Ryan White CARE Act
Estimated Effect of Proposed Stop-Loss Provision on Urban Areas Gao ID: GAO-09-472R March 6, 2009Congress asked GAO to estimate the effect on Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) funding to urban areas if certain stop-loss provisions are enacted. The CARE Act, administered by the Department of Health and Human Services's (HHS) Health Resources and Services Administration (HRSA), was enacted to address the needs of jurisdictions, health care providers, and people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In December 2006, the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (Modernization Act of 2006) reauthorized CARE Act programs for fiscal years 2007 through 2009. In February 2009, the House of Representatives passed H.R. 1105, the Omnibus Appropriations Act, 2009, which contains a stop-loss provision covering CARE Act funding for urban areas that receive funding under the CARE Act. This bill has not been passed by the Senate.
Under the CARE Act, funding for urban areas--Eligible Metropolitan Areas (EMA) and Transitional Grant Areas (TGA)--is primarily provided through three categories of grants: (1) formula grants that are awarded based on the case counts of people with HIV/AIDS in an urban area; (2) supplemental grants that are awarded on a competitive basis based on an urban area's demonstration of need, including criteria such as HIV/AIDS prevalence; and (3) Minority AIDS Initiative (MAI) grants, which are supplemental grants awarded on a competitive basis for urban areas to address disparities in access, treatment, care, and health outcomes. Changes in grantee characteristics and funding formulas can cause increases or decreases in grantees' funding. H.R. 1105, which was passed by the House of Representatives on February 25, 2009, contains a provision to ensure that decreases in total 2008 Part A funding for fiscal year 2008 for each EMA and TGA would not exceed levels specified in the bill. It would limit the total funding decrease for an EMA for the 2008 fiscal year to no more than 6.3 percent of what the EMA received for the 2006 fiscal year. Decreases for a TGA for the 2008 fiscal year would be limited to 11.3 percent of its total funding for fiscal year 2006. The funding necessary to limit the decreases to urban areas would be given as increases to supplemental grants for fiscal year 2009.
GAO-09-472R, Ryan White CARE Act: Estimated Effect of Proposed Stop-Loss Provision on Urban Areas
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GAO-09-472R:
March 6, 2009:
The Honorable Michael B. Enzi:
Ranking Member:
Committee on Health, Education, Labor, and Pensions:
United States Senate:
The Honorable Tom A. Coburn:
United States Senate:
Subject: Ryan White CARE Act: Estimated Effect of Proposed Stop-Loss
Provision on Urban Areas:
You asked us to estimate the effect on Ryan White Comprehensive AIDS
Resources Emergency Act of 1990 (CARE Act) funding to urban areas if
certain stop-loss provisions are enacted. The CARE Act, administered by
the Department of Health and Human Services's (HHS) Health Resources
and Services Administration (HRSA), was enacted to address the needs of
jurisdictions, health care providers, and people with human
immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).
[Footnote 1] In December 2006, the Ryan White HIV/AIDS Treatment
Modernization Act of 2006 (Modernization Act of 2006) reauthorized CARE
Act programs for fiscal years 2007 through 2009.[Footnote 2] In
February 2009, the House of Representatives passed H.R. 1105, the
Omnibus Appropriations Act, 2009, which contains a stop-loss provision
covering CARE Act funding for urban areas that receive funding under
the CARE Act.[Footnote 3] This bill has not been passed by the Senate.
Under the CARE Act, funding for urban areas--Eligible Metropolitan
Areas (EMA) and Transitional Grant Areas (TGA)[Footnote 4]--is
primarily provided through three categories of grants: (1) formula
grants that are awarded based on the case counts of people with HIV/
AIDS in an urban area; (2) supplemental grants that are awarded on a
competitive basis based on an urban area's demonstration of need,
including criteria such as HIV/AIDS prevalence; and (3) Minority AIDS
Initiative (MAI) grants, which are supplemental grants awarded on a
competitive basis for urban areas to address disparities in access,
treatment, care, and health outcomes. Changes in grantee
characteristics and funding formulas can cause increases or decreases
in grantees' funding.
H.R. 1105, which was passed by the House of Representatives on February
25, 2009, contains a provision to ensure that decreases in total 2008
Part A funding for fiscal year 2008 for each EMA and TGA would not
exceed levels specified in the bill.[Footnote 5] It would limit the
total funding decrease for an EMA for the 2008 fiscal year to no more
than 6.3 percent of what the EMA received for the 2006 fiscal year.
Decreases for a TGA for the 2008 fiscal year would be limited to 11.3
percent of its total funding for fiscal year 2006.[Footnote 6] The
funding necessary to limit the decreases to urban areas would be given
as increases to supplemental grants for fiscal year 2009.
To provide you with technical assistance, we developed an estimate of
fiscal year 2009 Part A CARE Act funding for EMAs and TGAs with the
stop-loss provision in H.R. 1105. We also developed an estimate of such
funding without that provision. We used data from HHS, H.R. 1105, and
an Explanatory Statement submitted by the Chairman of the House
Committee on Appropriations to H.R. 1105 to estimate these amounts.
[Footnote 7] In order to conduct these analyses, we made a number of
assumptions. These assumptions are described in notes to the
accompanying tables. See enclosure I for estimates of Part A CARE Act
funding for EMAs with and without the stop-loss provision. See
enclosure II for estimates of Part A CARE Act funding for TGAs with and
without the stop-loss provision.
The objective of this work was to provide pertinent and timely
information by showing the effect of the stop-loss provision on EMAs
and TGAs for fiscal year 2009 that Congress can use in determining
funding for CARE Act programs. We used data from agency reference
documents to conduct our analyses. Because of time constraints, we did
not conduct any additional analysis of the proposed provision. We
performed our work in March 2009.
We are sending copies of this letter to interested congressional
committees. The letter will be available at no charge on GAO's Web site
at [hyperlink, http://www.gao.gov].
If you or your staff have any questions about this letter, please
contact me at (202) 512-7114 or crossem@gao.gov. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on
the last page of this letter.
Signed by:
Marcia Crosse:
Director, Health Care:
enclosures:
[End of section]
Enclosure I:
Table 1: Total Eligible Metropolitan Area Formula, Supplemental, and
Minority AIDS Initiative Grants for Fiscal Year 2006, Fiscal Year 2008,
and Projected Funding for Fiscal Year 2009 under Part A Funding Levels
Identified in the Explanatory Statement to H.R. 1105:
Eligible Metropolitan Area (EMA): Atlanta, Ga.;
Fiscal year 2006 funding: $18,869,561;
93.7 percent of fiscal year 2006 funding[A]: $17,680,779;
Fiscal year 2008 funding: $17,942,992; H.R. 1105:
Estimated fiscal year 2009 funding before applying stop-loss[B]:
$18,337,471;
H.R. 1105: Estimated stop-loss: $0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$18,337,471;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $18,660,212.
Eligible Metropolitan Area (EMA): Baltimore, Md.;
Fiscal year 2006 funding: $20,628,895;
93.7 percent of fiscal year 2006 funding[A]: $19,329,275;
Fiscal year 2008 funding: $20,594,272;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $23,889,479;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$23,889,479;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $24,292,574.
Eligible Metropolitan Area (EMA): Boston, Mass.;
Fiscal year 2006 funding: $13,339,141;
93.7 percent of fiscal year 2006 funding[A]: $12,498,775;
Fiscal year 2008 funding: $14,027,340;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $16,274,966;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$16,274,966;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $16,564,752.
Eligible Metropolitan Area (EMA): Chicago, Ill.;
Fiscal year 2006 funding: $25,044,633;
93.7 percent of fiscal year 2006 funding[A]: $23,466,821;
Fiscal year 2008 funding: $26,632,351;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $30,882,913;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$30,882,913;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $31,427,282.
Eligible Metropolitan Area (EMA): Dallas, Tex.;
Fiscal year 2006 funding: $13,196,377;
93.7 percent of fiscal year 2006 funding[A]: $12,365,005;
Fiscal year 2008 funding: $13,547,516;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $15,792,149;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$15,792,149;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $16,070,891.
Eligible Metropolitan Area (EMA): Detroit, Mich.;
Fiscal year 2006 funding: $8,428,477;
93.7 percent of fiscal year 2006 funding[A]: $7,897,483;
Fiscal year 2008 funding: $8,055,626;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $9,201,600;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$9,201,600;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $9,360,130.
Eligible Metropolitan Area (EMA): Ft. Lauderdale, Fla.;
Fiscal year 2006 funding: $14,963,638;
93.7 percent of fiscal year 2006 funding[A]: $14,020,929;
Fiscal year 2008 funding: $15,171,291;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $17,501,950;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$17,501,950;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $17,810,954.
Eligible Metropolitan Area (EMA): Houston, Tex.;
Fiscal year 2006 funding: $19,953,520;
93.7 percent of fiscal year 2006 funding[A]: $18,696,448;
Fiscal year 2008 funding: $20,094,436;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $22,938,330;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$22,938,330;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $23,338,238.
Eligible Metropolitan Area (EMA): Los Angeles, Calif.;
Fiscal year 2006 funding: $34,895,377;
93.7 percent of fiscal year 2006 funding[A]: $32,696,968;
Fiscal year 2008 funding: $36,013,941;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $41,310,363;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$41,310,363;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $42,038,454.
Eligible Metropolitan Area (EMA): Miami, Fla.;
Fiscal year 2006 funding: $23,999,914;
93.7 percent of fiscal year 2006 funding[A]: $22,487,919;
Fiscal year 2008 funding: $24,974,906;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $28,478,276;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$28,478,276;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $28,964,002.
Eligible Metropolitan Area (EMA): New Orleans, La.;
Fiscal year 2006 funding: $7,434,812;
93.7 percent of fiscal year 2006 funding[A]: $6,966,419;
Fiscal year 2008 funding: $7,669,652;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $8,838,306;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$8,838,306;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $8,994,183.
Eligible Metropolitan Area (EMA): New York, N.Y.;
Fiscal year 2006 funding: $120,423,326;
93.7 percent of fiscal year 2006 funding[A]: $112,836,656;
Fiscal year 2008 funding: $111,883,651;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $114,607,968;
H.R. 1105: Estimated stop-loss: $953,005;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$115,560,973;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $116,582,701.
Eligible Metropolitan Area (EMA): Newark, N.J.;
Fiscal year 2006 funding: $14,752,254;
93.7 percent of fiscal year 2006 funding[A]: $13,822,862;
Fiscal year 2008 funding: $14,038,197;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $15,447,478;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$15,447,478;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $15,713,291.
Eligible Metropolitan Area (EMA): Orlando, Fla.;
Fiscal year 2006 funding: $8,561,273;
93.7 percent of fiscal year 2006 funding[A]: $8,021,913;
Fiscal year 2008 funding: $7,968,264;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $9,047,025;
H.R. 1105: Estimated stop-loss: $53,649;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$9,100,674;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $9,204,349.
Eligible Metropolitan Area (EMA): Philadelphia, Pa.;
Fiscal year 2006 funding: $22,384,551;
93.7 percent of fiscal year 2006 funding[A]: $20,974,324;
Fiscal year 2008 funding: $22,773,161;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $25,550,597;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$25,550,597;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $25,994,618.
Eligible Metropolitan Area (EMA): Phoenix, Ariz.;
Fiscal year 2006 funding: $6,519,338;
93.7 percent of fiscal year 2006 funding[A]: $6,108,620;
Fiscal year 2008 funding: $7,522,978;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $8,762,472;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$8,762,472;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $8,923,024.
Eligible Metropolitan Area (EMA): San Diego, Calif.;
Fiscal year 2006 funding: $9,269,256;
93.7 percent of fiscal year 2006 funding[A]: $8,685,293;
Fiscal year 2008 funding: $10,955,986;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $12,877,535;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$12,877,535;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $13,109,380.
Eligible Metropolitan Area (EMA): San Francisco, Calif.;
Fiscal year 2006 funding: $27,964,864;
93.7 percent of fiscal year 2006 funding[A]: $26,203,078;
Fiscal year 2008 funding: $19,419,733;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $19,722,536;
H.R. 1105: Estimated stop-loss: $6,783,345;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$26,505,881;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $19,815,968.
Eligible Metropolitan Area (EMA): San Juan, P.R.;
Fiscal year 2006 funding: $13,470,347;
93.7 percent of fiscal year 2006 funding[A]: $12,621,715;
Fiscal year 2008 funding: $12,877,445;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $13,087,902;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$13,087,902;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $13,148,287.
Eligible Metropolitan Area (EMA): Tampa-St. Petersburg, Fla.;
Fiscal year 2006 funding: $9,571,830;
93.7 percent of fiscal year 2006 funding[A]: $8,968,805;
Fiscal year 2008 funding: $9,524,707;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $10,465,933;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$10,465,933;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $10,652,830.
Eligible Metropolitan Area (EMA): Washington, D.C.;
Fiscal year 2006 funding: $26,923,066;
93.7 percent of fiscal year 2006 funding[A]: $25,226,913;
Fiscal year 2008 funding: $27,911,311;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $31,591,530;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$31,591,530;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $32,142,719.
Eligible Metropolitan Area (EMA): West Palm Beach, Fla.;
Fiscal year 2006 funding: $8,276,018;
93.7 percent of fiscal year 2006 funding[A]: $7,754,629;
Fiscal year 2008 funding: $8,352,071;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $8,602,738;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$8,602,738;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $8,753,459.
Eligible Metropolitan Area (EMA): Total;
Fiscal year 2006 funding: $468,870,468;
93.7 percent of fiscal year 2006 funding[A]: $439,331,629;
Fiscal year 2008 funding: $457,951,827;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $503,209,515;
H.R. 1105: Estimated stop-loss: $7,789,999[C];
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$510,999,514;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $511,562,296.
Source: GAO analysis of HHS data, H.R. 1105, and the Explanatory
Statement to H.R. 1105.
Notes: The projected fiscal year 2009 funding in this table is based on
the funding amount for urban areas identified in the Explanatory
Statement to H.R. 1105. We assumed that the percent of Part A funding
allotted to EMAs and the percent allotted to Transitional Grant Areas
(TGA) in fiscal year 2009 would be the same as the percent allotted to
each in fiscal year 2008.
Because updated human immunodeficiency virus/acquired immunodeficiency
syndrome (HIV/AIDS) case counts were not available, we used the HIV/
AIDS case counts that Health Resources and Services Administration
(HRSA) used to determine fiscal year 2008 funding.
We cannot determine the exact effect of the stop-loss provision on
total funding for each EMA for fiscal year 2009. It is not possible to
determine exactly how each EMA would be affected by the 6.3 percent
stop-loss for EMAs because it is not known how HRSA will award fiscal
year 2009 supplemental and Minority AIDS Initiative (MAI) grants and
because the case counts on which formula grants will be based are not
yet available.
To estimate fiscal year 2009 supplemental funding for EMAs, we
calculated the percent of fiscal year 2008 total funding that each
area's fiscal year 2008 supplemental funding represented. We then
multiplied that percentage by the estimated total supplemental funding
to be available for distribution in fiscal year 2009. For example, if
an EMA received 2 percent of the total supplemental funding available
for distribution to EMAs in fiscal year 2008, then we estimated that
area's supplemental funding in fiscal year 2009 to be 2 percent of the
amount of supplemental funding available for distribution to EMAs.
We based our estimate of fiscal year 2009 MAI funding for EMAs on the
amount to be reserved for fiscal year 2009 Part A MAI funding in the
Ryan White HIV/AIDS Treatment Modernization Act of 2006 (Modernization
Act of 2006). (The exact amount used was 95.985 percent of the amount
specified in the Modernization Act of 2006. This amount was used
because this was the percent of the amount specified in the
Modernization Act of 2006 for fiscal years 2007 and 2008 that had been
distributed in those years.) We calculated the percent of fiscal year
2008 total funding that each area's fiscal year 2008 MAI funding
represented. We then multiplied that percentage by the estimated total
MAI funding to be available for distribution in fiscal year 2009. For
example, if an EMA received 2 percent of the total MAI funding
available for distribution to EMAs in fiscal year 2008, then we
estimated that area's MAI funding in fiscal year 2009 to be 2 percent
of the amount of supplemental funding available for distribution to
EMAs.
[A] Under the stop-loss provision in H.R. 1105, an EMA is ensured that
its total formula, supplemental, and MAI grants for fiscal year 2008
would not be less than 93.7 percent of what it received for fiscal year
2006.
[B] The total funding that an EMA would receive in fiscal year 2009
with the stop-loss provision in place can be found by adding the amount
in this column to the amount in the column titled "H.R. 1105: Estimated
stop-loss."
[C] We estimate the funding needed to satisfy the H.R. 1105 stop-loss
provision for both EMAs and TGAs to be $11,130,937. However, the amount
specified in H.R. 1105 to cover the stop-loss provision is $10,853,000,
a difference of $277,937. See enclosure II for the funding needed to
satisfy the stop-loss provision for TGAs.
[End of table]
[End of enclosure]
Enclosure II:
Table 2: Total Transitional Grant Area Formula, Supplemental, and
Minority AIDS Initiative Grants for Fiscal Year 2006, Fiscal Year 2008,
and Projected Funding for Fiscal Year 2009 under Part A Funding Levels
Identified in the Explanatory Statement to H.R. 1105:
Transitional Grant Area (TGA): Austin, Tex.;
Fiscal year 2006 funding: $3,719,076;
88.7 percent of fiscal year 2006 funding[A]: $3,298,820;
Fiscal year 2008 funding: $3,780,228;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $4,162,255;
H.R. 1105: Estimated stop-loss: $0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$4,162,255;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $4,232,183.
Transitional Grant Area (TGA): Baton Rouge, La.;
Fiscal year 2006 funding: 0;
88.7 percent of fiscal year 2006 funding[A]: 0;
Fiscal year 2008 funding: $3,235,045;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $3,558,823;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$3,558,823;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $3,617,603.
Transitional Grant Area (TGA): Bergen-Passaic, N.J.;
Fiscal year 2006 funding: $4,485,650;
88.7 percent of fiscal year 2006 funding[A]: $3,978,772;
Fiscal year 2008 funding: $3,772,874;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $4,151,023;
H.R. 1105: Estimated stop-loss: $205,898;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$4,356,920;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $4,219,835.
Transitional Grant Area (TGA): Caguas, P.R.;
Fiscal year 2006 funding: $1,648,356;
88.7 percent of fiscal year 2006 funding[A]: $1,462,092;
Fiscal year 2008 funding: $1,063,691;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $1,167,262;
H.R. 1105: Estimated stop-loss: $398,401;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$1,565,663;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $1,185,745.
Transitional Grant Area (TGA): Charlotte-Gastonia, N.C.-S.C.;
Fiscal year 2006 funding: 0;
88.7 percent of fiscal year 2006 funding[A]: 0;
Fiscal year 2008 funding: $4,676,968;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $5,143,544;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$5,143,544;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $5,228,264.
Transitional Grant Area (TGA): Cleveland, Ohio;
Fiscal year 2006 funding: $3,349,096;
88.7 percent of fiscal year 2006 funding[A]: $2,970,648;
Fiscal year 2008 funding: $3,911,591;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $4,302,543;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$4,302,543;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $4,373,547.
Transitional Grant Area (TGA): Denver, Colo.;
Fiscal year 2006 funding: $4,283,042;
88.7 percent of fiscal year 2006 funding[A]: $3,799,058;
Fiscal year 2008 funding: $7,298,643;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $8,048,873;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$8,048,873;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $8,187,495.
Transitional Grant Area (TGA): Dutchess County, N.Y.;
Fiscal year 2006 funding: $1,367,584;
88.7 percent of fiscal year 2006 funding[A]: $1,213,047;
Fiscal year 2008 funding: $1,155,700;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $1,269,994;
H.R. 1105: Estimated stop-loss: $57,347;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$1,327,341;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $1,290,615.
Transitional Grant Area (TGA): Fort Worth, Tex.;
Fiscal year 2006 funding: $3,409,819;
88.7 percent of fiscal year 2006 funding[A]: $3,024,509;
Fiscal year 2008 funding: $3,588,582;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $3,952,428;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$3,952,428;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $4,019,120.
Transitional Grant Area (TGA): Hartford, Conn.;
Fiscal year 2006 funding: $4,666,281;
88.7 percent of fiscal year 2006 funding[A]: $4,138,991;
Fiscal year 2008 funding: $3,185,949;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $3,503,924;
H.R. 1105: Estimated stop-loss: $953,042;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$4,456,966;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $3,561,619.
Transitional Grant Area (TGA): Indianapolis, Ind.;
Fiscal year 2006 funding: 0;
88.7 percent of fiscal year 2006 funding[A]: 0;
Fiscal year 2008 funding: $3,587,145;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $3,952,045;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$3,952,045;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $4,019,096.
Transitional Grant Area (TGA): Jacksonville, Fla.;
Fiscal year 2006 funding: $4,913,816;
88.7 percent of fiscal year 2006 funding[A]: $4,358,555;
Fiscal year 2008 funding: $4,826,190;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $5,308,171;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$5,308,171;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $5,395,750.
Transitional Grant Area (TGA): Jersey City, N.J.;
Fiscal year 2006 funding: $5,145,142;
88.7 percent of fiscal year 2006 funding[A]: $4,563,741;
Fiscal year 2008 funding: $4,593,150;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $5,048,353;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$5,048,353;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $5,130,699.
Transitional Grant Area (TGA): Kansas City, Mo.;
Fiscal year 2006 funding: $2,916,485;
88.7 percent of fiscal year 2006 funding[A]: $2,586,922;
Fiscal year 2008 funding: $4,011,340;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $4,420,666;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$4,420,666;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $4,496,001.
Transitional Grant Area (TGA): Las Vegas, Nev.;
Fiscal year 2006 funding: $4,323,627;
88.7 percent of fiscal year 2006 funding[A]: $3,835,057;
Fiscal year 2008 funding: $4,552,895;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $5,017,196;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$5,017,196;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $5,102,314.
Transitional Grant Area (TGA): Memphis, Tenn.;
Fiscal year 2006 funding: 0;
88.7 percent of fiscal year 2006 funding[A]: 0;
Fiscal year 2008 funding: $5,859,876;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $6,438,653;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$6,438,653;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $6,543,133.
Transitional Grant Area (TGA): Middlesex-Somerset-Hunterdon, N.J.;
Fiscal year 2006 funding: $2,595,663;
88.7 percent of fiscal year 2006 funding[A]: $2,302,353;
Fiscal year 2008 funding: $2,462,767;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $2,711,055;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$2,711,055;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $2,756,415.
Transitional Grant Area (TGA): Minneapolis-St. Paul, Minn.;
Fiscal year 2006 funding: $3,046,512;
88.7 percent of fiscal year 2006 funding[A]: $2,702,256;
Fiscal year 2008 funding: $4,675,211;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $5,148,836;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$5,148,836;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $5,235,593.
Transitional Grant Area (TGA): Nashville, Tenn.;
Fiscal year 2006 funding: 0;
88.7 percent of fiscal year 2006 funding[A]: 0;
Fiscal year 2008 funding: $3,743,376;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $4,123,916;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$4,123,916;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $4,193,729.
Transitional Grant Area (TGA): Nassau-Suffolk, N.Y.;
Fiscal year 2006 funding: $6,148,307;
88.7 percent of fiscal year 2006 funding[A]: $5,453,548;
Fiscal year 2008 funding: $4,811,511;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $5,295,773;
H.R. 1105: Estimated stop-loss: $642,037;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$5,937,810;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $5,384,059.
Transitional Grant Area (TGA): New Haven, Conn.;
Fiscal year 2006 funding: $6,684,594;
88.7 percent of fiscal year 2006 funding[A]: $5,929,235;
Fiscal year 2008 funding: $5,209,416;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $5,735,036;
H.R. 1105: Estimated stop-loss: $719,819;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$6,454,855;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $5,831,010.
Transitional Grant Area (TGA): Norfolk, Va.;
Fiscal year 2006 funding: $4,414,760;
88.7 percent of fiscal year 2006 funding[A]: $3,915,892;
Fiscal year 2008 funding: $5,360,103;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $5,898,719;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$5,898,719;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $5,996,942.
Transitional Grant Area (TGA): Oakland, Calif.;
Fiscal year 2006 funding: $5,735,837;
88.7 percent of fiscal year 2006 funding[A]: $5,087,687;
Fiscal year 2008 funding: $5,867,538;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $6,462,486;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$6,462,486;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $6,570,622.
Transitional Grant Area (TGA): Orange County, Calif.;
Fiscal year 2006 funding: $4,858,579;
88.7 percent of fiscal year 2006 funding[A]: $4,309,560;
Fiscal year 2008 funding: $5,332,920;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $5,877,173;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$5,877,173;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $5,976,553.
Transitional Grant Area (TGA): Ponce, P.R.;
Fiscal year 2006 funding: $2,391,444;
88.7 percent of fiscal year 2006 funding[A]: $2,121,211;
Fiscal year 2008 funding: $1,926,154;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $2,117,579;
H.R. 1105: Estimated stop-loss: $195,057;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$2,312,636;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $2,152,253.
Transitional Grant Area (TGA): Portland, Ore.;
Fiscal year 2006 funding: $3,401,956;
88.7 percent of fiscal year 2006 funding[A]: $3,017,535;
Fiscal year 2008 funding: $3,310,036;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $3,714,698;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$3,714,698;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $3,779,492.
Transitional Grant Area (TGA): Riverside-San Bernardino, Calif.;
Fiscal year 2006 funding: $7,074,521;
88.7 percent of fiscal year 2006 funding[A]: $6,275,100;
Fiscal year 2008 funding: v6,949,457;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $7,667,837;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$7,667,837;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $7,800,012.
Transitional Grant Area (TGA): Sacramento, Calif.;
Fiscal year 2006 funding: $2,778,729;
88.7 percent of fiscal year 2006 funding[A]: $2,464,733;
Fiscal year 2008 funding: $2,325,684;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $2,565,172;
H.R. 1105: Estimated stop-loss: $139,049;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$2,704,221;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $2,609,095.
Transitional Grant Area (TGA): San Antonio, Tex.;
Fiscal year 2006 funding: $3,325,881;
88.7 percent of fiscal year 2006 funding[A]: $2,950,056;
Fiscal year 2008 funding: $3,969,302;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $4,368,560;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$4,368,560;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $4,441,414.
Transitional Grant Area (TGA): San Jose, Calif.;
Fiscal year 2006 funding: $2,304,762;
88.7 percent of fiscal year 2006 funding[A]: $2,044,324;
Fiscal year 2008 funding: $2,578,512;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $2,841,808;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$2,841,808;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $2,889,886.
Transitional Grant Area (TGA): Santa Rosa, Calif.;
Fiscal year 2006 funding: $1,028,634;
88.7 percent of fiscal year 2006 funding[A]: $912,398;
Fiscal year 2008 funding: $1,072,099;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $1,182,455;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$1,182,455;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $1,202,669.
Transitional Grant Area (TGA): Seattle, Wash.;
Fiscal year 2006 funding: $5,445,484;
88.7 percent of fiscal year 2006 funding[A]: $4,830,144;
Fiscal year 2008 funding: $6,316,558;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $6,969,212;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$6,969,212;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $7,089,141.
Transitional Grant Area (TGA): St. Louis, Mo.;
Fiscal year 2006 funding: $4,502,572;
88.7 percent of fiscal year 2006 funding[A]: $3,993,781;
Fiscal year 2008 funding: $5,796,624;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $6,098,186;
H.R. 1105: Estimated stop-loss: 0;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$6,098,186;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $6,199,596.
Transitional Grant Area (TGA): Vineland-Millville-Bridgeton, N.J.;
Fiscal year 2006 funding: $849,715;
88.7 percent of fiscal year 2006 funding[A]: $753,697;
Fiscal year 2008 funding: $723,408;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $795,232;
H.R. 1105: Estimated stop-loss: $30,289;
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$825,521;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $808,204.
Transitional Grant Area (TGA): Total;
Fiscal year 2006 funding: $110,815,924;
88.7 percent of fiscal year 2006 funding[A]: $98,293,725;
Fiscal year 2008 funding: $135,530,543;
H.R. 1105: Estimated fiscal year 2009 funding before applying stop-
loss[B]: $149,019,485;
H.R. 1105: Estimated stop-loss: $3,340,938[C];
H.R. 1105: Estimated fiscal year 2009 funding after applying stop loss:
$152,360,424;
Estimated fiscal year 2009 funding without H.R. 1105 stop-loss
provision in place: $151,519,703.
Source: GAO analysis of HHS data, H.R. 1105, and the Explanatory
Statement to H.R. 1105.
Notes: The projected fiscal year 2009 funding in this table is based on
the funding amount for urban areas identified in the Explanatory
Statement to H.R. 1105. We assumed that the percent of Part A funding
allotted to Eligible Metropolitan Areas (EMA)and the percent allotted
to TGAs in fiscal year 2009 would be the same as the percent allotted
to each in fiscal year 2008.
Because updated human immunodeficiency virus/acquired immunodeficiency
syndrome (HIV/AIDS) case counts were not available, we used the HIV/
AIDS case counts that Health Resources and Services Administration
(HRSA) used to determine fiscal year 2008 funding.
We cannot determine the exact effect of the stop-loss provision on
total funding for each TGA for fiscal year 2009. It is not possible to
determine exactly how each TGA would be affected by the 11.3 percent
stop-loss provision for TGAs because it is not known how HRSA will
award fiscal year 2009 supplemental and Minority AIDS Initiative (MAI)
grants and because the case counts on which formula grants will be
based are not yet available.
To estimate fiscal year 2009 supplemental funding for TGAs, we
calculated the percent of fiscal year 2008 total funding that each
area's fiscal year 2008 supplemental funding represented. We then
multiplied that percentage by the estimated total supplemental funding
to be available for distribution in fiscal year 2009. For example, if a
TGA received 2 percent of the total supplemental funding available for
distribution to TGAs in fiscal year 2008, then we estimated that area's
supplemental funding in fiscal year 2009 to be 2 percent of the amount
of supplemental funding available for distribution to TGAs.
We based our estimate of fiscal year 2009 MAI funding for TGAs on the
amount to be reserved for fiscal year 2009 Part A MAI funding in the
Ryan White HIV/AIDS Treatment Modernization Act of 2006 (Modernization
Act of 2006). (The exact amount used was 95.985 percent of the amount
specified in the Modernization Act of 2006. This amount was used
because this was the percent of the amount specified in the
Modernization Act of 2006 for fiscal years 2007 and 2008 that had been
distributed in those years.) We calculated the percent of fiscal year
2008 total funding that each area's fiscal year 2008 MAI funding
represented. We then multiplied that percentage by the estimated total
MAI funding to be available for distribution in fiscal year 2009. For
example, if a TGA received 2 percent of the total MAI funding available
for distribution to TGAs in fiscal year 2008, then we estimated that
area's MAI funding in fiscal year 2009 to be 2 percent of the amount of
supplemental funding available for distribution to TGAs.
[A] Under the stop-loss provision in H.R. 1105, a TGA is ensured that
its total formula, supplemental, and MAI grants for fiscal year 2008
would not be less than 88.7 percent of what it received for fiscal year
2006.
[B] The total funding that a TGA would receive in fiscal year 2009 with
the stop-loss provision in place can be found by adding the amount in
this column to the amount in the column titled "H.R. 1105: Estimated
stop-loss."
[C] We estimate the funding needed to satisfy the H.R. 1105 stop-loss
provision for both EMAs and TGAs to be $11,130,937. However, the amount
specified in H.R. 1105 to cover the stop-loss provision is $10,853,000,
a difference of $277,937. See enclosure I for the funding needed to
satisfy the stop-loss provision for EMAs.
[End of table]
[End of enclosure]
Enclosure III:
GAO Contacts and Staff Acknowledgments:
For information about this letter, please contact Marcia Crosse,
Director, Health Care, who can be reached at (202) 512-7114 or
crossem@gao.gov. Contact points for our Offices of Congressional
Relations and Public Affairs may be found on the last page of this
letter. Major contributors to this letter were Thomas Conahan,
Assistant Director; Martha Kelly, Assistant Director; Robert Copeland;
Helen Desaulniers; Rachel Moskowitz; Jennifer Whitworth; and Suzanne
Worth.
[End of enclosure]
Footnotes:
[1] Pub. L. No. 101-381, 104 Stat. 576 (codified as amended at 42
U.S.C. §§ 300ff through 300ff-121). Unless otherwise indicated,
references to the CARE Act refer to current law.
[2] Pub. L. No. 109-415, 120 Stat. 2767. The CARE Act programs had
previously been reauthorized by the Ryan White CARE Act Amendments of
1996 (Pub. L. No. 104-146, 110 Stat. 1346) and the Ryan White CARE Act
Amendments of 2000 (Pub. L. No. 106-345, 114 Stat. 1319).
[3] H.R. 1105, 111th Cong. (2009). For purposes of this report, unless
otherwise specified we use the term H.R. 1105 to refer to the bill as
passed by the House of Representatives.
[4] In this report, we use the term urban areas to refer to both EMAs
and TGAs. An EMA is a metropolitan area with a population of 50,000 or
more that had more than 2,000 AIDS cases reported in the most recent 5-
year period. The 2,000 AIDS-case criterion does not include cases of
HIV that have not progressed to AIDS. In fiscal year 2008, there were
22 EMAs. The Modernization Act of 2006 created a new program for TGAs.
A TGA is a metropolitan area with a population of 50,000 or more, which
had 1,000 to 1,999 AIDS cases reported in the most recent 5-year
period. Under this program, urban areas that were eligible for EMA
funding in fiscal year 2006 but that no longer meet the eligibility
criteria for either EMAs or TGAs maintain their eligibility for funding
and are considered TGAs until for 3 consecutive years they (1) fail to
have at least 1,000 to 1,999 AIDS cases reported in the most recent 5-
year period and (2) do not have more than 1,500 living cases of AIDS.
In fiscal year 2008, there were 34 TGAs according to HRSA.
[5] Part A of the CARE Act covers funding to urban areas. Part B covers
funding to states, territories, and the District of Columbia.
[6] The stop-loss provision in H.R. 1105 states that "within the
amounts provided for Part A..., $10,853,000 is available... for
increasing supplemental grants for fiscal year 2009 to metropolitan
areas that received grant funding in fiscal year 2008... to ensure that
an area's total funding under [Part A to an EMA] for fiscal year 2008,
together with the amount of this additional funding, is not less than
93.7 percent of the amount of such area's total funding under part A
for fiscal year 2006, and to ensure... that an area's total funding
under [Part A to a TGA] for fiscal year 2008, together with the amount
of this additional funding, is not less than 88.7 percent of the amount
of such area's total funding under part A for fiscal year 2006."
Because the provision would apply to an EMA's or TGA's "total funding"
under Part A, we consider the total amount subject to the stop-loss
provision to be formula, supplemental, and MAI grants made with Part A
funds. MAI grants are authorized by 42 U.S.C. § 300ff-121, which
specifically directs HHS to provide funding under Part A.
[7] 155 Cong. Rec. H1653, H2377 (daily ed. Feb. 23, 2009) (statement of
Rep. Obey).
[End of section]
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