Ryan White CARE Act of 1990

GAO's analysis of existing funding formulas demonstrates that federal funding under the Ryan White Care Act can be made more equitable. An important goal of the act was to target emergency funding to areas of greatest need. At the time the law was enacted, high rates of human immunodeficiency virus (HIV) infection were found in fewer areas of the country, service delivery networks were just beginning to form, and these service delivery systems had to rely primarily on private and volunteer resources. During the past five years, however, the HIV epidemic has become more widespread and less localized. Hence, areas where the AIDS caseload had burgeoned recently need per-case funding levels comparable to those in areas where AIDS was initially concentrated.

GAO found that: (1) although Ryan White Care Act funding formulas include factors used in equity-based formulas, they result in per-case funding discrepancies because EMA cases are double counted; (2) states without EMA do not benefit from double counting and receive significantly less funding; (3) the indicators used to target funds to needy states and EMA fail to take geographic cost differences into consideration; (4) EMA funding levels are based on the cumulative number of reported acquired immunodeficiency syndrome (AIDS) cases, resulting in the oldest EMA receiving the most funding; (5) better cost indicators could be used to target more funds to states and EMA where resources are the most needed; and (6) funding equity could be improved by eliminating the inappropriate double counting of AIDS cases and by using more appropriate measures of EMA and state funding needs.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Team: Phone: