Ryan White CARE Act – Reauthorization – ‘What you can do!’ Sue Rowland -- VORA September 20, 2005 ‘What you can do!’ Sue Rowland -- VORA September 20, 2005

The Problem What’s the future for HIV/AIDS Treatment funding? Or “The canary is awfully sick …”

Or … The Ryan White C.A.R.E. Act provides significant levels of public funding for HIV/AIDS treatment services It is authorized by Congress for 5 years at a time The current authority for Ryan White funds expires on Sept 30, 2005

History Of the Ryan White C.A.R.E. Act

First passed as “the Ryan White CARE Act of 1990” [Public law ] Amended as the Ryan White CARE Act of 1996 Again amended as the Ryan White CARE Act of 2000

The primary purpose of the Act is established by Congress -- in the Law. The details (the rules) are established by the federal agency assigned … Administered by the Health Resources and Services Administration (HRSA)

The Act is complex … Title I -- Eligible Metro Areas (EMA’s) Title II -- the States –ADAP Title III -- Community-based care Title IV -- Family-centered care

… there’s more Part F -- AETC’s Part F -- Dental Reimbursement Program SPNS -- Special Projects of National Significance Community-Based Dental Partnership Program

Total RWCA Funds

Title I Funds

Title II Funds

Title III Funds

Title IV Funds

AETC & Dental Funds

Virginia’s awards Title I –Washington DC EMA - $ 29,431,967 ** –Norfolk EMA - $ 4,726,063 –Richmond EMA - $241,396 Title II –State - $ 5,543,229 –ADAP - $ 15,188,795 – Minority AIDS Initiative - $ 112,908 –Emerging Communities - $ 241,396

Virginia Awards Title III –University of Virginia - $ 430,537 (05) –Carilion Medical Center - $ 107,634 (05) –Centra Health, Inc. - $55,170 (04) Title IV –VCU/MCV - $309,777 (04) AETC –Based in Richmond Dental –None

RWCA: Problems … Structure of the titles results in “double counting” PLWH/A “Hold harmless” - 90% provided to San Francisco Southern states receiving less funding Disproportionate distribution of funds

President Bush’s Principles

The President’s Principles Eliminate “hold harmless” Eliminate double-counting Develop “severity of need for core services index” (SNCSI) National ADAP core meds

President’s Principles (con’t) 75% of Titles I - IV directed to essential cores services Change role/make-up of Title I Councils Use HIV data in distribution formula New routine voluntary HIV testing

Sen. Tom Coburn leading the Reauthorization review Held Hearing in June 2005 GAO Report on “RWCA: Factors that Impact HIV and AIDS Funding and Client Coverage” Testimony provided to respond to GAO Report implications; supports President

Current Status of Reauthorization No bill yet introduced to Amend One bill continues the Title IV portion

The Problem Every day, 4 new cases of HIV are found in Virginia every day One third of Va. PLWH/A are women Two thirds are African American Treating HIV/AIDS costs about $20,000 per person per year

The Problem Funding has not kept pace with the growing number of persons living with HIV/AIDS in Virginia Waiting lists have developed in Virginia Funding is not even distributed where PLWH/A live

The Problem During AIDS Watch, we learned that Virginia’s delegation not well aware of needs In Richmond, Virginia’s State Legislators are unaware of what’s happening with federal funding for HIV/AIDS prevention & treatment

“I Can’t Lobby …. …. Can I?”

You, the Agency … Your leadership decides “Lobbying” IS allowable -- and limited.

You, the Individual … Does the source of your livelihood explicitly prohibit you from lobbying? –Very few do … How about “implicit” prohibitions? Know your Rights as an American Citizen.

What are the Rules?

“Yes, You can …” Two Senators One Congressperson One State Senator One State Delegate

“What do I say?”

Sources of Help And many more ….

Efforts in Virginia Joint Commission on Health Care Study of Federal Funding for HIV/AIDS prevention and treatment