HIV/AIDS
Changes Needed to Improve the Distribution of Ryan White CARE Act and Housing Funds Gao ID: GAO-06-332 February 28, 2006Among federal efforts to address the HIV/AIDS epidemic are the CARE Act of 1990 and the Housing Opportunities for Persons with AIDS program (HOPWA) administered by the Departments of Health and Human Services (HHS) and Housing and Urban Development (HUD), respectively. Both use formulas based upon a grantee's number of AIDS cases, rather than HIV and AIDS cases, to distribute funds to metropolitan areas, states, and territories. HIV cases must be incorporated with AIDS cases in CARE Act formulas not later than fiscal year 2007. GAO was asked to examine (1) how CARE Act and HOPWA funds are allocated among types of services, (2) the extent of funding distribution differences among CARE Act and HOPWA grantees, and how funding formula provisions contribute to these differences, and (3) what distribution differences could result from incorporating HIV case counts in CARE Act and HOPWA funding formulas.
CARE Act and HOPWA grants are allocated by grantees for health care, housing assistance, and a variety of services for people with HIV/AIDS. These grants provide services for persons who have been diagnosed with HIV that has not progressed to AIDS as well as those for whom it has. In fiscal year 2003, more than half of Title I CARE Act funds awarded to eligible metropolitan areas (EMAs) were allocated for health care services such as outpatient care and home health services, and over two-thirds of Title II CARE Act funds awarded to states and territories were allocated for medications. Two-thirds of HOPWA funds were used for direct housing costs for people with HIV/AIDS and their families. Multiple provisions in the CARE Act and HOPWA grant funding formulas as enacted result in funding not being comparable per AIDS case across grantees. First, both the CARE Act and HOPWA use measures of AIDS cases that do not accurately reflect the number of persons living with AIDS. For example, the statutory funding formulas require the use of cumulative AIDS case counts, which could include deceased cases. Second, AIDS cases within EMAs are counted once for determining funding under Title I of the CARE Act for EMAs and again under Title II for determining funding for the states and territories in which those EMAs are located. As a result, states with EMAs receive more total funding per case than states without EMAs. Third, CARE Act hold-harmless provisions under Titles I and II and the grandfather clause for EMAs under Title I sustain the funding and eligibility of CARE Act grantees on the basis of a previous year's measurements of the number of AIDS cases in these jurisdictions. For example, under Title I's hold-harmless provision, one EMA continues to have deceased AIDS cases factored into its allocation because its hold-harmless funding dates back to the mid-1990s when formula funding was based on a count of AIDS cases from the beginning of the epidemic. If HIV case counts had been incorporated along with AIDS case counts in allocating fiscal year 2004 CARE Act and HOPWA grants, funding would have shifted among jurisdictions. Grantees in the South and the Midwest generally would have received more funding, although there would have been grantees that would have received increased funding and grantees that would have received decreased funding in every region of the country. Although CARE Act and HOPWA grantees have established HIV case reporting systems, differences between these systems--in their maturity and reporting methods, for instance--would impact the appropriateness of using HIV case counts in distributing CARE Act and HOPWA funding. GAO found that CARE Act and HOPWA fiscal year 2004 funding would have shifted to jurisdictions with more mature HIV reporting systems.
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Director: Team: Phone:GAO-06-332, HIV/AIDS: Changes Needed to Improve the Distribution of Ryan White CARE Act and Housing Funds
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Report to Congressional Requesters:
United States Government Accountability Office:
GAO:
February 2006:
HIV/AIDS:
Changes Needed to Improve the Distribution of Ryan White CARE Act and
Housing Funds:
GAO-06-332:
GAO Highlights:
Highlights of GAO-06-332, a report to congressional requesters:
Why GAO Did This Study:
Among federal efforts to address the HIV/AIDS epidemic are the CARE Act
of 1990 and the Housing Opportunities for Persons with AIDS program
(HOPWA) administered by the Departments of Health and Human Services
(HHS) and Housing and Urban Development (HUD), respectively. Both use
formulas based upon a grantee‘s number of AIDS cases, rather than HIV
and AIDS cases, to distribute funds to metropolitan areas, states, and
territories. HIV cases must be incorporated with AIDS cases in CARE Act
formulas not later than fiscal year 2007.
GAO was asked to examine (1) how CARE Act and HOPWA funds are allocated
among types of services, (2) the extent of funding distribution
differences among CARE Act and HOPWA grantees, and how funding formula
provisions contribute to these differences, and (3) what distribution
differences could result from incorporating HIV case counts in CARE Act
and HOPWA funding formulas.
What GAO Found:
CARE Act and HOPWA grants are allocated by grantees for health care,
housing assistance, and a variety of services for people with HIV/AIDS.
These grants provide services for persons who have been diagnosed with
HIV that has not progressed to AIDS as well as those for whom it has.
In fiscal year 2003, more than half of Title I CARE Act funds awarded
to eligible metropolitan areas (EMAs) were allocated for health care
services such as outpatient care and home health services, and over two-
thirds of Title II CARE Act funds awarded to states and territories
were allocated for medications. Two-thirds of HOPWA funds were used for
direct housing costs for people with HIV/AIDS and their families.
Multiple provisions in the CARE Act and HOPWA grant funding formulas as
enacted result in funding not being comparable per AIDS case across
grantees. First, both the CARE Act and HOPWA use measures of AIDS cases
that do not accurately reflect the number of persons living with AIDS.
For example, the statutory funding formulas require the use of
cumulative AIDS case counts, which could include deceased cases.
Second, AIDS cases within EMAs are counted once for determining funding
under Title I of the CARE Act for EMAs and again under Title II for
determining funding for the states and territories in which those EMAs
are located. As a result, states with EMAs receive more total funding
per case than states without EMAs. Third, CARE Act hold-harmless
provisions under Titles I and II and the grandfather clause for EMAs
under Title I sustain the funding and eligibility of CARE Act grantees
on the basis of a previous year‘s measurements of the number of AIDS
cases in these jurisdictions. For example, under Title I‘s hold-
harmless provision, one EMA continues to have deceased AIDS cases
factored into its allocation because its hold-harmless funding dates
back to the mid-1990s when formula funding was based on a count of AIDS
cases from the beginning of the epidemic.
If HIV case counts had been incorporated along with AIDS case counts in
allocating fiscal year 2004 CARE Act and HOPWA grants, funding would
have shifted among jurisdictions. Grantees in the South and the Midwest
generally would have received more funding, although there would have
been grantees that would have received increased funding and grantees
that would have received decreased funding in every region of the
country. Although CARE Act and HOPWA grantees have established HIV case
reporting systems, differences between these systems”in their maturity
and reporting methods, for instance”would impact the appropriateness of
using HIV case counts in distributing CARE Act and HOPWA funding. GAO
found that CARE Act and HOPWA fiscal year 2004 funding would have
shifted to jurisdictions with more mature HIV reporting systems.
What GAO Recommends:
If Congress wishes CARE Act and HOPWA funding to more closely reflect
the distribution of persons living with AIDS, it should consider taking
actions that lead to more comparable funding per case by revising the
funding formulas. HHS and HUD generally agreed with GAO‘s
identification of issues in the funding formulas.
www.gao.gov/cgi-bin/getrpt?GAO-06-332.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Marcia Crosse at (202)
512-7119 or crossem@gao.gov.
[End of section]
Contents:
Letter:
Background:
Results in Brief:
CARE Act and HOPWA Funds Allocated for Health Care, Housing Assistance,
and a Variety of Other Services:
Multiple Provisions Contribute to Disproportionate Distribution of CARE
Act and HOPWA Formula Funding:
Funding Effect of Using HIV Case Counts Would Depend on Multiple
Factors:
Conclusions:
Matters for Congressional Consideration:
Agency Comments and Our Evaluation:
Appendix I: Objectives, Scope, and Methodology:
Objectives:
Scope and Methodology:
Appendix II: CARE Act Title I Awards, Fiscal Year 2004:
Appendix III: CARE Act Title II Awards, Fiscal Year 2004:
Appendix IV: HOPWA Formula Grantees and Award Amounts, Fiscal Year
2004:
Appendix V: HOPWA Base Funding Allocations Using Cumulative and Living
AIDS Cases, Fiscal Year 2004:
Appendix VI: Total CARE Act Title I and Title II Funding by State and
Territory, Fiscal Year 2004:
Appendix VII: HRSA's Title I EMAs, GAO-Identified Set of Comparable
2004 OMB-Defined Metropolitan Areas, and Changes:
Appendix VIII: Estimated CARE Act Title I Funding Changes from Use of
HIV Case Counts and ELCs with Hold-harmless:
Appendix IX: Estimated CARE Act Title II Base Funding Changes from Use
of HIV Case Counts and ELCs with Hold-harmless:
Appendix X: Estimated CARE Act ADAP Base Funding Changes from Use of
HIV Case Counts and ELCs with Hold-harmless:
Appendix XI: Estimated CARE Act Title I Base Funding Changes from Use
of HIV Case Counts and ELCs without Hold-harmless:
Appendix XII: Estimated CARE Act Title II Base Funding Changes from Use
of HIV Case Counts and ELCs without Hold-harmless:
Appendix XIII: Estimated CARE Act ADAP Base Funding Changes from Use of
HIV Case Counts and ELCs without Hold-harmless:
Appendix XIV: Estimated HOPWA Base Funding Changes from Use of HIV and
Living AIDS Case Counts, Fiscal Year 2004:
Appendix XV: Comments from the Department of Health and Human Services:
Appendix XVI: Comments from the Department of Housing and Urban
Development:
Appendix XVII: GAO Contact and Staff Acknowledgments:
Related GAO Products:
Tables:
Table 1: CARE Act Programs, 2004:
Table 2: Description of CARE Act Title I and Title II Formula Grants:
Table 3: Relationship between ELCs in EMAs and Total CARE Act Title I
and II Funding per ELC, Fiscal Year 2004:
Table 4: Title II Emerging Communities in Fiscal Year 2004:
Table 5: Title I Hold-harmless Funding, Fiscal Year 2004:
Table 6: Grandfathered EMAs, Fiscal Year 2004:
Table 7: States That Received Title II Hold-harmless Funding from
Severe Need Set-aside, Fiscal Year 2004:
Table 8: Fiscal Year 2004 HOPWA Formula Funding:
Table 9: CDC Acceptance of HIV Case Counts and Year of Establishment of
HIV-reporting Systems, December 2005:
Table 10: Reported HIV Cases and ELCs as of June 2003:
Table 11: U.S. Census Bureau Regions:
Table 12: EMAs with Service Area Changes:
Table 13: EMAs with No Service Area Changes:
Figures:
Figure 1: Federal HIV/AIDS Funding by Category, Fiscal Year 2004:
Figure 2: Allocation of CARE Act Title I Funds, Fiscal Year 2003:
Figure 3: Allocation of CARE Act Title II Funds, Fiscal Year 2003:
Figure 4: Allocation of CARE Act Title III Funds, Fiscal Year 2002:
Figure 5: Allocation of HOPWA Funds, Fiscal Year 2003:
Abbreviations:
ADAP: AIDS Drug Assistance Program:
AIDS: acquired immunodeficiency syndrome:
CARE Act: Ryan White Comprehensive AIDS Resources Emergency Act:
CDC: Centers for Disease Control and Prevention:
ELC: estimated living AIDS case:
EMA: eligible metropolitan area:
EMSA: eligible metropolitan statistical area:
HHS: Department of Health and Human Services:
HIV: human immunodeficiency virus:
HOPWA: Housing Opportunities for Persons with AIDS program:
HRSA: Health Resources and Services Administration:
HUD: Department of Housing and Urban Development:
IOM: Institute of Medicine:
MSA: metropolitan statistical area:
OMB: Office of Management and Budget:
United States Government Accountability Office:
Washington, DC 20548:
February 28, 2006:
The Honorable Michael B. Enzi:
Chairman:
Committee on Health, Education, Labor, and Pensions:
United States Senate:
The Honorable Mark E. Souder:
Chairman:
Subcommittee on Criminal Justice, Drug Policy and Human Resources:
Committee on Government Reform:
House of Representatives:
The Honorable Tom A. Coburn:
United States Senate:
The Honorable Judd Gregg:
United States Senate:
It has been nearly 25 years since the first cases of acquired
immunodeficiency syndrome (AIDS) in the United States were identified.
Treatment advances in combination antiretroviral therapy during the
1990s have significantly reduced AIDS mortality and slowed the
progression from a positive human immunodeficiency virus (HIV)
diagnosis to AIDS.[Footnote 1] Yet the number of new HIV infections,
which is estimated at 40,000 annually, has not decreased. The Centers
for Disease Control and Prevention (CDC) estimate that between
1,039,000 and 1,185,000 people in the United States were living with
HIV/AIDS at the end of 2003. The number of people infected with
HIV/AIDS is likely to have risen since then, and CDC estimates that, as
of December 2004, it included 415,193 individuals with AIDS.
Among the federal government's efforts to address the HIV/AIDS epidemic
are the Ryan White Comprehensive AIDS Resources Emergency Act of 1990
(CARE Act)[Footnote 2] and the Housing Opportunities for Persons with
AIDS program (HOPWA). The CARE Act, which is administered by the
Department of Health and Human Services's (HHS) Health Resources and
Services Administration (HRSA), established a number of grant programs
through which funds are made available to states--including the
District of Columbia--territories,[Footnote 3] and metropolitan areas
to provide health care, medications, and support services to
individuals and families affected by HIV/AIDS. The AIDS Housing
Opportunity Act, which was enacted in 1990 and is administered by the
Department of Housing and Urban Development (HUD), established
HOPWA.[Footnote 4] HOPWA provides housing assistance for low-income
persons with HIV/AIDS and their families. In fiscal year 2004, over $2
billion was distributed through the CARE Act and $295 million was
distributed through HOPWA.
Under the CARE Act and HOPWA, funding is distributed through a
combination of competitive grants and, in accordance with CDC data on
the number of individuals diagnosed with AIDS, formula grants.
Approximately 68 percent of CARE Act funding and 90 percent of HOPWA
funding were distributed through formula grants in fiscal year 2004.
The use of AIDS cases in the distribution of formula grants was
prescribed because most jurisdictions tracked and reported AIDS cases
instead of HIV cases when the grant programs were established. Because
of concerns that a jurisdiction's disease burden is not adequately
reflected by only counting cases that have progressed to AIDS, the Ryan
White CARE Act Amendments of 2000 required the use of HIV/AIDS case
counts in the distribution of formula grants not later than fiscal year
2007.[Footnote 5] We have reported that because CARE Act grants serve
persons who have been diagnosed with HIV that has not progressed to
AIDS as well as those for whom it has, it would be reasonable to
distribute funds on the basis of the total number of persons living
with HIV/AIDS.[Footnote 6] Incorporating HIV data along with AIDS data
would result in targeting funds more accurately according to need.
However, because there is a lack of HIV data that are sufficiently
adequate and reliable to serve as a basis for CARE Act formula grant
allocations, as of December 2005, HIV cases have not been used in the
distribution of formula grants under the CARE Act.
Various provisions governing CARE Act and HOPWA grants affect the
distribution of funds. As Congress prepares to reauthorize CARE Act
programs, you asked us to examine how funds are distributed under the
CARE Act and HOPWA. We are reporting on (1) how CARE Act and HOPWA
funds are allocated by grantees among the types of services each
program supports; (2) the extent of funding differences among CARE Act
and HOPWA grantees, and how specific CARE Act and HOPWA funding-formula
provisions contribute to these differences; and (3) what distribution
differences could result from using HIV cases in CARE Act and HOPWA
funding formulas.
To report on these issues, we reviewed the CARE Act of 1990, as well as
the 1996 and 2000 CARE Act amendments, the AIDS Housing Opportunity Act
of 1990, HRSA and HUD documents on CARE Act and HOPWA funding, HUD
memoranda, Institute of Medicine (IOM) reports on the CARE Act, and
other related reports. We analyzed data, spanning from 2002 through
2004, obtained from HRSA, HUD, and CDC.[Footnote 7] We also collected
data on HIV case counts from state and local HIV/AIDS officials. We
interviewed CDC, HRSA, HUD, and state officials, as well as officials
from the National Alliance of State and Territorial AIDS Directors.
To determine how grantees allocate CARE Act and HOPWA funds by type of
service, we obtained information from HRSA and HUD on grantees' use of
funds. We analyzed these data and, where available, calculated the
percentage of total spending represented by each category of service.
To assess the reliability of HRSA and HUD data on allocations of CARE
Act and HOPWA grant funds, we interviewed agency officials about the
data and reviewed relevant documentation. We determined that the data
were sufficiently reliable for the purposes of our report.
In order to examine the effect of specific funding-formula provisions
on the distribution of fiscal year 2004 funds by HRSA and HUD under the
CARE Act and HOPWA to grantees, we first assessed the use of 2-and 5-
year cumulative AIDS case counts[Footnote 8] and the use of estimated
living AIDS cases (ELC) in CARE Act programs by comparing these
measures with living AIDS case counts received from CDC. HRSA
calculates a jurisdiction's ELCs by using data from CDC on the reported
AIDS case counts for the last 10 years and weighting those numbers to
account for the likelihood of deaths. We then examined the effect of
the following CARE Act formula provisions: the counting of ELCs in
eligible metropolitan areas (EMA) for both Title I and Title II
funding,[Footnote 9] the dividing of Emerging Communities into two
tiers for determining funding, the Title I hold-harmless provision, the
Title I grandfather clause, and the Title II hold-harmless provision
that is funded from amounts that would otherwise be available for
states with severe need in their drug programs. To examine the effect
of each provision on the distribution of CARE Act and HOPWA funds, we
measured differences either on a per case basis, by the amount of
funding received, or both. To determine the effects of adopting the
Office of Management and Budget's (OMB) 2004 definitions of
metropolitan statistical areas (MSA) on EMAs, we compared the
boundaries of existing EMAs with those that would be created, and we
determined the change in the number of ELCs that would be counted under
Title I. In addition, we examined the effect of using living AIDS cases
instead of cumulative AIDS cases[Footnote 10] in making HOPWA base
grant distributions by comparing the actual funding distributions with
simulated distributions using living AIDS cases.[Footnote 11] We also
assessed the effect of HOPWA bonus grants on funding for eligible
metropolitan statistical areas (EMSA) by examining the size of these
grants and which EMSAs received them.[Footnote 12]
In our analyses we used funding per AIDS case to illustrate the effect
of certain funding-formula provisions on the distribution of CARE Act
and HOPWA funds. There are other considerations that could be included
in funding formulas that could justify deviations from equal funding
per case. For example, differing health care and housing costs across
regions and differences in grantees' capacities to fund services from
local resources could be used as bases for distributing program funds
and could justify such deviations.[Footnote 13] Currently, these
considerations are not taken into account when distributing formula
grants under either the CARE Act or HOPWA, and are not considered here.
To assess the reliability of the HRSA and HUD data on the distribution
of funds under the CARE Act and HOPWA, we asked agency officials about
how the data were developed and reported. We also reviewed relevant
documentation. We determined the data were sufficiently reliable for
the purposes of our report.
To show how CARE Act and HOPWA funding could be affected by including
HIV cases in funding formulas, we examined how CARE Act and HOPWA
fiscal year 2004 formula grants would have been affected by using HIV
cases in addition to living AIDS cases to determine formula
funding.[Footnote 14] We undertook our analyses in light of the
statutory requirement that HIV cases be used in CARE Act funding
formulas not later than fiscal year 2007. Our analyses, however, rely
on data whose reliability has been questioned. The Secretary of Health
and Human Services has determined that because of the problems
associated with these data, they should not currently be used in
determining CARE Act funding. We used these data in our analyses to
give a general indication of the effect of using HIV cases in future
formula allocations as required by the CARE Act. The extent to which
the use of HIV cases could affect formula allocations cannot be
determined by these analyses because jurisdictions use different
methods to identify HIV cases, and it is unclear to what degree the
resulting case counts are comparable. However, we think our approaches
in these analyses are informative given the required incorporation of
HIV cases into CARE Act funding formulas. To assess the reliability of
the case-count data, we asked HRSA, HUD, CDC, state, and local
officials a series of questions about how the data were collected and
the methods used to ensure their accuracy. On the basis of the
information provided regarding the verification of these data, we
determined these data to be sufficiently reliable for the purposes of
our analyses. Appendix I provides a more detailed explanation of the
scope and methodology for this report. We performed our work from July
2004 through February 2006, in accordance with generally accepted
government auditing standards.
Background:
In 1990, Congress passed the CARE Act and HOPWA legislation to address
the needs of jurisdictions, health care providers, and people with
HIV/AIDS and their family members. Within the CARE Act and HOPWA
legislation, there are provisions for determining the distribution of
program funding. Furthermore, amendments in 1996 and 2000 changed some
CARE Act provisions, and public debate continues on how best to measure
the effect of HIV/AIDS within the United States, and how to distribute
funding accordingly.
HIV/AIDS in the United States:
Over the course of the last quarter century, the HIV/AIDS epidemic has
spread to every region of the country. CDC has estimated that in the 50
states approximately 40,000 persons become infected with HIV annually.
While AIDS cases remained concentrated in metropolitan areas through
2004, AIDS prevalence rates in nonmetropolitan areas rose.[Footnote 15]
The United States population living with HIV/AIDS is diverse. Racial
and ethnic minorities have been disproportionately affected by HIV/AIDS
since the beginning of the epidemic, but in 2004 African Americans
accounted for more new AIDS cases, more of those estimated to be living
with AIDS, and more of those who died with AIDS than any other racial
or ethnic group. Latinos also account for a greater proportion of AIDS
cases and deaths than their representation in the overall population.
Despite the number of deaths from AIDS and the steady increase of AIDS
prevalence, there have been successes in the fight against HIV/AIDS.
Developments in treatment have enhanced care options and can extend the
lives of those living with HIV/AIDS. The introduction of highly active
antiretroviral therapy in 1996 was followed by a decline in the number
of deaths and new AIDS cases in the United States for the first time
since the beginning of the epidemic.
The federal government's efforts to address the domestic HIV/AIDS
epidemic include providing federal funding for the following categories
of activities--treatment and income support for individuals with
HIV/AIDS, prevention efforts, and research. In fiscal year 2004,
federal funding for domestic HIV/AIDS programs was nearly $16.3
billion. Of this total, about $2.1 billion was distributed through CARE
Act programs, and $295 million was distributed through the HOPWA
program. Medicaid was the largest source of federal assistance for
HIV/AIDS health care, with $5.4 billion in federal funding. Other large
sources of federal funding for HIV/AIDS are Medicare--$2.6 billion--and
the National Institutes of Health--about $2.5 billion. Funding from
other federal sources ranged from $1 million from the Department of
Labor to more than $1 billion from the Social Security Disability
Insurance Program. Figure 1 provides a breakdown of federal HIV/AIDS
funding by category.
Figure 1: Federal HIV/AIDS Funding by Category, Fiscal Year 2004:
[See PDF for image]
[End of figure]
The CARE Act:
The majority of CARE Act funds are distributed through four different
programs, each contained in a separate title, to the states, EMAs, and
other entities. Titles I and II of the act provide for formula grants
(base grants) to EMAs and states according to each jurisdiction's
number of ELCs relative to all EMAs and states. These titles also
provide for other grants to subsets of eligible jurisdictions either by
formula or by a competitive process. For example, in addition to AIDS
Drug Assistance Program (ADAP) base grants, Title II also authorizes
grants for states and certain territories with demonstrated need for
additional funding to support their ADAPs.[Footnote 16] These grants,
known as Severe Need Grants, are funded through a set-aside of funds
otherwise available for ADAP grants. Title II also authorizes funding
for "Emerging Communities," which are communities affected by AIDS that
have not had a sufficient number of AIDS cases reported in the last 5
calendar years to be eligible for Title I grants as EMAs. In order to
address the effect of the disease on racial and ethnic minorities, HRSA
has used funds otherwise available under Title I and Title II for
Minority AIDS Initiative grants to EMAs, states, and territories. EMAs
may also receive Title I supplemental grants, which are awarded using a
competitive application process based on the demonstration of severe
need and other criteria.[Footnote 17] Table 1 describes the purposes
and the grantees of each title.
Table 1: CARE Act Programs, 2004:
CARE Act program: Title I. Grants to Eligible Metropolitan Areas
(EMAs);
Grantees: 51 EMAs[A];
Purpose: Support primary health care, medications, and a range of
services, such as case management, substance abuse treatment, housing,
mental health treatment, and nutritional counseling.
CARE Act program: Title II. Grants to States and Territories;
Grantees: States and territories;
Purpose: Support primary and home-based health care, insurance
coverage, medications, support services, and early intervention
services, such as HIV counseling, testing, and referral. Funding for
AIDS Drug Assistance Programs provides medications, treatment adherence
and support, and health insurance with prescription drug benefits.
CARE Act program: Title III. Early Intervention Services, Capacity
Development, and Planning Grants;
Grantees: Primary care providers, including health centers, city and
county health departments, and outpatient medical centers;
Purpose: Support comprehensive services including HIV counseling,
testing, outpatient medical care, and case management; funds also go
toward developing HIV service delivery systems and building capacity to
provide services.
CARE Act program: Title IV. Services for Women, Infants, Children,
Youth, and Their Affected Family Members;
Grantees: Health care facilities, public health agencies, and community-
based organizations that serve Title IV target populations;
Purpose: Support family- centered and coordinated health care and
support services that benefit children, youth, and women living with
HIV, and their families. Also support initiatives to help identify HIV-
positive pregnant women and ensure access to prenatal care that could
prevent perinatal transmission.
CARE Act program: Special Projects of National Significance;
Grantees: University and community clinics, evaluation centers,[B]
local and state health departments, community-based organizations, and
nonprofit agencies;
Purpose: Support the development of innovative models of HIV/AIDS care
that can be replicated, such as interventions for HIV- positive
substance abusers.
CARE Act program: AIDS Education and Training Center Program;
Grantees: 4 national centers and 11 regional centers with 130
associated sites;
Purpose: Conduct education and training programs for health care
providers treating people with HIV/AIDS.
CARE Act program: Dental Programs;
Grantees: Dental education institutions, hospitals, and other
institutions with dental education programs;
Purpose: Improve access to oral health care and enhance dental training
on caring for people with HIV/AIDS through the Dental Reimbursement
Program and Community-Based Dental Partnership grants.
Source: HRSA.
[A] Under Title I, a metropolitan area with a population of at least
500,000 and more than 2,000 reported AIDS cases in the last 5 calendar
years is eligible to receive a formula base grant. As a result of the
CARE Act Amendments of 1996, EMAs that were eligible for Title I grants
in that year are grandfathered: they will be eligible for grants under
Title I even if their number of AIDS cases drops below the threshold
for eligibility. App. II contains a list of the EMAs.
[B] Evaluation centers support Special Projects grantees and coordinate
the evaluation of initiatives under the Special Projects of National
Significance program.
[End of table]
CARE Act Amendments:
The Ryan White CARE Act Amendments of 1996[Footnote 18] and the Ryan
White CARE Act Amendments of 2000[Footnote 19] modified the original
funding formulas. For example, prior to the 1996 amendments, the CARE
Act required that for purposes of determining grant amounts a
metropolitan area's caseload be measured by a cumulative count of AIDS
cases recorded in the jurisdiction since reporting began in 1981. The
1996 amendments required the use of ELCs instead of cumulative AIDS
cases.[Footnote 20] Because this switch would have resulted in large
shifts of funding away from jurisdictions with a longer history of the
disease than other jurisdictions, due in part to a higher proportion of
deceased cases, the 1996 CARE Act amendments added a hold-harmless
provision under Title I, as well as under Title II, that limit the
extent a grantee's funding can decline from one year to the next.
Metropolitan areas heavily affected by HIV/AIDS have always been
recognized within the structure of the CARE Act. We previously found
that, with combined funding under Title I and Title II, states with
EMAs receive more funding per AIDS case than states without
EMAs.[Footnote 21] To adjust for this situation, the 1996 amendments
instituted a two-part formula for Title II base grants that takes into
account the number of ELCs that reside within a state but outside of
any EMA. Under this distribution formula, 80 percent of the Title II
base grant is based upon a state's proportion of all ELCs, and 20
percent of the base grant is based on a states' proportion of ELCs
outside of EMAs relative to all such ELCs. A second provision included
in 1996 protected the eligibility of EMAs. The 1996 amendments provided
that a jurisdiction designated as an EMA for that fiscal year would be
"grandfathered" so it would continue to receive Title I funding even if
its reported number of AIDS cases dropped below the threshold for
eligibility. Table 2 describes CARE Act formula grants for Titles I and
II.
Table 2: Description of CARE Act Title I and Title II Formula Grants:
Formula grant: Title I Base Grant;
Eligible grantees: Metropolitan areas with 500,000 or more in
population and with more than 2,000 reported AIDS cases in the most
recent 5 calendar years[B];
Distribution: Distributed among EMAs according to each EMA's proportion
of ELCs relative to all EMAs;
Minimum grant: No;
Hold-harmless provision[A]: Grant annually declines to 98%, 95%, 92%,
and 89% of the base year grant, respectively.[C] In the fifth and all
subsequent years, EMA receives 85% of base year grant. The funds
necessary to meet the hold-harmless requirement are deducted from funds
available for supplemental grants under Title I[D].
Formula grant: Title II Base Grant;
Eligible grantees: States and territories[E];
Distribution: Eighty percent of base grant funding divided among
states/territories according to each grantee's proportion of all ELCs.
Twenty percent of base grant funding divided among states/territories
according to each grantee's ELCs located outside the EMAs within the
state's/territory's borders relative to such ELCs in all
states/territories;
Minimum grant: For states with fewer than 90 ELCs, $200,000; states
with 90 or more ELCs, $500,000; for territories, $50,000;
Hold-harmless provision[A]: Grant declines by 1% per year from the
fiscal year 2000 grant. In fifth year, grant is 95% of 2000 grant.
Formula grant: Title II ADAP Base Grant;
Eligible grantees: States and certain territories[F];
Distribution: Distributed according to each grantee's proportion of all
ELCs;
Minimum grant: No;
Hold-harmless provision[A]: Grant declines by 1% per year from the
fiscal year 2000 grant. In fifth year grant is 95% of 2000 grant.
Formula grant: Title II ADAP Severe Need Grant[G];
Eligible grantees: States and certain territories[F] with a severe need
for a grant to increase access to medications;
Distribution: Distributed according to each grantee's proportion of all
ELCs: grantees must agree to match 25 percent of their severe need
grant and not to impose eligibility requirements stricter than those in
place on January 1, 2000;
Minimum grant: No;
Hold-harmless provision[A]: No.
Formula grant: Title II Emerging Communities Grant;
Eligible grantees: States and territories with metropolitan areas that
are not eligible for Title I, and that have 500-1,999 reported AIDS
cases in the most recent 5 calendar years;
Distribution: Funds are divided into two tiers: 50% distributed among
communities with 1,000-1,999 AIDS cases, and 50% distributed among
communities with 500-999 AIDS cases. Funding is distributed according
to each community's proportion of AIDS cases (reported in the most
recent 5 calendar years) in Emerging Communities within the tier;
Minimum grant: Minimum of $5 million for each tier;
Hold-harmless provision[A]: No.
Source: HRSA.
Notes: HRSA has also awarded Minority AIDS Initiative grants to EMAs,
states, and territories. HRSA characterizes Minority AIDS Initiative
grants to EMAs as Title I grants and Minority AIDS Initiative grants to
states and territories as Title II grants. These funds are allocated by
formula. Title I funds have been used for grants to EMAs with greater
than zero reported nonwhite AIDS cases in the most recent 2 calendar
years. The funds are distributed among all EMAs according to each EMA's
proportion of nonwhite AIDS cases reported over the most recent 2
calendar years. Title II funds have been used for grants to states and
territories with greater than zero reported nonwhite AIDS cases in the
most recent 2 calendar years. The funds are distributed among all
grantees according to each grantee's proportion of nonwhite AIDS cases
reported over the most recent 2 calendar years. There are no minimum-
grant or hold-harmless provisions for these grants.
[A] If the distribution formula would otherwise result in a funding
decrease from a prior year, a hold-harmless provision may be triggered
to mitigate the decrease in funding.
[B] A grandfather clause added in 1996 provides that areas eligible at
that time continue to be eligible even if they no longer meet the
eligibility criteria.
[C] The base year is the fiscal year prior to that in which the EMA
first becomes eligible for hold-harmless funding.
[D] Title I also includes supplemental grants, which are awarded to
EMAs using a competitive application process based on the demonstration
of severe need and other criteria.
[E] In addition to the 50 states, Title II base grants are authorized
for the District of Columbia, the Commonwealth of Puerto Rico, Guam,
the Virgin Islands, American Samoa, the Commonwealth of the Northern
Mariana Islands, the Federated States of Micronesia, the Republic of
Palau, and the Republic of the Marshall Islands.
[F] In addition to the 50 states, these grants are authorized for the
District of Columbia, the Commonwealth of Puerto Rico, Guam, and the
Virgin Islands.
[G] Funding for Severe Need grants may be reduced to maintain funding
for some states under a Title II hold-harmless provision. Severe Need
grants are funded by setting aside 3 percent of the funds earmarked
specifically for ADAPs.
[End of table]
Metropolitan Statistical Areas:
In determining a metropolitan area's eligibility for Title I funding
and for purposes of defining areas served under Title I, the CARE Act
uses the OMB 1993 definitions of MSAs. OMB's 1993 definitions were
based on applying OMB's 1990 standards for defining an MSA to data from
the 1990 census. OMB's standards create a metropolitan classification
scheme that includes rules for determining which counties (the basic
building block of MSAs) would be designated as the central counties of
metropolitan areas and which outlying counties would be associated with
particular central counties. The 1996 CARE Act amendments froze the
metropolitan areas to those specified in the 1993 OMB definitions.
[Footnote 22]
HIV Case Counts:
The 2000 amendments provided for HIV case counts to be incorporated in
the Title I and Title II funding formulas as early as fiscal year 2005
if such data were available and deemed "sufficiently accurate and
reliable" by the Secretary of Health and Human Services.[Footnote 23]
They also required that HIV data be used no later than the beginning of
fiscal year 2007. In June 2004 the Secretary of Health and Human
Services determined that HIV data were not yet ready to be used for the
purposes of distributing formula funding under Title I and Title II of
the CARE Act. The Secretary cited a 2004 IOM report, which identified
several limitations in the ability of states to provide adequate and
reliable HIV case counts for use in distributing CARE Act
grants.[Footnote 24]
HOPWA:
HOPWA is the only federal program dedicated to providing housing
assistance to persons living with HIV/AIDS and their families. Funding
under HOPWA supports a variety of services, including rental assistance
and the acquisition, rehabilitation, and construction of housing units.
HOPWA funds also provide for supportive services, such as health care,
substance abuse treatment, and case management. In fiscal year 2004,
$295 million was distributed through HOPWA.
Ninety percent of HOPWA funds are distributed through formula grants to
states, Puerto Rico, and metropolitan areas. The remaining 10 percent
of HOPWA funds are provided through competitive grants to states,
Puerto Rico, local governments, and nonprofit organizations. Formula
grants under HOPWA incorporate cumulative AIDS case counts, rather than
an estimate of persons living with AIDS, such as ELCs as used in the
CARE Act. Seventy-five percent of HOPWA formula funding is awarded
through base grants to EMSAs, which are jurisdictions with more than
500,000 people and more than 1,500 cumulative AIDS cases, and to states
and Puerto Rico that have more than 1,500 cumulative AIDS cases outside
EMSAs. The remaining 25 percent of HOPWA formula funding is awarded
through bonus grants for EMSAs that meet the eligibility threshold but
also demonstrate a higher-than-average per capita incidence of AIDS.
These grants are based on the number of cases in excess of the average
AIDS incidence rates of EMSAs. HUD first used OMB's new MSA definitions
in determining EMSAs for fiscal year 2004 funding.
Results in Brief:
CARE Act and HOPWA grants are used for health care, housing assistance,
and a variety of services for people with HIV/AIDS. In fiscal year
2003, more than half of the approximately $600 million in Title I CARE
Act funds were allocated by grantees for health care services such as
outpatient care and home health services, and over two-thirds of the
approximately $1 billion in Title II funds were allocated by states and
territories for medications. Over three-quarters of the approximately
$194 million in Title III fiscal year 2002 funds were allocated for
health care services. In fiscal year 2003, about $68 million in Title
IV grants was provided for health care and support services for
children, youth, and women with HIV/AIDS and their families. Also in
fiscal year 2003, about $74 million in funding was provided in total
for dental programs, projects that support innovative models of
HIV/AIDS care, and AIDS Education and Training Centers for health care
providers. HOPWA funds were used for a variety of housing-related
expenses, such as rental assistance, and support services. In fiscal
year 2003, two-thirds of the approximately $249 million in HOPWA funds
were used for direct housing costs, such as rental assistance, for
people with HIV/AIDS and their families.
Multiple provisions in the CARE Act and HOPWA grant funding formulas
result in funding not being distributed according to the current
distribution of the disease. Grantees do not receive the same level of
CARE Act or HOPWA funding per person living with AIDS because various
formula provisions affect the proportional allocation of funding.
* We found that both the CARE Act and HOPWA use measures of AIDS cases
that do not accurately reflect the number of persons living with AIDS.
Some CARE Act grants and HOPWA base grant funding are based on case
counts that could include deceased cases because the eligibility and
allocations are determined using cumulative case counts. In addition,
the CARE Act's use of ELCs, which are determined using the most recent
10 years of reported AIDS cases, to distribute the majority of formula
funding does not take into account that many AIDS patients now live
longer than 10 years after their disease is reported.
* We found that certain CARE Act Title I and II provisions related to
metropolitan areas result in variability in the amounts of funding per
ELC among grantees. For instance, the counting of ELCs within EMAs once
for determining Title I base grants and once again for determining
Title II base grants results in states with a higher proportion of ELCs
in EMAs and Puerto Rico, which has a similar percentage, receiving more
total Title I and Title II funding per ELC than states with no EMA or
with comparatively few ELCs located in EMAs. Also, the division of
Emerging Communities into two tiers based on their numbers of reported
AIDS cases in the past 5 years leads to funding disparities among
grantees. This divergence occurs because funding is divided equally
between the two tiers regardless of the number of communities or the
number of reported AIDS cases in each tier. In fiscal year 2004, the 4
communities in the first tier received $1,052 per reported case while
the 25 communities in the second tier received $313 per reported case.
* We found that because of CARE Act hold-harmless provisions under
Titles I and II and the grandfather clause for EMAs under Title I, the
funding of certain grantees is protected. For example, the CARE Act
Title I hold-harmless provision results in the San Francisco EMA's
funding being based in part on deceased cases in the EMA in 1995. In
addition, a Title II hold-harmless provision, which has had little
effect thus far, has the potential to reduce the amount of funding to
grantees with severe need for drug treatment funds because the hold-
harmless provision is funded from amounts set aside for ADAP Severe
Need grants. The Title I grandfather clause protected the funding of
more than half of EMAs.
The Ryan White CARE Act Amendments of 2000 required the use of HIV/AIDS
case counts in the distribution of formula grants not later than fiscal
year 2007. If case counts from HIV-reporting systems had been used
along with a measure of the number of persons living with AIDS in
distributing fiscal year 2004 CARE Act and HOPWA grants, funding would
have shifted among jurisdictions. Although CARE Act and HOPWA grantees
have established HIV case-reporting systems, differences between these
systems--in their maturity and reporting methods, for instance--would
have affected the distribution of CARE Act and HOPWA funds based on
HIV/AIDS case counts. Recently established HIV-reporting systems might
not have captured an accurate count of a grantee's HIV cases in part
because cases diagnosed prior to the establishment of the reporting
system might not have been reported and entered into the system. Also,
because CDC does not accept case reports that are reported using a code
rather than a person's name to protect their anonymity, those states
with code-based systems would not have had their HIV cases counted when
funding distributions were made. Accordingly, we developed two
approaches to assess the effect of using the HIV case counts, as they
currently exist, on CARE Act and HOPWA formula grants. While the extent
to which funding may have shifted cannot be determined given the
different methods jurisdictions use to identify HIV cases, we think
these approaches are informative given the required corporation of HIV
cases into CARE Act funding formulas. Using these approaches, we found
that up to 13 percent of CARE Act formula funding would have shifted
among grantees if HIV cases were included in the funding formulas and
the hold-harmless provisions analyzed and minimum-grant provision were
maintained. Larger changes for individual grantees would have occurred
with some grantees more than doubling their funding. Grantees in the
South and Midwest would generally have received more funding from using
HIV cases in funding formulas. However, there would have been grantees
that would have received increased funding and grantees that would have
received decreased funding in every region of the country. If, in
addition to using HIV data, the hold-harmless provisions we analyzed
and minimum-grant provisions were eliminated, the redistribution of
program funds would have been more dramatic. Up to 24 percent of
funding would have shifted. HOPWA base funding would also have shifted
if HIV and living AIDS cases were used to distribute funding. In fiscal
year 2004, up to 15 percent of HOPWA base funding would have shifted
among grantees, with six grantees more than doubling their funding.
Differences in HIV case-reporting systems would affect the distribution
of funding, and we found that funding would have tended to shift to
jurisdictions with older HIV-reporting systems. Jurisdictions with
older HIV-reporting systems tend to have more reported HIV cases
compared with their number of AIDS cases than do jurisdictions with
newer reporting systems.
If Congress wishes CARE Act and HOPWA funding to more closely reflect
the distribution of persons living with AIDS, it should take actions
that lead to more-comparable funding per case by revising the funding
formulas. In accordance with achieving more-comparable funding per AIDS
case, we raise a number of matters for consideration when Congress
reviews the CARE Act and HOPWA.
We provided a draft of this report to HHS and HUD. HHS and HUD
generally agreed with our identification of issues in the funding
formulas. While HHS also generally agreed with our matters for
congressional consideration, it expressed concern that our discussion
of the Title I grandfather provision in the CARE Act could be
interpreted as suggesting that the metropolitan areas that continue to
receive grants because of this provision need not be funded. However,
these areas could still receive funding through their respective states
or territories, which receive funds under Title II. HUD concurred with
our matter for congressional consideration that HOPWA formula grant
eligibility and base grant funding be based on a measure of living AIDS
cases.
CARE Act and HOPWA Funds Allocated for Health Care, Housing Assistance,
and a Variety of Other Services:
The CARE Act and HOPWA grants fund a variety of treatment and support
services for people with HIV/AIDS. For fiscal year 2003, Title I
grantees allocated more than half of the approximately $600 million in
Title I grants for health care services such as outpatient care and
home health care, and over 70 percent of the approximately $1 billion
in Title II funds were allocated for medications. Almost 80 percent of
the approximately $194 million in Title III fiscal year 2002 funds were
allocated for health care services such as physician office visits and
HIV counseling and testing.[Footnote 25] In fiscal year 2003, there was
also about $68 million in funding for Title IV grantees and about $74
million for other programs, such as Special Projects of National
Significance. Two-thirds of the approximately $249 million in HOPWA
fiscal year 2003 funds were used to assist with housing costs for
people with HIV/AIDS and their families.
More Than Half of Title I Fiscal Year 2003 Funding Was Allocated for
Health Care Services:
For fiscal year 2003, HRSA provided about $600 million in grants to
EMAs under Title I of the CARE Act to support services for people with
HIV/AIDS. Grantees allocated the largest portion of these funds, about
52 percent, for health care services such as outpatient care, home
health care, rehabilitation care, and medications. About 12 percent of
these Title I health care services funds were allocated for substance
abuse treatment and counseling services. For the same year, Title I
grantees allocated about 36 percent of those funds for case management
and support services. Support services include child care, client
advocacy, and emergency financial assistance, among others. The
remaining 12 percent of Title I funding was allocated for
administration, planning councils, and program support.[Footnote 26]
(See fig. 2.)
Figure 2: Allocation of CARE Act Title I Funds, Fiscal Year 2003:
[See PDF for image]
Note: About $600 million was allocated under Title I.
[End of figure]
Over Two-thirds of Title II Fiscal Year 2003 Funding Was Allocated for
Medications:
HRSA provided approximately $1 billion to states and territories under
Title II in fiscal year 2003. Title II grantees allocated the majority
of these funds, about 71 percent, for medications, which includes ADAP
medications, non-ADAP medications, and pharmacy assistance for CARE Act
clients. Ten percent of Title II funds were allocated for health care
services, similar to those provided under Title I. Grantees allocated
about 3 percent of Title II health care services funds for substance
abuse treatment services. Case management and support services similar
to those provided under Title I accounted for approximately 10 percent
of the Title II funds. The remainder of Title II funds, about 9
percent, was allocated for program administration, planning, and
evaluation.[Footnote 27] (See fig. 3.)
Figure 3: Allocation of CARE Act Title II Funds, Fiscal Year 2003:
[See PDF for image]
Notes: Approximately $1 billion was allocated under Title II.
[A] Medications includes ADAP medications, non-ADAP medications, and
pharmacy assistance.
[End of figure]
Over Three-quarters of Title III Fiscal Year 2002 Funding Was Allocated
for Health Care Services:
Under Title III of the CARE Act, HRSA provided about $194 million in
grants to certain public and nonprofit primary care providers in
support of early intervention services for people with HIV/AIDS for
fiscal year 2002. Title III grantees allocated about 79 percent of
these funds for health care services such as physician office visits,
HIV counseling and testing, and employing primary care personnel.
Health care services also included outpatient mental health care and
substance abuse treatment. Title III grantees allocated another 13
percent for other activities, including case management and HIV patient
education. The remaining 8 percent was allocated for
administration.[Footnote 28] (See fig. 4.)
Figure 4: Allocation of CARE Act Title III Funds, Fiscal Year 2002:
[See PDF for image]
Note: About $194 million was allocated under Title III.
[End of figure]
CARE Act Grants Funded Other Activities in Fiscal Year 2003:
Grants made under Title IV of the CARE Act address the specific needs
of women, infants, children, and youth living with HIV/AIDS. The funds
cover primary and specialty medical care, psychosocial services, case
management, and other activities. For fiscal year 2003, HRSA provided
about $68 million for Title IV programs. Other CARE Act programs
include the Special Projects of National Significance Program, funded
at about $25 million for fiscal year 2003; the AIDS Education and
Training Centers Program, funded at about $36 million for fiscal year
2003; and the HIV/AIDS Dental Reimbursement Program and Community-Based
Dental Partnership program funded at nearly $10 million and $3 million
respectively for fiscal year 2003.
Two-thirds of HOPWA Fiscal Year 2003 Funds Were Spent on Housing Costs:
For fiscal year 2003, HOPWA grantees spent about $249 million to
support housing services for people with HIV/AIDS. The largest portion
of these funds, about 66 percent, was spent on direct housing costs,
such as rental assistance, and housing facility operating costs.
Support services accounted for 25 percent of the funds. HOPWA-funded
support services include case management, health care, alcohol and drug
abuse treatment, and child care, among others. Housing information
services and permanent housing placement costs accounted for 4 percent
of HOPWA funds, while grant administration was 5 percent of the total.
(See fig. 5.)
Figure 5: Allocation of HOPWA Funds, Fiscal Year 2003:
[See PDF for image]
Notes: About $249 million was spent under HOPWA.
[End of figure]
Multiple Provisions Contribute to Disproportionate Distribution of CARE
Act and HOPWA Formula Funding:
Provisions in the CARE Act and HOPWA funding formulas result in a
distribution of funds among grantees that does not reflect the relative
distribution of AIDS cases in these jurisdictions.[Footnote 29] CARE
Act grantees do not receive the same amount of funding per ELC, and
HOPWA grantees do not receive the same amount of funding per living
AIDS case. We found that provisions affected the proportional
allocation of funding as follows: (1) the AIDS case-count provisions in
the CARE Act and HOPWA each result in a distribution of funding that is
not reflective of the distribution of persons living with AIDS, (2)
CARE Act provisions related to metropolitan areas result in variability
in the amounts of funding per ELC among grantees, (3) the CARE Act hold-
harmless provisions and grandfather clause protect the funding of
certain grantees, and (4) the ineligibility of grantees other than
EMSAs for HOPWA bonus funding restricts the distribution of these funds
and limits HUD's ability to fund areas outside of EMSAs with high rates
of new AIDS cases. We also considered the provision in the 1996 CARE
Act amendments that froze the EMA boundaries to 1993 OMB definitions.
We found that the boundaries for more than half of current EMAs would
change if OMB's 2004 MSA definitions were adopted for purposes of CARE
Act funding.
CARE Act and HOPWA Grants Are Not Distributed Solely in Proportion to
Number of Persons Living with AIDS:
Funds distributed under Title I of the CARE Act are not distributed
proportionally per ELC across EMAs.[Footnote 30] In fiscal year 2004,
the total funding for all Title I grants to EMAs was about $595
million. If this funding had been distributed solely by a grantee's
proportion of ELCs, each EMA would have received $2,443 per ELC.
However, Title I provisions affect the grant awards so that funding is
not distributed strictly on a proportional basis, but instead is
allocated in part according to the number of ELCs and in part on other
bases, such as the amounts awarded in a prior year, as reflected in the
hold-harmless funding. Total funding for EMAs also reflects Minority
AIDS Initiative grants and supplemental grants. In fiscal year 2004,
total Title I funding for the 51 EMAs ranged from $2,130 per ELC case
in Riverside-San Bernardino to $4,137 in San Francisco, with an average
of $2,380. Excluding San Francisco, West Palm Beach had the highest
Title I funding per ELC at $2,515. Appendix II lists the EMAs and
amounts awarded under Title I for fiscal year 2004.
CARE Act Title II funding is also not distributed proportionally per
ELC. In fiscal year 2004, the total funding for all Title II grants was
about $1.051 billion. If this funding had been distributed solely
according to the proportion of ELCs, each grantee would have received
$3,053 per ELC. However, minimum-award requirements and hold-harmless
provisions affect the distribution of Title II funds. In addition,
grants for Emerging Communities as well as the Minority AIDS Initiative
are not determined proportionally by the number of ELCs. Total Title II
funding for fiscal year 2004 ranged from $2,793 for the District of
Columbia to $7,275 for South Dakota, with an average of $3,559.
Appendix III shows the grantees and amounts awarded under Title II for
fiscal year 2004.
HOPWA formula funding is also disproportionate across grantees. In
fiscal year 2004, about $263 million was allocated by formula to 117
grantees. Seventy-five percent of this funding was distributed
according to the number of cumulative AIDS cases[Footnote 31] in a
jurisdiction and 25 percent was distributed based on the rate of new
AIDS cases in EMSAs. If this funding had been distributed
proportionally by the number of cumulative AIDS cases across
jurisdictions each grantee would have received $306 per cumulative
case. However, 26 grantees received bonus grants that are based on the
rate of new AIDS cases in an EMSA, not the number of cumulative AIDS
cases. Therefore, the actual amounts grantees received ranged from $230
per cumulative AIDS case for 91 grantees to $626 per case in Baton
Rouge, with an average of $260. We also determined how much funding
each grantee received per living AIDS case.[Footnote 32] We found that
grantees received an average of $573 per living AIDS case, with funding
ranging from $387 per case in Nashville to $1,290 per case in Baton
Rouge. These funding differences are due to the use of cumulative AIDS
cases to distribute base grant funding and because bonus grants are
distributed according to the rate of new cases in EMSAs.[Footnote 33]
Appendix IV identifies the fiscal year 2004 HOPWA formula grantees and
award amounts.
Provisions in HOPWA and CARE Act Funding Formulas Incorporate Measures
of AIDS Cases That Do Not Reflect an Accurate Count of Persons Living
with AIDS:
HOPWA and the CARE Act both use measurements of AIDS cases that do not
reflect an accurate count of people currently living with AIDS. To
determine eligibility for HOPWA formula grants and to distribute base
funding, allocations are determined using a measure of AIDS cases that
is based on the number of living and deceased AIDS cases reported in
the jurisdiction since the beginning of the AIDS epidemic in 1981.
Also, eligibility and distribution of certain CARE Act grants are based
on the number of reported AIDS cases over either the last 2-or 5-year
period,[Footnote 34] which likely does not reflect all live cases and
could include deceased AIDS cases. In addition, Title I, Title II, and
ADAP base grants are calculated using ELCs, which can underestimate the
number of living cases because many persons with AIDS now live longer
than 10 years after their cases are reported.
HOPWA Grants:
Eligibility for HOPWA formula grants is determined by the number of
cumulative AIDS cases in a metropolitan area, state, and Puerto Rico,
and base funding allocations (which represent 75 percent of total HOPWA
formula funding) to grantees are determined by the grantee's proportion
of the total number of cumulative AIDS cases. As we reported in 1995,
the use of cumulative case counts is an inappropriate caseload measure
because it includes all AIDS cases, living and dead, reported to CDC
for the jurisdiction since the beginning of the epidemic in
1981.[Footnote 35]
Because the HOPWA funding formula includes deceased persons, the
distribution of funds does not reflect the current distribution of
people living with AIDS. Using estimates of living AIDS cases obtained
from CDC, we calculated how base funding for grantees would have
changed in fiscal year 2004 if these estimates had been used instead of
the cumulative case counts. Each of the 117 grantees would have
received approximately $537 per living AIDS case. We found that 25
grantees received more funding in fiscal year 2004 using cumulative
case counts than they would have received if the number of living AIDS
cases had been used. The additional funding received by the grantees
ranged from approximately $2,000 in San Jose to $4,020,000 in New York
City. Conversely, if the number of living cases had been used, 92
grantees would have received increased funding. The funding increases
would have ranged from $1,000 in Springfield, Massachusetts, to
$1,120,000 in the District of Columbia. Areas that receive more funding
from the use of cumulative case counts include jurisdictions in
California, Michigan, New Jersey, and New York. (App. V contains
information on funding using cumulative AIDS counts and living AIDS
cases.)
Use of cumulative case counts rather than living cases can lead to
areas with similar numbers of living AIDS cases receiving markedly
different amounts of funding. For example, as of March 31, 2003,
Oakland and New Orleans both reported 3,374 living AIDS cases.[Footnote
36] However, in fiscal year 2004 Oakland received $221,000 more ($66
more per living AIDS case) in HOPWA base funding than did New Orleans.
Atlanta and Houston also have similar numbers of living AIDS cases
(8,557 and 8,579 respectively). However, in fiscal year 2004 Houston
received $806,000 more ($93 more per case) in HOPWA base funding than
did Atlanta.
CARE Act Grants:
The use of cumulative case counts is not limited to the HOPWA program.
Deceased cases can also be included when determining eligibility for
CARE Act funding. Eligibility for Title I funding and Title II Emerging
Communities grants is based on cumulative totals of AIDS cases reported
in the most recent 5-year period, not on the number of ELCs. Funding
amounts for Emerging Communities grants are also determined using the
most recent 5 years of reported cases. In addition, HRSA determines
eligibility and funding amounts of Minority AIDS Initiative grants
according to the number of reported AIDS cases in the most recent 2-
year period.
The use of the cumulative number of reported cases over a certain
period to determine eligibility and allocate funding results in funding
not being distributed according to the current distribution of the
disease. For example, because Emerging Communities funding is
determined by using 5-year cumulative case counts, allocations could be
based in part on deceased cases, that is, people for whom AIDS was
reported in the past 5 years but who have since died. In addition,
these case counts do not take into account living cases in which AIDS
was diagnosed more than 5 years earlier. Consequently, 5-year
cumulative case counts can substantially misrepresent the number of
AIDS patients in these communities. For example, while the 5-year
cumulative case count in Buffalo for determining fiscal year 2004
Emerging Communities eligibility and funding was 581 cases, the number
of ELCs was 956. Similarly, the 5-year cumulative case count in
Charleston, South Carolina, was 538, but the number of ELCs was 758.
The use of ELCs as provided for in the CARE Act can also lead to
inaccurate estimates of living AIDS cases. Currently, Title I, Title
II, and ADAP base funding, which constitute the majority of formula
funding, are distributed according to ELCs. ELCs are an estimate of
living AIDS cases calculated by applying annual national survival
weights to the most recent 10 years of reported AIDS cases and adding
the totals from each year. This method for estimating cases was first
included in the CARE Act Amendments of 1996. At that time, this
approach captured the vast majority of living AIDS cases. However, some
persons with AIDS now live more than 10 years after their case is first
reported, and they are not accounted for by this formula.[Footnote 37]
Thus, like the 2-and 5-year reported case counts, ELCs can misrepresent
the number of living AIDS cases in an area in part by not taking into
account those persons living with AIDS whose cases were reported more
than 10 years earlier. For example, fiscal year 2004 Title I base
funding for the Atlanta EMA was based on 7,589 ELCs, but CDC estimated
that there were 8,560 reported living AIDS cases in the EMA.[Footnote
38] Similarly, funding for the Seattle EMA was based on 2,468 ELCs
while CDC estimated that there were 3,273 reported living
cases.[Footnote 39]
CARE Act Funding Provisions for Metropolitan Areas Result in
Disproportionate Funding:
The counting of ELCs within EMAs once to determine the amount of the
base grant under Title I and once again to determine the amount of the
Title II base grant results in states with EMAs and Puerto Rico
receiving more total Title I and Title II funding per ELC than states
without EMAs.[Footnote 40] In addition, the formula for awarding Title
II Emerging Communities grants results in different levels of funding
per AIDS case across grantees.
Counting ELCs within EMAs Twice Results in Disproportionate Funding per
ELC across States and Puerto Rico:
When total Title I and Title II funding is considered, states with EMAs
and Puerto Rico receive more funding per ELC than states without EMAs
because cases within EMAs are counted twice, once in connection with
Title I base grants and once for Title II base grants. Eighty percent
of Title II base grants is determined by the total number of ELCs in
the state or territory. The remaining 20 percent is based on the number
of ELCs in each jurisdiction outside of any EMA. This 80/20 split was
established by the 1996 CARE Act amendments to address the concern that
grantees with EMAs received more total Title I and Title II funding per
case than grantees without EMAs. However, even with the 80/20 split,
states with EMAs and Puerto Rico receive more total Title I and Title
II funding per ELC than states without EMAs. States without EMAs
receive no funding under Title I, and thus, when total Title I and
Title II funds are considered, states with EMAs and Puerto Rico receive
more funding per ELC.[Footnote 41] Appendix VI shows the combined Title
I and Title II fiscal year 2004 funding received by each state and
Puerto Rico.
Table 3 illustrates the effect of counting EMA cases twice by comparing
the relationship between the percentage of a state's and Puerto Rico's
ELCs that are within EMAs and the amount of total Title I and Title II
funding they receive per ELC. Table 3 shows that as the percentage of a
state's or Puerto Rico's ELCs within EMAs increases, the total Title I
and II funding per ELC also increases. For example, states with no ELCs
in EMAs received on average $3,592 per ELC. States with 75 percent or
more of their cases in EMAs and Puerto Rico[Footnote 42] received on
average $4,955 per ELC, or 38 percent more funding than states with no
EMA. If the total Title I and Title II funding had been distributed
proportionally per ELC among all states and Puerto Rico, each grantee
would have received $4,782 per ELC.
Table 3: Relationship between ELCs in EMAs and Total CARE Act Title I
and II Funding per ELC, Fiscal Year 2004:
Percentage of states' and Puerto Rico's ELCs in EMAs: None; Average
funding per ELC[A]: $3,592.
Percentage of states' and Puerto Rico's ELCs in EMAs: Less than 50
percent;
Average funding per ELC[A]: $3,954.
Percentage of states' and Puerto Rico's ELCs in EMAs: 50 to 75 percent;
Average funding per ELC[A]: $4,717.
Percentage of states' and Puerto Rico's ELCs in EMAs: More than 75
percent;
Average funding per ELC[A]: $4,955.
Source: GAO analysis of HRSA data.
[A] We excluded from our analyses the nine states that received the
minimum Title II base grant awards. Under Title II, states with fewer
than 90 cases receive no less than $200,000 in Title II base grant and
states with 90 or more cases receive at least $500,000.
[End of table]
The effect of counting EMA cases twice is that grantees with similar
numbers of ELCs can receive different levels of combined Title I and
Title II funding. For example, for fiscal year 2004 funding,
Connecticut had 5,363 ELCs while South Carolina had 5,563 ELCs.
However, Connecticut had two EMAs that accounted for 91.3 percent of
its ELCs while South Carolina had none. Connecticut received
$26,797,308 ($4,997 per ELC) in combined Title I and Title II funding
while South Carolina, with 200 more cases, received $20,705,328 ($3,722
per ELC). Connecticut received 29 percent more funding than South
Carolina, a difference of $6,091,980, or $1,275 per ELC. (See app. VI.)
The Two-tiered Division of Emerging Communities Results in Funding
Disparities Among Metropolitan Areas:
The two-tiered division of Emerging Communities results in disparities
in funding among metropolitan areas. Title II provides for a minimum of
$10 million to states with metropolitan areas that have 500 to 1,999
AIDS cases reported in the last 5 calendar years but do not qualify for
funding under Title I as EMAs.[Footnote 43] The funding is equally
split so that half the funding is divided among the first tier of
communities with 500 to 999 reported cases in the most recent 5
calendar years while the other half is for a second tier of communities
with 1,000 to 1,999 reported cases in that period. The funding is then
allocated within each tier by the proportion of reported cases in the
most recent 5 calendar years in each community. The two tiers and the
50/50 split were meant to ensure that a significant portion of the
Emerging Communities funding was allocated to the communities with the
largest number of new cases.
In fiscal year 2004, the two-tiered structure of Emerging Communities
funding led to large differences in funding per reported AIDS case in
the last 5 calendar years among the Emerging Communities because the
total number of AIDS cases in each tier was not equal. Twenty-nine
communities qualified for Emerging Communities funds in fiscal year
2004. Four of these communities had 1,000 to 1,999 reported AIDS cases
in the last 5 calendar years and 25 communities had 500 to 999 cases.
This distribution meant that the 4 communities with a total of 4,754
reported cases in the last 5 calendar years split $5 million while the
remaining 25 communities with a total of 15,994 reported cases in the
last 5 calendar years also split $5 million. These case counts resulted
in the 4 communities receiving $1,052 per reported case while the other
25 received $313 per reported case. These 4 communities received 236
percent more funding per reported case than the other 25. If the total
$10 million funding for Emerging Communities grants had been
distributed equally per reported case among the communities, each would
have received $482 per reported case. Table 4 lists the 29 Emerging
Communities along with their reported AIDS case counts over the most
recent 5 years and their funding.
Table 4: Title II Emerging Communities in Fiscal Year 2004:
Emerging Community: Memphis, Tenn;
AIDS cases reported in the most recent 5 calendar years: 1,588;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $1,052.
Emerging Community: Nashville, Tenn;
AIDS cases reported in the most recent 5 calendar years: 1,123;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $1,052.
Emerging Community: Baton Rouge, La;
AIDS cases reported in the most recent 5 calendar years: 1,038;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $1,052.
Emerging Community: Indianapolis, Ind;
AIDS cases reported in the most recent 5 calendar years: 1,005;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $1,052.
Emerging Community: Columbia, S.C;
AIDS cases reported in the most recent 5 calendar years: 972;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Charlotte, N.C;
AIDS cases reported in the most recent 5 calendar years: 875;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Wilmington, Del;
AIDS cases reported in the most recent 5 calendar years: 801;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Richmond, Va;
AIDS cases reported in the most recent 5 calendar years: 783;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Raleigh-Durham-Chapel Hill, N.C;
AIDS cases reported in the most recent 5 calendar years: 775;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Jackson, Miss;
AIDS cases reported in the most recent 5 calendar years: 722;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Louisville, Ky;
AIDS cases reported in the most recent 5 calendar years: 705;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Rochester, N.Y;
AIDS cases reported in the most recent 5 calendar years: 681;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Fort Pierce-Port St. Lucie, Fla;
AIDS cases reported in the most recent 5 calendar years: 636;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Greensboro-Winston-Salem, N.C;
AIDS cases reported in the most recent 5 calendar years: 617;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Birmingham, Ala;
AIDS cases reported in the most recent 5 calendar years: 615;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Oklahoma City, Okla;
AIDS cases reported in the most recent 5 calendar years: 608;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Pittsburgh, Pa;
AIDS cases reported in the most recent 5 calendar years: 602;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Springfield, Mass;
AIDS cases reported in the most recent 5 calendar years: 588;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Monmouth-Ocean, N.J;
AIDS cases reported in the most recent 5 calendar years: 582;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Buffalo-Niagara Falls, N.Y;
AIDS cases reported in the most recent 5 calendar years: 581;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Greenville, S.C;
AIDS cases reported in the most recent 5 calendar years: 560;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Columbus, Ohio;
AIDS cases reported in the most recent 5 calendar years: 558;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Milwaukee, Wis;
AIDS cases reported in the most recent 5 calendar years: 558;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Salt Lake City, Utah;
AIDS cases reported in the most recent 5 calendar years: 555;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Sarasota, Fla;
AIDS cases reported in the most recent 5 calendar years: 539;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Charleston, S.C;
AIDS cases reported in the most recent 5 calendar years: 538;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Cincinnati, Ohio;
AIDS cases reported in the most recent 5 calendar years: 517;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Daytona Beach, Fla;
AIDS cases reported in the most recent 5 calendar years: 514;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Providence, R.I;
AIDS cases reported in the most recent 5 calendar years: 512;
Emerging Communities funding per AIDS case reported in the most recent
5 calendar years: $313.
Emerging Community: Total;
AIDS cases reported in the most recent 5 calendar years: 20,748.
Source: GAO analysis of HRSA data.
Note: Emerging Communities are metropolitan areas not eligible for
Title I grants and that have 500-1,999 reported AIDS cases in the most
recent 5 calendar years. The 5 most recent calendar years are 1998-
2002.
[End of table]
Similar to the counting of ELCs in EMAs for both Title I and Title II
base grant funding, AIDS cases reported in the past 5 calendar years in
Emerging Communities are counted more than once for determining Title
II funding. For example, these cases are counted once for determining
Title II base funding and again for Emerging Communities grants. Title
II grantees with Emerging Communities receive an average of $3,443 per
ELC while grantees without an Emerging Community receive about
$3,089.[Footnote 44] The Emerging Communities funding accounted for
about $125 per ELC of this difference. Other Title II funds that are
also not distributed proportionally by the number of ELCs, such as the
Minority AIDS Initiative grants, account for the rest of the
difference.[Footnote 45]
Hold-harmless Provisions and Grandfather Clause Protect Funding of
Certain CARE Act Grantees:
Titles I and II of the CARE Act both contain provisions that protect
certain grantees' funding levels. Title I has a hold-harmless provision
that guarantees that the Title I base grant to an EMA will be at least
as large as a statutorily specified percentage of a previous year's
funding. The Title I hold-harmless provision has primarily protected
the funding of one EMA. Title I also contains a grandfather clause that
has resulted in a large number of EMAs maintaining their eligibility
for grants despite no longer meeting the eligibility criteria. Title II
has a hold-harmless provision that ensures that the total of Title II
and ADAP base grants awarded to a grantee will be at least as large as
the total of these grants a grantee received the previous year. This
provision has the potential of reducing the amount of funding to
grantees that had demonstrated severe need for drug treatment funds
because it is funded out of amounts that would otherwise be used for
that purpose.
One EMA Has Been the Primary Recipient of Title I Hold-harmless
Funding:
The San Francisco EMA has been the primary recipient of Title I hold-
harmless funding. An EMA's base funding is determined according to its
proportion of ELCs. The hold-harmless provision guarantees each EMA a
statutorily specified percentage of the base grant it received in a
previous year regardless of how much its proportion of the number of
ELCs in all EMAs may have decreased in the current year.[Footnote 46]
If an EMA qualifies for hold-harmless funding, that amount is added to
the base funding and distributed together as the base grant. In fiscal
year 2004, the San Francisco EMA received $7,358,239 in hold-harmless
funding, or 91.6 percent of the hold-harmless funding that was
distributed.[Footnote 47] The second largest recipient was Kansas City,
which received $134,485, or 1.7 percent of the hold-harmless funding
under Title I. Table 5 lists the EMAs that received hold-harmless
funding in fiscal year 2004.[Footnote 48]
Table 5: Title I Hold-harmless Funding, Fiscal Year 2004:
EMA: San Francisco, Calif;
Hold-harmless funding: $7,358,239;
Percent of hold-harmless funding: 91.6%;
Hold-harmless funding per ELC: $1,020;
Base grant per ELC[A]: $2,241;
Hold-harmless as a percent of base grant: 45.5%.
EMA: Kansas City, Mo;
Hold-harmless funding: $134,485;
Percent of hold-harmless funding: 1.7%;
Hold-harmless funding per ELC: $104;
Base grant per ELC[A]: $1,325;
Hold-harmless as a percent of base grant: 7.8%.
EMA: Santa Rosa, Calif;
Hold-harmless funding: $22,614;
Percent of hold-harmless funding: 0.3%;
Hold-harmless funding per ELC: $47;
Base grant per ELC[A]: $1,268;
Hold-harmless as a percent of base grant: 3.7%.
EMA: Sacramento, Calif;
Hold-harmless funding: $36,456;
Percent of hold-harmless funding: 0.5%;
Hold-harmless funding per ELC: $29;
Base grant per ELC[A]: $1,251;
Hold-harmless as a percent of base grant: 2.3%.
EMA: Minneapolis-St. Paul, Minn;
Hold-harmless funding: $33,770;
Percent of hold-harmless funding: 0.4%;
Hold-harmless funding per ELC: $27;
Base grant per ELC[A]: $1,248;
Hold-harmless as a percent of base grant: 2.1%.
EMA: Bergen-Passaic, N.J;
Hold-harmless funding: $55,288;
Percent of hold-harmless funding: 0.7%;
Hold-harmless funding per ELC: $26;
Base grant per ELC[A]: $1,248;
Hold-harmless as a percent of base grant: 2.1%.
EMA: Jersey City, N.J;
Hold-harmless funding: $58,310;
Percent of hold-harmless funding: 0.7%;
Hold-harmless funding per ELC: $24;
Base grant per ELC[A]: $1,245;
Hold-harmless as a percent of base grant: 1.9%.
EMA: Oakland, Calif;
Hold-harmless funding: $50,744;
Percent of hold-harmless funding: 0.6%;
Hold-harmless funding per ELC: $18;
Base grant per ELC[A]: $1,239;
Hold-harmless as a percent of base grant: 1.4%.
EMA: New Haven, Conn;
Hold-harmless funding: $42,573;
Percent of hold-harmless funding: 0.5%;
Hold-harmless funding per ELC: $14;
Base grant per ELC[A]: $1,236;
Hold-harmless as a percent of base grant: 1.2%.
EMA: Tampa-St. Petersburg, Fla;
Hold-harmless funding: $44,908;
Percent of hold-harmless funding: 0.6%;
Hold-harmless funding per ELC: $12;
Base grant per ELC[A]: $1,233;
Hold-harmless as a percent of base grant: 0.9%.
EMA: San Jose, Calif;
Hold-harmless funding: $12,097;
Percent of hold-harmless funding: 0.2%;
Hold-harmless funding per ELC: $11;
Base grant per ELC[A]: $1,232;
Hold-harmless as a percent of base grant: 0.9%.
EMA: Boston, Mass;
Hold-harmless funding: $60,284;
Percent of hold-harmless funding: 0.8%;
Hold-harmless funding per ELC: $10;
Base grant per ELC[A]: $1,231;
Hold-harmless as a percent of base grant: 0.8%.
EMA: Nassau-Suffolk, N.Y;
Hold-harmless funding: $21,212;
Percent of hold-harmless funding: 0.3%;
Hold-harmless funding per ELC: $8;
Base grant per ELC[A]: $1,230;
Hold-harmless as a percent of base grant: 0.7%.
EMA: Middlesex-Somerset-Hunterdon, N.J;
Hold-harmless funding: $8,315;
Percent of hold-harmless funding: 0.1%;
Hold-harmless funding per ELC: $7;
Base grant per ELC[A]: $1,228;
Hold-harmless as a percent of base grant: 0.5%.
EMA: Jacksonville, Fla;
Hold-harmless funding: $12,825;
Percent of hold-harmless funding: 0.2%;
Hold-harmless funding per ELC: $6;
Base grant per ELC[A]: $1,228;
Hold-harmless as a percent of base grant: 0.5%.
EMA: San Juan, P.R;
Hold-harmless funding: $41,011;
Percent of hold-harmless funding: 0.5%;
Hold-harmless funding per ELC: $6;
Base grant per ELC[A]: $1,228;
Hold-harmless as a percent of base grant: 0.5%.
EMA: Seattle, Wash;
Hold-harmless funding: $9,844;
Percent of hold-harmless funding: 0.1%;
Hold-harmless funding per ELC: $4;
Base grant per ELC[A]: $1,225;
Hold-harmless as a percent of base grant: 0.3%.
EMA: Denver, Colo;
Hold-harmless funding: $6,745;
Percent of hold-harmless funding: 0.1%;
Hold-harmless funding per ELC: $3;
Base grant per ELC[A]: $1,225;
Hold-harmless as a percent of base grant: 0.3%.
EMA: Cleveland, Ohio;
Hold-harmless funding: $4,616;
Percent of hold-harmless funding: 0.1%;
Hold-harmless funding per ELC: $3;
Base grant per ELC[A]: $1,224;
Hold-harmless as a percent of base grant: 0.2%.
EMA: West Palm Beach, Fla;
Hold-harmless funding: $8,523;
Percent of hold-harmless funding: 0.1%;
Hold-harmless funding per ELC: $2;
Base grant per ELC[A]: $1,224;
Hold-harmless as a percent of base grant: 0.2%.
EMA: Newark, N.J;
Hold-harmless funding: $10,975;
Percent of hold-harmless funding: 0.1%;
Hold-harmless funding per ELC: $2;
Base grant per ELC[A]: $1,223;
Hold-harmless as a percent of base grant: 0.1%.
EMA: All Other EMAs;
Hold-harmless funding: $0;
Percent of hold-harmless funding: 0%;
Hold-harmless funding per ELC: $0;
Base grant per ELC[A]: $1,221;
Hold-harmless as a percent of base grant: 0.0%.
EMA: Total;
Hold-harmless funding: $8,033,563[B];
Percent of hold-harmless funding: 100.0%[B].
Source: GAO analysis of HRSA data.
Notes: An EMA's base funding is determined according to its proportion
of ELCs. If an EMA qualifies for hold-harmless funding, that amount is
added to the base funding and distributed together as the base grant.
[A] This amount was calculated by dividing the base grant, including
any hold-harmless funding, received by each EMA by the number of ELCs
in the EMA.
[B] Individual entries do not sum to total because of rounding.
[End of table]
The effect of the hold-harmless provision varies among the EMAs that
receive hold-harmless funding, but it can be substantial. In order to
place hold-harmless funding in perspective, it is helpful to consider
how much of an EMA's Title I base grant was made up of hold-harmless
funding. EMAs that did not receive hold-harmless funding received
approximately $1,221 in base grant funding per ELC in fiscal year 2004.
Fiscal year 2004 base grant funding per ELC in EMAs that received hold-
harmless funding ranged from $1,223 (Newark) to $2,241 (San Francisco).
Thus, the San Francisco EMA received $1,020 more in base grant funding
per ELC than did EMAs that did not receive hold-harmless funding. This
hold-harmless funding represents approximately 46 percent of San
Francisco's base grant. Because of its hold-harmless funding, San
Francisco, which had 7,216 ELCs in fiscal year 2004, received a base
grant equivalent to what an EMA with approximately 13,245 ELCs (84
percent more) would have received. Kansas City, the second largest hold-
harmless grantee, received about what an EMA with 9 percent more ELCs
would have received.
Forty-eight of the 51 EMAs would have received more funding if there
had been no hold-harmless provision and if the $8 million that was
actually used for hold-harmless funding had been distributed in the
same proportions as the supplemental grants.[Footnote 49] Although 21
EMAs received hold-harmless funding in fiscal year 2004, only 3 (San
Francisco, Kansas City, and Santa Rosa) received more funding because
of the hold-harmless provision than they would have received through
supplemental grants in the absence of the hold-harmless provision.
Without the hold-harmless funding, San Francisco would have received
$960 less per ELC, Kansas City $70 less, and Santa Rosa $15 less.
In fiscal year 2004 the San Francisco EMA was guaranteed to receive 89
percent of its fiscal year 2000 Title I base grant under the hold-
harmless provision. However, the amount of San Francisco's 2000 Title I
base grant had been determined by formulas specified in the CARE Act
Amendments of 1996, which guaranteed EMAs 95 percent of their 1995 base
grant in fiscal year 2000.[Footnote 50] San Francisco was the only EMA
to qualify for hold-harmless funding in 2000 because it was the only
EMA that would have received less than 95 percent of its fiscal year
1995 base grant. Taken together, the hold-harmless provisions mean that
in fiscal year 2004 San Francisco was guaranteed approximately 85
percent of its fiscal year 1995 base grant of $19,126,679.[Footnote 51]
Prior to the CARE Act Amendments of 1996, funding was distributed among
EMAs on the basis of the cumulative count of diagnosed AIDS cases (that
is, all cases reported in an EMA both living and deceased since the
beginning of the epidemic in 1981). Because San Francisco's Title I
funding reflects the application of hold-harmless provisions under the
1996 amendments, as well as under current law, San Francisco's Title I
base grant is determined in part by the number of deceased cases in the
San Francisco EMA as of 1995.
Grandfathering Maintains Eligibility for EMAs That No Longer Meet
Certain Eligibility Criteria:
More than half of the EMAs received Title I funding in fiscal year 2004
even though they were below Title I eligibility thresholds.[Footnote
52] The eligibility of these EMAs was protected based on a CARE Act
grandfather clause. Under a grandfather clause established by the CARE
Act Amendments of 1996, metropolitan areas eligible for funding for
fiscal year 1996 remain eligible for Title I funding even if the number
of reported cases in the most recent 5 calendar years drops below the
statutory threshold. We found that in fiscal year 2004, 29 of the 51
EMAs did not meet the eligibility threshold of more than 2,000 reported
AIDS cases during the most recent 5 calendar years but nonetheless
retained their status as EMAs (see table 6). The number of reported
AIDS cases in the most recent 5 calendar years in the 29 EMAs ranged
from 223 to 1,941. Title I funding awarded to these 29 EMAs was about
$116 million, or approximately 20 percent of the total Title I funding.
Table 6: Grandfathered EMAs, Fiscal Year 2004:
EMA: Riverside-San Bernardino, Calif;
Number of AIDS cases reported in the most recent 5 calendar years:
1,941;
Total Title I funding: $6,823,183.
EMA: New Haven, Conn;
Number of AIDS cases reported in the most recent 5 calendar years:
1,717;
Total Title I funding: $7,069,348.
EMA: Oakland, Calif;
Number of AIDS cases reported in the most recent 5 calendar years:
1,633;
Total Title I funding: $6,611,607.
EMA: Nassau-Suffolk, N.Y;
Number of AIDS cases reported in the most recent 5 calendar years:
1,560;
Total Title I funding: $5,951,789.
EMA: Norfolk, Va;
Number of AIDS cases reported in the most recent 5 calendar years:
1,502;
Total Title I funding: $4,820,201.
EMA: Seattle, Wash;
Number of AIDS cases reported in the most recent 5 calendar years:
1,459;
Total Title I funding: $5,842,615.
EMA: Jacksonville, Fla;
Number of AIDS cases reported in the most recent 5 calendar years:
1,423;
Total Title I funding: $4,863,093.
EMA: Orange County, Calif;
Number of AIDS cases reported in the most recent 5 calendar years:
1,422;
Total Title I funding: $5,233,329.
EMA: St. Louis, Mo;
Number of AIDS cases reported in the most recent 5 calendar years:
1,247;
Total Title I funding: $4,371,154.
EMA: Jersey City, N.J;
Number of AIDS cases reported in the most recent 5 calendar years:
1,226;
Total Title I funding: $5,884,194.
EMA: Las Vegas, Nev;
Number of AIDS cases reported in the most recent 5 calendar years:
1,182;
Total Title I funding: $4,473,401.
EMA: Denver, Colo;
Number of AIDS cases reported in the most recent 5 calendar years:
1,167;
Total Title I funding: $4,529,097.
EMA: Austin, Tex;
Number of AIDS cases reported in the most recent 5 calendar years:
1,149;
Total Title I funding: $3,800,250.
EMA: Bergen-Passaic, N.J;
Number of AIDS cases reported in the most recent 5 calendar years:
1,067;
Total Title I funding: $4,814,704.
EMA: Hartford, Conn;
Number of AIDS cases reported in the most recent 5 calendar years:
1,059;
Total Title I funding: $4,552,237.
EMA: San Antonio, Tex;
Number of AIDS cases reported in the most recent 5 calendar years:
1,034;
Total Title I funding: $3,833,443.
EMA: Cleveland, Ohio;
Number of AIDS cases reported in the most recent 5 calendar years: 970;
Total Title I funding: $3,486,936.
EMA: Portland, Oreg;
Number of AIDS cases reported in the most recent 5 calendar years: 937;
Total Title I funding: $3,567,475.
EMA: Fort Worth, Tex;
Number of AIDS cases reported in the most recent 5 calendar years: 854;
Total Title I funding: $3,373,450.
EMA: Kansas City, Mo;
Number of AIDS cases reported in the most recent 5 calendar years: 822;
Total Title I funding: $3,240,813.
EMA: Minneapolis, Minn;
Number of AIDS cases reported in the most recent 5 calendar years: 794;
Total Title I funding: $3,093,915.
EMA: Sacramento, Calif;
Number of AIDS cases reported in the most recent 5 calendar years: 717;
Total Title I funding: $2,968,051.
EMA: Ponce, P.R;
Number of AIDS cases reported in the most recent 5 calendar years: 710;
Total Title I funding: $2,718,331.
EMA: Middlesex-Somerset-Hunterdon, N.J;
Number of AIDS cases reported in the most recent 5 calendar years: 682;
Total Title I funding: $2,723,697.
EMA: San Jose, Calif;
Number of AIDS cases reported in the most recent 5 calendar years: 656;
Total Title I funding: $2,656,550.
EMA: Caguas, P.R;
Number of AIDS cases reported in the most recent 5 calendar years: 411;
Total Title I funding: $1,816,647.
EMA: Dutchess County, N.Y;
Number of AIDS cases reported in the most recent 5 calendar years: 255;
Total Title I funding: $1,231,242.
EMA: Vineland-Millville-Bridgeton, N.J;
Number of AIDS cases reported in the most recent 5 calendar years: 238;
Total Title I funding: $847,898.
EMA: Santa Rosa, Calif;
Number of AIDS cases reported in the most recent 5 calendar years: 223;
Total Title I funding: $1,107,428.
EMA: Total;
Total Title I funding: $116,306,348.
Source: GAO analysis of CDC and HRSA data.
Note: The 5 most recent calendar years are 1998-2002.
[End of table]
The number of EMAs ineligible for Title I funds in the absence of the
grandfather clause reflects the combination of the decline in the
number of new AIDS cases following the advent of more effective
therapies and the more restrictive eligibility standards adopted in the
CARE Act Amendments of 1996.[Footnote 53] No metropolitan areas have
become eligible for Title I funding since 1999, when Las Vegas and
Norfolk received their initial funding, because no additional
metropolitan areas have reported enough new cases to meet the AIDS case-
count-eligibility threshold. This decline in the number of new cases
reflects the general pattern of AIDS case counts in the country. While
the number of people living with AIDS has been increasing as persons
with AIDS live longer, the number of new AIDS cases reported each year
throughout the country decreased from about 1993 until about 1999 and
has since leveled off. In addition, six of the EMAs not meeting the
current eligibility threshold became eligible on the basis of their
case rates, under the 1990 thresholds, rather than their number of
cases. These include Caguas, Dutchess County, Santa Rosa, and Vineland-
Millville-Bridgeton, the four EMAs with the fewest reported cases. In
addition, the Jersey City and Ponce EMAs also became eligible on the
basis of their case rates.
As discussed earlier, some metropolitan areas are designated as
Emerging Communities under Title II because their numbers of reported
AIDS cases in the most recent 5 calendar years are not large enough to
make them eligible for Title I funding as EMAs. However, some Emerging
Communities had more reported AIDS cases in the last 5 years than some
EMAs that were eligible for Title I funding because of the grandfather
clause.[Footnote 54] For example, for fiscal year 2004 Memphis, a
designated Emerging Community, had 1,588 reported AIDS cases during the
most recent 5 calendar years, which is more than the number of cases
reported in 26 EMAs. The overall effect is that Emerging Communities
received less funding than EMAs with comparable numbers of reported
AIDS cases in the most recent 5 calendar years. For example, Baton
Rouge, with 1,038 reported cases, received $1,091,976 in Emerging
Communities funding while the San Antonio EMA, with 1,034 reported
cases, received $3,833,443 in Title I funding.
Title II Hold-harmless Funding Could Diminish ADAP Severe Need Grants
in the Future:
A Title II hold-harmless provision established by the CARE Act
Amendments of 2000 could diminish ADAP Severe Need grant amounts in the
future because the hold-harmless payments and the grants are funded
from the same 3 percent set-aside of Title II funds available for drug
treatment programs. If larger amounts are needed to meet this hold-
harmless provision in the future, grantees that have demonstrated a
severe need for drug treatment funds could get less than the amounts
they would otherwise receive.[Footnote 55]
Fiscal year 2004 was the first time that any grantees triggered the
Title II hold-harmless provision funded with amounts that would
otherwise be used for Severe Need grants. Severe Need grants are funded
with a 3 percent set-aside of the funds appropriated specifically for
ADAPs. The Title II hold-harmless provision, also funded by the 3
percent set-aside for Severe Need grants, guarantees that the total of
Title II and ADAP base grants made to a grantee will be at least as
large as the total the previous year.[Footnote 56] Eight states became
eligible for this hold-harmless funding in fiscal year 2004. In 2004,
the 3 percent set-aside for Severe Need grants was $22.5 million. Of
these funds, $1.6 million, or 7 percent, was used to provide this Title
II hold-harmless protection. (See table 7.) The remaining $20.8
million, or 93 percent of the set-aside amount, was distributed in
Severe Need grants.
Table 7: States That Received Title II Hold-harmless Funding from
Severe Need Set-aside, Fiscal Year 2004:
State: Arkansas;
Hold-harmless amount: $23,705.
State: Kansas;
Hold-harmless amount: $22,168.
State: New Mexico;
Hold-harmless amount: $55,171.
State: North Dakota;
Hold-harmless amount: $1,820.
State: Oklahoma;
Hold-harmless amount: $96,423.
State: Tennessee;
Hold-harmless amount: $1,300,502.
State: Utah;
Hold-harmless amount: $119,695.
State: Vermont;
Hold-harmless amount: $128.
State: Total;
Hold-harmless amount: $1,619,612.
Source: HRSA.
[End of table]
The potential exists for this Title II hold-harmless provision to
diminish the size of Severe Need grants further in the future if larger
amounts are needed to fund this hold-harmless protection. The total
amount of Severe Need grant funds available in fiscal year 2004 to
distribute among the eligible grantees was less than it would have been
without the hold-harmless payments. However, in fiscal year 2004 not
all 25 of the Title II grantees eligible for Severe Need grants made
the required match. Consequently, the Severe Need grants were not as
small as they would otherwise have been because of the application of
the hold-harmless provision. In future years, if all of the eligible
Title II grantees make the match, and if there are also grantees that
qualify to receive hold-harmless funds under this provision, grantees
with severe need for ADAP funding would get less than the amounts they
would otherwise receive.
HOPWA Provision Restricts Bonus Grant Eligibility for Some Grantees:
The structure of the HOPWA program restricts states and Puerto Rico
from receiving HOPWA bonus grant funding for areas outside
EMSAs.[Footnote 57] Bonus grants, which totaled about $66 million in
fiscal year 2004, are awarded only to the EMSAs in which the AIDS
epidemic is spreading most rapidly.[Footnote 58] In fiscal year 2004,
EMSAs with more than 19.5 new AIDS cases per 100,000 people over the
past year qualified for bonus grants. In fiscal year 2004, 26 EMSAs
qualified for bonus grants (see table 8).
Table 8: Fiscal Year 2004 HOPWA Formula Funding:
EMSA: Atlanta, Ga;
Base funding: $4,262,000;
Bonus funding: $637,000;
Bonus funding as a percent of base funding: 15%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $264;
Total HOPWA formula funding when calculated per living AIDS case: $573.
EMSA: Baltimore, Md;
Base funding: $3,940,000;
Bonus funding: $3,996,000;
Bonus funding as a percent of base funding: 101%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $463;
Total HOPWA formula funding when calculated per living AIDS case:
$1,039.
EMSA: Baton Rouge, La;
Base funding: $666,000;
Bonus funding: $1,147,000;
Bonus funding as a percent of base funding: 172%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $626;
Total HOPWA formula funding when calculated per living AIDS case:
$1,290.
EMSA: Bridgeport, Conn;
Base funding: $752,000;
Bonus funding: $27,000;
Bonus funding as a percent of base funding: 4%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $238;
Total HOPWA formula funding when calculated per living AIDS case: $476.
EMSA: Charleston, S.C;
Base funding: $411,000;
Bonus funding: $7,000;
Bonus funding as a percent of base funding: 2%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $234;
Total HOPWA formula funding when calculated per living AIDS case: $480.
EMSA: Chicago, Ill;
Base funding: $5,622,000;
Bonus funding: $2,716,000;
Bonus funding as a percent of base funding: 48%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $341;
Total HOPWA formula funding when calculated per living AIDS case: $805.
EMSA: Columbia, S.C;
Base funding: $626,000;
Bonus funding: $644,000;
Bonus funding as a percent of base funding: 103%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $466;
Total HOPWA formula funding when calculated per living AIDS case: $824.
EMSA: Detroit, Mich;
Base funding: $1,624,000;
Bonus funding: $355,000;
Bonus funding as a percent of base funding: 22%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $280;
Total HOPWA formula funding when calculated per living AIDS case: $749.
EMSA: District of Columbia;
Base funding: $5,626,000;
Bonus funding: $6,176,000;
Bonus funding as a percent of base funding: 110%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $482;
Total HOPWA formula funding when calculated per living AIDS case: $939.
EMSA: Fort Lauderdale, Fla;
Base funding: $3,337,000;
Bonus funding: $2,903,000;
Bonus funding as a percent of base funding: 87%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $430;
Total HOPWA formula funding when calculated per living AIDS case: $954.
EMSA: Jackson, Miss;
Base funding: $449,000;
Bonus funding: $275,000;
Bonus funding as a percent of base funding: 61%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $371;
Total HOPWA formula funding when calculated per living AIDS case: $728.
EMSA: Jacksonville, Fla;
Base funding: $1,195,000;
Bonus funding: $369,000;
Bonus funding as a percent of base funding: 31%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $301;
Total HOPWA formula funding when calculated per living AIDS case: $623.
EMSA: Memphis, Tenn;
Base funding: $920,000;
Bonus funding: $1,214,000;
Bonus funding as a percent of base funding: 132%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $533;
Total HOPWA formula funding when calculated per living AIDS case:
$1,000.
EMSA: Miami, Fla;
Base funding: $6,149,000;
Bonus funding: $4,566,000;
Bonus funding as a percent of base funding: 74%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $400;
Total HOPWA formula funding when calculated per living AIDS case: $934.
EMSA: New Haven, Conn;
Base funding: $937,000;
Bonus funding: $295,000;
Bonus funding as a percent of base funding: 31%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $302;
Total HOPWA formula funding when calculated per living AIDS case: $605.
EMSA: New Orleans, La;
Base funding: $1,785,000;
Bonus funding: $1,207,000;
Bonus funding as a percent of base funding: 68%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $385;
Total HOPWA formula funding when calculated per living AIDS case: $887.
EMSA: New York, N.Y;
Base funding: $33,487,000;
Bonus funding: $26,868,000;
Bonus funding as a percent of base funding: 80%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $414;
Total HOPWA formula funding when calculated per living AIDS case:
$1,099.
EMSA: Newark, N.J;
Base funding: $4,297,000;
Bonus funding: $885,000;
Bonus funding as a percent of base funding: 21%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $277;
Total HOPWA formula funding when calculated per living AIDS case: $828.
EMSA: Philadelphia, Pa;
Base funding: $4,340,000;
Bonus funding: $3,292,000;
Bonus funding as a percent of base funding: 76%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $404;
Total HOPWA formula funding when calculated per living AIDS case: $799.
EMSA: Orlando, Fla;
Base funding: $1,660,000;
Bonus funding: $1,529,000;
Bonus funding as a percent of base funding: 92%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $441;
Total HOPWA formula funding when calculated per living AIDS case: $913.
EMSA: Wake County, N.C;
Base funding: $345,000;
Bonus funding: $7,000;
Bonus funding as a percent of base funding: 2%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $234;
Total HOPWA formula funding when calculated per living AIDS case: $408.
EMSA: San Francisco, Calif;
Base funding: $6,698,000;
Bonus funding: $1,864,000;
Bonus funding as a percent of base funding: 28%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $294;
Total HOPWA formula funding when calculated per living AIDS case:
$1,130.
EMSA: San Juan, P.R;
Base funding: $4,585,000;
Bonus funding: $2,555,000;
Bonus funding as a percent of base funding: 56%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $358;
Total HOPWA formula funding when calculated per living AIDS case:
$1,000.
EMSA: Tampa, Fla;
Base funding: $2,221,000;
Bonus funding: $168,000;
Bonus funding as a percent of base funding: 8%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $247;
Total HOPWA formula funding when calculated per living AIDS case: $569.
EMSA: West Palm Beach, Fla;
Base funding: $2,019,000;
Bonus funding: $1,817,000;
Bonus funding as a percent of base funding: 90%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $436;
Total HOPWA formula funding when calculated per living AIDS case: $933.
EMSA: Wilmington, Del;
Base funding: $566,000;
Bonus funding: $232,000;
Bonus funding as a percent of base funding: 41%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $325;
Total HOPWA formula funding when calculated per living AIDS case: $624.
EMSA: All other grantees;
Base funding: [B];
Bonus funding: $0;
Bonus funding as a percent of base funding: 0%;
Total HOPWA formula funding when calculated per cumulative AIDS
case[A]: $230;
Total HOPWA formula funding when calculated per living AIDS case: [C].
Source: GAO analysis of CDC and HUD data.
[A] Cumulative AIDS cases are the total number of AIDS cases, both
living and dead, reported in the jurisdiction since the beginning of
the epidemic in 1981.
[B] Varies by number of cumulative AIDS cases.
[C] Varies by number of living AIDS cases.
[End of table]
Bonus funding can be an important component of an EMSA's HOPWA formula
funding. Bonus grants exceeded base funding amounts in five EMSAs
(Baltimore, Maryland; Baton Rouge, Louisiana; Columbia, South Carolina;
Memphis, Tennessee; and the District of Columbia), and were more than
50 percent of base funding in another nine. EMSAs that did not receive
bonus funding received approximately $230 per cumulative AIDS case in
fiscal year 2004 formula funding. Because grantees other than EMSAs
were not eligible for the bonus funding, they also received $230 per
cumulative case. However, the 26 EMSAs that received bonus funding were
allocated an average of $367 per cumulative case in total formula
funding, ranging from $234 to $626 per case. If all of the formula
funding had been allocated on the basis of cumulative AIDS cases,
instead of allocating base grants by cumulative cases and bonus grants
by incidence rates, each grantee would have received $306 per case. The
last column in table 8 shows that EMSAs that received bonus funding
also received more funds per living AIDS case.[Footnote 59] These EMSAs
received an average of approximately $816 per living case, ranging from
$408 per case in Wake County, North Carolina, to $1,290 per case in
Baton Rouge, Louisiana. Those grantees that did not receive bonus
funding received about $503 per living case, ranging from $387 to $627
per case. (See app. IV).
The Use of Revised OMB Metropolitan Area Definitions Would Change Most
EMA Boundaries, but Increase in ELCs within EMAs Would Be Minimal:
Title I EMA boundaries were made permanent by the 1996 amendments to
the CARE Act, and they have not been altered to conform to OMB's 2004
definitions of metropolitan areas.[Footnote 60] Since existing Title I
and Title II organizational and administrative arrangements within
states and EMAs are connected to current EMA boundaries, changing EMA
boundaries to conform to OMB 2004 metropolitan areas could disrupt
those arrangements. On the other hand, adopting the 2004 OMB
definitions for EMAs would reflect the same metropolitan areas for
which statistical agencies make data available to the public and
reflect the 2000 decennial census demographic data. OMB recommends that
policymakers review and consider the appropriateness of the new
definitions of metropolitan area boundaries for program purposes.
If OMB's 2004 definitions of metropolitan area[Footnote 61] boundaries
were used to establish the area to be considered when defining an EMA
under Title I,[Footnote 62] the service area boundaries would change
for the majority of the current EMAs.[Footnote 63] To demonstrate the
changes involved in reconfiguring EMA boundaries to conform to the new
metropolitan areas, we chose a method that could be used for this
conversion. As described in appendix I, the method we chose would
combine new metropolitan areas so as to minimize changes to current EMA
boundaries.[Footnote 64]
If our method of converting EMA boundaries to metropolitan areas using
the 2004 definitions were incorporated in the CARE Act funding
formulas, the service area boundaries of more than half of current EMAs
would change. In addition, 5 EMAs would be consolidated to 2, reducing
the total number of EMAs from 51 to 48.[Footnote 65] We found that 31
of the 51 current EMAs would add, lose, or both add and lose counties
in their service areas. For example, the Atlanta EMA would add 8
counties, the Las Vegas EMA would lose 2 counties, and the Newark EMA
(New Jersey) would both add 2 counties and lose 1 other county.
Overall, 17 counties would no longer be part of an EMA and 53 counties
that were not previously included in an EMA would be added to the
service area of a newly reconfigured EMA. Service area boundaries of 20
current EMAs would not change if the new OMB metropolitan area
definitions were adopted. (See app. VII.)
Changing the service area boundaries of current Title I EMAs to reflect
the new OMB metropolitan area definitions would result in most EMAs
having a change in the number of ELCs within their boundaries, and the
total net effect would be an increase of ELCs counted under Title I of
less than 1 percent. Any ELCs that would no longer be counted under
Title I would continue to be considered for purposes of Title II base
grants as ELCs outside an EMA. Our analysis of the change in ELCs
resulting from a change in EMA boundaries to the new OMB definitions
shows that 19 of the 51 current EMAs would have less than a 2 percent
change in their number of ELCs, and 23 EMAs would have no change in the
number of ELCs in their service area. In total, these 42 EMAs represent
about 88 percent of the total number of Title I ELCs. Of the remaining
9 EMAs, 3 EMAs would experience a gain or loss of more than 9
percentage points in their ELCs. The Dutchess County EMA (New York)
would have about a 93 percentage-point increase in ELCs (a gain of 486
in the number of ELCs) as a result of adding Orange County to its
service area. In New Jersey, Middlesex would have a 79 percentage-point
increase in ELCs (a gain of 979 in the number of ELCs) by adding
Monmouth and Ocean Counties. The Boston EMA would have about a 9
percentage-point decrease (a loss of 554 in the number of ELCs) because
Bristol County (Massachusetts) would be reassigned from the Boston EMA
to the Providence (Rhode Island) metropolitan area, which is not an
EMA. Because the overall change in the number of Title I ELCs that
would result from EMA service area boundary changes under the new OMB
definitions would be an increase of less than 1 percent (a net gain of
1,742 in the number of ELCs), a minimal overall effect on funding per
ELC would be expected.
Funding Effect of Using HIV Case Counts Would Depend on Multiple
Factors:
CARE Act and HOPWA funding would have shifted among grantees if HIV
case counts had been used with a measure of persons living with AIDS to
allocate fiscal year 2004 formula grants. While all states and Puerto
Rico have established HIV case-reporting systems, IOM identified
characteristics of these systems that limit their appropriateness for
the distribution of CARE Act and HOPWA funds.[Footnote 66] We found
that up to 13 percent of CARE Act funding would have shifted if HIV
case counts had been used with ELCs in the distribution of fiscal year
2004 funds and if the hold-harmless and minimum-grant provisions we
considered were maintained.[Footnote 67] Larger changes for individual
grantees would have occurred with some grantees more than doubling
their funding. Grantees in the South and Midwest would generally have
received more funding from using HIV cases in funding
formulas.[Footnote 68] However, there would have been grantees that
would have received increased funding and grantees that would have
received decreased funding in every region of the country. Larger
funding shifts would have occurred without these CARE Act hold-harmless
and minimum-grant provisions. HOPWA funding would also have shifted if
HIV cases along with living AIDS cases had been used to determine
funding rather than cumulative AIDS case counts. Differences in HIV
case-reporting systems would affect funding allocations, and we found
that funding would have tended to shift to jurisdictions with older HIV-
reporting systems. Jurisdictions with older HIV-reporting systems tend
to have more reported HIV cases compared with their number of AIDS
cases than do jurisdictions with newer reporting systems.
Current HIV Case-reporting Systems Have Limitations for Providing Case
Counts for Funding Allocations:
In order to monitor HIV infection, the states and Puerto Rico have
established HIV case-reporting systems under which individuals who have
been diagnosed with HIV are reported to health departments by
physicians and other practitioners.[Footnote 69] In 2000 we reported
that HIV cases accounted for a much smaller percent of total HIV/AIDS
cases in states with newer HIV-reporting systems.[Footnote 70] In its
2004 report, IOM updated our earlier analysis and identified several
limitations in the ability of these jurisdictions to provide accurate
HIV case counts to CDC for use in CARE Act funding allocations. Among
these limitations, IOM found that the maturity of HIV case-reporting
systems continued to vary widely across grantees. The earliest HIV-
reporting systems were established in Colorado, Minnesota, and
Wisconsin in 1985, followed by most southern and other midwestern
states prior to 1995. The newest systems were established after 2003 in
six states and Philadelphia, Pennsylvania.[Footnote 71] Case-reporting
systems need several years to become fully operational. Practitioners
need to be made aware of the requirement to report new HIV cases and
the methods for doing so. Existing cases also need to be reported by
practitioners and entered into the system. Grantees with newer systems
may not have collected and entered data on existing cases, and,
consequently, may underreport the number of HIV cases. Underreporting
of HIV cases in states with newer HIV-reporting systems would result in
grantees receiving less funding than they would be entitled to receive
according to the actual number of HIV/AIDS cases.
IOM also found that differences in how jurisdictions report HIV case
counts to CDC preclude HRSA's use of those case counts in the
distribution of CARE Act funds.[Footnote 72] While some HIV case-
reporting systems are code-based, CDC will only accept name-based case
counts as no code-based system has met its quality criteria as of
January 2006.[Footnote 73] Therefore, HIV cases reported using codes
rather than names would not be counted in distributing CARE Act funds,
if HIV case counts were used in funding formulas. As of December 2005,
thirteen states have some form of a code-based system rather than a
name-based system.[Footnote 74] CDC does not accept the code-based data
principally because methods have not been developed to make certain
that a code-reported HIV case is only being counted once across all
reporting jurisdictions.[Footnote 75] Table 9 shows the 39
jurisdictions where HIV case counts are accepted by CDC and the 13
jurisdictions where they are not accepted, and the year in which each
jurisdiction established its HIV-reporting system.
Table 9: CDC Acceptance of HIV Case Counts and Year of Establishment of
HIV-reporting Systems, December 2005:
Accepted:
Colorado (1985);
Minnesota (1985);
Wisconsin (1985);
Idaho (1986);
South Carolina (1986);
Arizona (1987);
Missouri (1987);
Alabama (1988);
Indiana (1988);
Mississippi (1988);
North Dakota (1988);
Oklahoma (1988);
South Dakota (1988);
Arkansas (1989);
Utah (1989);
Virginia (1989);
West Virginia (1989);
Wyoming (1989);
North Carolina (1990);
Ohio (1990);
Michigan (1992);
Nevada (1992);
New Jersey (1992);
Tennessee (1992);
Louisiana (1993);
Nebraska (1995);
Florida (1997);
Iowa (1998);
New Mexico (1998);
Alaska (1999);
Kansas (1999);
Texas (1999);
New York (2000);
Pennsylvania (2002)[A];
Georgia (2003);
Puerto Rico (2003);
Kentucky (2004);
Connecticut (2005)[B];
New Hampshire (2005)[C].
Not accepted:
Maryland (1994);
Massachusetts (1999);
Illinois (1999)[D];
Maine (1999)[E];
Washington (1999);
Montana (2000);
Rhode Island (2000);
Vermont (2000);
Delaware (2001);
District of Columbia (2001);
Hawaii (2001);
Oregon (2001);
California (2002).
Sources: CDC, IOM, Connecticut, Kentucky, and Philadelphia.
Connecticut, Kentucky, and Philadelphia provided us with updated
information about their HIV case-reporting systems.
Notes: Currently, CDC will only accept name-based case counts.
[A] Name-based HIV reporting has been established in all parts of
Pennsylvania except Philadelphia since 2002. Philadelphia was given
permission by the state to establish code-based HIV reporting, and the
system began in 2004. However, in August 2005, the Philadelphia Board
of Health voted to implement a name-based HIV-reporting system. This
system went into effect in October 2005. Philadelphia is in the process
of having its HIV surveillance data certified by CDC; once certified,
its data will be accepted by CDC.
[B] Connecticut established mandatory name-based HIV reporting in 2005.
Previously, name-based reporting was only required for pediatric cases.
[C] New Hampshire established mandatory name-based HIV reporting in
2005. Previously, HIV cases could be reported using the patient name, a
code, or no identifier at all.
[D] Illinois established name-based HIV reporting in January 2006. It
is in the process of having its HIV surveillance data certified by CDC
and, once certified, its data will be accepted by CDC.
[E] Maine established name-based HIV reporting in January 2006. It is
in the process of having its HIV surveillance data certified by CDC
and, once certified, its data will be accepted by CDC.
[End of table]
The Use of HIV Case Counts in Funding Formulas Would Have Changed the
Distribution of Fiscal Year 2004 CARE Act and HOPWA Funds:
While we are aware of differences in the HIV data across jurisdictions,
we conducted this analysis in light of the CARE Act requirement that
HIV case counts be used for the distribution of Title I and Title II
formula grants not later than fiscal year 2007. We used two approaches
to examine the potential effect of including HIV cases in addition to
persons living with AIDS in fiscal year 2004 CARE Act and HOPWA funding
formulas. We found that some CARE Act fiscal year 2004 funding would
have shifted among grantees if HIV case counts and ELCs had been used
to allocate the funds. While our analyses indicate that up to 13
percent of CARE Act funding would have shifted, larger changes for
individual grantees would have occurred. Southern and midwestern
grantees would generally have received more funding, but there would
have been grantees that would have received increased funding and
grantees that would have received decreased funding in every region of
the country. Funding changes in our model would have been larger
without the hold-harmless and minimum-grant provisions that we
included. There would also have been at most a 15 percent shift in
HOPWA funding if HIV cases were used to allocate funding, although
there would have been larger changes for some grantees.[Footnote 76]
CARE Act and HOPWA funding changes could have resulted from the number
of people living with HIV/AIDS in each jurisdiction or differences in
HIV case-reporting systems.
Methodological Approaches Used:
We used two approaches to examine the effect of using HIV cases in
addition to AIDS cases[Footnote 77] in funding formulas for CARE Act
Title I and Title II base grants, ADAP base grants, and HOPWA base
funding in the states and Puerto Rico. Under the first approach, we
used HIV and AIDS case counts for the 35 grantees from which CDC
accepted HIV data.[Footnote 78] Because CDC did not receive HIV case
counts from the other 17 grantees, we used only the AIDS case counts
received by CDC for these grantees. Consequently, for some grantees we
used HIV and AIDS case counts, but for others we used only AIDS case
counts. This approach reflects the data that would have been used if
funding allocations were based on the HIV and AIDS case counts received
by CDC in time for determining fiscal year 2004 formula grants. Under
the second approach, we used the same HIV and AIDS case counts as our
first approach, but supplemented these data with the code-based HIV
case counts collected by the grantees from which CDC did not receive
HIV data.[Footnote 79] We obtained these HIV case counts directly from
these jurisdictions.[Footnote 80]
For both approaches, we calculated the grantee's percentage of the
total number of HIV/AIDS cases in each jurisdiction[Footnote 81] and
estimated the fiscal year 2004 formula grants that each would have
received. Under each approach, CARE Act formula grants were calculated
both with certain hold-harmless and minimum-grant provisions and again
without those provisions.[Footnote 82] Eliminating hold-harmless and
minimum-grant provisions was done to reveal the full effect of
distributing fiscal year 2004 funding solely according to HIV/AIDS data
available at that time. We also estimated the effect of using HIV cases
and living AIDS cases for HOPWA base funding. Although there are
limitations associated with the underlying data, the results of our
analyses indicate the general effect of using HIV and AIDS cases to
distribute CARE Act and HOPWA formula funding. (See app. I for a
discussion of the limitations in the data.)
Changes in CARE Act Funding Using HIV Cases and Hold-harmless and
Minimum-grant Provisions:
Our analyses indicate that for fiscal year 2004 as much as 13 percent
of Title I, Title II, and ADAP base grants would have shifted, with
southern and midwestern grantees being the primary beneficiaries, if
hold-harmless and minimum-grant provisions were maintained. However,
there would have been grantees that would have received increased
funding and grantees that would have received decreased funding in
every region of the country. Changes in funding could have resulted
from the actual number of HIV/AIDS cases living in each jurisdiction or
from differences across jurisdictions in HIV case-reporting systems.
The funding changes under each of our approaches would have been larger
if we had not applied the hold-harmless and minimum-grant provisions.
Title I Base Funding:
Title I base grant funding would have shifted among grantees under both
our approaches, but because the funds necessary to meet the hold-
harmless provision are taken from funds that would otherwise be used
for supplemental grants, the overall effect on Title I EMAs is
unclear.[Footnote 83] The Title I base grant includes (1) funding
amounts determined by the number of ELCs and (2) the hold-harmless
amounts, if applicable. In fiscal year 2004, a total of about $8.0
million was needed to fund the hold-harmless payments for EMAs. The
amount of Title I hold-harmless funding for all EMAs would have
increased from $8.0 million to $43.3 million under our first approach
in which we used only HIV data received by CDC and ELCs. It would have
increased to $29.4 million under our second approach in which we used
the HIV case counts collected by CDC, the code-based HIV counts we
collected from the grantees, and ELCs. In order to meet the hold-
harmless levels, funds would have to be deducted from the amounts
otherwise available for Title I supplemental grants. Supplemental
grants are divided among all EMAs using a competitive application
process based on the demonstration of severe need and other criteria.
Because these awards are made competitively, it is unclear how the
reduction in funding for supplemental grants would have affected
individual EMAs and, therefore, what the overall effect on funding for
each EMA would have been under our two approaches.
Under the first approach--using ELCs and HIV cases when accepted by CDC
and only ELCs elsewhere--13 EMAs would have received a total of $2.8
million less in fiscal year 2004 Title I base grants, about 1 percent
of the total Title I base grants. Twenty-nine grantees would have
received $38.1 million in additional Title I base grant funding, about
13 percent of total Title I base grants, if HIV cases and ELCs had been
used to allocate funding instead of just ELCs. The other 9 EMAs would
have had no change in their funding. The effect on certain EMAs would
have been large, with the Denver EMA more than doubling its Title I
base funding and 16 others receiving at least a 25 percent increase in
funding. Of the 29 that would have received more funding, 13 are in the
South. In addition, 5 of the 6 EMAs in the Midwest and 8 of 12 EMAs in
the Northeast would have received increased funding. However, only 3 of
14 EMAs in the West would have received increased funding.[Footnote 84]
Under the second approach--using the HIV case counts collected by CDC,
the code-based HIV counts we collected from the grantees, and ELCs--15
EMAs would have received a total of $1.9 million less in fiscal year
2004 Title I base grants, about 1 percent of the total Title I base
grants. Twenty-eight grantees would have received $23.3 million more in
fiscal year 2004 Title I base grants, about 8 percent of total Title I
base grants. Eight EMAs would have had no change in their funding. Some
EMAs would have received large increases in funding, with the Denver
EMA more than doubling its Title I base grant funding and 9 others
receiving at least a 25 percent increase in funding. Of the 28 EMAs
that would have received additional funding, 10 are in the South. All 6
midwestern EMAs would have received additional funding. Seven of 12
EMAs in the Northeast and 5 of 14 EMAs in the West would have received
increased funding. Appendix VIII shows the results of the analyses for
each EMA under each approach.
Title II Base Funding:
There would be some shifting of funds if HIV cases and ELCs had been
used to allocate CARE Act Title II base grants while maintaining the
hold-harmless and minimum-grant provisions.[Footnote 85] Most southern
and midwestern grantees would receive increased funding under either
approach we used for analysis. Under the first approach--using ELCs and
HIV cases when accepted by CDC and only ELCs elsewhere--about 5 percent
or $14.3 million of Title II base grants would have shifted among
grantees. Unlike funding for the Title I hold-harmless provision, the
amounts necessary to fund the Title II base grant hold-harmless and
minimum-grant provisions are subtracted from the base grants of those
states that did not qualify for funding under these provisions.
Consequently, the total amount of funding increases received by some
Title II grantees would have to be equal to the total decreases
received by other grantees. Twenty-one grantees would have received
additional funding in their Title II base grants, and 22 would have
received less. Nine grantees would have had no change in their funding.
Of the 21 that would have received more funding, 9 are in the South and
7 in the Midwest. Of the 22 that would have received less funding, 6
are in the Northeast and 5 are in the West. Changes in funding for
individual grantees would have ranged from a 150 percent increase in
North Dakota and Wyoming to a 22 percent decrease in Delaware and the
District of Columbia.
The second approach--using the HIV case counts accepted by CDC, the
code-based HIV counts we collected from the grantees, and ELCs--would
yield a smaller shift in funding. Under this approach, approximately 4
percent or $12.6 million of fiscal year 2004 Title II base grants would
have shifted. Of the 22 grantees that would have received additional
funding, 10 are in the South and 7 in the Midwest. Among those that
would have received less funding, 4 are in the Northeast and 4 are in
the West. Twenty grantees would have received less funding and 10 would
have received the same amount. Funding changes for individual grantees
would have ranged from a 150 percent increase in North Dakota and
Wyoming to a 22 percent decrease in Delaware and the District of
Columbia. Appendix IX shows the results of these analyses for each
grantee under each approach.
While a majority of southern grantees would have received increased
funding under both approaches, the amount of the increase would have
been relatively small. Southern grantees would have received a total of
about $430,000 more funding under our first approach and about $640,000
under the second approach. This relatively small shift can be
attributed to the fact that southern states generally would not benefit
from the minimum-grant and hold-harmless provisions. For example, many
southern states would have their grants reduced in order to fund the
hold-harmless provision. Midwestern grantees would have received larger
dollar and percent increases in funding than the southern grantees
under both approaches.
ADAP Base Funding:
Our analyses indicate that there would have been some shifting of
funding for ADAP base grants if HIV and AIDS case counts had been used
to determine allocations while maintaining the hold-harmless
provision,[Footnote 86] with southern and midwestern grantees generally
being among the areas that would have received increased
funding.[Footnote 87] Under the first approach--using ELCs and HIV
cases when accepted by CDC and only ELCs elsewhere--about 12 percent or
$85.2 million of fiscal year 2004 ADAP base grants would have shifted
among grantees. The amounts necessary to fund the ADAP base grant hold-
harmless provision are subtracted from the ADAP base grants of those
states that did not qualify for hold-harmless funding. Consequently,
the total amount of funding increases received by some Title II
grantees must be equal to the total decreases received by other
grantees. Thirty-one of the 52 grantees would have received additional
funding in their ADAP base grants if HIV cases and ELCs had been used
to allocate funding instead of just ELCs. Of the 31 that would have
received more funding, 12 are in the South and 11 in the Midwest. The
funding changes for some grantees would have been large. For example,
Colorado's allocation would have doubled and South Dakota's would have
increased by 84 percent while funding would be reduced by 38 percent in
Delaware, the District of Columbia, Illinois, Kentucky, and Maryland.
The second approach--using the HIV case counts accepted by CDC, the
code-based HIV counts we collected from the grantees, and ELCs--yields
a smaller shift in funding. Under this approach, approximately 9
percent or $65.2 million of fiscal year 2004 ADAP base grants would
have shifted. Of the 35 grantees that would have received additional
funding, 12 are in the South and 10 are in the Midwest. Funding changes
for some grantees would have been large. For example, the allocation
for Montana would have increased 93 percent and the allocation for
Colorado 84 percent, while funding would have declined by 40 percent in
the District of Columbia and by 38 percent in Kentucky. Appendix X
shows the results of these analyses for each grantee under both
approaches.
Changes in CARE Act Formula Funding Would Be Larger If Hold-harmless
and Minimum-grant Provisions Were Not in Effect:
Hold-harmless provisions limit how much funding can decline from one
grant period to the next. However, while these provisions limit changes
in funding they also reduce a program's ability to respond to changing
need. Minimum-grant provisions guarantee that no grantee will receive
less than a specified funding amount. These provisions also limit how
funding can be distributed.[Footnote 88]
Changes in CARE Act funding levels for Title I base grants, Title II
base grants, and ADAP base grants caused by shifting to HIV cases and
AIDS cases would be larger--up to 24 percent--if the current hold-
harmless or minimum-grant amounts were not in effect than if they were
in effect.[Footnote 89] Consider the hypothetical situation in which an
EMA or Title II grantee received a $2 million base grant award
according to its number of ELCs. Assume that in the following year, the
formula is changed so that HIV cases and ELCs are used to determine
funding allocations, and the grantee is then only entitled to $1
million. However, there is a hold-harmless provision that guarantees
the grantee 98 percent of what it received the previous year. The
grantee would receive 98 percent of its $2 million allocation, or $1.96
million, largely offsetting the reduction in funding due to the shift
to HIV cases and ELCs. The change in funding with the hold-harmless
provision would be a decrease of $40,000, but the loss would grow to
$1,000,000 without the hold-harmless provision. If a grantee qualified
for $100,000 in formula funding using HIV case counts and ELCs, but the
minimum award was $500,000, the grantee would receive $500,000 because
of the minimum-grant provision, thereby offsetting the changes due to
using HIV cases and ELCs.
Title I Base Funding:
Under both our methodological approaches, Title I funding would have
been affected by eliminating the Title I base grant hold-harmless
provision.[Footnote 90] If the hold-harmless provision had been
eliminated, the number of EMAs that would have received less Title I
base grant funding would have increased from 13 to 23 under our first
approach--using ELCs and HIV cases when accepted by CDC and only ELCs
elsewhere--and from 15 to 24 under our second approach--using the HIV
case counts collected by CDC, the code-based HIV counts we collected
from the grantees, and ELCs.[Footnote 91] The effect of the hold-
harmless provision on an individual grantee can be illustrated with the
New Haven EMA. New Haven, which would have had no change in base grant
funding if the hold-harmless provision was maintained would have had
Title I base grant funding reductions of 31 and 35 percent under the
first and second approaches, respectively, without the hold-harmless
provision. Overall, southern and midwestern EMAs would gain funding
under both approaches whether or not the hold-harmless provision was
maintained while northeastern EMAs would lose funding only under our
second approach and only if the hold-harmless provision was not
maintained.[Footnote 92] However, in all four regions of the country,
there would have been EMAs that would have received increased funding
and EMAs that would have received decreased funding. Appendix XI shows
the results of our analyses for Title I base grants if the hold-
harmless provision was not maintained.
Title II Base Funding:
The hold-harmless and minimum-grant provisions have a large effect on
funding shifts in Title II base grants. Under our first approach--using
ELCs and HIV cases when accepted by CDC and only ELCs elsewhere--14
percent of Title II base grants would have shifted among grantees if
the hold-harmless and minimum-grant provisions had been eliminated,
while 5 percent would have shifted if they had been maintained. Under
our second approach--using the HIV case counts collected by CDC, the
code-based HIV counts we collected from the grantees, and ELCs--10
percent would have shifted if the provisions were eliminated and 4
percent if they had been maintained. The importance of these provisions
can be illustrated by examining individual grantees. For example,
Vermont, which received a minimum grant of $500,000 in fiscal year
2004, would have had a decrease of 74 percent under approach one and 52
percent under approach two if the hold-harmless and minimum-grant
provisions had not been maintained. However, it would have had no
change in funding if these provisions had been maintained. California
would have received decreases of $11.8 million under our first approach
and $5.0 million under our second approach if the provisions had been
eliminated, but the state would have had no change in funding if the
provisions had been maintained. Conversely, North Carolina would have
received $5.0 million in additional funding under our first approach
and $4.0 million under our second approach if the hold-harmless and
minimum-grant provisions had not been maintained. It would have
received $2.4 million and $2.1 million additional under each approach
respectively if the provision had been maintained. Southern and
midwestern grantees would gain funding under both approaches whether or
not the hold-harmless and minimum-grant provisions had been maintained,
while northeastern grantees would lose funding.[Footnote 93] However,
in all four regions of the country, there would have been grantees that
would have received increased funding and grantees that would have
received decreased funding. Appendix XII shows the results of our
analyses for Title II base grants if the hold-harmless and minimum-
grant provisions were not maintained.
ADAP Base Funding:
The overall effect of the hold-harmless provision is smaller on funding
shifts for the ADAP base grants.[Footnote 94] Under our first approach-
-using ELCs and HIV cases when accepted by CDC and only ELCs elsewhere-
-14 percent instead of 12 percent of ADAP base funding would have
shifted among grantees if the hold-harmless provision was eliminated.
Ten percent instead of 9 percent of the funding would have shifted
under our second approach--using the HIV case counts collected by CDC,
the code-based HIV counts we collected from the grantees, and ELCs. The
reason for the smaller effect on the ADAP base grants than on the Title
I and Title II base grants is the increase in ADAP base funding since
fiscal year 2000. In fiscal year 2000, $528 million was distributed to
grantees while $728 million was distributed in fiscal year 2004.
Because of these increases, the hold-harmless provision had less effect
in our analyses. However, under all our scenarios grantees in the
Northeast and West would have received less total funding while
grantees in the Midwest and South would have received more. In all four
regions of the country, there would have been grantees that would have
received increased funding and grantees that would have received
decreased funding. For example, in the Northeast, New Jersey would have
gained funding and New York would have lost funding under both our
approaches. In the South, Alabama would gain funding and Georgia would
lose funding under both our approaches. Appendix XIII shows the results
of our analyses for ADAP base grants if the hold-harmless provision had
not been in effect.
HOPWA Base Funding Would Generally Shift If HIV Cases Were Used in
Formula Allocations:
There would have been some shifting of funds if HIV and living AIDS
case counts[Footnote 95] had been used to allocate HOPWA base grants
instead of cumulative AIDS cases under either of our methodological
approaches--with or without the code-based HIV case counts--with
southern and midwestern grantees generally being among the
jurisdictions that would have received increased funding.[Footnote 96]
Under the first approach--using living AIDS cases and HIV cases when
accepted by CDC and only living AIDS cases elsewhere--about 15 percent
or $30.0 million of fiscal year 2004 HOPWA base grants would have
shifted among grantees. Seventy of 117 grantees would have received
additional funding in their HOPWA base grants if living HIV and AIDS
cases had been used to allocate funding. Six grantees would have more
than doubled their funding.[Footnote 97] Thirty-five of 47 southern
grantees[Footnote 98] and 18 of the 20 midwestern grantees would have
received more funding. Southern grantees would have received an
additional $15.8 million (22 percent) in funding while those in the
Midwest would have received an additional $3.3 million (17 percent).
Seventeen of the 24 northeastern grantees and 14 of the 24 western
grantees would have received less funding. The northeastern and western
grantees would have received $6.3 million (10 percent) and $9.7 million
(24 percent) less in funding respectively.
The second approach--using the HIV case counts accepted by CDC, the
code-based HIV counts we collected from the grantees, and living AIDS
cases--yields an overall smaller shift in funding although changes
would have been larger in the Midwest and Northeast. Under this
approach, approximately 13 percent or $25.6 million of fiscal year 2004
HOPWA base grants would have shifted, with Maryland and Charlotte,
North Carolina, more than doubling their funding. Of the 82 grantees
that would have received additional funding, 39 are in the South, 19 in
the Midwest, 14 in the West, and 10 in the Northeast. Overall, the
South would have received $13.7 million (19 percent) in additional
funding and the Midwest would have received an additional $4.0 million
(21 percent). The Northeast would have received $8.5 million (14
percent) less in funding and the West $5.8 million (15 percent) less.
Appendix XIV shows the results of these analyses for each jurisdiction
under both approaches.
Differences in Case-reporting Systems Would Affect Allocations:
One explanation for the changes in funding allocations when HIV cases
and either ELCs or living AIDS cases are used--whether or not the code-
based HIV case counts are included--instead of only AIDS cases[Footnote
99] is the maturity of HIV case-reporting systems. We found that those
grantees that would receive increased funding from the use of HIV cases
tend to be those with the oldest HIV case-reporting systems. Those
grantees with the oldest reporting systems include 11 southern and 8
midwestern states whose HIV-reporting systems were implemented prior to
1995. As shown in table 10, jurisdictions with long histories of
counting HIV cases tend to have many more reported HIV cases compared
with their number of ELCs than do jurisdictions with less-mature
reporting systems. This difference is likely because jurisdictions with
newer systems do not have reports on many cases of HIV that were
diagnosed before their reporting systems were established.[Footnote
100] This divergence can be illustrated by comparing Wisconsin and
Delaware, two states with similar numbers of AIDS cases. Wisconsin
began reporting HIV cases in 1985 while Delaware began in 2001. In
Wisconsin, as of June 2003, there were about 50 percent more reported
HIV cases than AIDS cases, or 2,287 HIV cases and 1,507 AIDS cases. As
of June 2003, the 909 reported HIV cases in Delaware were about 40
percent less than the 1,518 ELCs. This variability could be reduced as
Delaware identifies more preexisting HIV cases. However, the
variability between HIV cases and ELCs would remain if there was a
difference in the actual number of HIV cases.
Table 10: Reported HIV Cases and ELCs as of June 2003:
HIV case-reporting system start date: 1985-1991;
Number of jurisdictions[A]: 21;
Ratio of HIV cases to ELCs: 1.42.
HIV case-reporting system start date: 1992-1998;
Number of jurisdictions[A]: 11;
Ratio of HIV cases to ELCs: 1.01.
HIV case-reporting system start date: 1999-2002;
Number of jurisdictions[A]: 17;
Ratio of HIV cases to ELCs: 0.68.
Source: GAO analysis of CDC, HRSA, and state data.
[A] Georgia, Kentucky, and Puerto Rico are not included in this table
because they established their HIV-reporting systems after 2002.
Connecticut and New Hampshire established their name-based HIV-
reporting system in 2005. However, in this table, Connecticut is
classified as having established its reporting system in 2001 (and so
is included in the 1999-2002 time period) since state officials
provided us HIV case counts based on the system in operation as of June
2003. New Hampshire is classified as having established its reporting
system in 1990 (and so is included in the 1985-1991 time period),
because state officials provided us HIV case counts based on the system
in operation as of June 2003.
[End of table]
Under either approach, grantees might receive increased funding because
other grantees did not yet have an accurate measure of HIV case counts.
IOM has reported that it could take from 18 months to several years
after the implementation of an HIV-reporting system before there would
be valid estimates of the number of people living with HIV.[Footnote
101]
The maturity of the HIV-reporting systems can be linked to whether a
jurisdiction has a name-or code-based system. As discussed earlier, CDC
does not currently accept HIV case reports from code-based systems.
However, even if code-based data were incorporated into the CDC case
counts, the age of the code-based systems could still be a factor since
the code-based systems tend to be newer than the name-based systems. As
of December 2005, twelve of the 13 code-based systems were implemented
in 1999 or later, compared with 10 of the 39 name-based systems. The
effect of the maturity of the code-based systems could be increased if,
as CDC believes, name-based systems can be executed with more complete
coverage of cases in much less time than code-based systems. As a
result, jurisdictions with code-based systems could find themselves
with undercounts of HIV cases for longer periods of time than
jurisdictions with name-based systems.
The use of HIV cases in CARE Act funding formulas could result in
fluctuations in funding over time because of newly identified
preexisting HIV cases. Grantees with more mature HIV-reporting systems
have generally identified more of their HIV cases. Therefore, if HIV
cases were used to distribute funding, these grantees would tend to
receive more funds. As grantees with newer systems identify and report
a higher percentage of their HIV cases, their proportion of the total
number of ELCs and HIV cases in the country would increase and funding
that had shifted away from states with newer HIV-reporting systems
would shift back, creating potentially significant additional shifts in
program funding. Without corresponding increases in CARE Act funding,
this increase in identified HIV cases could cause grantees with more
mature systems to experience funding decreases. Hold-harmless
provisions would protect grantees with older reporting systems from
funding losses. However, grantees with newer systems could receive less
funding per case because funds would be needed to cover hold-harmless
provisions.
Conclusions:
The funding provided under the CARE Act and HOPWA has filled important
gaps in communities throughout the country, but as Congress reviews
these programs, it is important to understand how much funding can vary
across communities with comparable numbers of persons living with AIDS.
While provisions in the formulas have served specific purposes, such as
maintaining consistent funding from year to year, it is clear that the
level of funding available per AIDS case is quite variable because of
these provisions:
* The use of ELCs--AIDS cases reported over the past 10 years weighted
by survival rates--and the use of 2-and 5-year cumulative reported AIDS
cases for CARE Act funding results in AIDS case counts that do not
reflect the number of persons who could be served by the program
because many persons with AIDS live longer than 10 years after their
disease is reported, deceased cases are included in the case counts,
and cases diagnosed prior to the reporting period are not included.
* Considerably more CARE Act funding has gone to some grantees than
others even though they have similar numbers of cases because of the
counting of ELCs in EMAs for both Title I base funding and Title II
base funding, hold-harmless provisions that protect Title I, Title II,
and ADAP base grant funding levels, the grandfathering of EMAs so that
metropolitan areas designated as EMAs for fiscal year 1996 continue to
be eligible for Title I funding, and the division of Emerging
Communities into two tiers with equal funding of each tier without
regard to the number of communities or the number of reported AIDS
cases in each tier.
* The use of cumulative AIDS cases to determine eligibility for HOPWA
formula grants, including for bonus grants, and the amount of HOPWA
base grants has led to disproportionate funding per living AIDS case
because the formula counts deceased cases in addition to living cases,
thereby resulting in increased funding for areas with early outbreaks.
The CARE Act Title II hold-harmless provision that is funded from
amounts that would otherwise be available for ADAP Severe Need grants
has had little effect so far as the amounts needed to fund this
provision have been comparatively small. However, reducing funds to be
made available for qualifying states could adversely affect the states
with severe need in the future if the amounts needed to fund the hold-
harmless provision increase.
Congress recognized in the 2000 CARE Act amendments that the CARE Act
benefits many people whose HIV infection has not progressed to AIDS
when it required that HIV case counts be used in the distribution of
funds. The inclusion of HIV cases in the CARE Act funding formulas by
fiscal year 2007 could eventually improve the targeting of funding to
needy individuals with HIV disease. However, it could result in
significant shifts in program funding that may not be related to the
geographic distribution of HIV/AIDS cases because of differences in the
type and maturity of the reporting system used in each state.
Matters for Congressional Consideration:
While only AIDS case counts are currently used for determining CARE Act
formula funding, Congress has required that HIV case counts be
incorporated into the funding formulas not later than fiscal year 2007.
Regardless of when HIV case counts are incorporated, issues will still
exist regarding how AIDS cases are used in the formulas and the effect
various provisions have on funding. If Congress wishes CARE Act funding
to more closely reflect the distribution of persons living with AIDS,
and to more closely reflect the distribution of persons living with
HIV/AIDS when HIV cases are incorporated into the funding formulas, it
should take the following five actions:
* revising the funding formulas used to determine grantee eligibility
and grant amounts using a measure of living AIDS cases that does not
include deceased cases and reflects the longer lives of persons living
with AIDS,
* eliminating the counting of cases in EMAs for Title I base grants and
again for Title II base grants,
* modifying the hold-harmless provisions for Title I, Title II, and
ADAP base grants to reduce the extent to which they prevent funding
from shifting to areas where the epidemic has been increasing,
* modifying the Title I grandfather clause, which protects the
eligibility of metropolitan areas that no longer meet the eligibility
criteria, and:
* eliminating the two-tiered structure of the Emerging Communities
program.
If Congress wishes to preserve funding for the ADAP Severe Need grants,
it should revise the Title II hold-harmless provision that is funded
with amounts set aside for ADAP Severe Need Grants.
If Congress wishes HOPWA funding to more closely reflect the
distribution of persons living with AIDS, it should change the program
so that HOPWA formula grant eligibility, including for bonus grants,
and base grant funding allocations are based on a measure of living
AIDS cases.
Agency Comments and Our Evaluation:
HHS and HUD provided written comments on a draft of this report. HHS
and HUD generally agreed with our identification of issues in the
funding formulas. Their comments are reprinted in appendixes XV and
XVI. HHS commended us for its comprehensive approach and ambitious
analysis that pulled together data from many disparate sources. HUD
noted that it appreciated that the report seeks to improve the
targeting of federal resources to better assist those with HIV/AIDS.
HHS noted that we identified various deficiencies in the current HIV
data. However, HHS suggested that we did not examine the distribution
differences that would result from incorporating HIV cases into the
CARE Act funding formulas. HHS noted that we did not assess the
potential usefulness of HIV data in funding formulas if all
jurisdictions participated in the national reporting system coordinated
by CDC using standardized methods of reporting. Such a determination
was beyond the scope of our work. However, as noted in the draft
report, we present analyses showing the impact of using HIV cases on
fiscal year 2004 funding for Title I, Title II, and ADAP base grants,
which comprise the bulk of CARE Act funding.
While HHS generally agreed with our matters for congressional
consideration, HHS made several comments on the issues these matters
address. HHS noted that our matters for congressional consideration
focus only on potential changes to the use of AIDS cases in formulas
but not to the use of HIV cases. The matters for consideration are
based on current funding formula provisions that require the use of
AIDS cases. Our discussion should not be interpreted as endorsing the
superiority of using living AIDS cases instead of HIV/AIDS cases.
Regardless of whether HIV case counts are used, the funding formula
provisions we identified will continue to affect proportional funding
per case if they are maintained. We believe that the use of AIDS case
counts that include deceased cases and do not reflect the current life
spans of persons living with AIDS will continue to be of concern. Also,
various provisions, such as allocating funding for Emerging Communities
by tier and hold-harmless provisions, will affect the distribution of
funding regardless of whether HIV cases are used in the formulas.
HHS pointed out that our assessment of the impact of hold-harmless
provisions on CARE Act formula funding appears accurate. HHS noted
disparities in funding per AIDS case that can result from counting
cases in EMAs once for Title I funding, and once again for Title II
funding. HHS also agreed with our analysis of the Emerging Communities
provision; we deleted our reference to a population threshold as an
eligibility requirement for Emerging Communities in response to its
comment on this issue. HHS concurred with our suggestion that the Title
II hold-harmless provision should be revised to preserve funding for
ADAP Severe Need grants.
HHS raised concerns that our discussion of the Title I grandfather
clause in the CARE Act could be interpreted as suggesting EMAs that
continue to receive grants because of this provision need not be
funded. HHS noted that a cessation of funding could lead to a decline
in these areas' systems of care and, by extension, a decline in the
progress made in fighting the epidemic. However, we note that these
areas could receive funding through their respective states or
territories, which receive funds under Title II. In addition, much of
the improvement in care for those with HIV/AIDS is due to the
improvement in drugs, which, as indicated in Appendix III, are
primarily provided through Title II ADAP grants. HHS noted that without
Title II minimum grant amounts for states and territories, the number
of reported AIDS cases in low prevalence areas would not be sufficient
to sustain state-of-the-art HIV/AIDS care and treatment services.
HHS also noted that we do not have a specific matter for congressional
consideration regarding the use of OMB's revised definitions of
metropolitan boundaries for determining Title I EMAs. HHS stated that
the report suggests that the revised definitions be accepted for
determining such boundaries. In the report, we discuss the methods used
in our analysis and the results of this analysis, but take no position
on whether the new definitions should be used in determining the EMA
boundaries.
HHS commented that the draft report lacked specificity regarding the
process by which CDC receives HIV case counts from the states. We have
modified our report to include a discussion of this process. HHS also
stated in its comments that it would not be appropriate to use the code-
based case counts in monitoring HIV/AIDS nationally. An assessment of
whether code-based data should be used for monitoring HIV/AIDS is
beyond the scope of our work. Our purpose was to provide Congress with
an indication of the impact of using HIV cases in the CARE Act and
HOPWA funding formulas in light of the statutory requirement that HIV
cases be used in CARE Act funding formulas not later than fiscal year
2007. We have added text to the report discussing HHS's concerns about
code-based data.
HUD concurred with our matter for congressional consideration that
cumulative AIDS cases no longer be used in the HOPWA formula. HUD
pointed out that incorporation of a more current estimate of persons
living with HIV/AIDS would be more effective in targeting these HOPWA
funds to grantees. HUD stated in its comments that we did not take into
account differing housing costs across jurisdictions in the draft
report. In response to this comment, we revised the report to note that
housing costs are not currently part of the HOPWA funding formula, and
consideration of housing costs was not within the scope of our work.
However, we have clarified the draft report to note that if housing
costs were included in the funding formulas, they could justify
deviations from proportional funding per case.
HUD suggested that we not use the terms base grant and bonus grant. We
have added a note to our report to reflect that our terminology differs
from HUD's, but retained the use of bonus and base grants in order to
differentiate between the two formula funding components.
HUD expressed concern that the full effect of incorporating HIV case
counts may not be apparent by only stating the amount of funding that
would shift among grantees. We have added text to note that the changes
could result in some grantees more than doubling their funding. HUD
suggested that these analyses could be done based solely on data from
jurisdictions with CDC-accepted HIV case counts, or those jurisdictions
with mature HIV-reporting systems. However, as noted in the draft
report, we present analyses showing the impact of using only CDC-
accepted HIV data on fiscal year 2004 HOPWA base grants. We do not
include an analysis using only jurisdictions with mature HIV-reporting
systems because it would exclude many jurisdictions and we determined
that such an analysis would not be appropriate. HUD also pointed out
that the draft report did not describe the incremental effect on HOPWA
allocations of using HIV cases with living AIDS cases rather than
living AIDS cases only. The draft report provided information on this
in appendix V, and we have added text to the report to refer the reader
to this appendix. HUD suggested that we expand a footnote to further
describe our analysis of HIV cases in funding formulas. However, this
information is already presented in detail in appendix I and is also
described in the text of the report.
In its comments HUD noted bonus funding can provide a significant
amount of resources to those eligible and that this funding can have a
large effect on formula funding per AIDS case. As noted in the draft
report, we show the amount of base funding and bonus funding that each
grantee received in fiscal year 2004 and state that funding differences
per case are due in part to the bonus grants. HUD suggested that we
revise our conclusion to reflect the importance of the bonus grants.
However, our conclusion focuses on the base grants because of the use
of cumulative AIDS cases in determining these grants. HUD also noted
that not all grantees that receive bonus grants sustain the funding
from year to year. We have added text to note the instability of the
bonus funding and that, with respect to fiscal year 2006 funding, HUD's
appropriation act included a provision to mitigate the variability of
incidence data by using data reported over a 3-year period.
HUD also suggested that we use different terms to categorize how HOPWA
funding was allocated by grantees and provided us with updated
information on how grantees allocated fiscal year 2003 HOPWA grants. We
have revised the report based on this information.
HHS and HUD also provided technical comments, which we have
incorporated where appropriate.
We are sending copies of this report to the Secretary of Health and
Human Services, the Secretary of Housing and Urban Development, the
Director of the Centers for Disease Control and Prevention, the
Administrator of the Health Resources and Services Administration, and
to interested congressional committees. We will also make copies
available to others upon request. In addition, the report will be
available on GAO's Web site at http://www.gao.gov.
If you or your staff have any questions about this report, please
contact me at (202) 512-7119 or crossem@gao.gov. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on
the last page of this report. GAO staff who made major contributions to
this report are listed in appendix XVII.
Marcia Crosse:
Director, Health Care:
[End of section]
Appendix I: Objectives, Scope, and Methodology:
Objectives:
We assessed the distribution of funding for human immunodeficiency
virus (HIV) and acquired immunodeficiency syndrome (AIDS) under the
Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE
Act) and the AIDS Housing Opportunity Act's Housing Opportunities for
Persons with AIDS program (HOPWA). Specifically, we are reporting on
(1) how CARE Act and HOPWA funds are allocated by grantees among the
types of services each program supports; (2) the extent of funding
distribution differences among CARE Act and HOPWA grantees, and how
CARE Act and HOPWA funding-formula provisions contribute to these
difference; and (3) what distribution differences would result from
using HIV cases in CARE Act and HOPWA funding formulas.
Scope and Methodology:
To report on these three objectives, we reviewed the CARE Act of 1990,
as well as the 1996 and 2000 CARE Act amendments, the AIDS Housing
Opportunity Act, Health Resources and Services Administration (HRSA)
and Department of Housing and Urban Development (HUD) documents on CARE
Act and HOPWA funding, HUD memoranda, Institute of Medicine reports on
the CARE Act, and other related reports. We interviewed officials from
HRSA, the Centers for Disease Control and Prevention (CDC), HUD, and
the National Alliance of State and Territorial AIDS Directors. We
received information from state government officials regarding their
HIV case-reporting systems. Details on the scope of our work and the
methods to address each objective follow.
Allocation of CARE Act and HOPWA Funds among Service Categories:
To determine how grantees allocate CARE Act and HOPWA funds by types of
service, we obtained information on the allocation of these funds from
HRSA and HUD.[Footnote 102] HRSA provided information on grantees'
allocation of CARE Act Titles I and II funds for fiscal year 2003, and
Title III allocations for fiscal year 2002. HRSA also provided funding
amounts for its HIV/AIDS Dental Reimbursement Program, Community-Based
Dental Partnership grants, Special Projects of National Significance,
and AIDS Education and Training Centers program for fiscal year 2003.
HUD provided HOPWA allocation data for fiscal year 2003, these being
the most recently available data. We analyzed these data and, where
available, calculated the percentage of the total amount each service
category represented. To assess the reliability of HRSA and HUD data on
the allocations of CARE Act and HOPWA grant funds, we interviewed
agency officials about the data and reviewed relevant documentation. We
determined that the data were sufficiently reliable for the purposes of
our report.
Funding-formula Provisions:
We examined the effect of specific funding-formula provisions on CARE
Act and HOPWA grants. We first assessed the use of 2-and 5-year
cumulative counts of AIDS cases and the use of estimated living AIDS
cases (ELC) in CARE Act programs by comparing these measures with
living AIDS case counts received from CDC.[Footnote 103] We then
examined the following CARE Act formula provisions: the counting of
ELCs in eligible metropolitan areas (EMA) for both Title I and Title II
funding, the tiered allocation of Emerging Communities funding, the
Title I hold-harmless provision, the Title I grandfathering clause, and
the Title II hold-harmless provision funded from amounts available for
Severe Need grants.[Footnote 104] To examine the effect of each
provision on the CARE Act and HOPWA grant amounts, we measured
differences on a per case basis, by the amount of funding received, or
both. We calculated each grantee's percentage of the total number of
AIDS cases in all relevant jurisdictions, and we used these percentages
to determine the funding each grantee would have received. We then
compared these amounts with what was actually received to show the
effect of a provision in the formula. In addition, we examined the
effect of using living AIDS cases instead of cumulative cases in making
HOPWA base grant distributions by comparing the actual funding
distributions with simulated distributions using living AIDS cases. We
also assessed the effect of HOPWA bonus grants on funding for eligible
metropolitan statistical areas (EMSA) by examining the size of these
grants and which EMSAs received them.
To conduct our analyses of the effect of funding-formula provisions on
CARE Act and HOPWA funding and programs in the states, including the
District of Columbia, Puerto Rico, and metropolitan areas, we obtained
fiscal year 2004 funding data and AIDS case counts from HRSA and HUD,
and supplemented this information with additional AIDS case-count data
from CDC. Fiscal year 2004 data were the latest data available at the
time of our review. We limited our CARE Act analyses to Titles I and II
because grants under other parts of the Act are not formula-driven.
Similarly, our HOPWA analyses are also limited to the parts of the
program that are formula-based, namely, the base and bonus grants.
Our analyses of funding provisions take into consideration that CARE
Act and HOPWA formula grants use different measures of the number of
AIDS cases to determine grant amounts. There are three measures used
for CARE Act grants--reported AIDS cases over 2 years, reported AIDS
cases over 5 years, and ELCs. HRSA calculates a jurisdiction's ELCs by
using data from CDC on the reported AIDS case counts for the last 10
years and weighting those numbers to account for the likelihood of
deaths. HOPWA uses two measures--total AIDS cases reported in the
jurisdiction since the beginning of the epidemic in 1981 and AIDS
incidence rates.
In our analyses of the funding formulas, we used the measure of AIDS
cases that is used to determine funding in a particular grant program
in order to show the effect of different formula provisions on fund
distribution. We also compared the AIDS data used for funding formulas
with data on living AIDS cases to assess the effect of not using living
AIDS cases on funding allocations. For the CARE Act, we used the
measure of living AIDS cases that is required by law to be used by the
program when distributing Title I, Title II, and ADAP base grants, that
is, the number of ELCs based on 10 years of reported cases and survival
rates. In the absence of a measure of living AIDS cases for HOPWA
funding, we used a measure of living AIDS cases calculated by
subtracting the number of reported deaths among AIDS cases in a
jurisdiction from the number of reported cases. This measure of living
AIDS cases is used for illustrative purposes only.
In our analysis of counting ELCs in EMAs for both Title I and Title II
CARE Act funding, we aggregated Title I and Title II funding received
by each of the states and Puerto Rico. Because some EMAs cross state
boundaries, we apportioned Title I funding among states according to
the proportionate share of an EMA's ELCs in each state. For example,
approximately 96 percent of the ELCs in the Boston EMA are in
Massachusetts and 4 percent are in New Hampshire. Consequently, we
allocated 96 percent of the Boston EMA's funding to Massachusetts and 4
percent to New Hampshire. We then compared the combined total Title I
and Title II funding received by all Title II grantees.
To examine the effect of using living AIDS case counts on funding for
HOPWA base grants, we estimated the amount of funding grantees would
have received by determining the number of living AIDS cases in each
jurisdiction. CDC provided us with living AIDS cases counts for states,
Puerto Rico, and EMSAs. To determine each grantee's number of living
AIDS cases, we subtracted the number of living AIDS cases in EMSAs in a
state from the total number of living AIDS cases in the state.[Footnote
105] When an EMSA crossed state boundaries, we used information from
CDC to determine the number of living AIDS cases in each state within
the EMSA. For example, the Memphis EMSA covers parts of Arkansas,
Mississippi, and Tennessee. We obtained the living AIDS case counts for
each of the states in the Memphis EMSA. We then subtracted the number
of living AIDS cases from Arkansas in the Memphis EMSA from the
Arkansas state total, and did comparable calculations for the cases
from the other two states. After doing similar calculations for all
EMSAs that crossed state boundaries, we had living AIDS case counts for
all HOPWA grantees. We then calculated each grantee's percentage of the
total number of living AIDS cases in all jurisdictions and simulated
the HOPWA base grant funding allocations according to this percentage.
We then compared the base funding received using cumulative AIDS case
counts with the simulated funding allocations using living AIDS cases.
The dates of the AIDS case counts used in our analyses varied by
program. Depending on the grant, formula allocations under the CARE Act
are based on the number of ELCs in a jurisdiction as of June 30
preceding the start of the fiscal year for which the award is to be
made or on the number of reported AIDS cases in either the most recent
2 or 5 calendar years. HOPWA eligibility is based on the number of
cumulative AIDS cases as of March 31 preceding the start of the fiscal
year. Where appropriate, we used ELCs as of June 30, 2003, to estimate
the effect of formula provisions on CARE Act funding for fiscal year
2004, which began on October 1, 2003. For other CARE Act grants, we
used reported cases for the appropriate calendar-year period. We used
AIDS case counts as of March 31, 2003, to estimate the effect of
formula provisions on HOPWA funding for fiscal year 2004.
We used funding per AIDS case[Footnote 106] to illustrate the effect of
certain funding-formula provisions on the distribution of CARE Act and
HOPWA funds. There are other considerations that could be included in
funding formulas. For example, differing health care and housing costs
across regions and differences in grantees' capacities to fund services
from local resources could be used as bases for distributing program
funds and to justify deviations from proportional funding per
case.[Footnote 107] Without such considerations, regions with the same
funding and the same number of AIDS cases could not treat the same
number of patients. Currently, these considerations are not taken into
account when awarding formula grants under either the CARE Act or
HOPWA.
To analyze the effect of retaining the current EMA boundaries, we
reviewed documents pertaining to the Office of Management and Budget's
(OMB) 2004 metropolitan boundary definitions. In particular, we relied
on information generated in our June 2004 report on metropolitan
statistical areas (MSA) that reported on the process used to develop
the 2000 standards and how the 2000 standards differ from the 1990
standards.[Footnote 108] Before each decennial census, OMB reviews the
standards used in defining the boundaries of these statistical areas to
ensure their continued usefulness and relevance and, if warranted,
revises them. OMB had determined that a more fundamental examination of
the standards was required for 2000, and advisory groups were formed to
look at the standards. These groups suggested OMB consider defining
less-populated areas, which had been statistically unrecognized. The
2000 standards differ from the 1990 standards in many ways, and the
Census Bureau and OMB have stated that the new standards are simpler
and more transparent.
To demonstrate the effect on the current boundaries of the 51 CARE Act
Title I EMAs if OMB's 2004 definitions of MSAs were used to establish
EMA boundaries, we compared the boundaries of existing EMAs with the
new MSA boundaries that could be created using the new definitions.
Because most EMA boundaries include portions of more than one new
metropolitan area, for our analysis we chose two decision rules to
serve as a basis for selecting new metropolitan areas to be compared
with the existing EMAs.[Footnote 109] First, we assumed there would be
no change in eligibility of the current 51 Title I EMAs. Second, since
the number of ELCs within an EMA would change if its boundaries were
revised, we chose whatever combination of the newly defined
metropolitan areas[Footnote 110] would result in the least change to
the numbers of ELCs within the EMA's boundaries. The results of our
method are shown in appendix VII, which lists each of the existing EMAs
together with the corresponding new areas, the number of counties
constituting the metropolitan areas, and the number of ELCs contained
within those areas.
To assess the reliability of the data on HRSA's and HUD's distribution
of CARE Act and HOPWA funds, we asked agency officials about how the
data were developed and reported. We also reviewed relevant
documentation. We determined the data were sufficiently reliable for
the purposes of our report.
Use of HIV Cases in Formulas:
We examined how CARE Act and HOPWA fiscal year 2004 allocations would
have been affected by using HIV cases in addition to living AIDS cases
to determine funding. We undertook our analyses in light of the
statutory requirement that HIV cases be used in CARE Act funding
formulas not later than fiscal year 2007.[Footnote 111] We examined the
effect of using HIV cases in addition to living AIDS cases on formula
funding for CARE Act Title I, Title II, and ADAP base grants, and HOPWA
base grants in the states, Puerto Rico, and metropolitan
areas.[Footnote 112] We limited our analyses to these grants because
they constitute the majority of the CARE Act and HOPWA formula funding.
For the CARE Act, we used the measure of living AIDS cases that is
required by law to be used by the program when distributing Title I,
Title II, and ADAP base grants, that is, the number of ELCs based on 10
years of reported cases and survival rates. In the absence of a measure
of living AIDS cases for HOPWA funding, we used a measure of living
AIDS cases calculated by subtracting the number of reported deaths
among AIDS cases in a jurisdiction from the number of reported cases.
This measure of living AIDS cases is used for illustrative purposes
only. We used fiscal year 2004 allocations, which were based on case
counts reported as of June 30, 2003, for the CARE Act and as of March
31, 2003, for HOPWA. As of these dates there were 35
jurisdictions[Footnote 113] from which CDC accepted HIV data and 17
without CDC-approved HIV data. CDC will only accept name-based case
counts as no code-based system has yet met CDC's quality
criteria.[Footnote 114]
Because CDC did not accept HIV case counts from 17 jurisdictions, we
conducted our analysis using two approaches to measure total HIV/AIDS
cases for purposes of formula calculations. Under the first approach,
we used HIV and live AIDS case counts for the 35 jurisdictions from
which CDC accepted HIV data.[Footnote 115] Because CDC did not accept
the HIV case counts from the other 17 jurisdictions, we used only the
live AIDS case counts received by CDC for these grantees. Consequently,
for some grantees we used HIV and AIDS case counts, but for others we
used only AIDS case counts. This approach reflects the data that would
have been used if funding allocations were based on the HIV and AIDS
case counts received by CDC in time for determining fiscal year 2004
allocations. Under the second approach, we used the same HIV and AIDS
case counts as our first approach, but supplemented these data with the
code-based HIV case counts collected by the grantees from which CDC did
not receive HIV data.[Footnote 116] We obtained these HIV case counts
directly from these jurisdictions.[Footnote 117] These case counts were
collected and reported to us by public health authorities. We also
received information from them regarding their HIV case-reporting
systems.
For both approaches, we calculated the grantee's percentage of the
total number of HIV/AIDS cases relative to all grantees for that
program and estimated the fiscal year 2004 grants that each would have
received.[Footnote 118] CARE Act formula allocations were calculated
both with certain hold-harmless and minimum-grant provisions and again
without those provisions.[Footnote 119] Eliminating hold-harmless and
minimum-grant provisions was done to show the full effect of
distributing fiscal year 2004 funding solely according to HIV/AIDS data
available at that time. We also estimated the effect of using HIV cases
and living AIDS cases for HOPWA base funding.
In our analyses of how the use of HIV cases would affect funding by
region, we use U.S. Census Bureau definitions to define regions of the
country. The Census Bureau divides the country into four regions:
Northeast, Midwest, South, and West.[Footnote 120] Table 11 lists the
four regions and the jurisdictions that constitute them.
Table 11: U.S. Census Bureau Regions:
Northeast:
Connecticut;
New York;
Maine;
Pennsylvania;
Massachusetts;
Rhode Island;
New Hampshire;
Vermont;
New Jersey;
Midwest:
Illinois;
Missouri;
Indiana;
Nebraska;
Iowa;
North Dakota;
Kansas;
Ohio;
Michigan;
South Dakota;
Minnesota;
Wisconsin;
South:
Alabama;
Mississippi;
Arkansas;
North Carolina;
Delaware;
Oklahoma;
District of Columbia;
South Carolina;
Florida;
Tennessee;
Georgia;
Texas;
Kentucky;
Virginia;
Louisiana;
West Virginia;
Maryland;
West:
Alaska;
Nevada;
Arizona;
New Mexico;
California;
Oregon;
Colorado;
Utah;
Hawaii;
Washington;
Idaho;
Wyoming;
Montana.
Source: U.S. Census Bureau.
[End of table]
Our analyses of the effect of using HIV case counts for determining
CARE Act and HOPWA funding rely on data whose reliability has been
questioned. In June 2004, the Secretary of Health and Human Services
determined that because of the problems associated with these data,
they should not currently be used in determining CARE Act funding. We
used these data in our analyses to give a general indication of the
effect of using HIV cases in future formula allocations as required by
the CARE Act. By using HIV/AIDS counts in determining CARE Act and
HOPWA funding, the number of persons on which funding is based would
increase. The effect on individual grantees would depend on the number
of reported HIV cases in the jurisdiction compared with the number
reported in other jurisdictions. The extent to which the use of HIV
cases could affect formula allocations cannot be determined by these
analyses because jurisdictions use different methods to identify HIV
cases, and it is unclear to what degree the resulting case counts are
comparable. However, we think our approaches in these analyses are
informative in light of the statutory requirement that HIV cases be
used in CARE Act funding formulas not later than fiscal year 2007.
To assess the reliability of the HIV and AIDS case-count data, we asked
HRSA, HUD, CDC, state, and local officials a series of questions about
how the data were collected and the methods used to ensure their
accuracy. We asked state and local officials about their HIV data only
when they were not accepted by CDC. On the basis of the information
provided regarding the verification of the reliability of these data,
we determined these data to be sufficiently reliable for the purposes
of our analyses.
Our analyses do not include the different costs of treating patients
with HIV and AIDS. The cost of serving persons who have HIV and AIDS
can vary substantially, depending on the stage of the disease. Patients
whose disease has progressed to AIDS often require more expensive drug
therapies and more intensive care than those whose disease has not
progressed to AIDS. One study found that the average annual cost of
treating an HIV patient was about $18,000 per year. However, the cost
ranged from about $14,000 per year for well patients with HIV to
$34,000 per year for patients with advanced-stage AIDS.[Footnote 121]
We performed our work from July 2004 through February 2006, in
accordance with generally accepted government auditing standards.
[End of section]
Appendix II: CARE Act Title I Awards, Fiscal Year 2004:
Eligible metropolitan area: Atlanta, Ga;
Base award: $9,268,937;
Supplemental award: $7,518,391;
Minority AIDS Initiative award: $1,552,404;
Total Title I award: $18,339,732;
Total Title I award per ELC[A]: $2,417.
Eligible metropolitan area: Austin, Tex;
Base award: $2,016,473;
Supplemental award: $1,559,617;
Minority AIDS Initiative award: $224,430;
Total Title I award: $3,800,520;
Total Title I award per ELC[A]: $2,302.
Eligible metropolitan area: Baltimore, Md;
Base award: $10,195,952;
Supplemental award: $7,615,994;
Minority AIDS Initiative award: $1,898,933;
Total Title I award: $19,710,879;
Total Title I award per ELC[A]: $2,361.
Eligible metropolitan area: Bergen-Passaic, N.J.[B];
Base award: $2,605,497;
Supplemental award: $2,002,220;
Minority AIDS Initiative award: $206,987;
Total Title I award: $4,814,704;
Total Title I award per ELC[A]: $2,306.
Eligible metropolitan area: Boston, Mass.[B,C];
Base award: $7,434,884;
Supplemental award: $6,630,052;
Minority AIDS Initiative award: $783,761;
Total Title I award: $14,848,697;
Total Title I award per ELC[A]: $2,459.
Eligible metropolitan area: Caguas, P.R;
Base award: $935,565;
Supplemental award: $735,726;
Minority AIDS Initiative award: $145,356;
Total Title I award: $1,816,647;
Total Title I award per ELC[A]: $2,372.
Eligible metropolitan area: Chicago, Ill;
Base award: $12,801,123;
Supplemental award: $10,363,895;
Minority AIDS Initiative award: $2,261,742;
Total Title I award: $25,426,760;
Total Title I award per ELC[A]: $2,426.
Eligible metropolitan area: Cleveland, Ohio[B];
Base award: $1,850,098;
Supplemental award: $1,379,848;
Minority AIDS Initiative award: $256,990;
Total Title I award: $3,486,936;
Total Title I award per ELC[A]: $2,308.
Eligible metropolitan area: Dallas, Tex;
Base award: $6,425,600;
Supplemental award: $5,378,653;
Minority AIDS Initiative award: $1,016,330;
Total Title I award: $12,820,583;
Total Title I award per ELC[A]: $2,437.
Eligible metropolitan area: Denver, Colo.[B];
Base award: $2,440,655;
Supplemental award: $1,843,081;
Minority AIDS Initiative award: $245,361;
Total Title I award: $4,529,097;
Total Title I award per ELC[A]: $2,273.
Eligible metropolitan area: Detroit, Mich;
Base award: $4,382,256;
Supplemental award: $3,427,753;
Minority AIDS Initiative award: $780,272;
Total Title I award: $8,590,281;
Total Title I award per ELC[A]: $2,394.
Eligible metropolitan area: District of Columbia[C];
Base award: $14,431,645;
Supplemental award: $9,840,164;
Minority AIDS Initiative award: $2,679,205;
Total Title I award: $26,951,014;
Total Title I award per ELC[A]: $2,281.
Eligible metropolitan area: Dutchess County, N.Y;
Base award: $639,995;
Supplemental award: $512,173;
Minority AIDS Initiative award: $79,074;
Total Title I award: $1,231,242;
Total Title I award per ELC[A]: $2,350.
Eligible metropolitan area: Fort Lauderdale, Fla;
Base award: $7,330,631;
Supplemental award: $6,349,097;
Minority AIDS Initiative award: $1,069,822;
Total Title I award: $14,749,550;
Total Title I award per ELC[A]: $2,457.
Eligible metropolitan area: Fort Worth, Tex;
Base award: $1,805,177;
Supplemental award: $1,386,868;
Minority AIDS Initiative award: $181,405;
Total Title I award: $3,373,450;
Total Title I award per ELC[A]: $2,282.
Eligible metropolitan area: Hartford, Conn;
Base award: $2,386,547;
Supplemental award: $1,899,397;
Minority AIDS Initiative award: $266,293;
Total Title I award: $4,552,237;
Total Title I award per ELC[A]: $2,330.
Eligible metropolitan area: Houston, Tex;
Base award: $9,416,722;
Supplemental award: $8,472,252;
Minority AIDS Initiative award: $1,239,598;
Total Title I award: $19,128,572;
Total Title I award per ELC[A]: $2,481.
Eligible metropolitan area: Jacksonville, Fla.[B];
Base award: $2,517,844;
Supplemental award: $1,873,132;
Minority AIDS Initiative award: $472,117;
Total Title I award: $4,863,093;
Total Title I award per ELC[A]: $2,371.
Eligible metropolitan area: Jersey City, N.J.[B];
Base award: $3,022,562;
Supplemental award: $2,548,825;
Minority AIDS Initiative award: $312,807;
Total Title I award: $5,884,194;
Total Title I award per ELC[A]: $2,424.
Eligible metropolitan area: Kansas City, Mo.[B, C];
Base award: $1,716,152;
Supplemental award: $1,358,374;
Minority AIDS Initiative award: $166,287;
Total Title I award: $3,240,813;
Total Title I award per ELC[A]: $2,503.
Eligible metropolitan area: Las Vegas, Nev.[C];
Base award: $2,375,554;
Supplemental award: $1,832,717;
Minority AIDS Initiative award: $265,130;
Total Title I award: $4,473,401;
Total Title I award per ELC[A]: $2,300.
Eligible metropolitan area: Los Angeles, Calif;
Base award: $18,540,316;
Supplemental award: $16,153,706;
Minority AIDS Initiative award: $1,950,099;
Total Title I award: $36,644,121;
Total Title I award per ELC[A]: $2,414.
Eligible metropolitan area: Miami, Fla;
Base award: $12,806,009;
Supplemental award: $10,268,761;
Minority AIDS Initiative award: $2,465,241;
Total Title I award: $25,540,011;
Total Title I award per ELC[A]: $2,436.
Eligible metropolitan area: Middlesex-Somerset-Hunterdon, N.J.[B];
Base award: $1,520,364;
Supplemental award: $988,206;
Minority AIDS Initiative award: $215,127;
Total Title I award: $2,723,697;
Total Title I award per ELC[A]: $2,200.
Eligible metropolitan area: Minneapolis-St. Paul, Minn.[B, C];
Base award: $1,587,346;
Supplemental award: $1,328,653;
Minority AIDS Initiative award: $177,916;
Total Title I award: $3,093,915;
Total Title I award per ELC[A]: $2,432.
Eligible metropolitan area: Nassau-Suffolk, N.Y.[B];
Base award: $3,182,104;
Supplemental award: $2,402,225;
Minority AIDS Initiative award: $367,460;
Total Title I award: $5,951,789;
Total Title I award per ELC[A]: $2,300.
Eligible metropolitan area: New Haven, Conn.[B];
Base award: $3,639,492;
Supplemental award: $3,012,393;
Minority AIDS Initiative award: $417,463;
Total Title I award: $7,069,348;
Total Title I award per ELC[A]: $2,400.
Eligible metropolitan area: New Orleans, La;
Base award: $3,852,184;
Supplemental award: $2,239,460;
Minority AIDS Initiative award: $695,384;
Total Title I award: $6,787,028;
Total Title I award per ELC[A]: $2,152.
Eligible metropolitan area: New York, N.Y;
Base award: $60,276,790;
Supplemental award: $52,106,068;
Minority AIDS Initiative award: $9,720,259;
Total Title I award: $122,103,117;
Total Title I award per ELC[A]: $2,474.
Eligible metropolitan area: Newark, N.J.[B];
Base award: $8,151,371;
Supplemental award: $6,076,957;
Minority AIDS Initiative award: $1,083,776;
Total Title I award: $15,312,104;
Total Title I award per ELC[A]: $2,297.
Eligible metropolitan area: Norfolk, Va.[C];
Base award: $2,732,193;
Supplemental award: $1,639,148;
Minority AIDS Initiative award: $448,860;
Total Title I award: $4,820,201;
Total Title I award per ELC[A]: $2,155.
Eligible metropolitan area: Oakland, Calif.[B];
Base award: $3,534,076;
Supplemental award: $2,614,717;
Minority AIDS Initiative award: $462,814;
Total Title I award: $6,611,607;
Total Title I award per ELC[A]: $2,318.
Eligible metropolitan area: Orange County, Calif;
Base award: $2,666,239;
Supplemental award: $2,282,192;
Minority AIDS Initiative award: $284,898;
Total Title I award: $5,233,329;
Total Title I award per ELC[A]: $2,397.
Eligible metropolitan area: Orlando, Fla;
Base award: $4,021,954;
Supplemental award: $3,028,863;
Minority AIDS Initiative award: $770,969;
Total Title I award: $7,821,786;
Total Title I award per ELC[A]: $2,375.
Eligible metropolitan area: Philadelphia, Pa.[C];
Base award: $12,038,992;
Supplemental award: $10,407,066;
Minority AIDS Initiative award: $2,002,427;
Total Title I award: $24,448,485;
Total Title I award per ELC[A]: $2,480.
Eligible metropolitan area: Phoenix, Ariz;
Base award: $3,480,889;
Supplemental award: $2,975,380;
Minority AIDS Initiative award: $358,158;
Total Title I award: $6,814,427;
Total Title I award per ELC[A]: $2,391.
Eligible metropolitan area: Ponce, P.R;
Base award: $1,414,340;
Supplemental award: $1,002,813;
Minority AIDS Initiative award: $301,178;
Total Title I award: $2,718,331;
Total Title I award per ELC[A]: $2,347.
Eligible metropolitan area: Portland, Oreg.[C];
Base award: $1,889,451;
Supplemental award: $1,572,205;
Minority AIDS Initiative award: $105,819;
Total Title I award: $3,567,475;
Total Title I award per ELC[A]: $2,306.
Eligible metropolitan area: Riverside-San Bernardino, Calif;
Base award: $3,913,252;
Supplemental award: $2,613,404;
Minority AIDS Initiative award: $296,527;
Total Title I award: $6,823,183;
Total Title I award per ELC[A]: $2,130.
Eligible metropolitan area: Sacramento, Calif.[B];
Base award: $1,558,276;
Supplemental award: $1,328,376;
Minority AIDS Initiative award: $81,399;
Total Title I award: $2,968,051;
Total Title I award per ELC[A]: $2,382.
Eligible metropolitan area: St. Louis, Mo.[C];
Base award: $2,412,195;
Supplemental award: $1,646,152;
Minority AIDS Initiative award: $312,807;
Total Title I award: $4,371,154;
Total Title I award per ELC[A]: $2,213.
Eligible metropolitan area: San Antonio, Tex;
Base award: $2,097,083;
Supplemental award: $1,400,297;
Minority AIDS Initiative award: $336,063;
Total Title I award: $3,833,443;
Total Title I award per ELC[A]: $2,233.
Eligible metropolitan area: San Diego, Calif;
Base award: $5,201,792;
Supplemental award: $4,554,583;
Minority AIDS Initiative award: $531,422;
Total Title I award: $10,287,797;
Total Title I award per ELC[A]: $2,416.
Eligible metropolitan area: San Francisco, Calif.[B];
Base award: $16,171,607;
Supplemental award: $13,199,079;
Minority AIDS Initiative award: $479,094;
Total Title I award: $29,849,780;
Total Title I award per ELC[A]: $4,137.
Eligible metropolitan area: San Jose, Calif.[B];
Base award: $1,411,781;
Supplemental award: $1,069,179;
Minority AIDS Initiative award: $175,590;
Total Title I award: $2,656,550;
Total Title I award per ELC[A]: $2,318.
Eligible metropolitan area: San Juan, P.R.[B];
Base award: $8,139,880;
Supplemental award: $5,255,408;
Minority AIDS Initiative award: $1,337,277;
Total Title I award: $14,732,565;
Total Title I award per ELC[A]: $2,222.
Eligible metropolitan area: Santa Rosa, Calif.[B];
Base award: $611,312;
Supplemental award: $469,370;
Minority AIDS Initiative award: $26,746;
Total Title I award: $1,107,428;
Total Title I award per ELC[A]: $2,298.
Eligible metropolitan area: Seattle, Wash.[B];
Base award: $3,024,172;
Supplemental award: $2,605,642;
Minority AIDS Initiative award: $212,801;
Total Title I award: $5,842,615;
Total Title I award per ELC[A]: $2,367.
Eligible metropolitan area: Tampa-St. Petersburg, Fla.[B];
Base award: $4,777,696;
Supplemental award: $3,348,920;
Minority AIDS Initiative award: $593,053;
Total Title I award: $8,719,669;
Total Title I award per ELC[A]: $2,250.
Eligible metropolitan area: Vineland-Millville-Bridgeton, N.J;
Base award: $473,889;
Supplemental award: $297,261;
Minority AIDS Initiative award: $76,748;
Total Title I award: $847,898;
Total Title I award per ELC[A]: $2,185.
Eligible metropolitan area: West Palm Beach, Fla.[B];
Base award: $4,577,648;
Supplemental award: $3,964,724;
Minority AIDS Initiative award: $866,323;
Total Title I award: $9,408,695;
Total Title I award per ELC[A]: $2,515.
Eligible metropolitan area: Total[D];
Base award: $305,704,561;
Supplemental award: $246,379,437;
Minority AIDS Initiative award: $43,258,002;
Total Title I award: $595,342,000.
Source: GAO analysis of HRSA data.
Notes: HRSA has awarded Minority AIDS Initiative grants to EMAs. HRSA
characterizes Minority AIDS Initiative grants to EMAs as Title I
grants.
[A] HRSA calculates a jurisdiction's ELCs by using data from CDC on the
reported AIDS case counts for the last 10 years and weighting those
numbers to account for the likelihood of death. The average total Title
I award per ELC was $2,380.
[B] EMA received hold-harmless funding that is included in base award.
[C] EMA boundaries include jurisdictions in more than one state.
[D] Individual entries may not sum to totals because of rounding.
[End of table]
[End of section]
Appendix III: CARE Act Title II Awards, Fiscal Year 2004:
Grantee: Alabama;
Base grant award: $4,042,811;
ADAP base grant award: $7,004,635;
Minority AIDS Initiative award: $77,828;
Emerging Communities award: $192,260;
ADAP Severe Need award: $824,913;
Total Title II award: $12,142,447;
Total Title II award per ELC[A]: $3,657.
Grantee: Alaska[B];
Base grant award: $500,000;
ADAP base grant award: $472,602;
Minority AIDS Initiative award: $2,103;
Total Title II award: $974,705;
Total Title II award per ELC[A]: $4,351.
Grantee: Arizona;
Base grant award: $3,201,547;
ADAP base grant award: $8,392,903;
Minority AIDS Initiative award: $54,164;
Total Title II award: $11,648,614;
Total Title II award per ELC[A]: $2,928.
Grantee: Arkansas;
Base grant award: $1,785,169;
ADAP base grant award: $3,116,716;
Minority AIDS Initiative award: $31,946;
Total Title II award: $4,933,831;
Total Title II award per ELC[A]: $3,366.
Grantee: California;
Base grant award: $31,236,233;
ADAP base grant award: $89,623,465;
Minority AIDS Initiative award: $565,829;
Total Title II award: $121,425,527;
Total Title II award per ELC[A]: $2,858.
Grantee: Colorado;
Base grant award: $2,117,525;
ADAP base grant award: $5,607,928;
Minority AIDS Initiative award: $34,181;
ADAP Severe Need award: $660,427;
Total Title II award: $8,420,061;
Total Title II award per ELC[A]: $3,168.
Grantee: Connecticut;
Base grant award: $3,779,591;
ADAP base grant award: $11,315,018;
Minority AIDS Initiative award: $81,114;
Total Title II award: $15,175,723;
Total Title II award per ELC[A]: $2,830.
Grantee: Delaware;
Base grant award: $1,848,490;
ADAP base grant award: $3,202,722;
Minority AIDS Initiative award: $39,177;
Emerging Communities award: $250,406;
Total Title II award: $5,340,795;
Total Title II award per ELC[A]: $3,518.
Grantee: District of Columbia;
Base grant award: $4,305,124;
ADAP base grant award: $13,842,594;
Minority AIDS Initiative award: $175,770;
Total Title II award: $18,323,488;
Total Title II award per ELC[A]: $2,793.
Grantee: Florida;
Base grant award: $29,860,865;
ADAP base grant award: $80,386,630;
Minority AIDS Initiative award: $893,442;
Emerging Communities award: $528,011;
Total Title II award: $111,668,948;
Total Title II award per ELC[A]: $2,931.
Grantee: Georgia;
Base grant award: $9,408,492;
ADAP base grant award: $23,684,951;
Minority AIDS Initiative award: $260,828;
ADAP Severe Need award: $2,789,298;
Total Title II award: $36,143,569;
Total Title II award per ELC[A]: $3,220.
Grantee: Hawaii;
Base grant award: $1,203,101;
ADAP base grant award: $2,084,512;
Minority AIDS Initiative award: $10,517;
Total Title II award: $3,298,130;
Total Title II award per ELC[A]: $3,338.
Grantee: Idaho[B];
Base grant award: $500,000;
ADAP base grant award: $464,163;
Minority AIDS Initiative award: $526;
ADAP Severe Need award: $54,663;
Total Title II award: $1,019,352;
Total Title II award per ELC[A]: $4,633.
Grantee: Illinois;
Base grant award: $8,837,193;
ADAP base grant award: $25,746,254;
Minority AIDS Initiative award: $287,121;
Total Title II award: $34,870,568;
Total Title II award per ELC[A]: $2,858.
Grantee: Indiana;
Base grant award: $3,768,825;
ADAP base grant award: $6,529,924;
Minority AIDS Initiative award: $47,196;
Emerging Communities award: $1,057,005;
Total Title II award: $11,402,950;
Total Title II award per ELC[A]: $3,684.
Grantee: Iowa;
Base grant award: $753,765;
ADAP base grant award: $1,305,985;
Minority AIDS Initiative award: $7,625;
Total Title II award: $2,067,375;
Total Title II award per ELC[A]: $3,340.
Grantee: Kansas;
Base grant award: $1,007,120;
ADAP base grant award: $2,045,495;
Minority AIDS Initiative award: $8,545;
Total Title II award: $3,061,160;
Total Title II award per ELC[A]: $3,192.
Grantee: Kentucky;
Base grant award: $2,358,712;
ADAP base grant award: $4,086,741;
Minority AIDS Initiative award: $22,875;
Emerging Communities award: $220,395;
ADAP Severe Need award: $481,282;
Total Title II award: $7,170,005;
Total Title II award per ELC[A]: $3,702.
Grantee: Louisiana;
Base grant award: $6,211,002;
ADAP base grant award: $13,829,935;
Minority AIDS Initiative award: $192,072;
Emerging Communities award: $1,091,712;
ADAP Severe Need award: $1,628,705;
Total Title II award: $22,953,426;
Total Title II award per ELC[A]: $3,502.
Grantee: Maine[B];
Base grant award: $500,000;
ADAP base grant award: $833,383;
Minority AIDS Initiative award: $526;
ADAP Severe Need award: $36,525;
Total Title II award: $1,370,434;
Total Title II award per ELC[A]: $3,469.
Grantee: Maryland;
Base grant award: $8,446,358;
ADAP base grant award: $25,746,254;
Minority AIDS Initiative award: $317,359;
Total Title II award: $34,509,971;
Total Title II award per ELC[A]: $2,828.
Grantee: Massachusetts;
Base grant award: $5,223,382;
ADAP base grant award: $14,684,416;
Minority AIDS Initiative award: $99,257;
Emerging Communities award: $183,819;
Total Title II award: $20,190,874;
Total Title II award per ELC[A]: $2,901.
Grantee: Michigan;
Base grant award: $4,335,555;
ADAP base grant award: $11,002,763;
Minority AIDS Initiative award: $117,531;
Total Title II award: $15,455,849;
Total Title II award per ELC[A]: $2,964.
Grantee: Minnesota;
Base grant award: $1,026,762;
ADAP base grant award: $3,010,727;
Minority AIDS Initiative award: $22,218;
Total Title II award: $4,059,707;
Total Title II award per ELC[A]: $2,845.
Grantee: Mississippi;
Base grant award: $3,345,060;
ADAP base grant award: $5,795,703;
Minority AIDS Initiative award: $88,477;
Emerging Communities award: $225,710;
Total Title II award: $9,454,950;
Total Title II award per ELC[A]: $3,442.
Grantee: Missouri;
Base grant award: $2,783,489;
ADAP base grant award: $7,409,723;
Minority AIDS Initiative award: $56,925;
Total Title II award: $10,250,137;
Total Title II award per ELC[A]: $2,919.
Grantee: Montana[B];
Base grant award: $500,000;
ADAP base grant award: $310,145;
Minority AIDS Initiative award: $526;
Total Title II award: $810,671;
Total Title II award per ELC[A]: $5,515.
Grantee: Nebraska;
Base grant award: $639,300;
ADAP base grant award: $1,107,661;
Minority AIDS Initiative award: $10,254;
ADAP Severe Need award: $130,445;
Total Title II award: $1,887,660;
Total Title II award per ELC[A]: $3,596.
Grantee: Nevada;
Base grant award: $1,684,896;
ADAP base grant award: $4,738,678;
Minority AIDS Initiative award: $32,735;
Total Title II award: $6,456,309;
Total Title II award per ELC[A]: $2,875.
Grantee: New Hampshire[B];
Base grant award: $500,000;
ADAP base grant award: $755,319;
Minority AIDS Initiative award: $1,709;
Total Title II award: $1,257,028;
Total Title II award per ELC[A]: $3,511.
Grantee: New Jersey;
Base grant award: $12,302,631;
ADAP base grant award: $34,877,598;
Minority AIDS Initiative award: $279,365;
Emerging Communities award: $181,943;
Total Title II award: $47,641,537;
Total Title II award per ELC[A]: $2,882.
Grantee: New Mexico;
Base grant award: $1,195,795;
ADAP base grant award: $2,127,024;
Minority AIDS Initiative award: $15,644;
Total Title II award: $3,338,463;
Total Title II award per ELC[A]: $3,400.
Grantee: New York;
Base grant award: $42,659,431;
ADAP base grant award: $124,956,784;
Minority AIDS Initiative award: $1,252,475;
Emerging Communities award: $394,523;
Total Title II award: $169,263,213;
Total Title II award per ELC[A]: $2,858.
Grantee: North Carolina;
Base grant award: $7,403,985;
ADAP base grant award: $12,834,095;
Minority AIDS Initiative award: $197,593;
Emerging Communities award: $708,703;
ADAP Severe Need award: $1,511,429;
Total Title II award: $22,655,805;
Total Title II award per ELC[A]: $3,724.
Grantee: North Dakota[C];
Base grant award: $200,000;
ADAP base grant award: $92,543;
Minority AIDS Initiative award: $0;
Total Title II award: $292,543;
Total Title II award per ELC[A]: $6,803.
Grantee: Ohio;
Base grant award: $5,448,305;
ADAP base grant award: $10,909,930;
Minority AIDS Initiative award: $67,968;
Emerging Communities award: $336,063;
Total Title II award: $16,762,266;
Total Title II award per ELC[A]: $3,242.
Grantee: Oklahoma;
Base grant award: $2,054,284;
ADAP base grant award: $3,655,707;
Minority AIDS Initiative award: $23,795;
Emerging Communities award: $190,071;
ADAP Severe Need award: $419,165;
Total Title II award: $6,343,022;
Total Title II award per ELC[A]: $3,760.
Grantee: Oregon;
Base grant award: $1,664,149;
ADAP base grant award: $4,225,989;
Minority AIDS Initiative award: $12,489;
Total Title II award: $5,902,627;
Total Title II award per ELC[A]: $2,947.
Grantee: Pennsylvania;
Base grant award: $10,779,206;
ADAP base grant award: $27,090,216;
Minority AIDS Initiative award: $258,856;
Emerging Communities award: $188,196;
Total Title II award: $38,316,474;
Total Title II award per ELC[A]: $2,984.
Grantee: Puerto Rico;
Base grant award: $8,238,917;
ADAP base grant award: $22,598,388;
Minority AIDS Initiative award: $260,697;
ADAP Severe Need award: $2,661,337;
Total Title II award: $33,759,339;
Total Title II award per ELC[A]: $3,152.
Grantee: Rhode Island;
Base grant award: $1,103,249;
ADAP base grant award: $1,911,506;
Minority AIDS Initiative award: $14,461;
Emerging Communities award: $160,060;
Total Title II award: $3,189,276;
Total Title II award per ELC[A]: $3,520.
Grantee: South Carolina;
Base grant award: $6,774,143;
ADAP base grant award: $11,736,984;
Minority AIDS Initiative award: $164,858;
Emerging Communities award: $647,118;
ADAP Severe Need award: $1,382,225;
Total Title II award: $20,705,328;
Total Title II award per ELC[A]: $3,722.
Grantee: South Dakota[B];
Base grant award: $500,000;
ADAP base grant award: $204,654;
Minority AIDS Initiative award: $1,052;
Total Title II award: $705,706;
Total Title II award per ELC[A]: $7,275.
Grantee: Tennessee;
Base grant award: $6,185,987;
ADAP base grant award: $12,018,438;
Minority AIDS Initiative award: $122,526;
Emerging Communities award: $2,851,283;
Total Title II award: $21,178,234;
Total Title II award per ELC[A]: $4,169.
Grantee: Texas;
Base grant award: $19,125,106;
ADAP base grant award: $50,471,351;
Minority AIDS Initiative award: $469,070;
ADAP Severe Need award: $5,943,843;
Total Title II award: $76,009,370;
Total Title II award per ELC[A]: $3,177.
Grantee: Utah;
Base grant award: $1,074,024;
ADAP base grant award: $1,980,565;
Minority AIDS Initiative award: $7,099;
Emerging Communities award: $173,503;
Total Title II award: $3,235,191;
Total Title II award per ELC[A]: $3,668.
Grantee: Vermont[B];
Base grant award: $500,000;
ADAP base grant award: $382,007;
Minority AIDS Initiative award: $1,052;
Total Title II award: $883,059;
Total Title II award per ELC[A]: $4,879.
Grantee: Virginia;
Base grant award: $5,929,341;
ADAP base grant award: $14,498,751;
Minority AIDS Initiative award: $145,007;
Emerging Communities award: $244,779;
ADAP Severe Need award: $1,707,470;
Total Title II award: $22,525,348;
Total Title II award per ELC[A]: $3,278.
Grantee: Washington;
Base grant award: $3,118,978;
ADAP base grant award: $7,966,718;
Minority AIDS Initiative award: $35,890;
Total Title II award: $11,121,586;
Total Title II award per ELC[A]: $2,945.
Grantee: West Virginia;
Base grant award: $713,239;
ADAP base grant award: $1,303,875;
Minority AIDS Initiative award: $4,733;
ADAP Severe Need award: $153,553;
Total Title II award: $2,175,400;
Total Title II award per ELC[A]: $3,520.
Grantee: Wisconsin;
Base grant award: $1,831,726;
ADAP base grant award: $3,179,514;
Minority AIDS Initiative award: $28,791;
Emerging Communities award: $174,440;
ADAP Severe Need award: $374,441;
Total Title II award: $5,588,912;
Total Title II award per ELC[A]: $3,709.
Grantee: Wyoming[C];
Base grant award: $200,000;
ADAP base grant award: $160,347;
Minority AIDS Initiative award: $0;
Total Title II award: $360,347;
Total Title II award per ELC[A]: $4,741.
Grantee: Total;
Base grant award: $284,712,863;
ADAP base grant award: $727,320,929;
Minority AIDS Initiative award: $6,903,797;
Emerging Communities award: $10,000,000;
ADAP Severe Need award: $20,759,721;
Total Title II award: $1,049,697,310.
Source: GAO analysis of HRSA data.
Notes: HRSA has awarded grants for Minority AIDS Initiative grants to
states and territories. HRSA characterizes Minority AIDS Initiative
grants to states and territories as Title II grants.
In addition to the grantees listed, American Samoa, the Federated
States of Micronesia, Guam, the Republic of the Marshall Islands, the
Commonwealth of the Northern Mariana Islands, the Republic of Palau,
and the Virgin Islands also received Title II funding ranging from a
total of $50,000 to $1,048,657.
[A] HRSA calculates a jurisdiction's ELCs by using data from CDC on the
reported AIDS case counts for the last 10 years and weighting those
numbers to account for the likelihood of death. The average total Title
II award per ELC was $3,559.
[B] State received a Title II base award of $500,000, the minimum it
could receive based on the number of ELCs in the state.
[C] State received a Title II base award of $200,000, the minimum it
could receive based on the number of ELCs in the state.
[End of table]
[End of section]
Appendix IV: HOPWA Formula Grantees and Award Amounts, Fiscal Year
2004:
Grantee: Alabama;
Base funding: $1,139,000;
Total formula funding: $1,139,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $444.
Grantee: Albany, N.Y;
Base funding: $429,000;
Total formula funding: $429,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $497.
Grantee: Arizona;
Base funding: $164,000;
Total formula funding: $164,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $474.
Grantee: Arkansas;
Base funding: $752,000;
Total formula funding: $752,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $418.
Grantee: Atlanta, Ga;
Base funding: $4,262,000;
Bonus funding[A]: $637,000;
Total formula funding: $4,899,000;
Total formula funding per cumulative AIDS case[B]: $264;
Total formula funding per living AIDS case[C]: $573.
Grantee: Augusta, Ga;
Base funding: $373,000;
Total formula funding: $373,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $455.
Grantee: Austin, Tex;
Base funding: $988,000;
Total formula funding: $988,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $520.
Grantee: Baltimore, Md;
Base funding: $3,940,000;
Bonus funding[A]: $3,996,000;
Total formula funding: $7,936,000;
Total formula funding per cumulative AIDS case[B]: $463;
Total formula funding per living AIDS case[C]: $1,039.
Grantee: Baton Rouge, La;
Base funding: $666,000;
Bonus funding[A]: $1,147,000;
Total formula funding: $1,813,000;
Total formula funding per cumulative AIDS case[B]: $626;
Total formula funding per living AIDS case[C]: $1,290.
Grantee: Birmingham, Ala;
Base funding: $520,000;
Total formula funding: $520,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $461.
Grantee: Boston, Mass;
Base funding: $1,829,000;
Total formula funding: $1,829,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $563.
Grantee: Bridgeport, Conn;
Base funding: $752,000;
Bonus funding[A]: $27,000;
Total formula funding: $779,000;
Total formula funding per cumulative AIDS case[B]: $238;
Total formula funding per living AIDS case[C]: $476.
Grantee: Buffalo, N.Y;
Base funding: $472,000;
Total formula funding: $472,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $523.
Grantee: California;
Base funding: $3,042,000;
Total formula funding: $3,042,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $518.
Grantee: Cambridge, Mass;
Base funding: $659,000;
Total formula funding: $659,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $518.
Grantee: Camden, N.J;
Base funding: $657,000;
Total formula funding: $657,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $567.
Grantee: Charleston, S.C;
Base funding: $411,000;
Bonus funding[A]: $7,000;
Total formula funding: $418,000;
Total formula funding per cumulative AIDS case[B]: $234;
Total formula funding per living AIDS case[C]: $480.
Grantee: Charlotte, N.C;
Base funding: $571,000;
Total formula funding: $571,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $450.
Grantee: Chicago, Ill;
Base funding: $5,622,000;
Bonus funding[A]: $2,716,000;
Total formula funding: $8,338,000;
Total formula funding per cumulative AIDS case[B]: $341;
Total formula funding per living AIDS case[C]: $805.
Grantee: Cincinnati, Ohio;
Base funding: $550,000;
Total formula funding: $550,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $523.
Grantee: Cleveland, Ohio;
Base funding: $854,000;
Total formula funding: $854,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $479.
Grantee: Colorado;
Base funding: $366,000;
Total formula funding: $366,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $462.
Grantee: Columbia, S.C;
Base funding: $626,000;
Bonus funding[A]: $644,000;
Total formula funding: $1,270,000;
Total formula funding per cumulative AIDS case[B]: $466;
Total formula funding per living AIDS case[C]: $824.
Grantee: Columbus, Ohio;
Base funding: $584,000;
Total formula funding: $584,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $619.
Grantee: Connecticut;
Base funding: $251,000;
Total formula funding: $251,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $479.
Grantee: Dallas, Tex;
Base funding: $3,192,000;
Total formula funding: $3,192,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $496.
Grantee: Delaware;
Base funding: $164,000;
Total formula funding: $164,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $463.
Grantee: Denver, Colo;
Base funding: $1,424,000;
Total formula funding: $1,424,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $547.
Grantee: Detroit, Mich;
Base funding: $1,624,000;
Bonus funding[A]: $355,000;
Total formula funding: $1,979,000;
Total formula funding per cumulative AIDS case[B]: $280;
Total formula funding per living AIDS case[C]: $749.
Grantee: District of Columbia;
Base funding: $5,626,000;
Bonus funding[A]: $6,176,000;
Total formula funding: $11,802,000;
Total formula funding per cumulative AIDS case[B]: $482;
Total formula funding per living AIDS case[C]: $939.
Grantee: Florida;
Base funding: $4,063,000;
Total formula funding: $4,063,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $489.
Grantee: Fort Lauderdale, Fla;
Base funding: $3,337,000;
Bonus funding[A]: $2,903,000;
Total formula funding: $6,240,000;
Total formula funding per cumulative AIDS case[B]: $430;
Total formula funding per living AIDS case[C]: $954.
Grantee: Fort Worth, Tex;
Base funding: $835,000;
Total formula funding: $835,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $500.
Grantee: Gaithersburg, Md;
Base funding: $535,000;
Total formula funding: $535,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $467.
Grantee: Georgia;
Base funding: $1,515,000;
Total formula funding: $1,515,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $469.
Grantee: Hartford, Conn;
Base funding: $1,023,000;
Total formula funding: $1,023,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $460.
Grantee: Hawaii;
Base funding: $181,000;
Total formula funding: $181,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $439.
Grantee: Honolulu, Hawaii;
Base funding: $452,000;
Total formula funding: $452,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $571.
Grantee: Houston, Tex;
Base funding: $5,068,000;
Total formula funding: $5,068,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $591.
Grantee: Illinois;
Base funding: $864,000;
Total formula funding: $864,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $466.
Grantee: Indiana;
Base funding: $836,000;
Total formula funding: $836,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $500.
Grantee: Indianapolis, Ind;
Base funding: $759,000;
Total formula funding: $759,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $476.
Grantee: Iowa;
Base funding: $347,000;
Total formula funding: $347,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $511.
Grantee: Islip, N.Y;
Base funding: $1,660,000;
Total formula funding: $1,660,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $577.
Grantee: Jackson, Miss;
Base funding: $449,000;
Bonus funding[A]: $275,000;
Total formula funding: $724,000;
Total formula funding per cumulative AIDS case[B]: $371;
Total formula funding per living AIDS case[C]: $728.
Grantee: Jacksonville, Fla;
Base funding: $1,195,000;
Bonus funding[A]: $369,000;
Total formula funding: $1,564,000;
Total formula funding per cumulative AIDS case[B]: $301;
Total formula funding per living AIDS case[C]: $623.
Grantee: Kansas;
Base funding: $363,000;
Total formula funding: $363,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $562.
Grantee: Kansas City, Mo;
Base funding: $978,000;
Total formula funding: $978,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $506.
Grantee: Kentucky;
Base funding: $423,000;
Total formula funding: $423,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $418.
Grantee: Las Vegas, Nev;
Base funding: $916,000;
Total formula funding: $916,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $455.
Grantee: Los Angeles, Calif;
Base funding: $10,476,000;
Total formula funding: $10,476,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $622.
Grantee: Louisiana;
Base funding: $940,000;
Total formula funding: $940,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $488.
Grantee: Louisville, Ky;
Base funding: $462,000;
Total formula funding: $462,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $443.
Grantee: Maryland;
Base funding: $345,000;
Total formula funding: $345,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $453.
Grantee: Massachusetts;
Base funding: $525,000;
Total formula funding: $525,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $521.
Grantee: Memphis, Tenn;
Base funding: $920,000;
Bonus funding[A]: $1,214,000;
Total formula funding: $2,134,000;
Total formula funding per cumulative AIDS case[B]: $533;
Total formula funding per living AIDS case[C]: $1,000.
Grantee: Miami, Fla;
Base funding: $6,149,000;
Bonus funding[A]: $4,566,000;
Total formula funding: $10,715,000;
Total formula funding per cumulative AIDS case[B]: $400;
Total formula funding per living AIDS case[C]: $934.
Grantee: Michigan;
Base funding: $911,000;
Total formula funding: $911,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $546.
Grantee: Milwaukee, Wis;
Base funding: $512,000;
Total formula funding: $512,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $511.
Grantee: Minneapolis, Minn;
Base funding: $839,000;
Total formula funding: $839,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $508.
Grantee: Minnesota;
Base funding: $110,000;
Total formula funding: $110,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $529.
Grantee: Mississippi;
Base funding: $756,000;
Total formula funding: $756,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $484.
Grantee: Missouri;
Base funding: $496,000;
Total formula funding: $496,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $471.
Grantee: Nashville, Tenn;
Base funding: $737,000;
Total formula funding: $737,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $387.
Grantee: Nevada;
Base funding: $238,000;
Total formula funding: $238,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $499.
Grantee: New Haven, Conn;
Base funding: $937,000;
Bonus funding[A]: $295,000;
Total formula funding: $1,232,000;
Total formula funding per cumulative AIDS case[B]: $302;
Total formula funding per living AIDS case[C]: $605.
Grantee: New Jersey;
Base funding: $1,106,000;
Bonus funding[A]: $;
Total formula funding: $1,106,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $593.
Grantee: New Mexico;
Base funding: $533,000;
Total formula funding: $533,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $501.
Grantee: New Orleans, La;
Base funding: $1,785,000;
Bonus funding[A]: $1,207,000;
Total formula funding: $2,992,000;
Total formula funding per cumulative AIDS case[B]: $385;
Total formula funding per living AIDS case[C]: $887.
Grantee: New York;
Base funding: $1,776,000;
Total formula funding: $1,776,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $500.
Grantee: New York, N.Y;
Base funding: $33,487,000;
Bonus funding[A]: $26,868,000;
Total formula funding: $60,355,000;
Total formula funding per cumulative AIDS case[B]: $414;
Total formula funding per living AIDS case[C]: $1,099.
Grantee: Newark, N.J;
Base funding: $4,297,000;
Bonus funding[A]: $885,000;
Total formula funding: $5,182,000;
Total formula funding per cumulative AIDS case[B]: $277;
Total formula funding per living AIDS case[C]: $828.
Grantee: North Carolina;
Base funding: $2,082,000;
Total formula funding: $2,082,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $437.
Grantee: Oakland, Calif;
Base funding: $2,006,000;
Total formula funding: $2,006,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $595.
Grantee: Ohio;
Base funding: $1,041,000;
Total formula funding: $1,041,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $524.
Grantee: Oklahoma;
Base funding: $518,000;
Total formula funding: $518,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $521.
Grantee: Oklahoma City, Okla;
Base funding: $466,000;
Total formula funding: $466,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $509.
Grantee: Orlando, Fla;
Base funding: $1,660,000;
Bonus funding[A]: $1,529,000;
Total formula funding: $3,189,000;
Total formula funding per cumulative AIDS case[B]: $441;
Total formula funding per living AIDS case[C]: $913.
Grantee: Pennsylvania;
Base funding: $1,540,000;
Total formula funding: $1,540,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $445.
Grantee: Philadelphia, Pa;
Base funding: $4,340,000;
Bonus funding[A]: $3,292,000;
Total formula funding: $7,632,000;
Total formula funding per cumulative AIDS case[B]: $404;
Total formula funding per living AIDS case[C]: $799.
Grantee: Phoenix, Ariz;
Base funding: $1,434,000;
Total formula funding: $1,434,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $490.
Grantee: Pittsburgh, Pa;
Base funding: $626,000;
Total formula funding: $626,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $568.
Grantee: Portland, Oreg;
Base funding: $1,006,000;
Total formula funding: $1,006,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $523.
Grantee: Poughkeepsie, N.Y;
Base funding: $604,000;
Total formula funding: $604,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $556.
Grantee: Providence, R.I;
Base funding: $807,000;
Total formula funding: $807,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $498.
Grantee: Puerto Rico;
Base funding: $1,748,000;
Total formula funding: $1,748,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $584.
Grantee: Richmond, Va;
Base funding: $692,000;
Total formula funding: $692,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $527.
Grantee: Riverside, Calif;
Base funding: $1,772,000;
Total formula funding: $1,772,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $462.
Grantee: Rochester, N.Y;
Base funding: $597,000;
Total formula funding: $597,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $460.
Grantee: Sacramento, Calif;
Base funding: $844,000;
Total formula funding: $844,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $574.
Grantee: St. Louis, Mo;
Base funding: $1,217,000;
Total formula funding: $1,217,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $491.
Grantee: Salt Lake City, Utah;
Base funding: $386,000;
Total formula funding: $386,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $455.
Grantee: San Antonio, Tex;
Base funding: $1,027,000;
Total formula funding: $1,027,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $480.
Grantee: San Diego, Calif;
Base funding: $2,683,000;
Total formula funding: $2,683,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $522.
Grantee: San Francisco, Calif;
Base funding: $6,698,000;
Bonus funding[A]: $1,864,000;
Total formula funding: $8,562,000;
Total formula funding per cumulative AIDS case[B]: $294;
Total formula funding per living AIDS case[C]: $1,130.
Grantee: San Jose, Calif;
Base funding: $792,000;
Total formula funding: $792,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $538.
Grantee: San Juan, P.R;
Base funding: $4,585,000;
Bonus funding[A]: $2,555,000;
Total formula funding: $7,140,000;
Total formula funding per cumulative AIDS case[B]: $358;
Total formula funding per living AIDS case[C]: $1,000.
Grantee: Santa Ana, Calif;
Base funding: $1,436,000;
Total formula funding: $1,436,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $489.
Grantee: Sarasota, Fla;
Base funding: $397,000;
Total formula funding: $397,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $501.
Grantee: Seattle, Wash;
Base funding: $1,688,000;
Total formula funding: $1,688,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $524.
Grantee: South Carolina;
Base funding: $1,387,000;
Total formula funding: $1,387,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $446.
Grantee: Springfield, Mass;
Base funding: $461,000;
Total formula funding: $461,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $535.
Grantee: Tampa, Fla;
Base funding: $2,221,000;
Bonus funding[A]: $168,000;
Total formula funding: $2,389,000;
Total formula funding per cumulative AIDS case[B]: $247;
Total formula funding per living AIDS case[C]: $569.
Grantee: Tennessee;
Base funding: $739,000;
Total formula funding: $739,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $438.
Grantee: Texas;
Base funding: $2,736,000;
Total formula funding: $2,736,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $454.
Grantee: Tucson, Ariz;
Base funding: $402,000;
Total formula funding: $402,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $515.
Grantee: Utah;
Base funding: $120,000;
Total formula funding: $120,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $467.
Grantee: Virginia;
Base funding: $640,000;
Total formula funding: $640,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $499.
Grantee: Virginia Beach, Va;
Base funding: $1,022,000;
Total formula funding: $1,022,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $505.
Grantee: Wake County, N.C;
Base funding: $345,000;
Bonus funding[A]: $7,000;
Total formula funding: $352,000;
Total formula funding per cumulative AIDS case[B]: $234;
Total formula funding per living AIDS case[C]: $408.
Grantee: Warren, Mich;
Base funding: $405,000;
Total formula funding: $405,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $571.
Grantee: Washington;
Base funding: $652,000;
Total formula funding: $652,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $480.
Grantee: West Palm Beach, Fla;
Base funding: $2,019,000;
Bonus funding[A]: $1,817,000;
Total formula funding: $3,836,000;
Total formula funding per cumulative AIDS case[B]: $436;
Total formula funding per living AIDS case[C]: $933.
Grantee: Wilmington, Del;
Base funding: $566,000;
Bonus funding[A]: $232,000;
Total formula funding: $798,000;
Total formula funding per cumulative AIDS case[B]: $325;
Total formula funding per living AIDS case[C]: $624.
Grantee: Wisconsin;
Base funding: $405,000;
Total formula funding: $405,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $509.
Grantee: Woodbridge, N.J;
Base funding: $1,462,000;
Total formula funding: $1,462,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $627.
Grantee: Worcester, Mass;
Base funding: $369,000;
Total formula funding: $369,000;
Total formula funding per cumulative AIDS case[B]: $230;
Total formula funding per living AIDS case[C]: $480.
Grantee: Total;
Base funding: $197,288,000;
Bonus funding[A]: $65,751,000;
Total formula funding: $263,039,000.
Sources: GAO analysis of CDC and HUD data.
[A] Bonus grants were awarded to EMSAs that have a higher-than-average
per capita incidence of AIDS over the previous year.
[B] The average formula funding per cumulative AIDS case was $260.
[C] The number of living AIDS cases was calculated by subtracting the
number of reported deaths among AIDS cases in a jurisdiction from the
number of reported cases. The average formula funding per living AIDS
case was $573.
[End of table]
[End of section]
Appendix V: HOPWA Base Funding Allocations Using Cumulative and Living
AIDS Cases, Fiscal Year 2004:
Grantee: Alabama;
Base funding: $1,139,000;
Cumulative AIDS cases: 4,969;
Percent of cumulative AIDS cases: 0.58%;
Living AIDS cases[A]: 2,568;
Percent of living AIDS cases: 0.70%;
Funding if allocated using living AIDS cases: $1,378,278;
Difference in funding[B]: -$239,278.
Grantee: Albany, N.Y;
Base funding: $429,000;
Cumulative AIDS cases: 1,867;
Percent of cumulative AIDS cases: 0.22%;
Living AIDS cases[A]: 864;
Percent of living AIDS cases: 0.24%;
Funding if allocated using living AIDS cases: $463,720;
Difference in funding[B]: -$34,720.
Grantee: Arizona;
Base funding: $164,000;
Cumulative AIDS cases: 712;
Percent of cumulative AIDS cases: 0.08%;
Living AIDS cases[A]: 346;
Percent of living AIDS cases: 0.09%;
Funding if allocated using living AIDS cases: $185,703;
Difference in funding[B]: -$21,703.
Grantee: Arkansas;
Base funding: $752,000;
Cumulative AIDS cases: 3,274;
Percent of cumulative AIDS cases: 0.38%;
Living AIDS cases[A]: 1,799;
Percent of living AIDS cases: 0.49%;
Funding if allocated using living AIDS cases: $965,546;
Difference in funding[B]: -$213,546.
Grantee: Atlanta, Ga;
Base funding: $4,262,000;
Cumulative AIDS cases: 18,554;
Percent of cumulative AIDS cases: 2.16%;
Living AIDS cases[A]: 8,557;
Percent of living AIDS cases: 2.33%;
Funding if allocated using living AIDS cases: $4,592,649;
Difference in funding[B]: -$330,649.
Grantee: Augusta, Ga;
Base funding: $373,000;
Cumulative AIDS cases: 1,623;
Percent of cumulative AIDS cases: 0.19%;
Living AIDS cases[A]: 819;
Percent of living AIDS cases: 0.22%;
Funding if allocated using living AIDS cases: $439,568;
Difference in funding[B]: -$66,568.
Grantee: Austin, Tex;
Base funding: $988,000;
Cumulative AIDS cases: 4,302;
Percent of cumulative AIDS cases: 0.50%;
Living AIDS cases[A]: 1,899;
Percent of living AIDS cases: 0.52%;
Funding if allocated using living AIDS cases: $1,019,217;
Difference in funding[B]: -$31,217.
Grantee: Baltimore, Md;
Base funding: $3,940,000;
Cumulative AIDS cases: 17,150;
Percent of cumulative AIDS cases: 2.00%;
Living AIDS cases[A]: 7,641;
Percent of living AIDS cases: 2.08%;
Funding if allocated using living AIDS cases: $4,101,020;
Difference in funding[B]: -$161,020.
Grantee: Baton Rouge, La;
Base funding: $666,000;
Cumulative AIDS cases: 2,898;
Percent of cumulative AIDS cases: 0.34%;
Living AIDS cases[A]: 1,405;
Percent of living AIDS cases: 0.38%;
Funding if allocated using living AIDS cases: $754,081;
Difference in funding[B]: -$ 88,081.
Grantee: Birmingham, Ala;
Base funding: $520,000;
Cumulative AIDS cases: 2,265;
Percent of cumulative AIDS cases: 0.26%;
Living AIDS cases[A]: 1,127;
Percent of living AIDS cases: 0.31%;
Funding if allocated using living AIDS cases: $604,875;
Difference in funding[B]: -$ 84,875.
Grantee: Boston, Mass;
Base funding: $1,829,000;
Cumulative AIDS cases: 7,960;
Percent of cumulative AIDS cases: 0.93%;
Living AIDS cases[A]: 3,248;
Percent of living AIDS cases: 0.88%;
Funding if allocated using living AIDS cases: $1,743,242;
Difference in funding[B]: $85,758.
Grantee: Bridgeport, Conn;
Base funding: $752,000;
Cumulative AIDS cases: 3,275;
Percent of cumulative AIDS cases: 0.38%;
Living AIDS cases[A]: 1,637;
Percent of living AIDS cases: 0.45%;
Funding if allocated using living AIDS cases: $878,598;
Difference in funding[B]: -$ 126,598.
Grantee: Buffalo, N.Y;
Base funding: $472,000;
Cumulative AIDS cases: 2,053;
Percent of cumulative AIDS cases: 0.24%;
Living AIDS cases[A]: 902;
Percent of living AIDS cases: 0.25%;
Funding if allocated using living AIDS cases: $484,115;
Difference in funding[B]: -$12,115.
Grantee: California;
Base funding: $3,042,000;
Cumulative AIDS cases: 13,240;
Percent of cumulative AIDS cases: 1.54%;
Living AIDS cases[A]: 5,870;
Percent of living AIDS cases: 1.60%;
Funding if allocated using living AIDS cases: $3,150,502;
Difference in funding[B]: -$108,502.
Grantee: Cambridge, Mass;
Base funding: $659,000;
Cumulative AIDS cases: 2,868;
Percent of cumulative AIDS cases: 0.33%;
Living AIDS cases[A]: 1,271;
Percent of living AIDS cases: 0.35%;
Funding if allocated using living AIDS cases: $682,162;
Difference in funding[B]: -$ 23,162.
Grantee: Camden, N.J;
Base funding: $657,000;
Cumulative AIDS cases: 2,861;
Percent of cumulative AIDS cases: 0.33%;
Living AIDS cases[A]: 1,159;
Percent of living AIDS cases: 0.32%;
Funding if allocated using living AIDS cases: $622,050;
Difference in funding[B]: $34,950.
Grantee: Charleston, S.C;
Base funding: $411,000;
Cumulative AIDS cases: 1,788;
Percent of cumulative AIDS cases: 0.21%;
Living AIDS cases[A]: 870;
Percent of living AIDS cases: 0.24%;
Funding if allocated using living AIDS cases: $466,940;
Difference in funding[B]: -$55,940.
Grantee: Charlotte, N.C;
Base funding: $571,000;
Cumulative AIDS cases: 2,486;
Percent of cumulative AIDS cases: 0.29%;
Living AIDS cases[A]: 1,269;
Percent of living AIDS cases: 0.35%;
Funding if allocated using living AIDS cases: $681,088;
Difference in funding[B]: -$110,088.
Grantee: Chicago, Ill;
Base funding: $5,622,000;
Cumulative AIDS cases: 24,471;
Percent of cumulative AIDS cases: 2.85%;
Living AIDS cases[A]: 10,362;
Percent of living AIDS cases: 2.82%;
Funding if allocated using living AIDS cases: $5,561,415;
Difference in funding[B]: $60,585.
Grantee: Cincinnati, Ohio;
Base funding: $550,000;
Cumulative AIDS cases: 2,394;
Percent of cumulative AIDS cases: 0.28%;
Living AIDS cases[A]: 1,051;
Percent of living AIDS cases: 0.29%;
Funding if allocated using living AIDS cases: $564,085;
Difference in funding[B]: -$ 14,085.
Grantee: Cleveland, Ohio;
Base funding: $854,000;
Cumulative AIDS cases: 3,718;
Percent of cumulative AIDS cases: 0.43%;
Living AIDS cases[A]: 1,784;
Percent of living AIDS cases: 0.49%;
Funding if allocated using living AIDS cases: $957,495;
Difference in funding[B]: -$103,495.
Grantee: Colorado;
Base funding: $366,000;
Cumulative AIDS cases: 1,595;
Percent of cumulative AIDS cases: 0.19%;
Living AIDS cases[A]: 792;
Percent of living AIDS cases: 0.22%;
Funding if allocated using living AIDS cases: $425,076;
Difference in funding[B]: -$59,076.
Grantee: Columbia, S.C;
Base funding: $626,000;
Cumulative AIDS cases: 2,727;
Percent of cumulative AIDS cases: 0.32%;
Living AIDS cases[A]: 1,541;
Percent of living AIDS cases: 0.42%;
Funding if allocated using living AIDS cases: $827,074;
Difference in funding[B]: -$201,074.
Grantee: Columbus, Ohio;
Base funding: $584,000;
Cumulative AIDS cases: 2,542;
Percent of cumulative AIDS cases: 0.30%;
Living AIDS cases[A]: 944;
Percent of living AIDS cases: 0.26%;
Funding if allocated using living AIDS cases: $506,657;
Difference in funding[B]: $77,343.
Grantee: Connecticut;
Base funding: $251,000;
Cumulative AIDS cases: 1,092;
Percent of cumulative AIDS cases: 0.13%;
Living AIDS cases[A]: 524;
Percent of living AIDS cases: 0.14%;
Funding if allocated using living AIDS cases: $281,237;
Difference in funding[B]: -$30,237.
Grantee: Dallas, Tex;
Base funding: $3,192,000;
Cumulative AIDS cases: 13,895;
Percent of cumulative AIDS cases: 1.62%;
Living AIDS cases[A]: 6,436;
Percent of living AIDS cases: 1.75%;
Funding if allocated using living AIDS cases: $3,454,282;
Difference in funding[B]: -$262,282.
Grantee: Delaware;
Base funding: $164,000;
Cumulative AIDS cases: 716;
Percent of cumulative AIDS cases: 0.08%;
Living AIDS cases[A]: 354;
Percent of living AIDS cases: 0.10%;
Funding if allocated using living AIDS cases: $189,996;
Difference in funding[B]: -$25,996.
Grantee: Denver, Colo;
Base funding: $1,424,000;
Cumulative AIDS cases: 6,200;
Percent of cumulative AIDS cases: 0.72%;
Living AIDS cases[A]: 2,602;
Percent of living AIDS cases: 0.71%;
Funding if allocated using living AIDS cases: $1,396,526;
Difference in funding[B]: $27,474.
Grantee: Detroit, Mich;
Base funding: $1,624,000;
Cumulative AIDS cases: 7,068;
Percent of cumulative AIDS cases: 0.82%;
Living AIDS cases[A]: 2,641;
Percent of living AIDS cases: 0.72%;
Funding if allocated using living AIDS cases: $1,417,458;
Difference in funding[B]: $206,542.
Grantee: District of Columbia;
Base funding: $5,626,000;
Cumulative AIDS cases: 24,490;
Percent of cumulative AIDS cases: 2.85%;
Living AIDS cases[A]: 12,570;
Percent of living AIDS cases: 3.42%;
Funding if allocated using living AIDS cases: $6,746,476;
Difference in funding[B]: -$1,120,476.
Grantee: Florida;
Base funding: $4,063,000;
Cumulative AIDS cases: 17,686;
Percent of cumulative AIDS cases: 2.06%;
Living AIDS cases[A]: 8,306;
Percent of living AIDS cases: 2.26%;
Funding if allocated using living AIDS cases: $4,457,934;
Difference in funding[B]: -$394,934.
Grantee: Fort Lauderdale, Fla;
Base funding: $3,337,000;
Cumulative AIDS cases: 14,527;
Percent of cumulative AIDS cases: 1.69%;
Living AIDS cases[A]: 6,541;
Percent of living AIDS cases: 1.78%;
Funding if allocated using living AIDS cases: $3,510,636;
Difference in funding[B]: -$173,636.
Grantee: Fort Worth, Tex;
Base funding: $835,000;
Cumulative AIDS cases: 3,635;
Percent of cumulative AIDS cases: 0.42%;
Living AIDS cases[A]: 1,670;
Percent of living AIDS cases: 0.45%;
Funding if allocated using living AIDS cases: $896,310;
Difference in funding[B]: -$ 61,310.
Grantee: Gaithersburg, Md;
Base funding: $535,000;
Cumulative AIDS cases: 2,328;
Percent of cumulative AIDS cases: 0.27%;
Living AIDS cases[A]: 1,146;
Percent of living AIDS cases: 0.31%;
Funding if allocated using living AIDS cases: $615,073;
Difference in funding[B]: -$ 80,073.
Grantee: Georgia;
Base funding: $1,515,000;
Cumulative AIDS cases: 6,593;
Percent of cumulative AIDS cases: 0.77%;
Living AIDS cases[A]: 3,233;
Percent of living AIDS cases: 0.88%;
Funding if allocated using living AIDS cases: $1,735,192;
Difference in funding[B]: -$220,192.
Grantee: Hartford, Conn;
Base funding: $1,023,000;
Cumulative AIDS cases: 4,455;
Percent of cumulative AIDS cases: 0.52%;
Living AIDS cases[A]: 2,222;
Percent of living AIDS cases: 0.60%;
Funding if allocated using living AIDS cases: $1,192,575;
Difference in funding[B]: -$169,575.
Grantee: Hawaii;
Base funding: $181,000;
Cumulative AIDS cases: 786;
Percent of cumulative AIDS cases: 0.09%;
Living AIDS cases[A]: 412;
Percent of living AIDS cases: 0.11%;
Funding if allocated using living AIDS cases: $221,126;
Difference in funding[B]: -$40,126.
Grantee: Honolulu, Hawaii;
Base funding: $452,000;
Cumulative AIDS cases: 1,966;
Percent of cumulative AIDS cases: 0.23%;
Living AIDS cases[A]: 791;
Percent of living AIDS cases: 0.22%;
Funding if allocated using living AIDS cases: $424,540;
Difference in funding[B]: $27,460.
Grantee: Houston, Tex;
Base funding: $5,068,000;
Cumulative AIDS cases: 22,063;
Percent of cumulative AIDS cases: 2.57%;
Living AIDS cases[A]: 8,579;
Percent of living AIDS cases: 2.33%;
Funding if allocated using living AIDS cases: $4,604,457;
Difference in funding[B]: $463,543.
Grantee: Illinois;
Base funding: $864,000;
Cumulative AIDS cases: 3,761;
Percent of cumulative AIDS cases: 0.44%;
Living AIDS cases[A]: 1,855;
Percent of living AIDS cases: 0.50%;
Funding if allocated using living AIDS cases: $995,602;
Difference in funding[B]: -$131,602.
Grantee: Indiana;
Base funding: $836,000;
Cumulative AIDS cases: 3,638;
Percent of cumulative AIDS cases: 0.42%;
Living AIDS cases[A]: 1,673;
Percent of living AIDS cases: 0.46%;
Funding if allocated using living AIDS cases: $897,920;
Difference in funding[B]: -$61,920.
Grantee: Indianapolis, Ind;
Base funding: $759,000;
Cumulative AIDS cases: 3,302;
Percent of cumulative AIDS cases: 0.38%;
Living AIDS cases[A]: 1,595;
Percent of living AIDS cases: 0.43%;
Funding if allocated using living AIDS cases: $856,056;
Difference in funding[B]: -$ 97,056.
Grantee: Iowa;
Base funding: $347,000;
Cumulative AIDS cases: 1,509;
Percent of cumulative AIDS cases: 0.18%;
Living AIDS cases[A]: 679;
Percent of living AIDS cases: 0.18%;
Funding if allocated using living AIDS cases: $364,428;
Difference in funding[B]: -$17,428.
Grantee: Islip, N.Y;
Base funding: $1,660,000;
Cumulative AIDS cases: 7,226;
Percent of cumulative AIDS cases: 0.84%;
Living AIDS cases[A]: 2,877;
Percent of living AIDS cases: 0.78%;
Funding if allocated using living AIDS cases: $1,544,122;
Difference in funding[B]: $115,878.
Grantee: Jackson, Miss;
Base funding: $449,000;
Cumulative AIDS cases: 1,953;
Percent of cumulative AIDS cases: 0.23%;
Living AIDS cases[A]: 994;
Percent of living AIDS cases: 0.27%;
Funding if allocated using living AIDS cases: $533,492;
Difference in funding[B]: -$84,492.
Grantee: Jacksonville, Fla;
Base funding: $1,195,000;
Cumulative AIDS cases: 5,202;
Percent of cumulative AIDS cases: 0.61%;
Living AIDS cases[A]: 2,509;
Percent of living AIDS cases: 0.68%;
Funding if allocated using living AIDS cases: $1,346,612;
Difference in funding[B]: -$151,612.
Grantee: Kansas;
Base funding: $363,000;
Cumulative AIDS cases: 1,582;
Percent of cumulative AIDS cases: 0.18%;
Living AIDS cases[A]: 646;
Percent of living AIDS cases: 0.18%;
Funding if allocated using living AIDS cases: $346,716;
Difference in funding[B]: $16,284.
Grantee: Kansas City, Mo;
Base funding: $978,000;
Cumulative AIDS cases: 4,256;
Percent of cumulative AIDS cases: 0.50%;
Living AIDS cases[A]: 1,933;
Percent of living AIDS cases: 0.53%;
Funding if allocated using living AIDS cases: $1,037,465;
Difference in funding[B]: -$59,465.
Grantee: Kentucky;
Base funding: $423,000;
Cumulative AIDS cases: 1,841;
Percent of cumulative AIDS cases: 0.21%;
Living AIDS cases[A]: 1,011;
Percent of living AIDS cases: 0.28%;
Funding if allocated using living AIDS cases: $542,616;
Difference in funding[B]: -$119,616.
Grantee: Las Vegas, Nev;
Base funding: $916,000;
Cumulative AIDS cases: 3,986;
Percent of cumulative AIDS cases: 0.46%;
Living AIDS cases[A]: 2,014;
Percent of living AIDS cases: 0.55%;
Funding if allocated using living AIDS cases: $1,080,939;
Difference in funding[B]: -$164,939.
Grantee: Los Angeles, Calif;
Base funding: $10,476,000;
Cumulative AIDS cases: 45,601;
Percent of cumulative AIDS cases: 5.31%;
Living AIDS cases[A]: 16,834;
Percent of living AIDS cases: 4.58%;
Funding if allocated using living AIDS cases: $9,035,018;
Difference in funding[B]: $1,440,982.
Grantee: Louisiana;
Base funding: $940,000;
Cumulative AIDS cases: 4,091;
Percent of cumulative AIDS cases: 0.48%;
Living AIDS cases[A]: 1,926;
Percent of living AIDS cases: 0.52%;
Funding if allocated using living AIDS cases: $1,033,708;
Difference in funding[B]: -$93,708.
Grantee: Louisville, Ky;
Base funding: $462,000;
Cumulative AIDS cases: 2,011;
Percent of cumulative AIDS cases: 0.23%;
Living AIDS cases[A]: 1,044;
Percent of living AIDS cases: 0.28%;
Funding if allocated using living AIDS cases: $560,328;
Difference in funding[B]: -$98,328.
Grantee: Maryland;
Base funding: $345,000;
Cumulative AIDS cases: 1,501;
Percent of cumulative AIDS cases: 0.17%;
Living AIDS cases[A]: 762;
Percent of living AIDS cases: 0.21%;
Funding if allocated using living AIDS cases: $408,975;
Difference in funding[B]: -$63,975.
Grantee: Massachusetts;
Base funding: $525,000;
Cumulative AIDS cases: 2,287;
Percent of cumulative AIDS cases: 0.27%;
Living AIDS cases[A]: 1,007;
Percent of living AIDS cases: 0.27%;
Funding if allocated using living AIDS cases: $540,469;
Difference in funding[B]: -$15,469.
Grantee: Memphis, Tenn;
Base funding: $920,000;
Cumulative AIDS cases: 4,006;
Percent of cumulative AIDS cases: 0.47%;
Living AIDS cases[A]: 2,133;
Percent of living AIDS cases: 0.58%;
Funding if allocated using living AIDS cases: $1,144,808;
Difference in funding[B]: -$224,808.
Grantee: Miami, Fla;
Base funding: $6,149,000;
Cumulative AIDS cases: 26,766;
Percent of cumulative AIDS cases: 3.12%;
Living AIDS cases[A]: 11,477;
Percent of living AIDS cases: 3.12%;
Funding if allocated using living AIDS cases: $6,159,849;
Difference in funding[B]: -$10,849.
Grantee: Michigan;
Base funding: $911,000;
Cumulative AIDS cases: 3,966;
Percent of cumulative AIDS cases: 0.46%;
Living AIDS cases[A]: 1,669;
Percent of living AIDS cases: 0.45%;
Funding if allocated using living AIDS cases: $895,773;
Difference in funding[B]: $15,227.
Grantee: Milwaukee, Wis;
Base funding: $512,000;
Cumulative AIDS cases: 2,228;
Percent of cumulative AIDS cases: 0.26%;
Living AIDS cases[A]: 1,001;
Percent of living AIDS cases: 0.27%;
Funding if allocated using living AIDS cases: $537,249;
Difference in funding[B]: -$25,249.
Grantee: Minneapolis, Minn;
Base funding: $839,000;
Cumulative AIDS cases: 3,654;
Percent of cumulative AIDS cases: 0.43%;
Living AIDS cases[A]: 1,650;
Percent of living AIDS cases: 0.45%;
Funding if allocated using living AIDS cases: $885,576;
Difference in funding[B]: -$ 46,576.
Grantee: Minnesota;
Base funding: $110,000;
Cumulative AIDS cases: 480;
Percent of cumulative AIDS cases: 0.06%;
Living AIDS cases[A]: 208;
Percent of living AIDS cases: 0.06%;
Funding if allocated using living AIDS cases: $111,636;
Difference in funding[B]: -$1,636.
Grantee: Mississippi;
Base funding: $756,000;
Cumulative AIDS cases: 3,291;
Percent of cumulative AIDS cases: 0.38%;
Living AIDS cases[A]: 1,563;
Percent of living AIDS cases: 0.43%;
Funding if allocated using living AIDS cases: $838,882;
Difference in funding[B]: -$82,882.
Grantee: Missouri;
Base funding: $496,000;
Cumulative AIDS cases: 2,157;
Percent of cumulative AIDS cases: 0.25%;
Living AIDS cases[A]: 1,053;
Percent of living AIDS cases: 0.29%;
Funding if allocated using living AIDS cases: $565,158;
Difference in funding[B]: -$69,158.
Grantee: Nashville, Tenn;
Base funding: $737,000;
Cumulative AIDS cases: 3,208;
Percent of cumulative AIDS cases: 0.37%;
Living AIDS cases[A]: 1,902;
Percent of living AIDS cases: 0.52%;
Funding if allocated using living AIDS cases: $1,020,827;
Difference in funding[B]: -$283,827.
Grantee: Nevada;
Base funding: $238,000;
Cumulative AIDS cases: 1,034;
Percent of cumulative AIDS cases: 0.12%;
Living AIDS cases[A]: 477;
Percent of living AIDS cases: 0.13%;
Funding if allocated using living AIDS cases: $256,012;
Difference in funding[B]: -$18,012.
Grantee: New Haven, Conn;
Base funding: $937,000;
Cumulative AIDS cases: 4,077;
Percent of cumulative AIDS cases: 0.47%;
Living AIDS cases[A]: 2,036;
Percent of living AIDS cases: 0.55%;
Funding if allocated using living AIDS cases: $1,092,747;
Difference in funding[B]: -$155,747.
Grantee: New Jersey;
Base funding: $1,106,000;
Cumulative AIDS cases: 4,778;
Percent of cumulative AIDS cases: 0.56%;
Living AIDS cases[A]: 1,864;
Percent of living AIDS cases: 0.51%;
Funding if allocated using living AIDS cases: $1,000,432;
Difference in funding[B]: $105,568.
Grantee: New Mexico;
Base funding: $533,000;
Cumulative AIDS cases: 2,319;
Percent of cumulative AIDS cases: 0.27%;
Living AIDS cases[A]: 1,064;
Percent of living AIDS cases: 0.29%;
Funding if allocated using living AIDS cases: $571,062;
Difference in funding[B]: -$38,062.
Grantee: New Orleans, La;
Base funding: $1,785,000;
Cumulative AIDS cases: 7,769;
Percent of cumulative AIDS cases: 0.90%;
Living AIDS cases[A]: 3,374;
Percent of living AIDS cases: 0.92%;
Funding if allocated using living AIDS cases: $1,810,868;
Difference in funding[B]: -$25,868.
Grantee: New York;
Base funding: $1,776,000;
Cumulative AIDS cases: 7,730;
Percent of cumulative AIDS cases: 0.90%;
Living AIDS cases[A]: 3,553;
Percent of living AIDS cases: 0.97%;
Funding if allocated using living AIDS cases: $1,906,940;
Difference in funding[B]: -$130,940.
Grantee: New York, N.Y;
Base funding: $33,487,000;
Cumulative AIDS cases: 145,769;
Percent of cumulative AIDS cases: 16.97%;
Living AIDS cases[A]: 54,900;
Percent of living AIDS cases: 14.94%;
Funding if allocated using living AIDS cases: $29,465,516;
Difference in funding[B]: $4,021,484.
Grantee: Newark, N.J;
Base funding: $4,297,000;
Cumulative AIDS cases: 18,704;
Percent of cumulative AIDS cases: 2.18%;
Living AIDS cases[A]: 6,262;
Percent of living AIDS cases: 1.70%;
Funding if allocated using living AIDS cases: $3,360,894;
Difference in funding[B]: $936,106.
Grantee: North Carolina;
Base funding: $2,082,000;
Cumulative AIDS cases: 9,065;
Percent of cumulative AIDS cases: 1.06%;
Living AIDS cases[A]: 4,761;
Percent of living AIDS cases: 1.30%;
Funding if allocated using living AIDS cases: $2,555,288;
Difference in funding[B]: -$473,288.
Grantee: Oakland, Calif;
Base funding: $2,006,000;
Cumulative AIDS cases: 8,731;
Percent of cumulative AIDS cases: 1.02%;
Living AIDS cases[A]: 3,374;
Percent of living AIDS cases: 0.92%;
Funding if allocated using living AIDS cases: $1,810,868;
Difference in funding[B]: $195,132.
Grantee: Ohio;
Base funding: $1,041,000;
Cumulative AIDS cases: 4,533;
Percent of cumulative AIDS cases: 0.53%;
Living AIDS cases[A]: 1,985;
Percent of living AIDS cases: 0.54%;
Funding if allocated using living AIDS cases: $1,065,374;
Difference in funding[B]: -$24,374.
Grantee: Oklahoma;
Base funding: $518,000;
Cumulative AIDS cases: 2,254;
Percent of cumulative AIDS cases: 0.26%;
Living AIDS cases[A]: 995;
Percent of living AIDS cases: 0.27%;
Funding if allocated using living AIDS cases: $534,029;
Difference in funding[B]: -$16,029.
Grantee: Oklahoma City, Okla;
Base funding: $466,000;
Cumulative AIDS cases: 2,027;
Percent of cumulative AIDS cases: 0.24%;
Living AIDS cases[A]: 916;
Percent of living AIDS cases: 0.25%;
Funding if allocated using living AIDS cases: $491,629;
Difference in funding[B]: -$25,629.
Grantee: Orlando, Fla;
Base funding: $1,660,000;
Cumulative AIDS cases: 7,228;
Percent of cumulative AIDS cases: 0.84%;
Living AIDS cases[A]: 3,494;
Percent of living AIDS cases: 0.95%;
Funding if allocated using living AIDS cases: $1,875,273;
Difference in funding[B]: -$215,273.
Grantee: Pennsylvania;
Base funding: $1,540,000;
Cumulative AIDS cases: 6,702;
Percent of cumulative AIDS cases: 0.78%;
Living AIDS cases[A]: 3,463;
Percent of living AIDS cases: 0.94%;
Funding if allocated using living AIDS cases: $1,858,635;
Difference in funding[B]: -$318,635.
Grantee: Philadelphia, Pa;
Base funding: $4,340,000;
Cumulative AIDS cases: 18,890;
Percent of cumulative AIDS cases: 2.20%;
Living AIDS cases[A]: 9,546;
Percent of living AIDS cases: 2.60%;
Funding if allocated using living AIDS cases: $5,123,457;
Difference in funding[B]: -$783,457.
Grantee: Phoenix, Ariz;
Base funding: $1,434,000;
Cumulative AIDS cases: 6,244;
Percent of cumulative AIDS cases: 0.73%;
Living AIDS cases[A]: 2,924;
Percent of living AIDS cases: 0.80%;
Funding if allocated using living AIDS cases: $1,569,347;
Difference in funding[B]: -$135,347.
Grantee: Pittsburgh, Pa;
Base funding: $626,000;
Cumulative AIDS cases: 2,723;
Percent of cumulative AIDS cases: 0.32%;
Living AIDS cases[A]: 1,103;
Percent of living AIDS cases: 0.30%;
Funding if allocated using living AIDS cases: $591,994;
Difference in funding[B]: $34,006.
Grantee: Portland, Oreg;
Base funding: $1,006,000;
Cumulative AIDS cases: 4,378;
Percent of cumulative AIDS cases: 0.51%;
Living AIDS cases[A]: 1,925;
Percent of living AIDS cases: 0.52%;
Funding if allocated using living AIDS cases: $1,033,172;
Difference in funding[B]: -$27,172.
Grantee: Poughkeepsie, N.Y;
Base funding: $604,000;
Cumulative AIDS cases: 2,630;
Percent of cumulative AIDS cases: 0.31%;
Living AIDS cases[A]: 1,087;
Percent of living AIDS cases: 0.30%;
Funding if allocated using living AIDS cases: $583,406;
Difference in funding[B]: $20,594.
Grantee: Providence, R.I;
Base funding: $807,000;
Cumulative AIDS cases: 3,514;
Percent of cumulative AIDS cases: 0.41%;
Living AIDS cases[A]: 1,622;
Percent of living AIDS cases: 0.44%;
Funding if allocated using living AIDS cases: $870,548;
Difference in funding[B]: -$ 63,548.
Grantee: Puerto Rico;
Base funding: $1,748,000;
Cumulative AIDS cases: 7,608;
Percent of cumulative AIDS cases: 0.89%;
Living AIDS cases[A]: 2,995;
Percent of living AIDS cases: 0.81%;
Funding if allocated using living AIDS cases: $1,607,454;
Difference in funding[B]: $140,546.
Grantee: Richmond, Va;
Base funding: $692,000;
Cumulative AIDS cases: 3,012;
Percent of cumulative AIDS cases: 0.35%;
Living AIDS cases[A]: 1,312;
Percent of living AIDS cases: 0.36%;
Funding if allocated using living AIDS cases: $704,167;
Difference in funding[B]: -$12,167.
Grantee: Riverside, Calif;
Base funding: $1,772,000;
Cumulative AIDS cases: 7,714;
Percent of cumulative AIDS cases: 0.90%;
Living AIDS cases[A]: 3,834;
Percent of living AIDS cases: 1.04%;
Funding if allocated using living AIDS cases: $2,057,756;
Difference in funding[B]: -$285,756.
Grantee: Rochester, N.Y;
Base funding: $597,000;
Cumulative AIDS cases: 2,599;
Percent of cumulative AIDS cases: 0.30%;
Living AIDS cases[A]: 1,297;
Percent of living AIDS cases: 0.35%;
Funding if allocated using living AIDS cases: $696,116;
Difference in funding[B]: -$99,116.
Grantee: Sacramento, Calif;
Base funding: $844,000;
Cumulative AIDS cases: 3,676;
Percent of cumulative AIDS cases: 0.43%;
Living AIDS cases[A]: 1,470;
Percent of living AIDS cases: 0.40%;
Funding if allocated using living AIDS cases: $788,967;
Difference in funding[B]: $55,033.
Grantee: St. Louis, Mo;
Base funding: $1,217,000;
Cumulative AIDS cases: 5,297;
Percent of cumulative AIDS cases: 0.62%;
Living AIDS cases[A]: 2,481;
Percent of living AIDS cases: 0.67%;
Funding if allocated using living AIDS cases: $1,331,584;
Difference in funding[B]: -$114,584.
Grantee: Salt Lake City, Utah;
Base funding: $386,000;
Cumulative AIDS cases: 1,680;
Percent of cumulative AIDS cases: 0.20%;
Living AIDS cases[A]: 849;
Percent of living AIDS cases: 0.23%;
Funding if allocated using living AIDS cases: $455,669;
Difference in funding[B]: -$69,669.
Grantee: San Antonio, Tex;
Base funding: $1,027,000;
Cumulative AIDS cases: 4,469;
Percent of cumulative AIDS cases: 0.52%;
Living AIDS cases[A]: 2,138;
Percent of living AIDS cases: 0.58%;
Funding if allocated using living AIDS cases: $1,147,491;
Difference in funding[B]: -$120,491.
Grantee: San Diego, Calif;
Base funding: $2,683,000;
Cumulative AIDS cases: 11,677;
Percent of cumulative AIDS cases: 1.36%;
Living AIDS cases[A]: 5,136;
Percent of living AIDS cases: 1.40%;
Funding if allocated using living AIDS cases: $2,756,555;
Difference in funding[B]: -$73,555.
Grantee: San Francisco, Calif;
Base funding: $6,698,000;
Cumulative AIDS cases: 29,156;
Percent of cumulative AIDS cases: 3.40%;
Living AIDS cases[A]: 7,577;
Percent of living AIDS cases: 2.06%;
Funding if allocated using living AIDS cases: $4,066,671;
Difference in funding[B]: $2,631,329.
Grantee: San Jose, Calif;
Base funding: $792,000;
Cumulative AIDS cases: 3,446;
Percent of cumulative AIDS cases: 0.40%;
Living AIDS cases[A]: 1,472;
Percent of living AIDS cases: 0.40%;
Funding if allocated using living AIDS cases: $790,041;
Difference in funding[B]: $1,959.
Grantee: San Juan, P.R;
Base funding: $4,585,000;
Cumulative AIDS cases: 19,960;
Percent of cumulative AIDS cases: 2.32%;
Living AIDS cases[A]: 7,141;
Percent of living AIDS cases: 1.94%;
Funding if allocated using living AIDS cases: $3,832,664;
Difference in funding[B]: $752,336.
Grantee: Santa Ana, Calif;
Base funding: $1,436,000;
Cumulative AIDS cases: 6,250;
Percent of cumulative AIDS cases: 0.73%;
Living AIDS cases[A]: 2,939;
Percent of living AIDS cases: 0.80%;
Funding if allocated using living AIDS cases: $1,577,398;
Difference in funding[B]: -$141,398.
Grantee: Sarasota, Fla;
Base funding: $397,000;
Cumulative AIDS cases: 1,730;
Percent of cumulative AIDS cases: 0.20%;
Living AIDS cases[A]: 792;
Percent of living AIDS cases: 0.22%;
Funding if allocated using living AIDS cases: $425,076;
Difference in funding[B]: -$28,076.
Grantee: Seattle, Wash;
Base funding: $1,688,000;
Cumulative AIDS cases: 7,347;
Percent of cumulative AIDS cases: 0.86%;
Living AIDS cases[A]: 3,221;
Percent of living AIDS cases: 0.88%;
Funding if allocated using living AIDS cases: $1,728,751;
Difference in funding[B]: -$40,751.
Grantee: South Carolina;
Base funding: $1,387,000;
Cumulative AIDS cases: 6,039;
Percent of cumulative AIDS cases: 0.70%;
Living AIDS cases[A]: 3,108;
Percent of living AIDS cases: 0.85%;
Funding if allocated using living AIDS cases: $1,668,102;
Difference in funding[B]: -$281,102.
Grantee: Springfield, Mass;
Base funding: $461,000;
Cumulative AIDS cases: 2,005;
Percent of cumulative AIDS cases: 0.23%;
Living AIDS cases[A]: 861;
Percent of living AIDS cases: 0.23%;
Funding if allocated using living AIDS cases: $462,109;
Difference in funding[B]: -$1,109.
Grantee: Tampa, Fla;
Base funding: $2,221,000;
Cumulative AIDS cases: 9,670;
Percent of cumulative AIDS cases: 1.13%;
Living AIDS cases[A]: 4,201;
Percent of living AIDS cases: 1.14%;
Funding if allocated using living AIDS cases: $2,254,729;
Difference in funding[B]: -$33,729.
Grantee: Tennessee;
Base funding: $739,000;
Cumulative AIDS cases: 3,218;
Percent of cumulative AIDS cases: 0.37%;
Living AIDS cases[A]: 1,689;
Percent of living AIDS cases: 0.46%;
Funding if allocated using living AIDS cases: $906,507;
Difference in funding[B]: -$167,507.
Grantee: Texas;
Base funding: $2,736,000;
Cumulative AIDS cases: 11,911;
Percent of cumulative AIDS cases: 1.39%;
Living AIDS cases[A]: 6,024;
Percent of living AIDS cases: 1.64%;
Funding if allocated using living AIDS cases: $3,233,156;
Difference in funding[B]: -$497,156.
Grantee: Tucson, Ariz;
Base funding: $402,000;
Cumulative AIDS cases: 1,749;
Percent of cumulative AIDS cases: 0.20%;
Living AIDS cases[A]: 780;
Percent of living AIDS cases: 0.21%;
Funding if allocated using living AIDS cases: $418,636;
Difference in funding[B]: -$16,636.
Grantee: Utah;
Base funding: $120,000;
Cumulative AIDS cases: 524;
Percent of cumulative AIDS cases: 0.06%;
Living AIDS cases[A]: 257;
Percent of living AIDS cases: 0.07%;
Funding if allocated using living AIDS cases: $137,935;
Difference in funding[B]: -$17,935.
Grantee: Virginia;
Base funding: $640,000;
Cumulative AIDS cases: 2,788;
Percent of cumulative AIDS cases: 0.32%;
Living AIDS cases[A]: 1,282;
Percent of living AIDS cases: 0.35%;
Funding if allocated using living AIDS cases: $688,065;
Difference in funding[B]: -$48,065.
Grantee: Virginia Beach, Va;
Base funding: $1,022,000;
Cumulative AIDS cases: 4,450;
Percent of cumulative AIDS cases: 0.52%;
Living AIDS cases[A]: 2,024;
Percent of living AIDS cases: 0.55%;
Funding if allocated using living AIDS cases: $1,086,306;
Difference in funding[B]: -$64,306.
Grantee: Wake County, N.C;
Base funding: $345,000;
Cumulative AIDS cases: 1,502;
Percent of cumulative AIDS cases: 0.17%;
Living AIDS cases[A]: 863;
Percent of living AIDS cases: 0.23%;
Funding if allocated using living AIDS cases: $463,183;
Difference in funding[B]: -$118,183.
Grantee: Warren, Mich;
Base funding: $405,000;
Cumulative AIDS cases: 1,763;
Percent of cumulative AIDS cases: 0.21%;
Living AIDS cases[A]: 709;
Percent of living AIDS cases: 0.19%;
Funding if allocated using living AIDS cases: $380,529;
Difference in funding[B]: $24,471.
Grantee: Washington;
Base funding: $652,000;
Cumulative AIDS cases: 2,839;
Percent of cumulative AIDS cases: 0.33%;
Living AIDS cases[A]: 1,357;
Percent of living AIDS cases: 0.37%;
Funding if allocated using living AIDS cases: $728,319;
Difference in funding[B]: -$76,319.
Grantee: West Palm Beach, Fla;
Base funding: $2,019,000;
Cumulative AIDS cases: 8,789;
Percent of cumulative AIDS cases: 1.02%;
Living AIDS cases[A]: 4,112;
Percent of living AIDS cases: 1.12%;
Funding if allocated using living AIDS cases: $2,206,962;
Difference in funding[B]: -$187,962.
Grantee: Wilmington, Del;
Base funding: $566,000;
Cumulative AIDS cases: 2,459;
Percent of cumulative AIDS cases: 0.29%;
Living AIDS cases[A]: 1,278;
Percent of living AIDS cases: 0.35%;
Funding if allocated using living AIDS cases: $685,919;
Difference in funding[B]: -$ 119,919.
Grantee: Wisconsin;
Base funding: $405,000;
Cumulative AIDS cases: 1,761;
Percent of cumulative AIDS cases: 0.21%;
Living AIDS cases[A]: 795;
Percent of living AIDS cases: 0.22%;
Funding if allocated using living AIDS cases: $426,686;
Difference in funding[B]: -$21,686.
Grantee: Woodbridge, N.J;
Base funding: $1,462,000;
Cumulative AIDS cases: 6,363;
Percent of cumulative AIDS cases: 0.74%;
Living AIDS cases[A]: 2,332;
Percent of living AIDS cases: 0.63%;
Funding if allocated using living AIDS cases: $1,251,614;
Difference in funding[B]: $210,386.
Grantee: Worcester, Mass;
Base funding: $369,000;
Cumulative AIDS cases: 1,607;
Percent of cumulative AIDS cases: 0.19%;
Living AIDS cases[A]: 768;
Percent of living AIDS cases: 0.21%;
Funding if allocated using living AIDS cases: $412,195;
Difference in funding[B]: -$43,195.
Grantee: Total;
Base funding: $197,288,000;
Cumulative AIDS cases: 858,752;
Living AIDS cases[A]: 367,586;
Funding if allocated using living AIDS cases: $197,288,000.
Sources: GAO analysis of CDC and HUD data.
Notes: By law HOPWA base grants are distributed according to cumulative
AIDS case counts.
[A] The number of living AIDS cases was calculated by subtracting the
number of reported deaths among AIDS cases in a jurisdiction from the
number of reported cases.
[B] This was calculated by subtracting the amount that would have been
received if living AIDS cases had been used from the amount that was
received using cumulative AIDS cases. A positive value indicates that
the jurisdiction received more funding using cumulative AIDS cases than
it would have received if living AIDS cases had been used. A negative
value indicates that the jurisdiction would have received more funding
if living AIDS cases had been used.
[End of table]
[End of section]
Appendix VI: Total CARE Act Title I and Title II Funding by State and
Territory, Fiscal Year 2004:
State/territory: Alabama;
Total Title I and Title II awards: $12,142,447;
ELCs[A]: 3,320;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,657.
State/territory: Alaska[B];
Total Title I and Title II awards: $974,705;
ELCs[A]: 224;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $4,351.
State/territory: Arizona;
Total Title I and Title II awards: $18,635,537;
ELCs[A]: 3,978;
Percent of ELCs in EMAs: 73.5%;
Total Title I and Title II awards per ELC: $4,685.
State/territory: Arkansas;
Total Title I and Title II awards: $4,933,831;
ELCs[A]: 1,466;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,366.
State/territory: California;
Total Title I and Title II awards: $223,607,373;
ELCs[A]: 42,479;
Percent of ELCs in EMAs: 88.9%;
Total Title I and Title II awards per ELC: $5,264.
State/territory: Colorado;
Total Title I and Title II awards: $12,949,158;
ELCs[A]: 2,658;
Percent of ELCs in EMAs: 75.0%;
Total Title I and Title II awards per ELC: $4,872.
State/territory: Connecticut;
Total Title I and Title II awards: $26,797,308;
ELCs[A]: 5,363;
Percent of ELCs in EMAs: 91.4%;
Total Title I and Title II awards per ELC: $4,997.
State/territory: Delaware;
Total Title I and Title II awards: $5,340,795;
ELCs[A]: 1,518;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,518.
State/territory: District of Columbia;
Total Title I and Title II awards: $33,288,417;
ELCs[A]: 6,561;
Percent of ELCs in EMAs: 100.0%;
Total Title I and Title II awards per ELC: $5,074.
State/territory: Florida;
Total Title I and Title II awards: $182,771,752;
ELCs[A]: 38,101;
Percent of ELCs in EMAs: 77.3%;
Total Title I and Title II awards per ELC: $4,797.
State/territory: Georgia;
Total Title I and Title II awards: $54,483,301;
ELCs[A]: 11,226;
Percent of ELCs in EMAs: 67.6%;
Total Title I and Title II awards per ELC: $4,853.
State/territory: Hawaii;
Total Title I and Title II awards: $3,298,130;
ELCs[A]: 988;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,338.
State/territory: Idaho[B];
Total Title I and Title II awards: $1,019,352;
ELCs[A]: 220;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $4,633.
State/territory: Illinois;
Total Title I and Title II awards: $60,837,359;
ELCs[A]: 12,203;
Percent of ELCs in EMAs: 87.9%;
Total Title I and Title II awards per ELC: $4,985.
State/territory: Indiana;
Total Title I and Title II awards: $11,402,950;
ELCs[A]: 3,095;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,684.
State/territory: Iowa;
Total Title I and Title II awards: $2,067,375;
ELCs[A]: 619;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,340.
State/territory: Kansas;
Total Title I and Title II awards: $3,881,999;
ELCs[A]: 959;
Percent of ELCs in EMAs: 34.2%;
Total Title I and Title II awards per ELC: $4,048.
State/territory: Kentucky;
Total Title I and Title II awards: $7,170,005;
ELCs[A]: 1,937;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,702.
State/territory: Louisiana;
Total Title I and Title II awards: $29,740,454;
ELCs[A]: 6,555;
Percent of ELCs in EMAs: 48.1%;
Total Title I and Title II awards per ELC: $4,537.
State/territory: Maine[B];
Total Title I and Title II awards: $1,333,909;
ELCs[A]: 395;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,377.
State/territory: Maryland;
Total Title I and Title II awards: $61,230,030;
ELCs[A]: 12,203;
Percent of ELCs in EMAs: 93.6%;
Total Title I and Title II awards per ELC: $5,018.
State/territory: Massachusetts;
Total Title I and Title II awards: $34,432,147;
ELCs[A]: 6,960;
Percent of ELCs in EMAs: 83.2%;
Total Title I and Title II awards per ELC: $4,947.
State/territory: Michigan;
Total Title I and Title II awards: $24,046,130;
ELCs[A]: 5,215;
Percent of ELCs in EMAs: 68.8%;
Total Title I and Title II awards per ELC: $4,611.
State/territory: Minnesota;
Total Title I and Title II awards: $7,139,028;
ELCs[A]: 1,427;
Percent of ELCs in EMAs: 88.7%;
Total Title I and Title II awards per ELC: $5,003.
State/territory: Mississippi;
Total Title I and Title II awards: $9,454,950;
ELCs[A]: 2,747;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,442.
State/territory: Missouri;
Total Title I and Title II awards: $16,501,234;
ELCs[A]: 3,512;
Percent of ELCs in EMAs: 76.8%;
Total Title I and Title II awards per ELC: $4,699.
State/territory: Montana[B];
Total Title I and Title II awards: $847,196;
ELCs[A]: 147;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $5,763.
State/territory: Nebraska;
Total Title I and Title II awards: $1,887,660;
ELCs[A]: 525;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,596.
State/territory: Nevada;
Total Title I and Title II awards: $10,757,214;
ELCs[A]: 2,246;
Percent of ELCs in EMAs: 83.3%;
Total Title I and Title II awards per ELC: $4,789.
State/territory: New Hampshire[B];
Total Title I and Title II awards: $1,864,452;
ELCs[A]: 358;
Percent of ELCs in EMAs: 69.0%;
Total Title I and Title II awards per ELC: $5,208.
State/territory: New Jersey;
Total Title I and Title II awards: $80,222,837;
ELCs[A]: 16,531;
Percent of ELCs in EMAs: 84.8%;
Total Title I and Title II awards per ELC: $4,853.
State/territory: New Mexico;
Total Title I and Title II awards: $3,338,463;
ELCs[A]: 982;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,400.
State/territory: New York;
Total Title I and Title II awards: $298,549,361;
ELCs[A]: 59,226;
Percent of ELCs in EMAs: 88.6%;
Total Title I and Title II awards per ELC: $5,041.
State/territory: North Carolina;
Total Title I and Title II awards: $22,668,734;
ELCs[A]: 6,083;
Percent of ELCs in EMAs: 0.1%;
Total Title I and Title II awards per ELC: $3,727.
State/territory: North Dakota[C];
Total Title I and Title II awards: $292,543;
ELCs[A]: 43;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $6,803.
State/territory: Ohio;
Total Title I and Title II awards: $20,249,202;
ELCs[A]: 5,171;
Percent of ELCs in EMAs: 29.2%;
Total Title I and Title II awards per ELC: $3,916.
State/territory: Oklahoma;
Total Title I and Title II awards: $6,343,022;
ELCs[A]: 1,687;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,760.
State/territory: Oregon;
Total Title I and Title II awards: $9,084,990;
ELCs[A]: 2,003;
Percent of ELCs in EMAs: 68.9%;
Total Title I and Title II awards per ELC: $4,536.
State/territory: Pennsylvania;
Total Title I and Title II awards: $59,766,256;
ELCs[A]: 12,840;
Percent of ELCs in EMAs: 67.4%;
Total Title I and Title II awards per ELC: $4,655.
State/territory: Puerto Rico;
Total Title I and Title II awards: $53,026,882;
ELCs[A]: 10,711;
Percent of ELCs in EMAs: 79.9%;
Total Title I and Title II awards per ELC: $4,951.
State/territory: Rhode Island;
Total Title I and Title II awards: $3,189,276;
ELCs[A]: 906;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,520.
State/territory: South Carolina;
Total Title I and Title II awards: $20,705,328;
ELCs[A]: 5,563;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,722.
State/territory: South Dakota[B];
Total Title I and Title II awards: $705,706;
ELCs[A]: 97;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $7,275.
State/territory: Tennessee;
Total Title I and Title II awards: $21,178,234;
ELCs[A]: 5,080;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $4,169.
State/territory: Texas;
Total Title I and Title II awards: $118,965,938;
ELCs[A]: 23,922;
Percent of ELCs in EMAs: 74.5%;
Total Title I and Title II awards per ELC: $4,973.
State/territory: Utah;
Total Title I and Title II awards: $3,235,191;
ELCs[A]: 882;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $3,668.
State/territory: Vermont[B];
Total Title I and Title II awards: $883,059;
ELCs[A]: 181;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $4,879.
State/territory: Virginia;
Total Title I and Title II awards: $32,149,863;
ELCs[A]: 6,872;
Percent of ELCs in EMAs: 63.2%;
Total Title I and Title II awards per ELC: $4,678.
State/territory: Washington;
Total Title I and Title II awards: $17,349,313;
ELCs[A]: 3,776;
Percent of ELCs in EMAs: 69.8%;
Total Title I and Title II awards per ELC: $4,595.
State/territory: West Virginia;
Total Title I and Title II awards: $2,335,062;
ELCs[A]: 618;
Percent of ELCs in EMAs: 11.3%;
Total Title I and Title II awards per ELC: $3,778.
State/territory: Wisconsin;
Total Title I and Title II awards: $5,603,506;
ELCs[A]: 1,507;
Percent of ELCs in EMAs: 0.4%;
Total Title I and Title II awards per ELC: $3,718.
State/territory: Wyoming[C];
Total Title I and Title II awards: $360,347;
ELCs[A]: 76;
Percent of ELCs in EMAs: 0%;
Total Title I and Title II awards per ELC: $4,741.
Source: GAO analysis of HRSA data.
Notes: Our analysis is limited to the states and Puerto Rico.
[A] HRSA calculates a jurisdiction's ELCs by using data from CDC on the
reported AIDS case counts for the last 10 years and weighting those
numbers to account for the likelihood of death.
[B] State received a Title II base award of $500,000, the minimum it
could receive based on the number of ELCs in the state.
[C] State received a Title II base award of $200,000, the minimum it
could receive based on the number of ELCs in the state.
[End of table]
[End of section]
Appendix VII: HRSA's Title I EMAs, GAO-Identified Set of Comparable
2004 OMB-Defined Metropolitan Areas, and Changes:
Table 12: EMAs with Service Area Changes:
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Atlanta, Ga. MSA;
Number of counties in EMA: 20;
ELCs in EMAs: 7,589;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Atlanta-Sandy Springs-
Ga. Marietta, Ga. MSA;
Number of counties in EMA: 28;
ELCs in EMAs: 7,663;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 8;
Changes: Change in ELCs (percent): 1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Boston- Worcester-Lawrence-
Lowell-Brockton, Mass.-N.H. NECMA;
Number of counties in EMA: 10;
ELCs in EMAs: 6,038;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Boston-Cambridge-Quincy,
Mass-N.H. MSA; Worcester, Mass. MSA; and Manchester-Nashua, N.H. MSA;
Number of counties in EMA: 9;
ELCs in EMAs: 5,484;
Changes: Decrease in counties: 1;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): -9%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Chicago, Ill. PMSA;
Number of counties in EMA: 9;
ELCs in EMAs: 10,481;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Chicago-Naperville-
Joliet, Ill. MDIV; and Lake County-Kenosha County, Ill.-Wis. MDIV;
Number of counties in EMA: 10;
ELCs in EMAs: 10,534;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 1;
Changes: Change in ELCs (percent): 1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Cleveland- Lorain-Elyria,
Ohio PMSA;
Number of counties in EMA: 6;
ELCs in EMAs: 1,511;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Cleveland-Elyria-Mentor,
Ohio MSA;
Number of counties in EMA: 5;
ELCs in EMAs: 1,484;
Changes: Decrease in counties: 1;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): -2%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Dallas, Tex. PMSA;
Number of counties in EMA: 8;
ELCs in EMAs: 5,261;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Dallas- Plano-Irving,
Tex. MDIV;
Number of counties in EMA: 8;
ELCs in EMAs: 5,229;
Changes: Decrease in counties: 1;
Changes: Increase in counties: 1;
Changes: Change in ELCs (percent): -1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Denver, Colo. PMSA;
Number of counties in EMA: 5;
ELCs in EMAs: 1,993;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Denver-Aurora,
Colo./MSA;
Number of counties in EMA: 10;
ELCs in EMAs: 2,017;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 5;
Changes: Change in ELCs (percent): 1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Detroit, Mich. PMSA;
Number of counties in EMA: 6;
ELCs in EMAs: 3,588;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Detroit-Warren-Livonia,
Mich. MSA and Monroe, Mich. MSA;
Number of counties in EMA: 7;
ELCs in EMAs: 3,601;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 1;
Changes: Change in ELCs (percent): 0%[B].
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Dutchess County, N.Y. PMSA;
Number of counties in EMA: 1;
ELCs in EMAs: 524;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Poughkeepsie-Newburgh-
Middletown, N.Y. MSA;
Number of counties in EMA: 2;
ELCs in EMAs: 1,010;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 1;
Changes: Change in ELCs (percent): 93%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Fort Worth- Arlington, Tex.
PMSA;
Number of counties in EMA: 4;
ELCs in EMAs: 1,478;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Fort Worth-Arlington,
Tex. MDIV;
Number of counties in EMA: 4;
ELCs in EMAs: 1,475;
Changes: Decrease in counties: 1;
Changes: Increase in counties: 1;
Changes: Change in ELCs (percent): 0%[B].
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Houston, Tex. PMSA;
Number of counties in EMA: 6;
ELCs in EMAs: 7,710;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Houston-Sugar Land-
Baytown, Tex. MSA;
Number of counties in EMA: 10;
ELCs in EMAs: 8,106;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 4;
Changes: Change in ELCs (percent): 5%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Jacksonville, Fla. MSA;
Number of counties in EMA: 4;
ELCs in EMAs: 2,051;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Jacksonville, Fla. MSA;
Number of counties in EMA: 5;
ELCs in EMAs: 2,080;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 1;
Changes: Change in ELCs (percent): 1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Kansas City, Mo.-Kans. MSA;
Number of counties in EMA: 11;
ELCs in EMAs: 1,295;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Kansas City, Mo.-Kans.
MSA;
Number of counties in EMA: 15;
ELCs in EMAs: 1,305;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 4;
Changes: Change in ELCs (percent): 1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Las Vegas, Nev.-Ariz. MSA;
Number of counties in EMA: 3;
ELCs in EMAs: 1,945;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Las Vegas-Paradise, Nev.
MSA;
Number of counties in EMA: 1;
ELCs in EMAs: 1,857;
Changes: Decrease in counties: 2;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): -5%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Middlesex- Somerset-
Hunterdon, N.J. PMSA;
Number of counties in EMA: 3;
ELCs in EMAs: 1,238;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Edison, N.J. MDIV;
Number of counties in EMA: 4;
ELCs in EMAs: 2,217;
Changes: Decrease in counties: 1;
Changes: Increase in counties: 2;
Changes: Change in ELCs (percent): 79%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: New Orleans, La. MSA;
Number of counties in EMA: 8;
ELCs in EMAs: 3,154;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): New Orleans-Metairie-
Kenner, La. MSA;
Number of counties in EMA: 7;
ELCs in EMAs: 3,130;
Changes: Decrease in counties: 1;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): -1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Newark, N.J. PMSA;
Number of counties in EMA: 5;
ELCs in EMAs: 6,665;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Newark- Union, N.J.-Pa.
MDIV;
Number of counties in EMA: 6;
ELCs in EMAs: 6,735;
Changes: Decrease in counties: 1;
Changes: Increase in counties: 2;
Changes: Change in ELCs (percent): 1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Norfolk- Virginia Beach-
Newport News, VA-N.C. MSA;
Number of counties in EMA: 15;
ELCs in EMAs: 2,237;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Virginia Beach-Norfolk-
Newport News, Va.-N.C. MSA;
Number of counties in EMA: 16;
ELCs in EMAs: 2,240;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 1;
Changes: Change in ELCs (percent): 0%[B].
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Philadelphia, Pa.-N.J.
PMSA;
Number of counties in EMA: 9;
ELCs in EMAs: 9,857;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Philadelphia, Pa. MDIV
and Camden, N.J. MDIV;
Number of counties in EMA: 8;
ELCs in EMAs: 9,782;
Changes: Decrease in counties: 1;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): -1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Ponce, P.R. MSA;
Number of counties in EMA: 6;
ELCs in EMAs: 1,158;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Ponce, P.R. MSA and
Yauco, P.R. MSA;
Number of counties in EMA: 7;
ELCs in EMAs: 1,202;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 1;
Changes: Change in ELCs (percent): 4%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Portland- Vancouver, Oreg.-
Wash. PMSA;
Number of counties in EMA: 6;
ELCs in EMAs: 1,547;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Portland-Vancouver-
Beaverton, Oreg.-Wash. MSA;
Number of counties in EMA: 7;
ELCs in EMAs: 1,548;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 1;
Changes: Change in ELCs (percent): 0%[B].
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Sacramento, Calif. PMSA;
Number of counties in EMA: 3;
ELCs in EMAs: 1,246;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Sacramento-Arden-Arcade-
Roseville, Calif. MSA;
Number of counties in EMA: 4;
ELCs in EMAs: 1,321;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 1;
Changes: Change in ELCs (percent): 6%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: St. Louis, Mo.-Ill. MSA;
Number of counties in EMA: 12;
ELCs in EMAs: 1,975;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): St. Louis, Mo.-Ill. MSA;
Number of counties in EMA: 16;
ELCs in EMAs: 1,993;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 4;
Changes: Change in ELCs (percent): 1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: San Antonio, Tex. MSA;
Number of counties in EMA: 4;
ELCs in EMAs: 1,717;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): San Antonio, Tex. MSA;
Number of counties in EMA: 8;
ELCs in EMAs: 1,750;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 4;
Changes: Change in ELCs (percent): 2%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: San Jose, Calif. PMSA;
Number of counties in EMA: 1;
ELCs in EMAs: 1,146;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): San Jose-Sunnyvale-Santa
Clara, Calif. MSA;
Number of counties in EMA: 2;
ELCs in EMAs: 1,163;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 1;
Changes: Change in ELCs (percent): 1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Seattle- Bellevue-Everett,
Wash. PMSA;
Number of counties in EMA: 3;
ELCs in EMAs: 2,468;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Seattle-Bellevue-
Everett, Wash. MDIV;
Number of counties in EMA: 2;
ELCs in EMAs: 2,445;
Changes: Decrease in counties: 1;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): -1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Washington, D.C.-Md.-Va-
W.Va. PMSA;
Number of counties in EMA: 25;
ELCs in EMAs: 11,816;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Washington-Arlington-
Alexandria, D.C.-Va.-Md. MSA;
Number of counties in EMA: 22;
ELCs in EMAs: 11,732;
Changes: Decrease in counties: 3;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): -1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Bergen- Passaic, N.J. PMSA;
Number of counties in EMA: 2;
ELCs in EMAs: 2,088;
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Jersey City, N.J. PMSA;
Number of counties in EMA: 1;
ELCs in EMAs: 2,427%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: New York City, N.Y. PMSA;
Number of counties in EMA: 8;
ELCs in EMAs: 49,352%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: San Juan- Bayamon, P.R.
PMSA;
Number of counties in EMA: 30;
ELCs in EMAs: 6,631%.
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): New York-White Plains-
Wayne, N.Y.-N.J. MDIV;
Number of counties in EMA: 11;
ELCs in EMAs: 53,867;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Caguas, P.R. PMSA;
Number of counties in EMA: 5;
ELCs in EMAs: 766;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): San Juan- Caguas-
Guaynabo, P.R. MSA;
Number of counties in EMA: 41;
ELCs in EMAs: 7,724;
Changes: Decrease in counties: 3;
Changes: Increase in counties: 9;
Changes: Change in ELCs (percent): 4%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Subtotal of changed areas;
Number of counties in EMA: 239;
ELCs in EMAs: 158,952;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Not applicable;
Number of counties in EMA: 275;
ELCs in EMAs: 160,694;
Changes: Decrease in counties: 17;
Changes: Increase in counties: 53;
Changes: Change in ELCs (percent): 1%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Subtotal of unchanged areas
(see table 13);
Number of counties in EMA: 57;
ELCs in EMAs: 84,768;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Not applicable;
Number of counties in EMA: 57;
ELCs in EMAs: 84,768;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Total;
Number of counties in EMA: 296;
ELCs in EMAs: 243,720;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Not applicable;
Number of counties in EMA: 332;
ELCs in EMAs: 245,462;
Changes: Decrease in counties: 17;
Changes: Increase in counties: 53;
Changes: Change in ELCs (percent): 1.
Sources: GAO analysis of CDC, HRSA, and OMB data.
Notes: HRSA's Title I EMAs are based on OMB's 1993 metropolitan area
definitions.This table uses OMB's terminology for classifying types of
metropolitan areas. Specifically, it includes metropolitan statistical
area (MSA), primary metropolitan statistical area (PMSA), New England
county metropolitan area (NECMA), and metropolitan division (MDIV). The
terms used and meaning of those terms differ between1993 and 2004
because of OMB's fundamental revisions of metropolitan concepts. For
further explanation, see GAO-04-758.
[A] We chose whatever combination of the newly defined metropolitan
areas that would result in the least change to the numbers of ELCs
within the EMA's boundaries.
[B] Percent change that rounds to zero, but does not equal zero
percent.
[End of table]
Table 13: EMAs with No Service Area Changes:
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Austin-San Marcos, Tex.
MSA;
Number of counties in EMA: 5;
ELCs in EMAs: 1,651;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Austin-Round Rock, Tex.
MSA;
Number of counties in EMA: 5;
ELCs in EMAs: 1,651;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Baltimore, Md. PMSA;
Number of counties in EMA: 7;
ELCs in EMAs: 8,348;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Baltimore-Towson, Md.
MSA;
Number of counties in EMA: 7;
ELCs in EMAs: 8,348;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Fort Lauderdale, Fla. PMSA;
Number of counties in EMA: 1;
ELCs in EMAs: 6,002;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Fort Lauderdale-Pompano
Beach-Deerfield Beach, Fla. MDIV;
Number of counties in EMA: 1;
ELCs in EMAs: 6,002;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Hartford, Conn. NECMA;
Number of counties in EMA: 3;
ELCs in EMAs: 1,954;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Hartford-West Hartford-
East Hartford, Conn. MSA;
Number of counties in EMA: 3;
ELCs in EMAs: 1,954;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Los Angeles- Long Beach,
Calif. PMSA;
Number of counties in EMA: 1;
ELCs in EMAs: 15,180;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Los Angeles-Long Beach-
Glendale, Calif. MDIV;
Number of counties in EMA: 1;
ELCs in EMAs: 15,180;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Miami, Fla. PMSA;
Number of counties in EMA: 1;
ELCs in EMAs: 10,485;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Miami-Miami Beach-
Kendall, Fla. MDIV;
Number of counties in EMA: 1;
ELCs in EMAs: 10,485;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Minneapolis- St. Paul,
Minn.-Wis. MSA;
Number of counties in EMA: 13;
ELCs in EMAs: 1,272;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Minneapolis-St. Paul-
Bloomington, Minn.-Wis. MSA;
Number of counties in EMA: 13;
ELCs in EMAs: 1,272;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Nassau- Suffolk, N.Y. PMSA;
Number of counties in EMA: 2;
ELCs in EMAs: 2,588;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Nassau-Suffolk, N.Y.
MDIV;
Number of counties in EMA: 2;
ELCs in EMAs: 2,588;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: New Haven- Bridgeport-
Stamford-Waterbury-Danbury, Conn. NECMA;
Number of counties in EMA: 2;
ELCs in EMAs: 2,945;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Bridgeport-Stamford-
Norwalk, Conn. MSA and New Haven-Milford, Conn. MSA;
Number of counties in EMA: 2;
ELCs in EMAs: 2,945;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Oakland, Calif. PMSA;
Number of counties in EMA: 2;
ELCs in EMAs: 2,852;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Oakland-Fremont-Hayward,
Calif. MDIV;
Number of counties in EMA: 2;
ELCs in EMAs: 2,852;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Orange County, Calif. PMSA;
Number of counties in EMA: 1;
ELCs in EMAs: 2,183;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Santa Ana-Anaheim-
Irvine, Calif. MDIV;
Number of counties in EMA: 1;
ELCs in EMAs: 2,183;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Orlando, Fla. MSA;
Number of counties in EMA: 4;
ELCs in EMAs: 3,293;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Orlando-Kissimmee, Fla.
MSA;
Number of counties in EMA: 4;
ELCs in EMAs: 3,293;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Phoenix- Mesa, Ariz. MSA;
Number of counties in EMA: 2;
ELCs in EMAs: 2,850;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Phoenix-Mesa-Scottsdale,
Ariz. MSA;
Number of counties in EMA: 2;
ELCs in EMAs: 2,850;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Riverside- San Bernardino,
Calif. PMSA;
Number of counties in EMA: 2;
ELCs in EMAs: 3,204;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Riverside-San Bernardino-
Ontario, Calif. MSA;
Number of counties in EMA: 2;
ELCs in EMAs: 3,204;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: San Diego, Calif. MSA;
Number of counties in EMA: 1;
ELCs in EMAs: 4,259;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): San Diego-Carlsbad San
Marcos, CA MSA;
Number of counties in EMA: 1;
ELCs in EMAs: 4,259;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: San Francisco, Calif. PMSA;
Number of counties in EMA: 3;
ELCs in EMAs: 7,216;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): San Francisco-San Mateo-
Redwood City, Calif. MDIV;
Number of counties in EMA: 3;
ELCs in EMAs: 7,216;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Santa Rosa, Calif. PMSA;
Number of counties in EMA: 1;
ELCs in EMAs: 482;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Santa Rosa-Petaluma,
Calif. MSA;
Number of counties in EMA: 1;
ELCs in EMAs: 482;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Tampa-St. Petersburg-
Clearwater, Fla. MSA;
Number of counties in EMA: 4;
ELCs in EMAs: 3,875;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Tampa-St. Petersburg-
Clearwater, Fla. MSA;
Number of counties in EMA: 4;
ELCs in EMAs: 3,875;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Vineland-Millville-
Bridgeton, N.J. PMSA;
Number of counties in EMA: 1;
ELCs in EMAs: 388;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Vineland-Millville-
Bridgeton, N.J. MSA;
Number of counties in EMA: 1;
ELCs in EMAs: 388;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: West Palm Beach-Boca Raton,
Fla. MSA;
Number of counties in EMA: 1;
ELCs in EMAs: 3,741;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): West Palm Beach-Boca
Raton-Boynton Beach, Fla. MDIV;
Number of counties in EMA: 1;
ELCs in EMAs: 3,741;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0%.
HRSA 2004 EMA:
OMB's 1993 full title of metropolitan area: Total;
Number of counties in EMA: 57;
ELCs in EMAs: 84,768;
GAO-identified comparable OMB newly defined 2004 MSA(s) or MDIV(s)[A]:
OMB's 2004 full title of metropolitan area(s): Not applicable;
Number of counties in EMA: 57;
ELCs in EMAs: 84,768;
Changes: Decrease in counties: 0;
Changes: Increase in counties: 0;
Changes: Change in ELCs (percent): 0.
Sources: GAO analysis of CDC, HRSA, and OMB data.
Notes: This table uses OMB's terminology for classifying types of
metropolitan areas. Specifically, it includes metropolitan statistical
area (MSA), primary metropolitan statistical area (PMSA), New England
county metropolitan area (NECMA), and metropolitan division (MDIV). The
terms used and meaning of those terms differs between1993 and 2004
because of OMB's fundamental revisions of metropolitan concepts. For
further explanation, see GAO-04-758.
[A] We chose whatever combination of the newly defined metropolitan
areas that would result in the least change to the numbers of ELCs
within the EMA's boundaries.
[End of table]
[End of section]
Appendix VIII: Estimated CARE Act Title I Funding Changes from Use of
HIV Case Counts and ELCs with Hold-harmless:
Eligible metropolitan area: Atlanta, Ga;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$210,000;
Percent change: -2%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$210,000;
Percent change: -2%.
Eligible metropolitan area: Austin, Tex;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $260,000;
Percent change: 13%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$10,000;
Percent change: 0%[C].
Eligible metropolitan area: Baltimore, Md;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$240,000;
Percent change: -2%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $3,210,000;
Percent change: 32%.
Eligible metropolitan area: Bergen-Passaic, N.J;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $600,000;
Percent change: 23%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $210,000;
Percent change: 8%.
Eligible metropolitan area: Boston, Mass;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $1,180,000;
Percent change: 16%.
Eligible metropolitan area: Caguas, P.R;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$50,000;
Percent change: -5%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$50,000;
Percent change: -5%.
Eligible metropolitan area: Chicago, Ill;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$950,000;
Percent change: -7%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $510,000;
Percent change: 4%.
Eligible metropolitan area: Cleveland, Ohio;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $940,000;
Percent change: 51%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $610,000;
Percent change: 33%.
Eligible metropolitan area: Dallas, Tex;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $1,630,000;
Percent change: 25%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $660,000;
Percent change: 10%.
Eligible metropolitan area: Denver, Colo;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $3,210,000;
Percent change: 132%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $2,530,000;
Percent change: 104%.
Eligible metropolitan area: Detroit, Mich;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $1,520,000;
Percent change: 35%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $810,000;
Percent change: 19%.
Eligible metropolitan area: District of Columbia;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$750,000;
Percent change: -5%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$750,000;
Percent change: -5%.
Eligible metropolitan area: Dutchess County, N.Y;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $40,000;
Percent change: 7%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$30,000;
Percent change: -5%.
Eligible metropolitan area: Fort Lauderdale, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $2,060,000;
Percent change: 28%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $940,000;
Percent change: 13%.
Eligible metropolitan area: Fort Worth, Tex;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $350,000;
Percent change: 19%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $90,000;
Percent change: 5%.
Eligible metropolitan area: Hartford, Conn;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$80,000;
Percent change: -3%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$80,000;
Percent change: -3%.
Eligible metropolitan area: Houston, Tex;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $1,130,000;
Percent change: 12%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$20,000;
Percent change: 0%[C].
Eligible metropolitan area: Jacksonville, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $570,000;
Percent change: 23%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $200,000;
Percent change: 8%.
Eligible metropolitan area: Jersey City, N.J;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $590,000;
Percent change: 20%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $160,000;
Percent change: 5%.
Eligible metropolitan area: Kansas City, Mo;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $870,000;
Percent change: 51%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $560,000;
Percent change: 32%.
Eligible metropolitan area: Las Vegas, Nev;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $1,460,000;
Percent change: 61%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $1,000,000;
Percent change: 42%.
Eligible metropolitan area: Los Angeles, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$10,000;
Percent change: 0%[C];
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$10,000;
Percent change: 0%[C].
Eligible metropolitan area: Miami, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $3,580,000;
Percent change: 28%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $1,620,000;
Percent change: 13%.
Eligible metropolitan area: Middlesex-Somerset-Hunterdon, N.J;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $400,000;
Percent change: 26%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $170,000;
Percent change: 11%.
Eligible metropolitan area: Minneapolis-St. Paul, Minn;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $1,130,000;
Percent change: 71%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $810,000;
Percent change: 51%.
Eligible metropolitan area: Nassau-Suffolk, N.Y;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $40,000;
Percent change: 1%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $40,000;
Percent change: 1%.
Eligible metropolitan area: New Haven, Conn;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $0;
Percent change: 0%.
Eligible metropolitan area: New Orleans, La;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $1,950,000;
Percent change: 51%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $1,250,000;
Percent change: 33%.
Eligible metropolitan area: New York, N.Y;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $5,660,000;
Percent change: 9%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$310,000;
Percent change: -1%.
Eligible metropolitan area: Newark, N.J;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $2,360,000;
Percent change: 29%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $1,100,000;
Percent change: 14%.
Eligible metropolitan area: Norfolk, Va;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $1,560,000;
Percent change: 57%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $1,040,000;
Percent change: 38%.
Eligible metropolitan area: Oakland, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $0;
Percent change: 0%.
Eligible metropolitan area: Orange County, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$30,000;
Percent change: -1%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$30,000;
Percent change: -1%.
Eligible metropolitan area: Orlando, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $1,190,000;
Percent change: 30%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $570,000;
Percent change: 14%.
Eligible metropolitan area: Philadelphia, Pa;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$230,000;
Percent change: -2%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$230,000;
Percent change: -2%.
Eligible metropolitan area: Phoenix, Ariz;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $2,020,000;
Percent change: 58%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $1,360,000;
Percent change: 39%.
Eligible metropolitan area: Ponce, P.R;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$30,000;
Percent change: -2%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$30,000;
Percent change: -2%.
Eligible metropolitan area: Portland, Oreg;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$20,000;
Percent change: -1%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$20,000;
Percent change: -1%.
Eligible metropolitan area: Riverside-San Bernardino, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$90,000;
Percent change: -2%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$90,000;
Percent change: -2%.
Eligible metropolitan area: Sacramento, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $0;
Percent change: 0%.
Eligible metropolitan area: St. Louis, Mo;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $1,120,000;
Percent change: 47%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $830,000;
Percent change: 34%.
Eligible metropolitan area: San Antonio, Tex;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $180,000;
Percent change: 8%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: -$20,000;
Percent change: -1%.
Eligible metropolitan area: San Diego, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: -$120,000;
Percent change: -2%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $800,000;
Percent change: 15%.
Eligible metropolitan area: San Francisco, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $0;
Percent change: 0%.
Eligible metropolitan area: San Jose, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $0;
Percent change: 0%.
Eligible metropolitan area: San Juan, P.R;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $0;
Percent change: 0%.
Eligible metropolitan area: Santa Rosa, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $0;
Percent change: 0%.
Eligible metropolitan area: Seattle, Wash;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $640,000;
Percent change: 21%.
Eligible metropolitan area: Tampa-St. Petersburg, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $1,000,000;
Percent change: 21%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $310,000;
Percent change: 7%.
Eligible metropolitan area: Vineland-Millville-Bridgeton, N.J;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $130,000;
Percent change: 28%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $60,000;
Percent change: 12%.
Eligible metropolitan area: West Palm Beach, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding with hold-harmless provision:
Dollar change[B]: $530,000;
Percent change: 12%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding with hold-harmless provision[A]:
Dollar change[B]: $0;
Percent change: 0%.
Sources: GAO analysis of CDC, HRSA, state, and local data.
Notes: The estimated dollar and percent changes are based on what the
EMAs received in their base grants, including any hold-harmless
funding, and what they would have received if HIV cases and ELCs had
been used to allocate funding. In fiscal year 2004, the amount of hold-
harmless funding was $8,033,563. Because the amounts needed to fund the
Title I hold-harmless provision are taken from funds that would
otherwise be available for supplemental grants, the total funding
actually allocated as base grants and our estimated base grant funding
differ by the amounts necessary to fund the hold-harmless provision.
The hold-harmless funding was $43,300,968 when only CDC-accepted HIV
case counts and ELCs were used and $29,413,708 when the HIV case counts
from all grantees were used.
HRSA calculates a jurisdiction's ELCs by using data from CDC on the
reported AIDS case counts for the last 10 years and weighting those
numbers to account for the likelihood of death.
[A] In some jurisdictions, HIV cases are collected by name while in
others HIV cases are collected using a coded identifier. We used both
name-and code-based case counts for this estimate. CDC only accepts
name-based case counts as no code-based system has yet met its quality
criteria.
[B] Rounded to nearest $10,000.
[C] Percent change that rounds to zero, but does not equal zero
percent.
[End of table]
[End of section]
Appendix IX: Estimated CARE Act Title II Base Funding Changes from Use
of HIV Case Counts and ELCs with Hold-harmless:
Grantee: Alabama;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $1,170,000;
Percent change: 29%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $1,000,000;
Percent change: 25%.
Grantee: Alaska[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $0;
Percent change: 0%.
Grantee: Arizona;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $620,000;
Percent change: 19%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $410,000;
Percent change: 13%.
Grantee: Arkansas;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $320,000;
Percent change: 18%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $250,000;
Percent change: 14%.
Grantee: California;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $0;
Percent change: 0%.
Grantee: Colorado;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $1,540,000;
Percent change: 73%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $1,340,000;
Percent change: 63%.
Grantee: Connecticut;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$150,000;
Percentchange: -4%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$150,000;
Percent change: -4%.
Grantee: Delaware;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$410,000;
Percent change: -22%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$410,000;
Percent change: -22%.
Grantee: District of Columbia;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$940,000;
Percent change: -22%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$940,000;
Percent change: -22%.
Grantee: Florida;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$1,330,000;
Percent change: -4%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$2,910,000;
Percent change: -10%.
Grantee: Georgia;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$1,350,000;
Percent change: -14%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$1,350,000;
Percent change: -14%.
Grantee: Hawaii;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$70,000;
Percent change: -6%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$70,000;
Percent change: -6%.
Grantee: Idaho[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $0;
Percent change: 0%.
Grantee: Illinois;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$1,780,000;
Percent change: -20%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$780,000;
Percent change: -9%.
Grantee: Indiana;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $180,000;
Percent change: 5%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $50,000;
Percent change: 1%.
Grantee: Iowa;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$90,000;
Percent change: -11%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$90,000;
Percent change: -11%.
Grantee: Kansas;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $0;
Percent change: 0%.
Grantee: Kentucky;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$400,000;
Percent change: -17%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$400,000;
Percent change: -17%.
Grantee: Louisiana;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $700,000;
Percent change: 11%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $390,000;
Percent change: 6%.
Grantee: Maine[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $0;
Percent change: 0%.
Grantee: Maryland;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$1,650,000;
Percent change: -20%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $2,060,000;
Percent change: 24%.
Grantee: Massachusetts;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$620,000;
Percentchange: -12%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $20,000;
Percent change: 0%[D]%.
Grantee: Michigan;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $370,000;
Percent change: 9%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $130,000;
Percent change: 3%.
Grantee: Minnesota;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $460,000;
Percent change: 45%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $370,000;
Percent change: 36%.
Grantee: Mississippi;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $590,000;
Percentchange: 18%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $460,000;
Percent change: 14%.
Grantee: Missouri;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $720,000;
Percent change: 26%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $520,000;
Percent change: 19%.
Grantee: Montana[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $0;
Percent change: 0%.
Grantee: Nebraska;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$10,000;
Percent change: -2%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$30,000;
Percent change: -5%.
Grantee: Nevada;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $520,000;
Percent change: 31%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $400,000;
Percent change: 24%.
Grantee: New Hampshire[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $0;
Percent change: 0%.
Grantee: New Jersey;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $370,000;
Percentchange: 3%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $0;
Percent change: 0%.
Grantee: New Mexico;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$70,000;
Percentchange: -6%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$70,000;
Percent change: -6%.
Grantee: New York;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$1,730,000;
Percent change: -4%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$1,730,000;
Percent change: -4%.
Grantee: North Carolina;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $2,440,000;
Percent change: 33%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $2,120,000;
Percent change: 29%.
Grantee: North Dakota[E];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $300,000;
Percentchange: 150%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $300,000;
Percent change: 150%.
Grantee: Ohio;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $940,000;
Percent change: 17%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $690,000;
Percent change: 13%.
Grantee: Oklahoma;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $370,000;
Percent change: 18%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $290,000;
Percent change: 14%.
Grantee: Oregon;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$130,000;
Percent change: -8%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$130,000;
Percent change: -8%.
Grantee: Pennsylvania;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$1,840,000;
Percentchange: -17%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$1,840,000;
Percent change: -17%.
Grantee: Puerto Rico;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$320,000;
Percentchange: -4%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$320,000;
Percent change: -4%.
Grantee: Rhode Island;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$30,000;
Percentchange: -2%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$30,000;
Percent change: -2%.
Grantee: South Carolina;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $470,000;
Percentchange: 7%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $230,000;
Percent change: 3%.
Grantee: South Dakota[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $0;
Percent change: 0%.
Grantee: Tennessee;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $490,000;
Percent change: 8%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $270,000;
Percent change: 4%.
Grantee: Texas;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$1,140,000;
Percent change: -6%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$1,140,000;
Percent change: -6%.
Grantee: Utah;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$60,000;
Percent change: -6%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$60,000;
Percent change: -6%.
Grantee: Vermont[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $0;
Percent change: 0%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $0;
Percent change: 0%.
Grantee: Virginia;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $1,100,000;
Percent change: 19%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $750,000;
Percent change: 13%.
Grantee: Washington;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$200,000;
Percentchange: -7%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$170,000;
Percent change: -5%.
Grantee: West Virginia;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$20,000;
Percentchange: -3%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$50,000;
Percent change: -7%.
Grantee: Wisconsin;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $360,000;
Percent change: 20%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $290,000;
Percent change: 16%.
Grantee: Wyoming[E];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions:
Dollar change[B]: $300,000;
Percentchange: 150%;
Change in Title II base funding if HIV case counts from all grantees
and ELCs were used to distribute funding with hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $300,000;
Percent change: 150%.
Sources: GAO analysis of CDC, HRSA, state, and local data.
Notes: HRSA calculates a jurisdiction's ELCs by using data from CDC on
the reported AIDS case counts for the last 10 years and weighting those
numbers to account for the likelihood of death.
For purposes of this analysis, we considered the Title II hold-harmless
provision that is funded by proportional reductions in Title II base
grants. We did not include the Title II hold-harmless provision funded
by amounts otherwise available for Severe Need grants.
[A] In some jurisdictions, HIV cases are collected by name while in
others HIV cases are collected using a coded identifier. We used both
name-and code-based case counts for this estimate. CDC only accepts
name-based case counts as no code-based system has yet met its quality
criteria.
[B] Rounded to nearest $10,000.
[C] State received a Title II base award of $500,000, the minimum it
could receive based on the number of AIDS cases in the state.
[D] Percent change that rounds to zero, but does not equal zero
percent.
[E] State received a Title II base award of $200,000, the minimum it
could receive based on the number of AIDS cases in the state.
[End of table]
[End of section]
Appendix X: Estimated CARE Act ADAP Base Funding Changes from Use of
HIV Case Counts and ELCs with Hold-harmless:
[See PDF for image]
Sources: GAO analysis of CDC, HRSA, state, and local data.
Notes: The ADAP base grant funding levels reported to us included any
hold-harmless funding that would otherwise be used for ADAP Severe Need
grants. The estimated dollar and percent changes presented here are
based on what grantees received in their ADAP base grants without this
hold-harmless funding.
HRSA calculates a jurisdiction's ELCs by using data from CDC on the
reported AIDS case counts for the last 10 years and weighting those
numbers to account for the likelihood of death.
For purposes of this analysis, we considered the Title II hold-harmless
provision that is funded by proportional reductions in ADAP base
grants. We did not include the Title II hold-harmless provision funded
by amounts otherwise available for Severe Need grants.
[A] In some jurisdictions, HIV cases are collected by name while in
others HIV cases are collected using a coded identifier. We used both
name-and code-based case counts for this estimate. CDC only accepts
name-based case counts as no code-based system has yet met its quality
criteria.
[B] Rounded to nearest $10,000.
[C] Percent change that rounds to zero, but does not equal zero
percent.
[End of table]
[End of section]
Appendix XI: Estimated CARE Act Title I Base Funding Changes from Use
of HIV Case Counts and ELCs without Hold-harmless:
Eligible metropolitan area: Atlanta, Ga;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$2,830,000;
Percent change: -31%%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$3,600,000;
Percent change: -39%.
Eligible metropolitan area: Austin, Tex;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $260,000;
Percent change: 13%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$10,000;
Percent change: 0%[C].
Eligible metropolitan area: Baltimore, Md;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$3,110,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $3,210,000;
Percent change: 32%.
Eligible metropolitan area: Bergen-Passaic, N.J;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $600,000;
Percent change: 23%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $210,000;
Percent change: 8%.
Eligible metropolitan area: Boston, Mass;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$2,310,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,180,000;
Percent change: 16%.
Eligible metropolitan area: Caguas, P.R;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$260,000;
Percent change: -28%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$340,000;
Percent change: -37%.
Eligible metropolitan area: Chicago, Ill;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$3,900,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $510,000;
Percent change: 4%.
Eligible metropolitan area: Cleveland, Ohio;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $940,000;
Percent change: 51%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $610,000;
Percent change: 33%.
Eligible metropolitan area: Dallas, Tex;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,630,000;
Percent change: 25%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $660,000;
Percent change: 10%.
Eligible metropolitan area: Denver, Colo;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $3,210,000;
Percent change: 132%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $2,530,000;
Percent change: 104%.
Eligible metropolitan area: Detroit, Mich;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,520,000;
Percent change: 35%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $810,000;
Percent change: 19%.
Eligible metropolitan area: District of Columbia;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$2,330,000;
Percent change: -16%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$1,390,000;
Percent change: -10%.
Eligible metropolitan area: Dutchess County, N.Y;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $40,000;
Percent change: 7%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$40,000;
Percent change: -6%.
Eligible metropolitan area: Fort Lauderdale, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $2,060,000;
Percent change: 28%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $940,000;
Percent change: 13%.
Eligible metropolitan area: Fort Worth, Tex;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $350,000;
Percent change: 19%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $90,000;
Percent change: 5%.
Eligible metropolitan area: Hartford, Conn;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$730,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$800,000;
Percent change: -34%.
Eligible metropolitan area: Houston, Tex;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,130,000;
Percent change: 12%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$140,000;
Percent change: -1%.
Eligible metropolitan area: Jacksonville, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $570,000;
Percent change: 23%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $200,000;
Percent change: 8%.
Eligible metropolitan area: Jersey City, N.J;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $590,000;
Percent change: 20%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $160,000;
Percent change: 5%.
Eligible metropolitan area: Kansas City, Mo;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $870,000;
Percent change: 51%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $560,000;
Percent change: 32%.
Eligible metropolitan area: Las Vegas, Nev;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,460,000;
Percent change: 61%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,000,000;
Percent change: 42%.
Eligible metropolitan area: Los Angeles, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$5,660,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$2,660,000;
Percent change: -14%.
Eligible metropolitan area: Miami, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $3,580,000;
Percent change: 28%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,620,000;
Percent change: 13%.
Eligible metropolitan area: Middlesex-Somerset-Hunterdon, N.J;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $400,000;
Percent change: 26%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $170,000;
Percent change: 11%.
Eligible metropolitan area: Minneapolis-St. Paul, Minn;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,130,000;
Percent change: 71%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $810,000;
Percent change: 51%.
Eligible metropolitan area: Nassau-Suffolk, N.Y;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$940,000;
Percent change: -29%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$1,210,000;
Percent change: -38%.
Eligible metropolitan area: New Haven, Conn;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$1,140,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$1,270,000;
Percent change: -35%.
Eligible metropolitan area: New Orleans, La;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,950,000;
Percent change: 51%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,250,000;
Percent change: 33%.
Eligible metropolitan area: New York, N.Y;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $5,660,000;
Percent change: 9%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$2,240,000;
Percent change: -4%.
Eligible metropolitan area: Newark, N.J;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $2,360,000;
Percent change: 29%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,100,000;
Percent change: 14%.
Eligible metropolitan area: Norfolk, Va;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,560,000;
Percent change: 57%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,040,000;
Percent change: 38%.
Eligible metropolitan area: Oakland, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$1,100,000;
Percent change: -32%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$680,000;
Percent change: -19%.
Eligible metropolitan area: Orange County, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$810,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$190,000;
Percent change: -7%.
Eligible metropolitan area: Orlando, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,190,000;
Percent change: 30%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $570,000;
Percent change: 14%.
Eligible metropolitan area: Philadelphia, Pa;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$2,620,000;
Percent change: -22%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$3,750,000;
Percent change: -31%.
Eligible metropolitan area: Phoenix, Ariz;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $2,020,000;
Percent change: 58%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,360,000;
Percent change: 39%.
Eligible metropolitan area: Ponce, P.R;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$420,000;
Percent change: -29%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$540,000;
Percent change: -38%.
Eligible metropolitan area: Portland, Oreg;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$580,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$90,000;
Percent change: -5%.
Eligible metropolitan area: Riverside-San Bernardino, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$1,190,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$170,000;
Percent change: -4%.
Eligible metropolitan area: Sacramento, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$500,000;
Percent change: -32%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$330,000;
Percent change: -21%.
Eligible metropolitan area: St. Louis, Mo;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,120,000;
Percent change: 47%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $830,000;
Percent change: 34%.
Eligible metropolitan area: San Antonio, Tex;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $180,000;
Percent change: 8%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$100,000;
Percent change: -5%.
Eligible metropolitan area: San Diego, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$1,590,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $800,000;
Percent change: 15%.
Eligible metropolitan area: San Francisco, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$10,050,000;
Percent change: -62%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$8,470,000;
Percent change: -52%.
Eligible metropolitan area: San Jose, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$440,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$30,000;
Percent change: -2%.
Eligible metropolitan area: San Juan, P.R;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$2,430,000;
Percent change: -30%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$3,120,000;
Percent change: -38%.
Eligible metropolitan area: Santa Rosa, Calif;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$200,000;
Percent change: -33%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$30,000;
Percent change: -5%.
Eligible metropolitan area: Seattle, Wash;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$930,000;
Percent change: -31%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $640,000;
Percent change: 21%.
Eligible metropolitan area: Tampa-St. Petersburg, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,000,000;
Percent change: 21%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $310,000;
Percent change: 7%.
Eligible metropolitan area: Vineland-Millville-Bridgeton, N.J;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $130,000;
Percent change: 28%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $60,000;
Percent change: 12%.
Eligible metropolitan area: West Palm Beach, Fla;
Change in Title I base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $530,000;
Percent change: 12%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$80,000;
Percent change: -2%.
Sources: GAO analysis of CDC, HRSA, state, and local data.
Notes: The estimated dollar and percent changes are based on what the
EMAs actually received in their base grants, which includes hold-
harmless funding, and what they would have received using HIV cases and
ELCs if there had been no hold-harmless provision. Because hold-
harmless funding is taken from amounts otherwise available for
supplemental grants, the total funding actually allocated as base
grants and our estimated funding differ by the amount of the hold-
harmless funding ($8,033,563).
HRSA calculates a jurisdiction's ELCs by using data from CDC on the
reported AIDS case counts for the last 10 years and weighting those
numbers to account for the likelihood of death.
[A] In some jurisdictions, HIV cases are collected by name while in
others HIV cases are collected using a coded identifier. We used both
name-and code-based case counts for this estimate. CDC only accepts
name-based case counts as no code-based system has yet met its quality
criteria.
[B] Rounded to nearest $10,000.
[C] Percent change that rounds to zero, but does not equal zero
percent.
[End of table]
[End of section]
Appendix XII: Estimated CARE Act Title II Base Funding Changes from Use
of HIV Case Counts and ELCs without Hold-harmless:
Grantee: Alabama;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $2,550,000;
Percent change: 63%%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $2,010,000;
Percent change: 50%.
Grantee: Alaska[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$270,000;
Percent change: -54%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$290,000;
Percent change: -58%.
Grantee: Arizona;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $1,220,000;
Percent change: 38%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $810,000;
Percent change: 25%.
Grantee: Arkansas;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $870,000;
Percent change: 49%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $650,000;
Percent change: 37%.
Grantee: California;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$11,750,000;
Percent change: -38%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$4,980,000;
Percent change: -16%.
Grantee: Colorado;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $2,100,000;
Percent change: 99%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $1,700,000;
Percent change: 81%.
Grantee: Connecticut;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$1,360,000;
Percent change: -36%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$1,410,000;
Percent change: -37%.
Grantee: Delaware;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$740,000;
Percent change: -40%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$220,000;
Percent change: -12%.
Grantee: District of Columbia;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$1,520,000;
Percent change: -35%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$1,800,000;
Percent change: -42%.
Grantee: Florida;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $2,970,000;
Percent change: 10%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$110,000;
Percent change: 0%[D].
Grantee: Georgia;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$3,530,000;
Percent change: -38%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$4,060,000;
Percent change: -43%.
Grantee: Hawaii;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$480,000;
Percent change: -40%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$170,000;
Percent change: -14%.
Grantee: Idaho[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$80,000;
Percent change: -16%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$110,000;
Percent change: -23%.
Grantee: Illinois;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$3,200,000;
Percent change: -36%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$60,000;
Percent change: -1%.
Grantee: Indiana;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $1,210,000;
Percent change: 32%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $810,000;
Percent change: 21%.
Grantee: Iowa;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $30,000;
Percent change: 3%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$40,000;
Percent change: -5%.
Grantee: Kansas;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $210,000;
Percent change: 21%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $110,000;
Percent change: 11%.
Grantee: Kentucky;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$940,000;
Percent change: -40%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$1,060,000;
Percent change: -45%.
Grantee: Louisiana;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $2,110,000;
Percent change: 34%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $1,380,000;
Percent change: 22%.
Grantee: Maine[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$210,000;
Percent change: -42%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $50,000;
Percent change: 10%.
Grantee: Maryland;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$3,020,000;
Percent change: -36%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $2,980,000;
Percent change: 35%.
Grantee: Massachusetts;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$1,910,000;
Percent change: -37%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $530,000;
Percent change: 10%.
Grantee: Michigan;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $1,180,000;
Percent change: 27%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $680,000;
Percent change: 16%.
Grantee: Minnesota;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $650,000;
Percent change: 64%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $490,000;
Percent change: 48%.
Grantee: Mississippi;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $1,630,000;
Percent change: 49%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $1,220,000;
Percent change: 37%.
Grantee: Missouri;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $1,260,000;
Percent change: 45%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $880,000;
Percent change: 32%.
Grantee: Montana[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$390,000;
Percent change: -79%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$170,000;
Percent change: -33%.
Grantee: Nebraska;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $150,000;
Percent change: 24%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $90,000;
Percent change: 14%.
Grantee: Nevada;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $840,000;
Percent change: 50%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $600,000;
Percent change: 36%.
Grantee: New Hampshire[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$310,000;
Percent change: -63%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$120,000;
Percent change: -24%.
Grantee: New Jersey;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $2,140,000;
Percent change: 17%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $760,000;
Percent change: 6%.
Grantee: New Mexico;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $60,000;
Percent change: 5%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$50,000;
Percent change: -4%.
Grantee: New York;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$600,000;
Percent change: -1%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$4,640,000;
Percent change: -11%.
Grantee: North Carolina;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $5,030,000;
Percent change: 68%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $4,020,000;
Percent change: 54%.
Grantee: North Dakota[E];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$120,000;
Percent change: -62%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$130,000;
Percent change: -65%.
Grantee: Ohio;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $2,420,000;
Percent change: 45%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $1,750,00;
Percent change: 32%.
Grantee: Oklahoma;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $1,010,000;
Percent change: 49%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $760,000;
Percent change: 37%.
Grantee: Oregon;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$620,000;
Percent change: -37%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$280,000;
Percent change: -17%.
Grantee: Pennsylvania;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$2,320,000;
Percent change: -22%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$3,080,000;
Percent change: -29%.
Grantee: Puerto Rico;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$2,950,000;
Percent change: -36%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$3,450,000;
Percent change: -42%.
Grantee: Rhode Island;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$440,000;
Percent change: -40%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$170,000;
Percent change: -15%.
Grantee: South Carolina;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $2,370,000;
Percent change: 35%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $1,620,000;
Percent change: 24%.
Grantee: South Dakota[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$290,000;
Percent change: -58%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$310,000;
Percent change: -62%.
Grantee: Tennessee;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $2,250,000;
Percent change: 36%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $1,550,000;
Percent change: 25%.
Grantee: Texas;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $870,000;
Percent change: 5%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$990,000;
Percent change: -5%.
Grantee: Utah;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $110,000;
Percent change: 10%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $10,000;
Percent change: 1%.
Grantee: Vermont[C];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$370,000;
Percent change: -74%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$260,000;
Percent change: -52%.
Grantee: Virginia;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $2,370,000;
Percent change: 40%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $1,620,000;
Percent change: 27%.
Grantee: Washington;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$1,170,000;
Percent change: -37%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $170,000;
Percent change: 5%.
Grantee: West Virginia;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $150,000;
Percent change: 21%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $80,000;
Percent change: 11%.
Grantee: Wisconsin;
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: $940,000;
Percent change: 51%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: $710,000;
Percent change: 39%.
Grantee: Wyoming[E];
Change in Title II base funding if CDC-accepted HIV case counts and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions:
Dollar change[B]: -$90,000;
Percent change: -46%;
Change in Title I base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless and minimum-
grant provisions[A]:
Dollar change[B]: -$100,000;
Percent change: -51.
Sources: GAO analysis of CDC, HRSA, state, and local data.
Notes: HRSA calculates a jurisdiction's ELCs by using data from CDC on
the reported AIDS case counts for the last 10 years and weighting those
numbers to account for the likelihood of death.
[A] In some jurisdictions, HIV cases are collected by name while in
others HIV cases are collected using a coded identifier. We used both
name-and code-based case counts for this estimate. CDC only accepts
name-based case counts as no code-based system has yet met its quality
criteria.
[B] Rounded to nearest $10,000.
[C] State received a Title II base award of $500,000, the minimum it
could receive based on the number of ELCs in the state. The estimated
changes compare this amount with what the state would have received if
HIV case counts and ELCs had been used to determine funding and if
there had been no hold-harmless and minimum-grant provisions.
[D] Percent change that rounds to zero, but does not equal zero
percent.
[E] State received a Title II base award of $200,000, the minimum it
could receive based on the number of ELCs in the state. The estimated
changes compare this amount with what the state would have received if
HIV case counts and ELCs had been used to determine funding and if
there had been no hold-harmless and minimum-grant provisions.
[End of table]
[End of section]
Appendix XIII: Estimated CARE Act ADAP Base Funding Changes from Use of
HIV Case Counts and ELCs without Hold-harmless:
Grantee: Alabama;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $5,190,000;
Percent change: 74%%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $3,970,000;
Percent change: 57%.
Grantee: Alaska;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$50,000;
Percent change: -10%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$90,000;
Percent change: -19%.
Grantee: Arizona;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $3,550,000;
Percent change: 42%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $2,370,000;
Percent change: 28%.
Grantee: Arkansas;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,820,000;
Percent change: 59%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,330,000;
Percent change: 43%.
Grantee: California;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$32,150,000;
Percent change: - 36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$12,590,000;
Percent change: -14%.
Grantee: Colorado;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $5,970,000;
Percent change: 106%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $4,820,000;
Percent change: 86%.
Grantee: Connecticut;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$4,060,000;
Percent change: - 36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$4,240,000;
Percent change: -38%.
Grantee: Delaware;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$1,150,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$250,000;
Percent change: -8%.
Grantee: District of Columbia;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$4,970,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$5,850,000;
Percent change: -42%.
Grantee: Florida;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $10,400,000;
Percent change: 13%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,390,000;
Percent change: 2%.
Grantee: Georgia;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$8,500,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$10,010,000;
Percent change: -42%.
Grantee: Hawaii;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$750,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$210,000;
Percent change: -10%.
Grantee: Idaho;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $310,000;
Percent change: 68%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $240,000;
Percent change: 51%.
Grantee: Illinois;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$9,240,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$250,000;
Percent change: -1%.
Grantee: Indiana;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $2,690,000;
Percent change: 41%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,770,000;
Percent change: 27%.
Grantee: Iowa;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $140,000;
Percent change: 10%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$10,000;
Percent change: -1%.
Grantee: Kansas;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $650,000;
Percent change: 32%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $390,000;
Percent change: 19%.
Grantee: Kentucky;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$1,470,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$1,730,000;
Percent change: -42%.
Grantee: Louisiana;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $5,440,000;
Percent change: 39%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $3,530,000;
Percent change: 26%.
Grantee: Maine;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$300,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $160,000;
Percent change: 19%.
Grantee: Maryland;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$9,240,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $7,700,000;
Percent change: 30%.
Grantee: Massachusetts;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$5,270,000;
Percent change: - 36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,530,000;
Percent change: 10%.
Grantee: Michigan;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $3,150,000;
Percent change: 29%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,740,000;
Percent change: 16%.
Grantee: Minnesota;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,910,000;
Percent change: 63%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,420,000;
Percent change: 47%.
Grantee: Mississippi;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $3,410,000;
Percent change: 60%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $2,490,000;
Percent change: 43%.
Grantee: Missouri;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $3,600,000;
Percent change: 49%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $2,510,000;
Percent change: 34%.
Grantee: Montana;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$110,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $300,000;
Percent change: 95%.
Grantee: Nebraska;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $360,000;
Percent change: 32%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $210,000;
Percent change: 19%.
Grantee: Nevada;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $2,400,000;
Percent change: 51%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,700,000;
Percent change: 36%.
Grantee: New Hampshire;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$270,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $210,000;
Percent change: 28%.
Grantee: New Jersey;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $6,500,000;
Percent change: 19%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $2,390,000;
Percent change: 7%.
Grantee: New Mexico;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $250,000;
Percent change: 12%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $20,000;
Percent change: 1%.
Grantee: New York;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$1,110,000;
Percent change: -1%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$13,400,000;
Percent change: -11%.
Grantee: North Carolina;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $10,190,000;
Percent change: 79%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $7,900,000;
Percent change: 62%.
Grantee: North Dakota;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $50,000;
Percent change: 57%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $40,000;
Percent change: 41%.
Grantee: Ohio;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $5,520,000;
Percent change: 51%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $3,890,000;
Percent change: 36%.
Grantee: Oklahoma;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $2,100,000;
Percent change: 59%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,540,000;
Percent change: 43%.
Grantee: Oregon;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$1,520,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$600,000;
Percent change: -14%.
Grantee: Pennsylvania;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$6,540,000;
Percent change: - 24%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$8,540,000;
Percent change: -32%.
Grantee: Puerto Rico;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$7,890,000;
Percent change: - 35%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$9,350,000;
Percent change: -41%.
Grantee: Rhode Island;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$690,000;
Percent change: - 36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$210,000;
Percent change: -11%.
Grantee: South Carolina;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $5,190,000;
Percent change: 44%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $3,510,000;
Percent change: 30%.
Grantee: South Dakota;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $180,000;
Percent change: 90%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $150,000;
Percent change: 71%.
Grantee: Tennessee;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $4,880,000;
Percent change: 46%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $3,330,000;
Percent change: 31%.
Grantee: Texas;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $3,440,000;
Percent change: 7%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: -$1,920,000;
Percent change: -4%.
Grantee: Utah;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $330,000;
Percent change: 18%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $110,000;
Percent change: 6%.
Grantee: Vermont;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$140,000;
Percent change: -36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $50,000;
Percent change: 14%.
Grantee: Virginia;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $6,260,000;
Percent change: 43%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $4,200,000;
Percent change: 29%.
Grantee: Washington;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: -$2,860,000;
Percent change: - 36%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $720,000;
Percent change: 9%.
Grantee: West Virginia;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $380,000;
Percent change: 29%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $210,000;
Percent change: 16%.
Grantee: Wisconsin;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $1,950,000;
Percent change: 61%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $1,440,000;
Percent change: 45%.
Grantee: Wyoming;
Change in ADAP base funding if CDC-accepted HIV case counts and ELCs
were used to distribute funding without hold-harmless provision:
Dollar change[B]: $40,000;
Percent change: 24%;
Change in ADAP base funding if HIV case counts from all grantees and
ELCs were used to distribute funding without hold-harmless
provision[A]:
Dollar change[B]: $20,000;
Percent change: 12%.
Sources: GAO analysis of CDC, HRSA, state, and local data.
Notes: The ADAP base grant funding levels reported to us included any
hold-harmless funding that would otherwise be used for ADAP Severe Need
grants. The estimated dollar and percent changes presented here are
based on what grantees received in their ADAP base grants without this
hold-harmless funding.
HRSA calculates a jurisdiction's ELCs by using data from CDC on the
reported AIDS case counts for the last 10 years and weighting those
numbers to account for the likelihood of death.
[A] In some jurisdictions, HIV cases are collected by name while in
others HIV cases are collected using a coded identifier. We used both
name-and code-based case counts for this estimate. CDC only accepts
name-based case counts as no code-based system has yet met its quality
criteria.
[B] Rounded to nearest $10,000.
[End of table]
[End of section]
Appendix XIV: Estimated HOPWA Base Funding Changes from Use of HIV and
Living AIDS Case Counts, Fiscal Year 2004:
Grantee: Alabama;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $1,150,000;
Percent change: 101%%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $960,000;
Percent change: 84%%.
Grantee: Albany, N.Y;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $80,000;
Percent change: 18%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $30,000;
Percent change: 8%.
Grantee: Arizona;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $60,000;
Percent change: 39%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $40,000;
Percent change: 27%.
Grantee: Arkansas;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $630,000;
Percent change: 84%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $520,000;
Percent change: 69%.
Grantee: Atlanta, Ga;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$1,160,000;
Percent change: -27%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$1,420,000;
Percent change: -33%.
Grantee: Augusta, Ga;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $10,000;
Percent change: 3%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$20,000;
Percent change: -6%.
Grantee: Austin, Tex;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $70,000;
Percent change: 7%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$20,000;
Percent change: -2%.
Grantee: Baltimore, Md;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$1,170,000;
Percent change: -30%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $1,770,000;
Percent change: 45%.
Grantee: Baton Rouge, La;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $470,000;
Percent change: 71%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $370,000;
Percent change: 56%.
Grantee: Birmingham, Ala;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $550,000;
Percent change: 106%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $460,000;
Percent change: 89%.
Grantee: Boston, Mass;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$650,000;
Percent change: -36%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $110,000;
Percent change: 6%.
Grantee: Bridgeport, Conn;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$160,000;
Percent change: -21%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$180,000;
Percent change: -24%.
Grantee: Buffalo, N.Y;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $30,000;
Percent change: 6%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$10,000;
Percent change: -3%.
Grantee: California;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$1,150,000;
Percent change: -38%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$600,000;
Percent change: -20%.
Grantee: Cambridge, Mass;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$200,000;
Percent change: -30%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $110,000;
Percent change: 16%.
Grantee: Camden, N.J;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $180,000;
Percent change: 27%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $110,000;
Percent change: 16%.
Grantee: Charleston, S.C;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $290,000;
Percent change: 72%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $230,000;
Percent change: 57%.
Grantee: Charlotte, N.C;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $900,000;
Percent change: 158%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $780,000;
Percent change: 137%.
Grantee: Chicago, Ill;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$1,860,000;
Percent change: -33%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$10,000;
Percent change: 0%[C]%.
Grantee: Cincinnati, Ohio;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $200,000;
Percent change: 36%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $130,000;
Percent change: 24%.
Grantee: Cleveland, Ohio;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $410,000;
Percent change: 48%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $300,000;
Percent change: 35%.
Grantee: Colorado;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $350,000;
Percent change: 97%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $290,000;
Percent change: 80%.
Grantee: Columbia, S.C;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $600,000;
Percent change: 96%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $490,000;
Percent change: 80%.
Grantee: Columbus, Ohio;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $360,000;
Percent change: 61%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $280,000;
Percent change: 48%.
Grantee: Connecticut;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$60,000;
Percent change: -24%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$70,000;
Percent change: -28%.
Grantee: Dallas, Tex;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $590,000;
Percent change: 19%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $270,000;
Percent change: 9%.
Grantee: Delaware;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$40,000;
Percent change: -22%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $30,000;
Percent change: 18%.
Grantee: Denver, Colo;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $1,210,000;
Percent change: 85%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $990,000;
Percent change: 69%.
Grantee: Detroit, Mich;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $270,000;
Percent change: 17%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $110,000;
Percent change: 7%.
Grantee: District of Columbia;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$230,000;
Percent change: -4%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $20,000;
Percent change: 0%[C]%.
Grantee: Florida;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$660,000;
Percent change: -16%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$950,000;
Percent change: -23%.
Grantee: Fort Lauderdale, Fla;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $820,000;
Percent change: 24%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $460,000;
Percent change: 14%.
Grantee: Fort Worth, Tex;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $110,000;
Percent change: 13%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $30,000;
Percent change: 3%.
Grantee: Gaithersburg, Md;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$120,000;
Percent change: -22%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $190,000;
Percent change: 35%.
Grantee: Georgia;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$340,000;
Percent change: -23%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$440,000;
Percent change: -29%.
Grantee: Hartford, Conn;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$220,000;
Percent change: -21%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$230,000;
Percent change: -23%.
Grantee: Hawaii;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$30,000;
Percent change: -17%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $10,000;
Percent change: 5%.
Grantee: Honolulu, Hawaii;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$160,000;
Percent change: -37%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$70,000;
Percent change: -16%.
Grantee: Houston, Tex;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$260,000;
Percent change: -5%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$660,000;
Percent change: -13%.
Grantee: Illinois;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$190,000;
Percent change: -22%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $140,000;
Percent change: 17%.
Grantee: Indiana;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $470,000;
Percent change: 56%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $360,000;
Percent change: 43%.
Grantee: Indianapolis, Ind;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $420,000;
Percent change: 56%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $320,000;
Percent change: 42%.
Grantee: Iowa;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $60,000;
Percent change: 17%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $30,000;
Percent change: 8%.
Grantee: Islip, N.Y;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$300,000;
Percent change: -18%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$410,000;
Percent change: -25%.
Grantee: Jackson, Miss;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $450,000;
Percent change: 99%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $370,000;
Percent change: 82%.
Grantee: Jacksonville, Fla;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $290,000;
Percent change: 24%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $160,000;
Percent change: 14%.
Grantee: Kansas;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $90,000;
Percent change: 25%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $50,000;
Percent change: 15%.
Grantee: Kentucky;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$60,000;
Percent change: -13%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$90,000;
Percent change: -21%.
Grantee: Kansas City, Mo;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $360,000;
Percent change: 36%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $240,000;
Percent change: 25%.
Grantee: Las Vegas, Nev;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $710,000;
Percent change: 77%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $570,000;
Percent change: 62%.
Grantee: Los Angeles, Calif;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$4,370,000;
Percent change: -42%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$3,660,000;
Percent change: -35%.
Grantee: Louisiana;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $580,000;
Percent change: 62%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $460,000;
Percent change: 49%.
Grantee: Louisville, Ky;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$40,000;
Percent change: -9%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$80,000;
Percent change: -17%.
Grantee: Maryland;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$70,000;
Percent change: -20%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $710,000;
Percent change: 204%.
Grantee: Massachusetts;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$160,000;
Percent change: -30%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $60,000;
Percent change: 12%.
Grantee: Memphis, Tenn;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $940,000;
Percent change: 102%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $780,000;
Percent change: 85%.
Grantee: Miami, Fla;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $1,140,000;
Percent change: 19%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $520,000;
Percent change: 9%.
Grantee: Michigan;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $370,000;
Percent change: 41%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $270,000;
Percent change: 29%.
Grantee: Milwaukee, Wis;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $340,000;
Percent change: 66%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $260,000;
Percent change: 52%.
Grantee: Minneapolis, Minn;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $350,000;
Percent change: 42%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $250,000;
Percent change: 30%.
Grantee: Minnesota;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $60,000;
Percent change: 56%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $50,000;
Percent change: 43%.
Grantee: Mississippi;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $630,000;
Percent change: 84%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $520,000;
Percent change: 68%.
Grantee: Missouri;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $270,000;
Percent change: 55%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $210,000;
Percent change: 42%.
Grantee: Nashville, Tenn;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $680,000;
Percent change: 93%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $560,000;
Percent change: 77%.
Grantee: Nevada;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $130,000;
Percent change: 55%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $100,000;
Percent change: 41%.
Grantee: New Haven, Conn;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$200,000;
Percent change: -21%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$220,000;
Percent change: -24%.
Grantee: New Jersey;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$770,000;
Percent change: -70%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$800,000;
Percent change: -72%.
Grantee: New Mexico;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $110,000;
Percent change: 21%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $60,000;
Percent change: 11%.
Grantee: New Orleans, La;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $760,000;
Percent change: 43%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $550,000;
Percent change: 31%.
Grantee: New York;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $300,000;
Percent change: 17%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $130,000;
Percent change: 7%.
Grantee: New York, N.Y;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$3,040,000;
Percent change: -9%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$5,610,000;
Percent change: -17%.
Grantee: Newark, N.J;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $40,000;
Percent change: 1%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$330,000;
Percent change: -8%.
Grantee: North Carolina;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $2,130,000;
Percent change: 103%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $1,780,000;
Percent change: 85%.
Grantee: Oakland, Calif;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$780,000;
Percent change: -39%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$670,000;
Percent change: -33%.
Grantee: Ohio;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $500,000;
Percent change: 49%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $370,000;
Percent change: 36%.
Grantee: Oklahoma;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $430,000;
Percent change: 83%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $350,000;
Percent change: 67%.
Grantee: Oklahoma City, Okla;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $180,000;
Percent change: 39%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $130,000;
Percent change: 27%.
Grantee: Orlando, Fla;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $610,000;
Percent change: 37%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $420,000;
Percent change: 25%.
Grantee: Pennsylvania;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$50,000;
Percent change: -4%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$180,000;
Percent change: -12%.
Grantee: Philadelphia, Pa;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$730,000;
Percent change: -17%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$1,040,000;
Percent change: -24%.
Grantee: Phoenix, Ariz;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $920,000;
Percent change: 65%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $730,000;
Percent change: 51%.
Grantee: Pittsburgh, Pa;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$120,000;
Percent change: -19%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$160,000;
Percent change: -26%.
Grantee: Portland, Oreg;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$300,000;
Percent change: -30%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$110,000;
Percent change: -11%.
Grantee: Poughkeepsie, N.Y;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$30,000;
Percent change: -5%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$80,000;
Percent change: -13%.
Grantee: Providence, R.I;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$220,000;
Percent change: -27%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $40,000;
Percent change: 5%.
Grantee: Puerto Rico;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$1,080,000;
Percent change: -62%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$1,130,000;
Percent change: -65%.
Grantee: Richmond, Va;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $490,000;
Percent change: 71%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $390,000;
Percent change: 57%.
Grantee: Riverside, Calif;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$380,000;
Percent change: -22%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$90,000;
Percent change: -5%.
Grantee: Rochester, N.Y;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $170,000;
Percent change: 29%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $110,000;
Percent change: 18%.
Grantee: Sacramento, Calif;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$310,000;
Percent change: -37%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$280,000;
Percent change: -33%.
Grantee: St. Louis, Mo;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $450,000;
Percent change: 37%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $370,000;
Percent change: 30%.
Grantee: Salt Lake City, Utah;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $120,000;
Percent change: 32%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $80,000;
Percent change: 21%.
Grantee: San Antonio, Tex;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $100,000;
Percent change: 10%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $0[ D];
Percent change: 1%.
Grantee: San Diego, Calif;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$820,000;
Percent change: -31%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $20,000;
Percent change: 1%.
Grantee: San Francisco, Calif;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$3,950,000;
Percent change: -59%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$3,420,000;
Percent change: -51%.
Grantee: San Jose, Calif;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$260,000;
Percent change: -33%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$100,000;
Percent change: -13%.
Grantee: San Juan, P.R;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$1,990,000;
Percent change: -44%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$2,210,000;
Percent change: -48%.
Grantee: Santa Ana, Calif;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$370,000;
Percent change: -26%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$130,000;
Percent change: -9%.
Grantee: Sarasota, Fla;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $40,000;
Percent change: 11%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $10,000;
Percent change: 1%.
Grantee: Seattle, Wash;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$520,000;
Percent change: -31%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $170,000;
Percent change: 10%.
Grantee: South Carolina;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $1,040,000;
Percent change: 75%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $840,000;
Percent change: 61%.
Grantee: Springfield, Mass;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$150,000;
Percent change: -32%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $90,000;
Percent change: 20%.
Grantee: Tampa, Fla;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $330,000;
Percent change: 15%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $110,000;
Percent change: 5%.
Grantee: Tennessee;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $490,000;
Percent change: 67%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $390,000;
Percent change: 53%.
Grantee: Texas;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $780,000;
Percent change: 29%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $480,000;
Percent change: 18%.
Grantee: Tucson, Ariz;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $210,000;
Percent change: 53%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $160,000;
Percent change: 40%.
Grantee: Utah;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $30,000;
Percent change: 26%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $20,000;
Percent change: 15%.
Grantee: Virginia;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $320,000;
Percent change: 50%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $240,000;
Percent change: 37%.
Grantee: Virginia Beach, Va;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $720,000;
Percent change: 71%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $580,000;
Percent change: 56%.
Grantee: Wake County, N.C;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $360,000;
Percent change: 105%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $300,000;
Percent change: 88%.
Grantee: Warren, Mich;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $120,000;
Percent change: 31%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $80,000;
Percent change: 20%.
Grantee: Washington;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$160,000;
Percent change: -25%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $70,000;
Percent change: 10%.
Grantee: West Palm Beach, Fla;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $270,000;
Percent change: 14%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $80,000;
Percent change: 4%.
Grantee: Wilmington, Del;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$70,000;
Percent change: -13%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $110,000;
Percent change: 19%.
Grantee: Wisconsin;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $220,000;
Percent change: 54%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $170,000;
Percent change: 41%.
Grantee: Woodbridge, N.J;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: $50,000;
Percent change: 4%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: -$80,000;
Percent change: -5%.
Grantee: Worcester, Mass;
Change in HOPWA base funding if CDC-accepted HIV case counts and living
AIDS case counts were used to distribute funding:
Dollar change[B]: -$90,000;
Percent change: -25%;
Change in HOPWA base funding if HIV case counts from all grantees and
living AIDS case counts were used to distribute funding[A]:
Dollar change[B]: $80,000;
Percent change: 22%.
Sources: GAO analysis of CDC, HUD, state, and local data.
Notes: The number of living AIDS cases was calculated by subtracting
the number of reported deaths among AIDS cases in a jurisdiction from
the number of reported cases.
[A] In some jurisdictions, HIV cases are collected by name while in
others HIV cases are collected using a coded identifier. We used both
name-and code-based case counts for this estimate. CDC only accepts
name-based case counts as no code-based system has yet met its quality
criteria.
[B] Rounded to nearest $10,000.
[C] Percent change that rounds to zero, but does not equal zero.
[D] Dollar change that rounds to zero, but does not equal zero.
[End of table]
[End of section]
Appendix XV: Comments from the Department of Health and Human Services:
DEPARTMENT OF HEALTH & HUMAN SERVICES:
Office of Inspector General:
Washington, D.C. 20201:
FEB 6 2006:
Ms. Marcia Crosse:
Director, Health Care:
U.S. Government Accountability Office:
Washington, DC 20548:
Dear Ms. Crosse:
Enclosed are the Department's comments on the U.S. Government
Accountability Office's (GAO) draft report entitled, "HIV/AIDS: Changes
Needed to Improve the Distribution of Ryan White CARE Act and Housing
Funds" (GAO-06-332). These comments represent the tentative position of
the Department and are subject to reevaluation when the final version
of this report is received.
The Department provided several technical comments directly to your
staff.
The Department appreciates the opportunity to comment on this draft
report before its publication. Sincerely,
Signed by:
Daniel R. Levinson:
Inspector General:
Enclosure:
The Office of Inspector General (OIG) is transmitting the Department's
response to this draft report in our capacity as the Department's
designated focal point and coordinator for U.S. Government
Accountability Office reports. OIG has not conducted an independent
assessment of these comments and therefore expresses no opinion on
them.
COMMENTS OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES ON THE U.S.
GOVERNMENT ACCOUNTABILITY OFFICE'S DRAFT REPORT ENTITLED, "HIV/AIDS:
CHANGES NEEDED TO IMPROVE THR DISTRIBUTION OF RYAN WHITE CARE ACT AND
HOUSING FUNDS" (GAO-06-332):
The Department of Health and Human Services (HHS) appreciates the
opportunity to comment on the draft report and commends the U.S.
Government Accountability Office (GAO) for its comprehensive approach
and ambitious analysis that pulls together data from many disparate
sources. As GAO has noted, HHS's Health Resources and Services
Administration (HRSA) administers the Ryan White Comprehensive AIDS
Resources Emergency (CARE) Act through grantees. HRSA utilizes, among
other elements, surveillance data published by HHS's Centers for
Disease Control and Prevention (CDC) in making decisions regarding CARE
Act funding activities. The draft report identifies the issues with
respect to many of the provisions in the current Ryan White
Comprehensive AIDS Resources Emergency (CARE) Act (Public Law 106-345).
However, the draft appears to disregard the potential usefulness of
including HIV data in the CARE Act formula. HHS suggests that GAO has
not fully addressed its charge to "examine what distribution
differences could result from incorporating HIV case counts in the CARE
Act" by omitting analyses of reported living HIV disease cases and HIV
disease estimated living cases (ELCs) as specified in the current
formula for Title I and Title 11 allocations.
GAO has done an excellent job of identifying various deficiencies in
the current HIV data, which suggests that HIV data should be used for
funding purposes. Although GAO states that HIV data used seem
sufficiently accurate for purposes of the presented analysis, no
assessment is provided regarding the potential usefulness of such
information, if all areas participated in the national reporting system
coordinated by CDC using standardized methods of reporting. Moreover,
the matters for Congressional consideration (page 65) focus only on
AIDS cases and potential changes to a formula that reflect the use of
AIDS case counts and not HIV disease. In this latter discussion, GAO
appears to endorse the superiority of the "Living AIDS Case" counts
provided by CDC, i.e., cumulative cases subtracting cases reported as
deceased. Congress is presented no similar formal consideration for the
use of HIV disease data in response to its request regarding
distribution differences that could result from incorporating HIV case
counts in CARE Act and Housing Opportunities for Persons with AIDS
program (HOPWA) funding formulas.
In discussions throughout the draft regarding data accepted and not
accepted by CDC because of differences between jurisdictions in the
methods used to report HIV-only cases (i.e., names versus codes), GAO
does not make clear that CDC does not receive case counts from
reporting areas. CDC receives, reviews, and processes case reports,
which do not contain personal identifiers, on individual cases.
Potential duplicate reports across jurisdictions are then manually
reviewed by the relevant reporting areas through a CDC-coordinated
process to remove duplicate reports from the national database. In
GAO's analysis, comparable data were not received from code-based
States. These States cannot participate in a manual, CDC-coordinated,
de-duplication process because they do not have comparable patient
identifiers to those maintained in name-based States. Therefore, it
would be scientifically indefensible for CDC in its monitoring of
HIV/AIDS nationally to replicate the process used by GAO in this study
of accepting only case counts from areas using code-based reporting.
The infeasibility of simply accepting case counts from areas using
code- based methods, both in terms of assuring data quality and
compiling data, is not made clear in the GAO report.
Regarding the matters for Congressional consideration, HHS submits the
following.
GAO Statement:
Revising the funding formulas used to determine grantee eligibility and
grant amounts using a measure of living AIDS cases that does not
include deceased cases and reflects the longer life spans of persons
living with AIDS.
HHS Comment:
The current CARE Act requires the use of differing formulas using ELCs
compiled over a 10-year period, AIDS cases for the most recent 2-year
period, or AIDS cases over the most recent 5-year period. HRSA has
sought to comply with the legislative intent of the specific program
goals and would welcome any recommendations that would simplify the
formulas or make them similar with respect to the time period and type
of HIV and AIDS case data used.
GAO Statement:
Eliminating the counting of cases in [eligible metropolitan areas] EMAs
for Title I base funding and again for Title II base funding.
HHS Comment:
In its analysis of the impact of CARE Act funding, GAO used as its
measurement dollars per AIDS case. In so doing, the draft points out
the disparity in AIDS case amounts, which occurs in those States or
Territories that have an EMA or multiple EMAs.
GAO Statement:
Modifying the hold-harmless provisions for Title I, Title II, and ADAP
base funding to reduce the extent to which they prevent funding from
shifting to areas where the epidemic has been increasing.
HHS Comment:
The intent of the hold-harmless provisions was to prevent the loss of
funding from a jurisdiction as a result of significant changes in the
number of ELCs or AIDS cases used in the formulas for calculating
funding amounts. GAO's analysis of the impact of the hold-harmless
provisions appears to provide an accurate assessment of these
provisions. HHS would like to add that the mandated minimum award
amounts for Title II States or Territories is a result of the
recognition that a certain level of funding was needed in order to
establish and sustain a system that provides HIV/AIDS care and
treatment in the jurisdictions. If the grant amount depended solely on
the number of reported AIDS cases or ELCs in these low prevalence
areas, the amount of the award would not be sufficient to sustain state
of the art HIV care and treatment services.
GAO Statement:
Modifying the Title I grandfathering provision that protects the
eligibility of metropolitan areas that no longer meet the eligibility
criteria.
HHS Comment:
The draft report states on page 38, "The number of EMAs ineligible for
Title I funds in the absence of the grandfathering clause reflects the
combination of the decline in the number of new AIDS cases following
the advent of more effective therapies." HHS believes that much of the
decline in new AIDS cases would not have been made if not for the
establishment and expansion of the systems of care supported by CARE
Act funds awarded to the 29 EMAs that would no longer meet eligibility
criteria. The suggestion that since these 29 EMAs no longer meet the
current eligibility criteria and, by extension, need not be funded
means that the systems of care now in place would in many cases cease
to exist. Such a circumstance would run counter to the progress that
has been made in fighting the epidemic in these areas.
GAO Statement:
Eliminating the two-tiered structure of the emerging communities (EC)
program.
HHS Comment:
HHS believes that GAO's analysis of the ECs provision of the CARE Act
is correct but notes that there is no reference to a population
requirement under the ECs legislation other than such ECs cannot be
eligible for Title I funding. The reference to "communities with
populations of 50,000 or more" on page 31, paragraph 2, of the draft
report should be deleted.
GAO Statement:
If Congress wishes to preserve funding of the [AIDS Drug Assistance
Program] ADAP Severe Need grants, it should revise the Title II hold-
harmless provision that is funded with amounts set aside for the ADAP
Severe Need Grants.
HHS Comment:
HHS concurs with GAO's assessment cited in the above statement;
however, GAO made no specific recommendation with regard to its
analysis of the use of revised Office of Management and Budget (OMB)
Metropolitan Area Definitions for determining the boundaries of Title I
EMAs.
In the 1996 amendments to the CARE Act, Congress made clear its intent
that EMAs deemed eligible prior to 1996 would remain EMAs, and their
boundaries would remain as they were when first designated. This was a
direct response to the problem of the changing boundaries of what were
then called Metropolitan Standard Statistical Areas by OMB as a result
of the 1990 census. The changes in boundaries would have resulted in
combining several EMAs into very large EMAs, covering broad
geographical areas and stretching across State boundaries. Such changes
would result in considerable disruption to established grantee
structures, planning council memberships, and the planning and needs
assessment activities conducted by both the grantee and planning
councils.
The current GAO report suggests that the new OMB definitions should be
accepted for use in determining EMA boundaries. GAO does not recognize
in the draft that combining current EMAs into a single EMA would
present significant program administration difficulties. For example,
in one case, the geographic area of a newly designated EMA for New York
City would result in an EMA comprised of all of New York City and a
significant portion of northern New Jersey. It is our belief that the
resulting disruption to the grantee and planning council activities, as
well as the need for several intergovernmental agreements among
multiple jurisdictions, would impede the progress made in providing
care services within the existing EMAs.
[End of section]
Appendix XVI: Comments from the Department of Housing and Urban
Development:
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT:
ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT:
WASHINGTON. DC 20410-7000:
FEB 14 2006:
Ms. Marcia Crosse:
Director, Health Care:
United States Government Accountability Office:
441 G Street, NW:
Washington, DC 20548:
Dear Ms. Crosse:
On behalf of Secretary Jackson, thank you for the opportunity to review
the Draft Report, GAO-06-332, HIV/AIDS, Changes Needed to Improve the
Distribution of Ryan White CARE Act and Housing Fund. This draft report
reviews the allocation of federal resources made available under the
Housing Opportunities for Persons With AIDS (HOPWA) program
administered by HUD, as well as the Ryan White Care Act program
administered by HHS.
HUD agrees with the report's recommendation to update the HOPWA program
formula and has been actively exploring options that would incorporate
a more current estimate of persons living with HIV/AIDS, coupled with a
housing cost factor to reflect differences in area housing needs.
This formula change would achieve a more equitable distribution of
resources and would better reflect housing cost differences experienced
by the recipient communities. The use of data on persons living with
HIV/AIDS would be more effective and efficient in targeting these
housing resources to program beneficiaries. In addition to recommending
formula improvements in 1999, HUD has proposed technical formula edits
to maintain eligibility and funding stability for current housing
programs and these have been enacted in recent years.
The Department appreciates that the report seeks to improve the
targeting of federal resources to better assist this special needs
population. HUD's experience demonstrates that the needs of HOPWA
beneficiaries are being addressed through the types of supportive
housing activities undertaken by the recipient communities. These local
HOPWA projects are supporting stable housing arrangements for very low-
income clients that result in improved access to health care and other
needed support. The Department will consider the information provided
in this review in developing a recommendation on this program
component.
Thank you for your thoughtful work on reviewing the HOPWA formula and
in providing an opportunity to comment on this draft report. HUD
provided GAO with specific program information that was incorporated
into this review. Since that information was submitted, additional data
verification actions were taken that have resulted in some adjustment
to the data illustrated in the report. Enclosed are our comments to the
draft report, including notations to specific technical corrections.
If you have questions or would like to discuss our comments, please
contact David Vos, Director, Office of HIV/AIDS Housing, at (202) 708-
1934.
Sincerely,
Signed by:
Pamela H. Patenaude:
Assistant Secretary:
Enclosure:
U.S. Department of Housing and Urban Development Office of Community
Planning and Development Office of HIV/AIDS Housing:
HUD's comments on GAO's January 12, 2006 draft report, Changes Needed
to Improve the Distribution of Ryan White CARE Act and Housing Funds
are shown below in "italics".
* The summary report notes that more than half of HOPWA funds are used
for housing assistance (and a similar comment is found on page 16).
HUD recommends that this summary point be clarified. All HOPWA funding
is directed towards addressing the housing needs of eligible low-income
persons who are living with HIV/AIDS and their family. While grantees
may report under different activity types, such as direct housing costs
or related supportive services, these are all activities that are
directly connected to the nature of this program's effort to provide
supportive housing for a special needs population.
Further, the summary and report could note that the availability of
relevant data has changed over time and that the Centers for Disease
Control and Prevention (CDC) have made recommendations on use of such
data, as collected under their guidance. As required by the authorizing
statute for the HOPWA program, the use of AIDS surveillance data
provides a unique data source that is tied directly to the size and
location of the population eligible to be assisted by this federal
program. HUD agrees that updated and relevant data sources should be
used for this program. In addition, as the program addresses housing
needs, data on the costs for carrying out the housing activities would
also be highly relevant in distributing these federal housing
resources. The Department looks forward to recommending needed
improvements to this program component.
* Page 6 - the second paragraph of this page proposes examining funding
per person living with AIDS (PLWA) to measure the equity of the formula
for program clients. The report points out that there are
considerations that might justify deviations from constant funding per
PLWA. The report mentions health care costs as an example, but not
housing. The report indicates that it did not consider such factors in
the study.
HUD recommends that the report specifically note that differences in
area housing costs were not considered in the review on the HOPWA
program. In the Department's view, housing costs are an important
consideration in allocating resources in accomplishing the HOPWA
program mission of providing supportive housing to this special needs
population. For example, in providing rental assistance to an eligible
household, a provider in rural Alabama would use the HUD fair market
rent standard of $491 per month to determine the amount of HOPWA
subsidy, the amount above the resident's own rent payment (at 30
percent of adjusted income) and the actual rent, limited to units at
that cost. This would compare to a similar household located in
Philadelphia with an FMR at $873, or another in San Diego with a FMR at
$1,183. As HOPWA grantees undertake assistance in their communities,
the housing cost factor will play a significant role in determining the
number of households that can be assisted with the allocated resources.
Based on the areas served by HOPWA grantees, the current range of FMRs
is at the lowest in Puerto Rico at $355 and highest in San Jose, CA at
$1,739.
* Page 9 - The first paragraph breaks down funding for HIV/AIDS but
includes Medicare, Medicaid and Social Security, as programs assisting
persons with HIV/AIDS. The paragraph indicates that $295 was designated
for HOPWA.
HUD recommends that the paragraph note if HOPWA funding is included in
the income support or, more appropriately, as "treatment costs " if a
separate section on housing is not to be displayed on the pie chart (a
1.8% slice). Also, the word "million " should be inserted after the to
clarify that number.
* Page 15 - This page provides a general explanation of the HOPWA
formula.
The report would benefit in referring to HOPWA funds distributed under
the base and bonus "factors " rather than as stated or implied as two
separate "grants ". In contrast to the RWCA, there is only one formula
grant awarded under HOPWA. To avoid confusion, we recommend revising
base grant and bonus grant terminology to refer to base and bonus
"factors " which added together compose the formula grant. This matter
is repeated in other parts of the report and in the appendices and
should be revised in a similar way throughout the document.
Page 18 - The bottom of the first paragraph on this page summarizes the
effect of using data on HIV (including PLWA estimates) for the base
funding. It indicates that up to 15% of HOPWA base funding would have
shifted. It suggests that the change is a result of shift to HIV data
as compared to cumulative data.
This statement about the 15% shift may not fairly describe the effect
on HOPWA grant amount in replacing the cumulative case factor and
incidence factor. The impact on funding would seem to be more
significant than suggested by the 15% figure if the changes shown in
Appendix XI are useful. HUD would be concerned that the HIV data that
is missing from those states that do not report HIV surveillance data
or those that do not use name-based reporting are excluded in the data
used to calculate the table. This would automatically mean significant
reductions in amounts shown for those states, adding to the seeming
significance of this funding shift. Perhaps a comparison could be
developed on the state data for only those areas with acceptable HIV
reporting systems, or like systems based on their maturity in use.
There may be sufficient data to observe the extent of change possible
for those recipients. Appendix XI does display losses and gains for
more than two-thirds of HOPWA grantees are in excess of 15%. Out of the
117 grantees, there are 22 with losses more than 15% and 58 with gains
more than 15%.
Also, the report does not describe the incremental effect on HOPWA
allocations of using HIV data for persons not diagnosed with AIDS on
top of the effect of PL WA data. Use of PLWA data alone, as a validated
national data source for a revised HOPWA allocation, would redistribute
funds among grantees in a similar pattern. A review of the incremental
effect might be of use in considering the transition to use of HIV data
for HOPWA funding, once it is available on a valid and nationally
consistent basis from CDC.
* Pages 22 and 23 - The funding distribution of HOPWA is characterized
as "more than half for housing assistance". This same characterization
is stated in the summary.
HUD recommends that this be revised to state that HOPWA grantees use
the program to undertake housing activities, including supportive
housing efforts, to address the needs of this special needs population.
Although shown as a distinct eligible activity, and eligible as such,
the supportive services undertaken with HOPWA funds are a vital part of
efforts to stabilize and maintain clients in their housing. Further,
since HUD provided the data to GAO. some addition data collection and
verification efforts were made with grantee to validate the information
on expenditures by type of activity. As shown on the chart on page 23,
HUD will now be showing that HOPWA grantee performance for that 2003-
04 operating year is 66% in direct housing costs, with an additional
4%for housing information services and permanent housing placement
costs, along with 25%for related supportive services and 5%for grant
administration. Some additional actions are pending on a few of these
grantee reports.
Pages 25 and 26 - the allocations for 2004 are characterized as varying
from the average funding when examined relative to PLWA ($573). The
description notes one case, Baton Rouge with $1,290 per PLWA, and
Nashville as the other extreme at $387.
While the numbers demonstrate a per person effect, the paragraph does
not comment that this reflects the impact of the bonus factor and note
that grantees receiving this bonus, do not all sustain that funding
from year to year. In the example, the allocation to Baton Rouge was
reduced by 13 percent in the subsequent FY05 allocation, due to a
change in AIDS incidence data reported for that metropolitan area, a
reduction of $155, 000 due to this factor. For Nashville, the other
example used, funding in FY2005 involved an increase of 14 percent as
that area qualified for one year for a bonus factor addition of
$113,000 to their grant funding. While the data shown may reflect a
point in time, formula funding concerns have also occurred in its use
over time. HUD would observe that the bonus funding provides a
significant amount of resources to those eligible for that factor, as
25 percent of formula funds are distributed on this basis. In FY2004,
this involved 26 of the 117 formula grantees. It should be noted that
14 of these 26 areas are in the South. For FY06, the Department's
Appropriation Act included an administrative provision that was
requested by HUD to help mitigate the variability of incidence data by
using data reported over a three-year period. That adjustment in the
bonus factor will have a beneficial impact as used over time to reduce
unexpected grant funding swings. In a general manner, the factor
results in three groups of grant recipients, those with the status as a
recipient in the higher-than-average incidence group, those that are
recipients of the basic allocation, and a few that switch between the
others from year to year.
HUD would recommend replacing the term "bonus grant" with "bonus" and
consider a more general reference to this matter, something on the line
of "more than a $1, 000 per case for grantees that receive the bonus
such as Baton Rouge, New York City, San Francisco, Baltimore, Memphis,
San Juan etc ". Also would recommend revising the penultimate sentence
in the top paragraph on page 26 to say that "There are existing funding
differences authorized in the HOPWA formula that result in a higher
level of grant funding to the metropolitan areas with a higher-than-
average incidence of AIDS. The incidence factor has a distinct impact
from that attributed to the use of cumulative cases on AIDS in this
analysis."
* Pages 26, 27, and 28 - these pages describe the effect of using
cumulative cases and the inequity of distribution funds based on
persons who are deceased.
* Pages 41, 42, and 43 - these pages describe the effect of bonus
funding.
HUD recommends a few clarifications. As noted, the term bonus or bonus
factor should be used rather than bonus grant. Second, it would be
helpful to note the instability in year to year allocations that
results from the bonus for some grantees whose incidence rates are near
the national average incidence rate. A grantee that newly qualifies for
the bonus in one year may not in a later year. Third, as a technical
correction to the end of the last sentence of footnote on page 41, add
the phrase "with more than 500,000 population ". As described in HOPWA
regulations, the average incidence is based on this subset of EMSAs.
* Page 50 - The last sentence in the first paragraph states that "there
would have been at most a 15% funding shift if HIV cases were used to
allocate funding".
This matter was addressed in comments above. It is recommended that the
footnote number 73 be expanded to clarify that GAO used two methods to
examine the effect of HIV data. Neither estimate uses data from CDC for
all grantees, perhaps tagging those for which this data is absent.
Under the first method the HIV data was based on data from CDC for 35
areas with name-based reporting and under the second method GAO also
used data provided to GAO by the other areas.
* Page 60 - addresses how HOPWA funding for the base factor would
generally shift if HIV cases were used in funding.
As noted in the comment for page 18, it would be useful to observe the
effect on funding if the data can be reviewed only on those for which
HIV data is available.
* Page 64 - the only conclusion for HOPWA is that cumulative case data
has led to disproportionate funding when examining grants with respect
to PLWA.
The conclusion may overstate the impact of the base factor alone, and
HUD would observe that the incidence factor is a significant part of
the allocation. As noted in earlier comments, the grantee group with
the highest funding per PL WA are the grantees that receive a bonus,
and not all maintain this status year to year. HUD would recommend
expanding the statement to indicate, " The use of cumulative AIDS cases
and the incidence has led to some level of disproportionate funding on
a per person basis comparing funding to data on persons living with
AIDS and, where available, data on persons living with HIV. This view
on the disproportionate effect does not consider how differences in
area housing costs would also impact on a fair distribution of support
under this housing program in assisting eligible households. "
If you have questions on these comments, please contact David Vos,
Director, Office of HIV/AIDS Housing, at (202) 708-1934.
[End of section]
Appendix XVII: GAO Contact and Staff Acknowledgments:
GAO Contact:
Marcia Crosse, (202) 512-7119 or crossem@gao.gov:
Acknowledgments:
In addition to the contact above, James McClyde, Assistant Director;
Robert Copeland; Robert Dinkelmeyer; Louise Duhamel; Cathy Hamann; Opal
Winebrenner; Craig Winslow; and Suzanne Worth made key contributions to
this report.
[End of section]
Related GAO Products:
Ryan White CARE Act: Factors that Impact HIV and AIDS Funding and
Client Coverage. GAO-05-841T. Washington, D.C.: June 23, 2005.
Ryan White CARE Act: Title I Funding for San Francisco. GAO/HEHS-00-
189R. Washington, D.C.: August 24, 2000.
Ryan White CARE Act: Opportunities to Enhance Funding Equity. GAO/T-
HEHS-00-150. Washington, D.C.: July 11, 2000.
HIV/AIDS: Use of Ryan White CARE Act and Other Assistance Grant Funds.
GAO/HEHS-00-54.Washington, D.C.: March 1, 2000.
HIV/AIDS Drugs: Funding Implications of New Combination Therapies for
Federal and State Programs. GAO/HEHS-99-2.Washington, D.C.: October 14,
1998.
Revising Ryan White Funding Formulas. GAO/HEHS-96-116R. Washington,
D.C.: March 26, 1996.
Ryan White CARE Act of 1990: Opportunities to Enhance Funding Equity.
GAO/HEHS-96-26. Washington, D.C.: November 13, 1995.
Ryan White CARE Act: Access to Services by Minorities, Women, and
Substance Abusers. GAO/T-HEHS-95-212. Washington, D.C.: July 17, 1995.
Ryan White CARE Act of 1990: Opportunities Are Available to Improve
Funding Equity. GAO/T-HEHS-95-126. Washington, D.C.: April 5, 1995.
Follow-up on Ryan White Testimony. GAO/HEHS-95-119R. Washington, D.C.:
March 31, 1995.
Ryan White CARE Act of 1990: Opportunities Are Available to Improve
Funding Equity. GAO/T-HEHS-95-91. Washington, D.C.: February 22, 1995.
Ryan White Funding Formulas. GAO/HEHS-95-79R. Washington, D.C.:
February 14, 1995.
Ryan White CARE Act: Access to Services by Minorities, Women, and
Substance Abusers. GAO/HEHS-95-49. Washington, D.C.: January 13, 1995.
FOOTNOTES
[1] HIV is the virus that causes AIDS. Throughout this report, we use
the common term "HIV/AIDS" to refer to HIV disease, inclusive of cases
that have progressed to AIDS. When we use these terms alone, HIV refers
to the disease without the presence of AIDS, and AIDS refers
exclusively to HIV disease that has progressed to AIDS.
[2] Pub. L. No. 101-381, 104 Stat. 576 (codified as amended at 42
U.S.C. §§ 300ff-300ff-111 (2000)). Unless otherwise indicated,
references to the CARE Act are to current law.
[3] In addition to the 50 states, the CARE Act authorizes grants to the
District of Columbia, the Commonwealth of Puerto Rico, Guam, the Virgin
Islands, American Samoa, the Commonwealth of the Northern Mariana
Islands, the Republic of the Marshall Islands, the Federated States of
Micronesia, and the Republic of Palau. Throughout this report, the term
state refers to the 50 states and the District of Columbia, and
territory refers to these listed territories.
[4] Pub. L. No. 101-625, tit. VIII, subtit. D, 104 Stat. 4079, 4375
(codified as amended at 42 U.S.C. §§ 12901-12912 (2000)). Unless
otherwise indicated, references to HOPWA are to the program as
administered under current law.
[5] Pub. L. No. 106-345, § 206(b), 114 Stat. 1319, 1334-35.
[6] GAO, Ryan White CARE Act: Opportunities to Enhance Funding Equity,
GAO/T-HEHS-00-150 (Washington, D.C.: July 11, 2000), 6.
[7] Our analyses of CARE Act and HOPWA funding-formula provisions and
the use of HIV cases in making CARE Act and HOPWA funding allocations
include the states, Puerto Rico, and metropolitan areas eligible for
funding.
[8] In this report, cumulative AIDS cases are the total number of AIDS
cases, both living and dead, reported in a jurisdiction in a given
period.
[9] The 1990 CARE Act added a new title XXVI to the Public Health
Service Act. In general, because Part A of that new title, which
authorizes grants to metropolitan areas, was established by Title I of
the CARE Act, it is commonly referred to as Title I, and because part
B, which authorizes grants to states and territories, was established
by Title II of the CARE Act, it is commonly referred to as Title II.
Titles III and IV of the Act established Parts C and D, respectively,
authorizing grants for early intervention services as well as grants
for services to women and children, among other things. Under Title I,
a metropolitan area with a population of at least 500,000 and more than
2,000 reported AIDS cases in the last 5 calendar years is eligible to
receive Title I funding, and is defined as an EMA.
[10] Under HOPWA, cumulative AIDS cases are the total AIDS cases
reported in a jurisdiction since the beginning of the epidemic in 1981.
[11] Under HOPWA there is a single formula grant for each grantee. It
consists of funding determined using a base factor and funding
determined using a bonus factor (which may be zero). In this report, we
use the terms base grants and bonus grants to differentiate between
funding determined using these factors.
[12] Bonus grants are awarded to EMSAs that have a higher-than-average
per capita incidence of AIDS over the previous year. Allocations are
based on the number of cases in excess of the average AIDS incidence
rates of EMSAs.
[13] In our November 1995 report, we showed that differences under the
CARE Act in funding per living AIDS case were not related to cost
differences. For a discussion of this issue as well as criteria for
distributing funds, see GAO, Ryan White CARE Act of 1990: Opportunities
to Enhance Funding Equity, GAO/HEHS-96-26 (Washington, D.C.: Nov. 13,
1995).
[14] For our CARE Act analyses, we used ELCs as our measure of living
AIDS cases. For HOPWA we used a measure of living AIDS cases calculated
by subtracting the number of reported deaths among AIDS cases in a
jurisdiction from the number of reported cases. In our analysis of
HOPWA, we used living AIDS cases instead of cumulative AIDS cases,
which is the measure currently required by law to be used to determine
HOPWA base funding. Consequently, our analyses of HOPWA funding reflect
the effect of using HIV and living AIDS cases instead of cumulative
AIDS cases. We do not compare how allocations could be affected if HIV
cases and cumulative cases were used to determine funding.
[15] Prevalence reflects the number of people living with the disease.
[16] In addition to the 50 states, these grants are authorized to the
District of Columbia, the Commonwealth of Puerto Rico, Guam, and the
Virgin Islands.
[17] All EMAs received a supplemental grant in fiscal year 2004.
[18] Pub. L. No. 104-146, 110 Stat. 136.
[19] Pub. L. No. 106-345, 114 Stat. 1319.
[20] HRSA calculates a jurisdiction's ELCs by using data from CDC on
the reported AIDS case counts for the last 10 years and weighting those
numbers to account for the likelihood of deaths. We used this measure
as our estimate of living AIDS cases in our analyses of CARE Act
funding-formula provisions and the use of HIV cases in CARE Act funding
formulas.
[21] See GAO, Ryan White CARE Act of 1990: Opportunities Are Available
to Improve Funding Equity, GAO/T-HEHS-95-126 (Washington, D.C.: Apr. 5,
1995).
[22] In 2005, OMB issued 2004 MSA definitions using fundamentally
revised standards issued in 2000 and data from the 2000 census. In an
attempt to make the classification of areas simpler and more
transparent than the previous standards, OMB's 2000 standards
introduced new terminology and employed new criteria for identifying
central counties and their outlying counties, and did not seek to
conform with past standards nor to preserve past metropolitan status.
[23] 42 U.S.C. §§ 300 ff-13(a)(3)(D)(i) and 300ff-28(a)(2)(D)(i)
(2000).
[24] Institute of Medicine of the National Academies, Measuring What
Matters: Allocation, Planning, and Quality Assessment for the Ryan
White CARE Act (Washington, D.C.: The National Academies Press, 2004).
[25] Fiscal year 2002 allocations were the most recent funding data
available for Title III.
[26] The CARE Act requires that grantees' administrative costs not
exceed 5 percent of the Title I funds awarded. Each EMA must establish
a planning council, which sets spending priorities according to local
unmet needs.
[27] The CARE Act requires that grantees not use more than 10 percent
of Title II funds for administration. The combined funding for
administration, planning, and program evaluation may not exceed 15
percent of a Title II grantee's award.
[28] The CARE Act requires that grantees not use more than 10 percent
of Title III funds for administration costs, including planning and
evaluation.
[29] Unless otherwise indicated, we use the term grantees to indicate
the jurisdictions on which our analyses are based, that is, the states,
Puerto Rico, and metropolitan areas.
[30] ELCs are the 10-year weighted estimate of living AIDS cases as
specified in the CARE Act. HRSA calculates a jurisdiction's ELCs by
using data from CDC on the reported AIDS case counts for the last 10
years. Data for each of the 10 years are adjusted to take into account
the number of deaths in each year. However, rather that simply
subtracting the number of deceased cases in each jurisdiction, the
number of reported cases is adjusted by the national average death rate
among AIDS cases.
[31] In this report, cumulative AIDS cases are the total number of AIDS
cases, both living and dead, reported in a jurisdiction in a given
period. Under HOPWA, cumulative AIDS cases encompass all reported cases
since the beginning of the epidemic in 1981. By statute, 75 percent of
HOPWA formula funding is allocated on the basis of cumulative AIDS
cases.
[32] In the absence of a measure of living AIDS cases used for HOPWA
funding, we used a measure of living AIDS cases calculated by
subtracting the number of reported deaths among AIDS cases in a
jurisdiction from the number of reported cases. This measure of living
AIDS cases is used for illustrative purposes only.
[33] Until fiscal year 2006, bonus funding was based on the per capita
incidence of AIDS over a 1-year period. As a result, the amount of
bonus funding a grantee received could vary significantly from year to
year. With respect to fiscal year 2006 funding, HUD's appropriation act
included a provision to help mitigate this variability by changing to
the use of data reported over a 3-year period. Pub. L. No. 109-115, §
303(d), 119 Stat. 2396, 2460 (2005).
[34] Eligibility for Minority AIDS Initiative grants and grant amounts
are determined using the last 2 years of reported AIDS cases.
[35] GAO/HEHS-96-26, 6.
[36] We used living AIDS case counts as of March 31, 2003, because this
date was the cutoff for reporting AIDS cases to be used for determining
fiscal year 2004 HOPWA formula funding.
[37] When determining CARE Act funding for fiscal year 2004, HRSA used
a survival weight of .28 for AIDS cases that had been reported 10 years
earlier. This figure represents the proportion of persons who had been
reported with AIDS 10 years earlier and were known to be alive.
[38] The estimate of reported living AIDS cases was calculated by
subtracting the number of reported deaths among AIDS cases from the
number of reported AIDS cases since the beginning of the epidemic.
[39] For an assessment of three methods for estimating the number of
persons living with AIDS, including the method used for the CARE Act,
see Centers for Disease Control and Prevention, "AIDS Cases and Persons
Living with AIDS," HIV/AIDS Surveillance Supplemental Report, vol. 8,
no. 3 (2002).
[40] There are three EMAs in Puerto Rico: Caguas, Ponce, and San Juan.
[41] For EMAs that cross state boundaries, we estimated the amount of
funding received by each state. Using data obtained from HRSA, we
calculated the number of ELCs from each state in these EMAs. We then
calculated the percentage of ELCs in each state and allocated the EMA
funding to each state according to this percentage. For example,
approximately 96 percent of the ELCs in the Boston EMA are in
Massachusetts and 4 percent are in New Hampshire. Consequently, we
allocated 96 percent of the Boston EMA's funding to Massachusetts and 4
percent to New Hampshire.
[42] Approximately 80 percent of Puerto Rico's ELCs are in EMAs.
[43] Under Title I, a metropolitan area with a population of at least
500,000 and more than 2,000 reported AIDS cases in the last 5 calendar
years is eligible to receive funding.
[44] We excluded from our analyses the nine states that received
minimum Title II base grant awards.
[45] HRSA provides Minority AIDS Initiative grants according to the
number of nonwhite reported AIDS cases in the most recent 2-year
period.
[46] The hold-harmless provision is triggered when, because of its
current number of ELCs, an EMA would not receive at least a specified
level of base funding. Hold-harmless funding under Title I is
calculated using a base year. The base year is the year preceding the
fiscal year in which the hold-harmless provision is triggered for a
particular EMA. Because the hold-harmless provision can first be
triggered in different years in different EMAs, the base year can
differ among EMAs. Under the CARE Act Amendments of 2000, an EMA is
guaranteed not less than 98 percent of its base grant in the first year
the hold-harmless is triggered, 95 percent in the second year, 92
percent in the third year, 89 percent in the fourth year, and 85
percent in the fifth or subsequent years.
[47] The funds used to meet the Title I hold-harmless requirement are
deducted from the funds otherwise available for supplemental grants
before these grants are awarded. Supplemental grants are awarded by
HRSA to EMAs using a competitive process based on the demonstration of
severe need and other criteria.
[48] San Francisco was the only EMA that received hold-harmless funding
from fiscal year 1999 through fiscal year 2002. In fiscal year 2003, 19
additional EMAs qualified for hold-harmless funding. Twenty-one EMAs
received hold-harmless funding in fiscal year 2004. Eleven EMAs
qualified in both fiscal years 2003 and 2004.
[49] This analysis shows how the hold-harmless funding would have been
distributed if it had been allocated in the same proportions as the
supplemental grant funding. For example, Newark received about 2.5
percent of the funds available for supplemental grants and,
consequently, we allocated 2.5 percent of the $8,033,563 hold-harmless
funding to Newark. It is not possible to determine the exact effect of
the hold-harmless provision on the amount of supplemental funding for
each EMA because it is not known how the funds would have been
distributed in the absence of the hold-harmless awards.
[50] The CARE Act Amendments of 1996 guaranteed amounts ranging from 95
to 100 percent of the 1995 base grant. The CARE Act Amendments of 2000
guaranteed amounts ranging from 85 to 98 percent of the grant received
in a base year. The base year varies by EMA.
[51] The guaranteed amount is calculated by multiplying the two
percentages (89 and 95) together. In fiscal year 2004 San Francisco was
guaranteed to receive at least 89 percent of its fiscal year 2000 Title
I base grant. Its fiscal year 2000 Title I base grant was guaranteed to
be no less than 95 percent of its fiscal year 1995 Title I base grant.
[52] To be eligible for Title I funding, a metropolitan area must have
reported a cumulative total of more than 2,000 AIDS cases during the
most recent 5 calendar years and have a population of at least 500,000.
These criteria differ from those used to calculate base grant funding
allocations, which are determined using the number of ELCs.
[53] The AIDS case eligibility thresholds contained in the 1990 statute
were either that an area had a cumulative total of more than 2,000 AIDS
cases (that is, more than 2,000 cases living or deceased) or greater
than 25 AIDS cases per 100,000 population reported to CDC. This
standard was changed in 1996 to the current threshold of more than
2,000 reported AIDS cases during the most recent 5 calendar years and a
population of 500,000 or more.
[54] Both EMA eligibility and Emerging Community funding are based on
the number of AIDS cases reported in the most recent 5 calendar years.
[55] To be eligible for a Severe Need grant, a jurisdiction must have
met one of four eligibility criteria as of January 1, 2000. It must
have limited (1) the eligibility of ADAP clients to those with incomes
at or below 200 percent of the federal poverty level, (2) the number of
ADAP clients by using medical eligibility restrictions, (3) the number
of antiretroviral drugs covered in its drug formulary, or (4) the
number of opportunistic infection medications to fewer than 10 in its
drug formulary. (Opportunistic infections are illnesses such as
parasitic, viral, and fungal infections, and some types of cancer, some
of which usually do not cause disease in people with normal immune
systems.) In addition, a jurisdiction must also have agreed to provide
a 25 percent match and not impose eligibility requirements more
restrictive than those in place on January 1, 2000. According to HRSA,
grantees have provided funds or in-kind services to meet the matching
requirement.
[56] 42 U.S.C. § 300ff-28(a)(2)(I)(ii)(VI) (2000). Title II also
contains a hold-harmless provision that requires HRSA to consider
separately Title II base grants and ADAP base grants. For the Title II
base grants, this hold-harmless provision is funded by proportionately
reducing the size of the Title II base grants made to other
jurisdictions that did not qualify for this hold-harmless funding or
receive a minimum grant . The ADAP portion would be funded by reducing
the size of the ADAP base grants made to those grantees that did not
qualify for ADAP base grant hold-harmless funding. 42 U.S.C. § 300ff-
28(a)(2)(H) (2000).
[57] States and Puerto Rico, as well as EMSAs, receive HOPWA base
grants that are determined by the grantee's proportion of the total
number of cumulative AIDS cases. CDC reported that there were 5.4 AIDS
cases per 100,000 people in nonmetropolitan areas in 2000 and 6.2 cases
per 100,000 people in these areas in 2004.
[58] Twenty-five percent of HOPWA formula funding is distributed
through bonus grants. Until fiscal year 2006, bonus funding was based
on the per capita incidence of AIDS over a one-year period. As a
result, the amount of bonus funding a grantee received could vary
significantly from year to year. With respect to fiscal year 2006
funding, HUD's appropriation act included a provision to help mitigate
this variability by changing to the use of data reported over a 3-year
period.
[59] These funding levels were calculated by dividing a grantee's
fiscal year 2004 formula allocation by the number of living cases in
the jurisdiction. If the funding had been allocated proportionally on
the basis of living AIDS cases, each grantee would have received $716
per case.
[60] OMB's new MSA standards and definitions represent a major break
with the classification scheme used in the past. In some instances OMB
retained a term that was used in the past, such as MSA, but OMB has
altered the meaning. As a result, 2004 MSA boundaries of some EMAs are
very different from those in 1993.
[61] We use the term "metropolitan area" here in a generic sense to
refer to both the MSA (metropolitan statistical area) and the
metropolitan division (OMB's newly defined term for a subdivision of
the very largest MSAs).
[62] If Title I EMA boundaries were reconfigured to conform with new
OMB definitions, those areas outside of EMAs that are currently served
by governments under Title II would also be changed. Though the effect
on areas outside EMAs can be inferred from the changes to EMAs, we do
not explicitly report those results here.
[63] While we focus on Title I of the CARE Act, the Title II Emerging
Communities program also uses metropolitan area definitions and it
would also be affected if the new OMB definitions were applied. We also
exclude HOPWA from this subsection because these new OMB definitions
have already been used to determine fiscal year 2004 HOPWA grant
funding. For HOPWA, HUD implemented a different method than we use for
the analysis here. HUD provided no grandfathering of eligibility for
previously designated EMSAs and instead, among all newly defined
metropolitan areas, HUD selected those whose data qualified them to be
eligible for HOPWA funding. In contrast, in our method we assume a
policy whereby the 51 current EMAs would retain their eligibility for
CARE Act Title I grants without needing to qualify on the basis of
their number of ELCs or population size, and we selected only those new
metropolitan areas (or combinations of those areas) that most closely
correspond to the geographic area of each of the 51 existing Title I
EMAs.
[64] App. I provides further explanation of the methodology we used for
selecting those combinations of metropolitan areas that would minimize
changes to current EMAs. As shown in the tables in app. VII, our
conversion method would equate some EMAs with more than one newly
defined metropolitan area in order to minimize any change in boundaries
that would occur. For example, we equate the New Haven EMA with two
newly defined units (the New Haven MSA and the Bridgeport MSA) because
the two units together have boundaries identical to the New Haven EMA.
[65] The Bergen-Passaic, Jersey City, and New York City EMAs would be
consolidated into the new New York City EMA (with no change to the
geographic area encompassed and no change to the numbers of ELCs
served). The Caguas and San Juan EMAs would be consolidated into the
new San Juan EMA (with a net increase of 6 counties and 4 percent in
ELCs.) Increases or decreases in the number of outlying counties
included in metropolitan area boundaries would mostly have small effect
on the numbers of ELCs because such outlying counties have many fewer
ELCs than the more populous central counties. In those instances where
EMAs would be consolidated, the changes to boundaries would be
substantial, though there would be little or no net change in numbers
of ELCs within those boundaries.
[66] Institute of Medicine, Measuring What Matters, 87-134. While IOM
examined only the CARE Act, its findings regarding the use of HIV data
for determining funding allocations are also relevant for HOPWA.
[67] In our analyses, we considered the Title I hold-harmless provision
and the Title II hold-harmless provisions that are funded by
proportional reductions in Title II base grants and ADAP base grants.
We did not include the Title II hold-harmless provision funded by
amounts otherwise available for Severe Need grants.
[68] See app. I for a listing of the four U.S. Census Bureau regions
and the jurisdictions that constitute each region. Because Puerto Rico
is not included in any of these four regions, we excluded it from our
regional analyses.
[69] HIV case-reporting systems are generally either name-or code-
based. In name-based systems, cases are collected by name while in a
code-based system cases are collected using a coded identifier.
Currently, 38 states and Puerto Rico have name-based systems while 8
states have code-based systems. In the remaining 5 states, names are
collected and converted to codes by public health authorities.
[70] GAO/T-HEHS-00-150.
[71] Name-based HIV reporting has been established in all parts of
Pennsylvania except Philadelphia since 2002. Philadelphia was given
permission by the state to establish code-based HIV reporting, and the
system began in 2004. However, in August 2005, the Philadelphia Board
of Health voted to implement a name-based HIV-reporting system. This
system went into effect in October 2005. Philadelphia is in the process
of having its HIV surveillance data certified by CDC; once certified,
its data will be accepted by CDC.
[72] HRSA uses AIDS case counts provided by CDC for determining CARE
Act formula funding. All states and territories report AIDS cases by
name.
[73] CDC has established a set of performance standards for accepting
case counts from HIV-reporting systems. These standards include that
case reporting be complete (greater than or equal to 85 percent of
cases are reported) and timely (greater than or equal to 66 percent of
cases reported within 6 months of diagnosis) and that evaluation
studies demonstrate that the approach must result in accurate case
counts (less than or equal to 5 percent of reported cases are
duplicates). CDC has determined that the only systems which have been
evaluated that meet these standards use confidential, name-based
reporting. Some jurisdictions use codes instead of names to secure the
privacy of the individuals being counted. In July 2005, CDC began
recommending that all states and territories adopt confidential name-
based surveillance systems to report HIV infections.
[74] Two of the 13 states, Illinois and Maine, established name-based
HIV reporting in January 2006.
[75] CDC also has other concerns about code-based reporting. For
example, code-based reporting places a greater burden on health care
providers because submitted codes are frequently incomplete and require
extensive follow-up with providers to resolve potential duplicate
reports on the same person.
[76] Unlike the CARE Act, there is currently no law requiring the use
of HIV cases in determining HOPWA funding. In our analysis of HOPWA, we
used living AIDS cases instead of cumulative AIDS cases, which is the
measure currently required by law to be used to determine HOPWA base
funding. As we reported in 1995, we believe that cumulative AIDS cases
is an inappropriate measure for allocating funds (GAO/HEHS-96-26, 6).
Consequently, our analyses of HOPWA funding reflect the effect of using
HIV and living AIDS cases instead of cumulative AIDS cases. This
measure of living AIDS cases is used for illustrative purposes only.
[77] We used ELCs in our analyses of CARE Act programs, which is the
measure of AIDS cases used by HRSA in determining funding for the
grants we examined: Title I, Title II, and ADAP base grants. HUD does
not have a measure of living AIDS cases that it uses to determine HOPWA
funding. Because ELCs are specific to the CARE Act and because of
shortcomings in this measure discussed earlier, we calculated an
alternative measure of living AIDS cases in our examination of HOPWA
funding. For the HOPWA analyses, the living AIDS case counts were
calculated by subtracting the number of reported deaths among AIDS
cases from the number of reported AIDS cases.
[78] Because HIV-reporting systems in some jurisdictions are changing
to name-based systems, CDC now accepts HIV case counts from some
jurisdictions from which it did not accept HIV case counts earlier. For
our analyses, we classified Connecticut, Kentucky, and New Hampshire as
having HIV case counts that are not accepted by CDC. Our analyses were
conducted using fiscal year 2004 allocations, which were based on case
reports as of June 30, 2003, for the CARE Act and as of March 31, 2003,
for HOPWA. At those times, Connecticut had name-based HIV reporting for
only pediatric cases, but established name-based reporting for all
cases in 2005. Kentucky had code-based reporting at that time and
established name-based reporting in 2004. New Hampshire established
mandatory name-based reporting in 2005, but previously accepted reports
using the patient name, a code, or no identifier. A fourth state,
Georgia, had not established any HIV case reporting as of June 30,
2003, but did so in 2004. Consequently, the HIV case count for Georgia
is zero in our analyses. Pennsylvania is classified as having its HIV
case counts accepted by CDC. However, these counts do not include any
cases from Philadelphia, which established its code-based system in
2004. Philadelphia established a name-base HIV-reporting system in
October 2005 and is in the process of having its HIV surveillance data
certified by CDC; once certified, its data will be accepted by CDC.
Illinois and Maine established name-based HIV-reporting systems in
January 2006 and are also in the process of having their HIV data
certified by CDC; once certified, their data will be accepted by CDC.
[79] CDC receives, reviews, and processes name-based HIV case reports
on individual cases. Potential duplicate reports across jurisdictions
are reviewed through a CDC-coordinated process to remove duplicate
reports from the national database. Code-based reports cannot be
included in this de-duplication process because name-based and code-
based systems do not have comparable patient identifiers. Because the
name-and code-based case counts are not comparable, in its comments on
a draft of this report HHS stated that it would not be appropriate to
use the code-based case counts in monitoring HIV/AIDS nationally. Our
purpose in using both the name-and code-based case counts was to
provide a general indication of how funding would be affected by using
HIV and AIDS cases to distribute CARE Act and HOPWA funds in light of
the statutory requirement that HIV cases be used in CARE Act funding
formulas not later than fiscal year 2007. Our use of the code-based
case counts should not be taken as endorsement for their use in
monitoring HIV/AIDS or distributing funds. An assessment of the
feasibility of using code-based case counts was beyond the scope of our
report.
[80] HIV case counts for three states--Georgia, Kentucky, and the
District of Columbia--were unavailable. Consequently, their HIV case
counts are zero under both approaches. HIV case counts were also
unavailable for Philadelphia, and as a consequence HIV counts were
incomplete for Pennsylvania.
[81] For example, for CARE Act Title I base funding, we calculated the
EMA's percentage of the total number of HIV/AIDS cases in all EMAs.
[82] Under the CARE Act, there is a minimum-grant provision for Title
II base grants, but not for Title I and ADAP base funding. However,
there are hold-harmless provisions for Title I, Title II, and ADAP base
funding. There is no comparable hold-harmless provision in HOPWA and
minimum-grant requirements have been effectively waived in recent
years. Consequently, the analyses in which the hold-harmless and
minimum-grant provisions are maintained are limited to the CARE Act.
For purposes of this analysis, we considered the Title I hold-harmless
provision and the Title II hold-harmless provision that is funded by
proportional reductions in Title II base grants and ADAP base grants.
We did not include the Title II hold-harmless provision funded by
amounts otherwise available for Severe Need grants. The effect on HOPWA
allocations are discussed later.
[83] There is no minimum funding provision for Title I base grants.
[84] See app. I for a listing of the four U.S. Census Bureau regions
and the jurisdictions that constitute each region.
[85] We assume that the case threshold for determining the size of
minimum grants would remain at 90 even if HIV cases were included in
the case counts. Currently, states with fewer than 90 ELCs are
guaranteed a minimum Title II base grant of $200,000 while states with
90 or more cases are guaranteed at least $500,000. Our analyses assume
that the threshold would be a total of 90 HIV cases and ELCs.
[86] There is no minimum funding provision for ADAP base grants.
[87] The ADAP base grant funding reported to us included any hold-
harmless funding taken from funds otherwise set aside for the ADAP
Severe Need grants. This hold-harmless funding results from a different
Title II hold-harmless provision than that which requires HRSA to
consider separately Title II base grants and ADAP base grants. In our
analyses, we excluded hold-harmless funding taken from the ADAP Severe
Need grants when we estimated the dollar and percent changes in the
ADAP base grants.
[88] For a description of features in funding formulas, see National
Research Council, Statistical Issues in Allocating Funds by Formula:
Panel on Formula Allocations (Washington, D.C.: The National Academies
Press, 2003).
[89] In these analyses we considered the Title I hold-harmless
provision and the Title II hold-harmless provisions that are funded by
proportional reductions in Title II base grants and ADAP base grants.
We did not include the Title II hold-harmless provision funded by
amounts otherwise available for Severe Need grants.
[90] There is no minimum funding provision for Title I base funding.
[91] The amount of base grant funding would have been about $8 million
less without the hold-harmless provision. This money would have been
distributed to EMAs in supplemental grants.
[92] EMAs in the West would gain funding under both approaches if the
hold-harmless was maintained but would receive less funding under both
approaches if it was not maintained.
[93] Grantees in the West would gain funding under both approaches if
the hold-harmless and minimum-grant provisions were maintained but
would receive less funding under both approaches if they were not
maintained.
[94] There is no minimum funding provision for ADAP base funding.
[95] For the HOPWA analyses, the living AIDS case counts were
calculated by subtracting the number of reported deaths among AIDS
cases from the number of reported AIDS cases.
[96] This analysis indicates how HOPWA base funding would have changed
if living AIDS cases and HIV cases had been used to distribute funding
rather than cumulative case counts. The effect of using living AIDS
cases but not HIV cases on HOPWA base funding is shown in app. V.
[97] These six grantees are the state of Alabama; Birmingham, Alabama;
Charlotte, North Carolina; Memphis, Tennessee; the state of North
Carolina; and Wake County, North Carolina.
[98] In those cases in which an EMSA included both southern and
nonsouthern jurisdictions, we classified the EMSA as not being in the
South.
[99] In this instance, AIDS cases refers to ELCs for the CARE Act and
cumulative AIDS cases for HOPWA.
[100] Other factors may also affect the ratio of HIV to AIDS cases in a
reporting system. For example, some jurisdictions with newer HIV-
reporting systems were among the first to be affected by the HIV
epidemic. This factor could mean that in those jurisdictions there are
relatively more AIDS cases and the ratio of HIV to AIDS cases would be
lower than in jurisdictions more recently experiencing an HIV epidemic.
[101] Institute of Medicine, Measuring What Matters, 92.
[102] Grantees are those entities that receive CARE and HOPWA funding.
Grantees vary by program and can include states, territories,
metropolitan areas, and primary-care providers.
[103] HRSA calculates a jurisdiction's ELCs by using data from CDC on
the reported AIDS case counts for the last 10 years and weighting those
numbers to account for the likelihood of death.
[104] Title II also contains a hold-harmless provision that requires
HRSA to consider separately Title II base grants and ADAP base grants.
For the Title II base grants, this hold-harmless provision is funded by
proportionately reducing the size of the Title II base grants made to
other jurisdictions that did not qualify for this hold-harmless funding
or receive a minimum grant. The ADAP portion would be funded by
reducing the size of the ADAP base grants made to those grantees that
did not qualify for ADAP base grant hold-harmless funding.
[105] Unlike the CARE Act in which ELCs in EMAs are counted once for
determining Title I funding and a second time for determining Title II
funding, under HOPWA AIDS cases in EMSAs are counted only for
determining funding for EMSAs. These cases are not counted a second
time for determining HOPWA base funding allocations for states and
territories. Funding for states and territories is based on the number
of cumulative AIDS cases outside of EMSAs. For example, HOPWA base
funding for Colorado is based on the number of cumulative AIDS cases in
the state minus the number of cumulative cases in the Denver EMSA.
[106] The AIDS case count used in the analyses varied by program (e.g.,
ELCs and cumulative AIDS cases).
[107] In our November 1995 report, we showed under the CARE Act that
differences in funding per living AIDS case were not related to cost
differences. For a discussion of this issue as well as criteria for
distributing funding per case, see GAO, Ryan White CARE Act of 1990:
Opportunities to Enhance Funding Equity, GAO/HEHS-96-26 (Washington,
D.C.: Nov. 13, 1995).
[108] GAO, Metropolitan Statistical Areas: New Standards and Their
Impact on Selected Federal Programs, GAO-04-758 (Washington, D.C.: June
14, 2004).
[109] There is no straightforward way to equate EMAs based on OMB's
1993 metropolitan areas with OMB's 2004 metropolitan areas. In
developing its 2000 metropolitan area standards and its 2004
metropolitan area boundary definitions, OMB did not seek to make them
conform to past standards and definitions. Moreover, even where OMB
employed the same terminology (e.g., the term "metropolitan statistical
area" was retained), the terms were given new meanings.
[110] These include combinations of adjoining MSAs or adjoining MSAs
and metropolitan divisions. We exclude the use of the smaller
micropolitan statistical areas (a new OMB designation for less-
populated areas) and also exclude combined statistical areas (a new OMB
designation for groupings of adjacent metropolitan and micropolitan
areas).
[111] Unlike the CARE Act, there are no requirements regarding the use
of HIV cases in determining HOPWA funding.
[112] In our analysis of HOPWA, we used living AIDS cases instead of
cumulative AIDS cases, which is the measure currently required by law
to be used to determine HOPWA base grant funding. Therefore, our
analyses reflect the effect of using HIV cases and living AIDS cases
instead of cumulative AIDS case counts on fiscal year 2004 HOPWA base
grant funding.
[113] These 35 include 34 states and Puerto Rico.
[114] Some HIV case-reporting systems are name-based while others are
code-based. Currently, CDC will only accept name-based case counts as
no code-based system has yet met CDC's quality criteria. CDC has
established a set of performance standards for accepting case counts
from HIV-reporting systems. These standards include that case reporting
be complete (greater than or equal to 85 percent of cases are reported)
and timely (greater than or equal to 66 percent of cases reported
within 6 months of diagnosis) and that evaluation studies demonstrate
that the approach must result in accurate case counts (less than or
equal to 5 percent of reported cases are duplicates). CDC has
determined that the only systems that have been evaluated that meet
these standards use confidential, name-based reporting. Some
jurisdictions use codes instead of names to secure the privacy of the
individuals being counted. In July 2005, CDC began recommending that
all states and territories adopt confidential, name-based surveillance
systems to report HIV infections.
[115] Because HIV-reporting systems in some jurisdictions are changing
to name-based systems, CDC now accepts HIV case counts from some
jurisdictions from which it did not accept HIV case counts earlier. For
our analyses, we classified Connecticut, Kentucky, and New Hampshire as
having HIV case counts that are not accepted by CDC. Our analyses were
conducted using fiscal year 2004 allocations, which were based on case
reports as of June 30, 2003, for the CARE Act and as of March 31, 2003,
for HOPWA. At those times, Connecticut had name-based HIV reporting for
only pediatric cases, but established name-based reporting for all
cases in 2005. Kentucky had code-based reporting at that time and
established name-based reporting in 2004. New Hampshire established
mandatory name-based reporting in 2005, but previously accepted reports
using the patient name, a code, or no identifier. A fourth state,
Georgia, had not established any HIV case reporting as of June 30,
2003, but did so in 2004. Consequently, the HIV case count for Georgia
is zero in our analyses. Pennsylvania is classified as having its HIV
case counts accepted by CDC. However, these counts do not include any
cases from Philadelphia, which established its code-based system in
2004. Philadelphia establsihed a name-based system in October 2005.
Philadelphia is in the process of having its HIV surveillance data
certified by CDC; once certified, its data will be accepted by CDC.
Illinois and Maine established name-based HIV-reporting systems in
January 2006 and are also in the process of having their HIV data
certified by CDC; once certified, their data will be accepted by CDC.
[116] HIV case counts for three of these jurisdictions, Georgia,
Kentucky, and the District of Columbia, were unavailable. Consequently,
their HIV case counts are zero under both approaches. HIV case counts
were also unavailable for Philadelphia, and as a consequence HIV counts
were incomplete for Pennsylvania.
[117] CDC receives, reviews, and processes name-based HIV case reports
on individual cases. Potential duplicate reports across jurisdictions
are reviewed through a CDC-coordinated process to remove duplicate
reports from the national database. Code-based reports cannot be
included in this de-duplication process because name-based and code-
based systems do not have comparable patient identifiers. Because the
name-and code-based case counts are not comparable, in its comments on
a draft of this report HHS stated that it would not be appropriate to
use the code-based case counts in monitoring HIV/AIDS nationally. Our
purpose in using both the name-and code-based case counts was to
provide a general indication of how funding would be affected by using
HIV and AIDS cases to distribute CARE Act and HOPWA funds. Our use of
the code-based case counts should not be taken as endorsement for their
use in monitoring HIV/AIDS or distributing funds. An assessment of the
feasibility of using code-based case counts was beyond the scope of our
report.
[118] For example, for CARE Act Title I base funding, we calculated the
EMA's percentage of the total number of HIV cases and ELCs across all
EMAs.
[119] Under the CARE Act, there is a minimum-grant provision for Title
II base grants, but not for Title I and ADAP base grants. However,
there are hold-harmless provisions for Title I, Title II, and ADAP base
grants. There are no comparable hold-harmless provisions in HOPWA and
minimum-grant requirements have been effectively waived in recent
years. Consequently, the analyses in which the hold-harmless and
minimum-grant provisions are maintained are limited to the CARE Act.
[120] Puerto Rico is not included in any of these regions and is,
therefore, excluded from these analyses.
[121] Michael Saag (paper presented at the XIV International AIDS
Conference: Plenary Session, HIV/AIDS Treatment and Care in the New
Century, Barcelona, July 2002); "UAB Announces Results of First HIV
Patient Care Cost Analysis," UAB Media Relations (Birmingham, Ala.:
University of Alabama at Birmingham, July 2002),
http://main.uab.edu/show.asp?durki=51750 (downloaded March 30, 2005).
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