Fiscal year 2006 grants: 9,571,830; 
Fiscal year 2007 grants: 9,201,080; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 9,692,491; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 9,500,031. 

EMA: Washington, D.C; 
Fiscal year 2006 grants: 26,923,066; 
Fiscal year 2007 grants: 27,631,723; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 28,861,975; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 28,297,491. 

EMA: West Palm Beach, Fla; 
Fiscal year 2006 grants: 8,276,018; 
Fiscal year 2007 grants: 8,295,497; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,404,609; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,241,277. 

EMA: Total; 
Fiscal year 2006 grants: $468,870,468; 
Fiscal year 2007 grants: $447,937,601; 
Estimated hold-harmless funding under H.R. 3043: $6,410,885; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: $472,873,680; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: $465,633,338. 

Sources: GAO analysis of HHS data, H.R. 3043, and report of the House of
Committee on Appropriations (110-231).

Notes: The projected fiscal year 2008 funding in this table is based on
the funding amount for urban areas identified in the report of the House
Committee on Appropriations (110-231). Before estimating the funding
allocations, we reduced the amount to be allocated by subtracting out the
amounts set aside by HRSA before awarding grants to urban areas. We used
the same amounts for these reductions as were used in fiscal year 2007,
$23,548,096.

We cannot determine the exact impact on total funding for each EMA for
fiscal year 2008. It is not possible to determine exactly how each EMA
would be affected by the proposed 8.4 percent hold-harmless provision for
EMAs because it is not known how HRSA will award fiscal year 2008
supplemental and MAI grants and because the case counts on which formula
grants will be based are not yet available.

[a]The projected funding amounts in this column include the CARE Act
hold-harmless provision that protects formula funding for EMAs.

[b]Under the proposed hold-harmless provision in H.R. 3043, the maximum
decrease in formula, supplemental, and MAI grants in total that an EMA
could receive for program year 2007 would be no more than 8.4 percent of
what it received for program year 2006. Funds would be taken from fiscal
year 2008 funding to cover this proposed hold-harmless provision. The
projected funding amounts in this column include the CARE Act
hold-harmless provision that protects formula funding for EMAs.

Under funding identified in H.R. 3043 and under our assumptions, funding
for each EMA would be similarly impacted if the proposed hold-harmless
provision is enacted. Sixteen of 22 EMAs would receive an increase in
funding over fiscal year 2007 if the proposed hold-harmless provision is
enacted. However, regardless of whether an EMA would receive an increase
over fiscal year 2007 or not, all EMAs would receive less funding awarded
as fiscal year 2008 funding with the hold-harmless provision in place than
if the entire amount was awarded as fiscal year 2008 funding without the
hold harmless because less funding would be available to be awarded. Less
funding would be available for fiscal year 2008 because funds would be
taken from fiscal year 2008 funding to cover the proposed hold-harmless
provision in H.R. 3043 that protects funds for the 2007 program year,
which ends March 31, 2008. The size of the difference in the amount of
funding with and without the hold-harmless provision would vary by EMA
with differences ranging from approximately 0.7 percent to 2.2 percent.
However, it is not possible to determine exactly how each EMA would be
affected by the proposed 8.4 percent hold-harmless provision because it is
not known how HRSA will award fiscal year 2008 funding. Table 5 lists EMA
funding for fiscal years 2006 and 2007, and the projected funding for
fiscal year 2008 with and without the proposed hold-harmless provision,
assuming funding levels identified in H.R. 3043.

Table 5: Total EMA Formula, Supplemental, and MAI Funding for Fiscal Years
2006 and 2007 and Projected Funding for Fiscal Year 2008 Under Funding
Levels as Identified in H.R. 3043

EMA: Atlanta, Ga; 
Fiscal year 2006 grants: $18,869,561; 
Fiscal year 2007 grants: $17,124,514; 
Estimated hold-harmless funding under H.R. 3043: $160,004; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: $16,972,555; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: $16,834,467. 

EMA: Baltimore, Md; 
Fiscal year 2006 grants: 20,628,895; 
Fiscal year 2007 grants: 20,388,061; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 22,270,467; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 21,829,310. 

EMA: Boston, Mass; 
Fiscal year 2006 grants: 13,339,141; 
Fiscal year 2007 grants: 13,675,999; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 14,950,405; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,638,161. 

EMA: Chicago, Ill; 
Fiscal year 2006 grants: 25,044,633; 
Fiscal year 2007 grants: 25,153,442; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 27,471,692; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 26,903,749. 

EMA: Dallas, Tex; 
Fiscal year 2006 grants: 13,196,377; 
Fiscal year 2007 grants: 13,550,581; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 14,814,360; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,506,230. 

EMA: Detroit, Mich; 
Fiscal year 2006 grants: 8,428,477; 
Fiscal year 2007 grants: 8,366,462; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,826,768; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,648,298. 

EMA: Fort Lauderdale, Fla; 
Fiscal year 2006 grants: 14,963,638; 
Fiscal year 2007 grants: 14,284,795; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 15,604,256; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 15,287,060. 

EMA: Houston, Tex; 
Fiscal year 2006 grants: 19,953,520; 
Fiscal year 2007 grants: 19,472,799; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 20,415,390; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 19,997,556. 

EMA: Los Angeles, Calif; 
Fiscal year 2006 grants: 34,895,377; 
Fiscal year 2007 grants: 35,263,560; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 37,812,312; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 37,030,382. 

EMA: Miami, Fla; 
Fiscal year 2006 grants: 23,999,914; 
Fiscal year 2007 grants: 25,061,316; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 27,315,466; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 26,771,801. 

EMA: New Orleans, La; 
Fiscal year 2006 grants: 7,434,812; 
Fiscal year 2007 grants: 7,256,199; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 7,890,291; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 7,731,802. 

EMA: New York, N.Y; 
Fiscal year 2006 grants: 120,423,326; 
Fiscal year 2007 grants: 110,213,357; 
Estimated hold-harmless funding under H.R. 3043: 94,410; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 109,269,779; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 108,337,417. 

EMA: Newark, N.J; 
Fiscal year 2006 grants: 14,752,254; 
Fiscal year 2007 grants: 13,927,385; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 14,514,997; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 14,222,586. 

EMA: Orlando, Fla; 
Fiscal year 2006 grants: 8,561,273; 
Fiscal year 2007 grants: 8,062,483; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,435,117; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,263,934. 

EMA: Philadelphia, Pa; 
Fiscal year 2006 grants: 22,384,551; 
Fiscal year 2007 grants: 21,639,722; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 21,452,200; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 21,271,561. 

EMA: Phoenix, Ariz; 
Fiscal year 2006 grants: 6,519,338; 
Fiscal year 2007 grants: 6,974,852; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 7,662,349; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 7,500,806. 

EMA: San Diego, Calif; 
Fiscal year 2006 grants: 9,269,256; 
Fiscal year 2007 grants: 10,224,751; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 11,573,534; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 11,330,412. 

EMA: San Francisco, Calif; 
Fiscal year 2006 grants: 27,964,864; 
Fiscal year 2007 grants: 19,459,344; 
Estimated hold-harmless funding under H.R. 3043: 6,156,471; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 19,278,829; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 19,130,563. 

EMA: San Juan, P.R; 
Fiscal year 2006 grants: 13,470,347; 
Fiscal year 2007 grants: 12,709,679; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 12,610,547; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 12,518,979. 

EMA: Tampa-St. Petersburg, Fla; 
Fiscal year 2006 grants: 9,571,830; 
Fiscal year 2007 grants: 9,201,080; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision[A]: 9,486,004; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 9,288,957. 

EMA: Washington, D.C; 
Fiscal year 2006 grants: 26,923,066; 
Fiscal year 2007 grants: 27,631,723; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 28,256,351; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 27,678,377. 

EMA: West Palm Beach, Fla; 
Fiscal year 2006 grants: 8,276,018; 
Fiscal year 2007 grants: 8,295,497; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: 8,229,377; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: 8,150,292. 

EMA: Total; 
Fiscal year 2006 grants: $468,870,468; 
Fiscal year 2007 grants: $447,937,601; 
Estimated hold-harmless funding under H.R. 3043: $6,410,885; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision[A]: $465,113,045; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[B]: $457,872,699. 

Sources: GAO analysis of HHS data and H.R. 3043.

Notes: The projected fiscal year 2008 funding in this table is based on
the funding amount identified in H.R. 3043 and our assumption that the
percentage of funding for Part A out of the total funding for Parts A and
B will be the same in fiscal year 2008 as it was in fiscal year 2007.
Before estimating the funding allocations, we reduced the amount to be
allocated by subtracting out the amounts set aside by HRSA before awarding
grants to urban areas. We used the same amounts for these reductions as
were used in fiscal year 2007, $23,548,096.

We cannot determine the exact impact on total funding for each EMA for
fiscal year 2008. It is not possible to determine exactly how each EMA
would be affected by the proposed 8.4 percent hold-harmless provision for
EMAs because it is not known how HRSA will award fiscal year 2008
supplemental and MAI grants and because the case counts on which formula
grants will be based are not yet available.

[a]The projected funding amounts in this column include the CARE Act
hold-harmless provision that protects formula funding for EMAs.

[b]Under the proposed hold-harmless provision in H.R. 3043, the maximum
decrease in formula, supplemental, and MAI grants in total that an EMA
could receive for program year 2007 would be no more than 8.4 percent of
what it received for program year 2006. Funds would be taken from fiscal
year 2008 funding to cover this proposed hold-harmless provision. The
projected funding amounts in this column include the CARE Act
hold-harmless provision that protects formula funding for EMAs.

Projected TGA Funding

We found that the impact of the proposed hold-harmless provision in H.R.
3043 on TGAs would be to increase the 2007 program year funding for 8 of
34 TGAs--Bergen-Passaic, New Jersey; Caguas, Puerto Rico; Dutchess County,
New York; Hartford, Connecticut; Nassau-Suffolk, New York; New Haven,
Connecticut; Ponce, Puerto Rico; and Sacramento, California--by a total of
$2,966,559.^21

We found that under funding identified in the report of the House
Committee on Appropriations and under our assumptions, funding would be
impacted for all TGAs. If the proposed hold-harmless provision is enacted,
each TGA would receive an increase in funding over fiscal year 2007, but
the increase would be less than if the entire amount was awarded as fiscal
year 2008 funding without the hold harmless because less funding would be
available to be awarded. Less funding would be available for fiscal year
2008 because funds would be taken from fiscal year 2008 funding to cover
the proposed hold-harmless provision in H.R. 3043 that protects funds for
the 2007 program year, which ends March 31, 2008. The size of the
difference in the amount of funding with and without the proposed
hold-harmless provision would vary by TGA with differences ranging from
approximately 1.5 to 1.6 percent.^22 However, it is not possible to
determine exactly how each TGA would be affected by the proposed 13.4
percent hold-harmless provision because it is not known how HRSA will
award fiscal year 2008 funding. Table 6 lists TGA funding for fiscal years
2006 and 2007, and the projected funding for fiscal year 2008 with and
without the proposed hold-harmless provision, assuming funding amounts
identified in the report of the House Committee on Appropriations.

^21The hold-harmless amounts for the eight TGAs would be $14,607 for
Bergen-Passaic; $345,012 for Caguas; $22,134 for Dutchess County; $870,472
for Hartford; $509,497 for Nassau-Suffolk; $687,111 for New Haven;
$371,153 for Ponce; and $146,573 for Sacramento.

^22Under our assumptions, MAI funding would not be used to fund the
hold-harmless provision. We assumed that the total funding for MAI grants
would increase to the amount specified in the CARE Act and that each TGA
would receive the same percentage of MAI funding in fiscal year 2008
funding that it received in fiscal year 2007. Consequently, those EMAs
that have a larger proportion of their funding provided through MAI have
smaller amounts that could be used to fund the hold-harmless provision.
This results in smaller funding differences between what they would
receive with and without the proposed hold-harmless provision.

Table 6: Total TGA Formula, Supplemental, and MAI Funding for Fiscal Years
2006 and 2007 and Projected Funding for Fiscal Year 2008 Under Funding
Levels as Identified in the Report of the House Committee on
Appropriations

TGA: Austin, Tex; 
Fiscal year 2006 grants: $3,719,076; 
Fiscal year 2007 grants: $3,614,135; 
Estimated hold-harmless funding under H.R. 3043: $0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: $3,815,614; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: $3,756,472. 

TGA: Baton Rouge, La; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,259,580; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,440,391; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,387,794. 

TGA: Bergen-Passaic, N.J; 
Fiscal year 2006 grants: 4,485,650; 
Fiscal year 2007 grants: 3,869,966; 
Estimated hold-harmless funding under H.R. 3043: 14,607; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,084,832; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,022,242. 

TGA: Caguas, P.R; 
Fiscal year 2006 grants: 1,648,356; 
Fiscal year 2007 grants: 1,082,464; 
Estimated hold-harmless funding under H.R. 3043: 345,012; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,141,704; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,124,924. 

TGA: Charlotte-Gastonia, N.C.-S.C; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 4,200,378; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,432,317; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,365,423. 

TGA: Cleveland, Ohio; 
Fiscal year 2006 grants: 3,349,096; 
Fiscal year 2007 grants: 3,983,088; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,203,795; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,139,736. 

TGA: Denver, Colo; 
Fiscal year 2006 grants: 4,283,042; 
Fiscal year 2007 grants: 7,061,342; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 7,458,467; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 7,339,910. 

TGA: Dutchess County, N.Y; 
Fiscal year 2006 grants: 1,367,584; 
Fiscal year 2007 grants: 1,162,194; 
Estimated hold-harmless funding under H.R. 3043: 22,134; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,226,371; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,207,875. 

TGA: Fort Worth, Tex; 
Fiscal year 2006 grants: 3,409,819; 
Fiscal year 2007 grants: 3,443,293; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,635,512; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,578,923. 

TGA: Hartford, Conn; 
Fiscal year 2006 grants: 4,666,281; 
Fiscal year 2007 grants: 3,170,527; 
Estimated hold-harmless funding under H.R. 3043: 870,472; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,346,206; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,295,231. 

TGA: Indianapolis, Ind; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,230,389; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,410,745; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,357,610. 

TGA: Jacksonville, Fla; 
Fiscal year 2006 grants: 4,913,816; 
Fiscal year 2007 grants: 4,886,573; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,157,261; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,078,765. 

TGA: Jersey City, N.J; 
Fiscal year 2006 grants: 5,145,142; 
Fiscal year 2007 grants: 4,535,846; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,786,028; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,714,081. 

TGA: Kansas City, Mo; 
Fiscal year 2006 grants: 2,916,485; 
Fiscal year 2007 grants: 3,724,815; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,933,437; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,871,632. 

TGA: Las Vegas, Nev; 
Fiscal year 2006 grants: 4,323,627; 
Fiscal year 2007 grants: 4,670,529; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,932,284; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,854,631. 

TGA: Memphis, Tenn; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 5,574,928; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,881,516; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,793,833. 

TGA: Middlesex-Somerset-Hunterdon, N.J; 
Fiscal year 2006 grants: 2,595,663; 
Fiscal year 2007 grants: 2,465,279; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 2,602,521; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,562,335. 

TGA: Minneapolis-St. Paul, Minn; 
Fiscal year 2006 grants: 3,046,512; 
Fiscal year 2007 grants: 4,468,112; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 4,717,553; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,644,114. 

TGA: Nashville, Tenn; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,688,043; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,894,140; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,833,330. 

TGA: Nassau-Suffolk, N.Y; 
Fiscal year 2006 grants: 6,148,307; 
Fiscal year 2007 grants: 4,814,937; 
Estimated hold-harmless funding under H.R. 3043: 509,497; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,082,928; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,004,488. 

TGA: New Haven, Conn; 
Fiscal year 2006 grants: 6,684,594; 
Fiscal year 2007 grants: 5,101,747; 
Estimated hold-harmless funding under H.R. 3043: 687,111; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,386,188; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,302,673. 

TGA: Norfolk, Va; 
Fiscal year 2006 grants: 4,414,760; 
Fiscal year 2007 grants: 5,054,931; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,335,464; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,253,782. 

TGA: Oakland, Calif; 
Fiscal year 2006 grants: 5,735,837; 
Fiscal year 2007 grants: 5,837,061; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 6,162,947; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 6,067,801. 

TGA: Orange County, Calif; 
Fiscal year 2006 grants: 4,858,579; 
Fiscal year 2007 grants: 4,966,678; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,244,811; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,163,142. 

TGA: Ponce, P.R; 
Fiscal year 2006 grants: 2,391,444; 
Fiscal year 2007 grants: 1,699,838; 
Estimated hold-harmless funding under H.R. 3043: 371,153; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,793,657; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,766,634. 

TGA: Portland, Oreg; 
Fiscal year 2006 grants: 3,401,956; 
Fiscal year 2007 grants: 3,156,465; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,335,454; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,281,669. 

TGA: Riverside-San Bernadino, Calif; 
Fiscal year 2006 grants: 7,074,521; 
Fiscal year 2007 grants: 6,720,094; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 7,099,329; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 6,986,369. 

TGA: Sacramento, Calif; 
Fiscal year 2006 grants: 2,778,729; 
Fiscal year 2007 grants: 2,259,806; 
Estimated hold-harmless funding under H.R. 3043: 146,573; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 2,387,096; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,349,311. 

TGA: St. Louis. Mo; 
Fiscal year 2006 grants: 4,502,572; 
Fiscal year 2007 grants: 5,273,629; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,566,687; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,481,157. 

TGA: San Antonio, Tex; 
Fiscal year 2006 grants: 3,325,881; 
Fiscal year 2007 grants: 3,655,732; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,858,822; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,799,575. 

TGA: San Jose, Calif; 
Fiscal year 2006 grants: 2,304,762; 
Fiscal year 2007 grants: 2,338,369; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 2,485,741; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,447,005. 

TGA: Santa Rosa, Calif; 
Fiscal year 2006 grants: 1,028,634; 
Fiscal year 2007 grants: 1,040,934; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,099,462; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,082,147. 

TGA: Seattle, Wash; 
Fiscal year 2006 grants: 5,445,484; 
Fiscal year 2007 grants: 5,953,167; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 6,288,967; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 6,189,029. 

TGA: Vineland-Millville-Bridgeton, N.J; 
Fiscal year 2006 grants: 849,715; 
Fiscal year 2007 grants: 783,864; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 827,169; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 814,671. 

TGA: Total; 
Fiscal year 2006 grants: $110,815,924; 
Fiscal year 2007 grants: $130,748,733; 
Estimated hold-harmless funding under H.R. 3043: $2,966,559; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: $138,055,416; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: $135,918,315. 

Sources: GAO analysis of HHS data, H.R. 3043, and report of the House of
Committee on Appropriations (110-231).

Notes: The projected fiscal year 2008 funding in this table is based on
the funding amount for urban areas identified in the report of the House
Committee on Appropriations (110-231). Before estimating the funding
allocations, we reduced the amount to be allocated by subtracting out the
amounts set aside by HRSA before awarding grants to urban areas. We used
the same amounts for these reductions as were used in fiscal year 2007,
$23,548,096.

We cannot determine the exact impact on total funding for each TGA for
fiscal year 2008. It is not possible to determine exactly how each TGA
would be affected by the proposed 13.4 percent hold-harmless provision for
TGAs because it is not known how HRSA will award fiscal year 2008
supplemental and MAI grants and because the case counts on which formula
grants will be based are not yet available.

[a]Under the proposed hold-harmless provision in H.R. 3043, the maximum
decrease in formula, supplemental, and MAI grants in total that a TGA
could receive for program year 2007 would be no more than 13.4 percent of
what it received for program year 2006. Funds would be taken from fiscal
year 2008 funding to cover this proposed hold-harmless provision.

Under funding identified in H.R. 3043 and under our assumptions, funding
for each TGA would be impacted if the proposed hold-harmless provision is
enacted. Each TGA would receive an increase in funding over fiscal year
2007 if the proposed hold-harmless provision is enacted, but the amount
would be less than if the entire amount was awarded as fiscal year 2008
funding without the hold harmless because less funding would be available
to be awarded. Less funding would be available for fiscal year 2008
because funds would be taken from fiscal year 2008 funding to cover the
proposed hold-harmless provision in H.R. 3043 that protects funds for the
2007 program year, which ends March 31, 2008. The size of the difference
in the amount of funding with and without the hold-harmless provision
would vary by TGA with differences ranging from approximately 1.5 percent
to 1.7 percent. However, it is not possible to determine exactly how each
TGA would be affected by the proposed 13.4 percent hold-harmless provision
because it is not known how HRSA will award fiscal year 2008 funding.
Table 7 lists TGA funding for fiscal years 2006 and 2007, and the
projected funding for fiscal year 2008 with and without the proposed
hold-harmless provision, assuming funding amounts identified in H.R. 3043.

Table 7: Total TGA Formula, Supplemental, and MAI Funding for Fiscal Years
2006 and 2007 and Projected Funding for Fiscal Year 2008 Under Funding
Levels as Identified in the H.R. 3043

TGA: Austin, Tex; 
Fiscal year 2006 grants: $3,719,076; 
Fiscal year 2007 grants: $3,614,135; 
Estimated hold-harmless funding under H.R. 3043: $0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: $3,752,222; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: $3,693,080. 

TGA: Baton Rouge, La; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,259,580; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,384,014; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,331,417. 

TGA: Bergen-Passaic, N.J; 
Fiscal year 2006 grants: 4,485,650; 
Fiscal year 2007 grants: 3,869,966; 
Estimated hold-harmless funding under H.R. 3043: 14,607; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,017,744; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,955,154. 

TGA: Caguas, P.R; 
Fiscal year 2006 grants: 1,648,356; 
Fiscal year 2007 grants: 1,082,464; 
Estimated hold-harmless funding under H.R. 3043: 345,012; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,123,718; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,106,937. 

TGA: Charlotte-Gastonia, N.C.-S.C; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 4,200,378; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,360,616; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,293,722. 

TGA: Cleveland, Ohio; 
Fiscal year 2006 grants: 3,349,096; 
Fiscal year 2007 grants: 3,983,088; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,135,132; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,071,073. 

TGA: Denver, Colo; 
Fiscal year 2006 grants: 4,283,042; 
Fiscal year 2007 grants: 7,061,342; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 7,331,391; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 7,212,834. 

TGA: Dutchess County, N.Y; 
Fiscal year 2006 grants: 1,367,584; 
Fiscal year 2007 grants: 1,162,194; 
Estimated hold-harmless funding under H.R. 3043: 22,134; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,206,546; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,188,050. 

TGA: Fort Worth, Tex; 
Fiscal year 2006 grants: 3,409,819; 
Fiscal year 2007 grants: 3,443,293; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,574,857; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,518,267. 

TGA: Hartford, Conn; 
Fiscal year 2006 grants: 4,666,281; 
Fiscal year 2007 grants: 3,170,527; 
Estimated hold-harmless funding under H.R. 3043: 870,472; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,291,568; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,240,594. 

TGA: Indianapolis, Ind; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,230,389; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,353,792; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,300,657. 

TGA: Jacksonville, Fla; 
Fiscal year 2006 grants: 4,913,816; 
Fiscal year 2007 grants: 4,886,573; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,073,124; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,994,629. 

TGA: Jersey City, N.J; 
Fiscal year 2006 grants: 5,145,142; 
Fiscal year 2007 grants: 4,535,846; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,708,911; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,636,964. 

TGA: Kansas City, Mo; 
Fiscal year 2006 grants: 2,916,485; 
Fiscal year 2007 grants: 3,724,815; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,867,191; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,805,386. 

TGA: Las Vegas, Nev; 
Fiscal year 2006 grants: 4,323,627; 
Fiscal year 2007 grants: 4,670,529; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 4,849,051; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,771,399. 

TGA: Memphis, Tenn; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 5,574,928; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,787,532; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,699,849. 

TGA: Middlesex-Somerset-Hunterdon, N.J; 
Fiscal year 2006 grants: 2,595,663; 
Fiscal year 2007 grants: 2,465,279; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 2,559,448; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,519,262. 

TGA: Minneapolis-St. Paul, Minn; 
Fiscal year 2006 grants: 3,046,512; 
Fiscal year 2007 grants: 4,468,112; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 4,638,837; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,565,398. 

TGA: Nashville, Tenn; 
Fiscal year 2006 grants: 0; 
Fiscal year 2007 grants: 3,688,043; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 3,828,960; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,768,150. 

TGA: Nassau-Suffolk, N.Y; 
Fiscal year 2006 grants: 6,148,307; 
Fiscal year 2007 grants: 4,814,937; 
Estimated hold-harmless funding under H.R. 3043: 509,497; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 4,998,851; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 4,920,411. 

TGA: New Haven, Conn; 
Fiscal year 2006 grants: 6,684,594; 
Fiscal year 2007 grants: 5,101,747; 
Estimated hold-harmless funding under H.R. 3043: 687,111; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,296,672; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,213,157. 

TGA: Norfolk, Va; 
Fiscal year 2006 grants: 4,414,760; 
Fiscal year 2007 grants: 5,054,931; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 5,247,912; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,166,230. 

TGA: Oakland, Calif; 
Fiscal year 2006 grants: 5,735,837; 
Fiscal year 2007 grants: 5,837,061; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 6,060,963; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,965,817. 

TGA: Orange County, Calif; 
Fiscal year 2006 grants: 4,858,579; 
Fiscal year 2007 grants: 4,966,678; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,157,273; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,075,603. 

TGA: Ponce, P.R; 
Fiscal year 2006 grants: 2,391,444; 
Fiscal year 2007 grants: 1,699,838; 
Estimated hold-harmless funding under H.R. 3043: 371,153; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,764,692; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,737,668. 

TGA: Portland, Oreg; 
Fiscal year 2006 grants: 3,401,956; 
Fiscal year 2007 grants: 3,156,465; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,277,805; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,224,020. 

TGA: Riverside-San Bernadino, Calif; 
Fiscal year 2006 grants: 7,074,521; 
Fiscal year 2007 grants: 6,720,094; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 6,978,252; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 6,865,292. 

TGA: Sacramento, Calif; 
Fiscal year 2006 grants: 2,778,729; 
Fiscal year 2007 grants: 2,259,806; 
Estimated hold-harmless funding under H.R. 3043: 146,573; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 2,346,595; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,308,810. 

TGA: St. Louis. Mo; 
Fiscal year 2006 grants: 4,502,572; 
Fiscal year 2007 grants: 5,273,629; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 5,475,011; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 5,389,481. 

TGA: San Antonio, Tex; 
Fiscal year 2006 grants: 3,325,881; 
Fiscal year 2007 grants: 3,655,732; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 3,795,318; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 3,736,072. 

TGA: San Jose, Calif; 
Fiscal year 2006 grants: 2,304,762; 
Fiscal year 2007 grants: 2,338,369; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 2,444,222; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 2,405,486. 

TGA: Santa Rosa, Calif; 
Fiscal year 2006 grants: 1,028,634; 
Fiscal year 2007 grants: 1,040,934; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 1,080,902; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 1,063,586. 

TGA: Seattle, Wash; 
Fiscal year 2006 grants: 5,445,484; 
Fiscal year 2007 grants: 5,953,167; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: 6,181,848; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 6,081,910. 

TGA: Vineland-Millville-Bridgeton, N.J; 
Fiscal year 2006 grants: 849,715; 
Fiscal year 2007 grants: 783,864; 
Estimated hold-harmless funding under H.R. 3043: 0; 
Projected fiscal year 2008 grants without H.R. 3043 hold-harmless 
provision: 813,773; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: 801,275. 

TGA: Total; 
Fiscal year 2006 grants: $110,815,924; 
Fiscal year 2007 grants: $130,748,733; 
Estimated hold-harmless funding under H.R. 3043: $2,966,559; 
Projected fiscal year 2008 grants without H.R. 3043 hold- harmless 
provision: $135,764,743; 
Projected fiscal year 2008 grants with H.R. 3043 hold-harmless 
provision[A]: $133,627,642. 

Sources: GAO analysis of HHS data and H.R. 3043.

Notes: The projected fiscal year 2008 funding in this table is based on
the funding amount identified in H.R. 3043 and our assumption that the
percentage of funding for Part A out of the total funding for Parts A and
B will be the same in fiscal year 2008 as it was in fiscal year 2007.
Before estimating the funding allocations, we reduced the amount to be
allocated by subtracting out the amounts set aside by HRSA before awarding
grants to urban areas. We used the same amounts for these reductions as
were used in fiscal year 2007, $23,548,096.

We cannot determine the exact impact on total funding for each TGA for
fiscal year 2008. It is not possible to determine exactly how each TGA
would be affected by the proposed 13.4 percent hold-harmless provision for
TGAs because it is not known how HRSA will award fiscal year 2008
supplemental and MAI grants and because the case counts on which formula
grants will be based are not yet available.

[a]Under the proposed hold-harmless provision in H.R. 3043, the maximum
decrease in formula, supplemental, and MAI grants in total that a TGA
could receive for program year 2007 would be no more than 13.4 percent of
what it received for program year 2006. Funds would be taken from fiscal
year 2008 funding to cover this proposed hold-harmless provision.

San Francisco EMA Continues to Have Deceased Cases Factored into Its
Funding Allocation

The San Francisco EMA continues to be the only urban area whose formula
funding is based on both living and deceased AIDS cases. In February 2006,
we reported that the San Francisco EMA was the only EMA still receiving
CARE Act formula funding based on the number of living and deceased cases
in a metropolitan area.^23 All other EMAs received formula funding based
on an estimate of the number of living AIDS cases. We showed that the
fiscal year 2004 CARE Act formula funding for the San Francisco EMA was
determined by its fiscal year 1995 funding, which was based on both living
and deceased AIDS cases. Since the San Francisco EMA also received
hold-harmless funding in fiscal years 2005, 2006, and 2007, its CARE Act
formula funding continues to be based, in part, on the number of deceased
cases in the San Francisco EMA as of 1995.^24

Information on Unobligated CARE Act Funding and ADAP Waiting Lists

Information on unobligated CARE Act funding can be found in two reports by
the HHS Office of the Inspector General issued in February 2007 and May
2007.^25

^23GAO-06-332, pp. 34-35.

^24Fiscal year 2007 funding for the San Francisco EMA can be traced to its
fiscal year 1995 funding due to the relationship between the amount it
received in fiscal year 1995 and the amounts it was guaranteed by law to
receive in fiscal years 2000, 2006, and 2007 due to the operation of the
hold-harmless provisions. In fiscal year 2000, the San Francisco EMA
received 95 percent of the amount it received from its grant in fiscal
year 1995. In fiscal year 2006, it received 85 percent of the amount it
received from its grant in fiscal year 2000. In fiscal year 2007, it
received 95 percent of the amount it received from its grant in fiscal
year 2006. Taken together, the hold-harmless provisions meant that in
fiscal year 2007 the San Francisco EMA received approximately 76.7 percent
of its fiscal year 1995 grant of $19,126,679, or $14,672,553. We
calculated the guaranteed percentage by multiplying the hold-harmless
amounts (95, 85, and 95 percents) for each year together. See GAO-06-332
for more discussion on how the hold-harmless provision operates and how it
has affected funding for the San Francisco EMA.

^25HHS, Review of the Management of Unobligated Funds Provided by Title I
of the Ryan White Comprehensive AIDS Resources Emergency Act,
A-02-03-02006 (Washington, D.C.: Feb. 27, 2007),
[3]http://www.oig.hhs.gov/oas/reports/region2/20302006.pdf (downloaded
September 6, 2007) and Review of the Management of Unobligated Funds
Provided by Title II of the Ryan White Comprehensive AIDS Resources
Emergency Act, A-06-04-00060 (Washington, D.C, May 15, 2007),
[4]http://www.oig.hhs.gov/oas/reports/region6/60400060.htm (downloaded
September 6, 2007).

Information on the number of people on ADAP waiting lists can be found in
the National ADAP Monitoring Project Annual Report and The ADAP Watch.^26
ADAPs purchase and provide HIV/AIDS drugs to people with HIV/AIDS and pay
for health insurance that includes HIV/AIDS treatments.

                                   - - - - -

We are sending copies of this report to the Secretary of Health and Human
Services, the Administrator of the Health Resources and Services
Administration, and to the Committee on Appropriations, United States
Senate; the Subcommittee on Labor, Health and Human Services, Education,
and Related Agencies, Committee on Appropriations, United States Senate;
the Committee on Health, Education, Labor, and Pensions, United States
Senate; the Committee on Appropriations, House of Representatives; the
Subcommittee on Labor, Health and Human Services, Education, and Related
Agencies, Committee on Appropriations, House of Representatives; and the
Committee on Energy and Commerce, House of Representatives. We will also
make copies available to others upon request. In addition, the report will
be available on GAO's Web site at [5]http://www.gao.gov .

If you or your staff have any questions about this report, please contact
me at (202) 512-7114 or [email protected]. Contact points for our Offices of
Congressional Relations and Public Affairs may be found on the last page
of this report. Major contributors to this report were Martha Kelly,
Assistant Director; Robert Copeland; Helen Desaulniers; Adrienne Griffin;
Cathy Hamann; and Suzanne Worth.

Marcia Crosse
Director, Health Care

^26Henry J. Kaiser Family Foundation and the National Alliance of State &
Territorial AIDS Directors, National ADAP Monitoring Project Annual Report
(Washington, D.C.: April 2007),
http://www.nastad.org/Docs/highlight/2007411_2007NationalADAPMonitoringRepFINAL.pdf
(downloaded September 6, 2007) and the National Alliance of State &
Territorial AIDS Directors, The ADAP Watch (Washington, D.C.: Aug. 16,
2007), [6]http://www.nastad.org/infocus/infocusresults.aspx (downloaded
September 6, 2007).

List of Requesters

The Honorable Nancy Pelosi: 
The Speaker of the House of Representatives: 

The Honorable Michael B. Enzi: 
Ranking Member: 
Committee on Health, Education, Labor, and Pensions: 
United States Senate: 

The Honorable Barbara Boxer: 
The Honorable Richard Burr: 
The Honorable Tom A. Coburn: 
The Honorable Christopher J. Dodd: 
The Honorable Dianne Feinstein: 
The Honorable Jeff Sessions: 
United States Senate: 

The Honorable Rosa L. DeLauro: 
The Honorable Anna G. Eshoo: 
The Honorable Tom Lantos: 
The Honorable Lynn C. Woolsey: 
House of Representatives: 

(290662)

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