United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2000-07-11 monographic deposited born digital 15 p. GA 1.13:T-HEHS-00-150 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-00-150 P0b002ee18038e347 f:he00150t DGPO 2010-08-12 2011-03-28 GAOREPORTS-T-HEHS-00-150 machine generated eng fdlp REPORT GAOREPORTS-T-HEHS-00-150 T-HEHS-00-150 Acquired immunodeficiency syndrome Federal/state relations Grants to states State-administered programs Statutory law Eligibility criteria Discretionary grants Health care services Grant administration Reporting requirements AIDS Drug Assistance Program AIDS California New York Texas Colorado San Francisco (CA) Medicaid Program Medicare Program Supplemental Security Income Program SSI Testimony HEHS Pursuant to a congressional request, GAO discussed ways to distribute Ryan White Comprehensive AIDS Resources Emergency (CARE) Act funds to states and localities, focusing on the: (1) potential for distributing funds on the basis of counts of persons with human immunodeficiency virus (HIV) infection in each geographic area rather than on counts of only persons whose disease has progressed to acquired immunodeficiency syndrome (AIDS); (2) differences in funds for states with an eligible metropolitan area (EMA), which receive grants under both title I and title II of the CARE Act, and states without an EMA, which receive only title II grants; and (3) current effect of the hold-harmless provision adopted in the 1996 reauthorization, when the method of counting living AIDS cases replaced the practice of counting cumulative AID cases.<p/>GAO noted that: (1) only about 60 percent of the states include HIV cases that have not progressed to AIDS in their reports to the Centers for Disease Control and Prevention (CDC); (2) to ensure that the formulas provide an equitable distribution, all states would need to report HIV cases; (3) CDC officials told GAO that they expect all states to be reporting new HIV cases by 2003 and that an additional 1 to 3 years may be needed to allow cases that existed before then to be entered into their reporting systems; (4) however, the states' ability to completely identify past cases is not known; (5) GAO also found substantial differences in funding between states with an EMA and those without one; (6) for example, in fiscal year (FY) 2000 states that had no eligible EMA received on average of $3,340 per person suffering from AIDS; (7) in contrast, the states with more than 75 percent of their AIDS cases in an EMA received nearly 50 percent more, averaging $4,954 per AIDS case; (8) states such as California and New York with more than 90 percent of their cases in EMAs received $5,240 per case or almost 60 percent more than states without an EMA; (9) GAO has in the past recommended changes to the Ryan White Funding Formulas that would result in more comparable funding across states; (10) a hold-harmless provision was included in the 1996 reauthorization to help with the transition of the EMAs that would receive less by using living AIDS rather than cumulative AIDS cases, which included both living and deceased cases; (11) the transition has been very gradual and has had the effect of providing some EMAs with more funding on a per-person-with-AIDS basis than other similarly situated EMAs; (12) only one EMA, San Francisco, continues to benefit from the hold-harmless provision, and it received substantially more aid than other similarly situated EMAs; (13) for example, San Francisco received more than 80 percent greater title I funding per person with AIDS than other EMAs; (14) Oakland, across the bay from San Francisco, and all other EMAs received $1,289 per person in FY 2000 title I funding compared with San Francisco's $2,359 per person; (15) San Francisco continues to benefit from the hold-harmless provision because a large proportion of its cumulative AIDs cases were deceased under the formula used before FY 1996 and because there have been smaller increases in new AIDS cases compared with other EMAs; and (16) GAO has in the past recommended changes to the Ryan White funding formulas that would enhance comparable funding across states. https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-00-150/html/GAOREPORTS-T-HEHS-00-150.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-T-HEHS-00-150/pdf/GAOREPORTS-T-HEHS-00-150.pdf GAO/T-HEHS-00-150 https://www.govinfo.gov/app/details/GAOREPORTS-T-HEHS-00-150 Testimony GAO/T-HEHS-00-150; Ryan White Care Act: Opportunities to Enhance Funding; Acquired immunodeficiency syndrome Federal/state relations Grants to states State-administered programs Statutory law Eligibility criteria Discretionary grants Health care services Grant administration Reporting requirements AIDS Drug Assistance Program AIDS California New York Texas Colorado San Francisco (CA) Medicaid Program Medicare Program Supplemental Security Income Program SSI