Ryan White Reauthorization New York City HIV Health and Human Services Planning Council April 16, 2009 Humberto Cruz, Director AIDS Institute

The 2006 Reauthorization Ryan White HIV/AIDS Treatment Modernization Act is a three-year law that expires on 9/30/09. The law changed funding formulas and the manner in which funds are allocated. New York’s proportion of cases/funding was reduced. New York has lost $16.7 million in Part A and Part B funds under the reauthorized law.

The 2006 Reauthorization If unobligated funds exceed two percent of the grant, grantees are not eligible for supplemental funds, and the subsequent year’s grant will be cut by the amount of unobligated funds. Law requires the development of a Severity of Need Index (SONI). An index that takes into account other available resources in determining need will penalize jurisdictions that have devoted their own resources to HIV services. Dutchess County is a “transitional grant area” but was covered in for the three years of the law and will not qualify under current Part A provisions. Seventy-five percent of funds must be used for core services, and support services must be linked to outcomes affecting HIV-related clinical status.

The 2006 Reauthorization The Minority AIDS Initiative was changed from a formula grant to a competitive grant. A new Part B base supplemental was created and carves away one-third of new base funding for competitive Part B grants. There was pressure to eliminate hold harmless provisions that prevent precipitous losses to jurisdictions. Impact: New York has lost resources. We had to eliminate some contracts and modify numerous contracts to meet the definition of support services. We have to compete for funds that were previously awarded via formula. We used to write one application; now we write three.

2009 Reauthorization Recommendations Federal AIDS Policy Partnership Ryan White Work Group is a coalition of national HIV/AIDS organizations, providers, advocates, and persons living with HIV/AIDS. Participants include NASTAD, CAEAR Coalition, NAPWA, NMAC, HIVMA, AAHIVM. The Work Group has developed a community consensus on the future of the Ryan White Law. The consensus statement has been signed by 154 organizations as of April 1, 2009.

2009 Reauthorization Recommendations Rationale for consensus recommendations: The 2006 reauthorization included many significant changes. The impact of the changes has not been fully assessed. For example: New distribution formulas New case data New core services requirement New requirements related to unobligated funds New Part B supplemental Policy discussions that are underway could affect the Ryan White program. For example: National AIDS strategy Health care reform CDC estimates that there will not be mature HIV data for all states until 2012.

2009 Reauthorization Recommendations Consensus Recommendations: Extend the RWHATMA for three years (i.e., re-start the clock on the current three-year authorization). Continued protection for states with maturing HIV case data. Extension of TGA eligibility. Extension of hold harmless provisions. Confirm that Part A and Part B funds will continue to be allocated through existing mechanisms, rather than through a SONI.

2009 Reauthorization Recommendations Consensus Recommendations (continued): Recommended modifications: Increase the penalty threshold for unobligated funds from two percent to five percent, and suspend penalties to enable grantees to access supplemental funding and avoid reductions in awards. Remove the qualifier “medical” from transportation in the support services category. Include “medical transportation” as a core medical service. Allow the provision of food pursuant to a doctor’s prescription as a core medical service. Eliminate requirement for Part D grantees to include medical expenses in their program budgets.

2009 Reauthorization NY Representatives on House Energy and Commerce Committee are encouraged by the community consensus and hope that it will lead to a smooth reauthorization. Congress is prioritizing health care reform and food safety. Need to remind representatives that the Ryan White law has a sunset clause, and without action, the program expires on 9/30/09.