Ryan White CARE Act
Estimated Effect of Continued Application of the Fiscal Year 2010 Stop-Loss Provision on 2011 Funding for Urban Areas Gao ID: GAO-11-405R February 18, 2011Congress asked us to estimate the effect on Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) funding to urban areas if the stop-loss provision applicable in fiscal year 2010 was applied to funding for 2011 under a continuing resolution. The CARE Act, administered by the Department of Health and Human Services' (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 October 2009, the Ryan White HIV/AIDS Treatment Extension Act of 2009 (RWTEA) reauthorized CARE Act programs for fiscal years 2010 through 2013. 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 awarded for urban areas to address disparities in access, treatment, care, and health outcomes.
The Consolidated Appropriations Act, 2010, contained a provision to ensure that decreases in total Part A funding for fiscal year 2009 for each EMA and TGA did not exceed specified levels. Specifically, it limited the total funding decrease for fiscal year 2009 to no more than 7.6 percent of what the EMA or TGA received for fiscal year 2006. The funds necessary to limit the decreases to urban areas were given as increases to supplemental grants for fiscal year 2010. To provide Congress with technical assistance, we developed an estimate of fiscal year 2011 CARE Act funding for EMAs and TGAs assuming 2010 funding levels and that the stop-loss provision applicable in fiscal year 2010 is applied. We also developed an estimate of such funding without the stop-loss provision. We used data from HHS and the Consolidated Appropriations Act, 2010, to estimate these amounts. In order to conduct these analyses, we made a number of assumptions. This document includes estimates of CARE Act funding for EMAs with and without the stop-loss provision. It also includes estimates of CARE Act funding for TGAs with and without the stop-loss provision.
GAO-11-405R, Ryan White CARE Act: Estimated Effect of Continued Application of the Fiscal Year 2010 Stop-Loss Provision on 2011 Funding for Urban Areas
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GAO-11-405R:
United States Government Accountability Office:
Washington, DC 20548:
February 18, 2011:
The Honorable Dennis R. Rehberg:
Chairman:
Subcommittee on Labor, Health and Human Services, Education, and
Related Agencies:
Committee on Appropriations:
House of Representatives:
Subject: Ryan White CARE Act: Estimated Effect of Continued
Application of the Fiscal Year 2010 Stop-Loss Provision on 2011
Funding for Urban Areas:
Dear Mr. Rehberg:
You asked us to estimate the effect on Ryan White Comprehensive AIDS
Resources Emergency Act of 1990 (CARE Act) funding to urban areas if
the stop-loss provision applicable in fiscal year 2010 was applied to
funding for 2011 under a continuing resolution. The CARE Act,
administered by the Department of Health and Human Services' (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 October 2009, the Ryan White HIV/AIDS
Treatment Extension Act of 2009 (RWTEA) reauthorized CARE Act programs
for fiscal years 2010 through 2013.[Footnote 2]
Under the CARE Act, funding for urban areas--eligible metropolitan
areas (EMA) and transitional grant areas (TGA)[Footnote 3]--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 awarded for urban areas to address
disparities in access, treatment, care, and health outcomes.
The Consolidated Appropriations Act, 2010, contained a provision to
ensure that decreases in total Part A funding for fiscal year 2009 for
each EMA and TGA did not exceed specified levels. Specifically, it
limited the total funding decrease for fiscal year 2009 to no more
than 7.6 percent of what the EMA or TGA received for fiscal year 2006.
[Footnote 4] The funds necessary to limit the decreases to urban areas
were given as increases to supplemental grants for fiscal year 2010.
To provide you with technical assistance, we developed an estimate of
fiscal year 2011 CARE Act funding for EMAs and TGAs assuming 2010
funding levels and that the stop-loss provision applicable in fiscal
year 2010 is applied.[Footnote 5] We also developed an estimate of
such funding without the stop-loss provision. We used data from HHS
and the Consolidated Appropriations Act, 2010, to estimate these
amounts. 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 CARE Act funding
for EMAs with and without the stop-loss provision. See enclosure II
for estimates of CARE Act funding for TGAs with and without the stop-
loss provision.
The objective of this report was to provide pertinent information by
showing the effect that the stop-loss provision for fiscal year 2010
would have on fiscal year 2011 funding for EMAs and TGAs under a
continuing resolution at the funding levels indicated. We used data
from agency reference documents to conduct our analyses. Because of
time constraints, we did not conduct any additional analysis of the
provision. We performed our work in January and February 2011.
We are sending copies of this report to interested congressional
committees. The report also is available at no charge on the GAO Web
site at [hyperlink, http://www.gao.gov].
If you or your staff have any questions about this report, 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 report. Key contributors to this report are
provided in enclosure III.
Sincerely yours,
Signed by:
Marcia Crosse:
Director, Health Care:
Enclosures - 3:
End of section]
Enclosure I: Total Eligible Metropolitan Area Formula, Supplemental,
and Minority AIDS Initiative Grants for Fiscal Year 2006 and Fiscal
Year 2010 and Estimated Funding for Fiscal Year 2011 Assuming the 2010
Stop-Loss Provision Is Applied:
Eligible metropolitan area (EMA): Atlanta, Georgia;
Fiscal year 2006 funding: $18,869,561;
92.4 percent of fiscal year 2006 funding[A]: $17,435,474;
Fiscal year 2010 funding: $20,336,854;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $21,862,667;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $21,862,667;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $22,054,205.
Eligible metropolitan area (EMA): Baltimore, Maryland;
Fiscal year 2006 funding: $20,628,895;
92.4 percent of fiscal year 2006 funding[A]: $19,061,099;
Fiscal year 2010 funding: $21,794,719;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $23,584,633;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $23,584,633;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $23,800,751.
Eligible metropolitan area (EMA): Boston, Massachusetts;
Fiscal year 2006 funding: $13,339,141;
92.4 percent of fiscal year 2006 funding[A]: $12,325,366;
Fiscal year 2010 funding: $14,148,413;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $15,307,194;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $15,307,194;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $15,456,386.
Eligible metropolitan area (EMA): Chicago, Illinois;
Fiscal year 2006 funding: $25,044,633;
92.4 percent of fiscal year 2006 funding[A]: $23,141,241;
Fiscal year 2010 funding: $27,070,245;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $29,333,904;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $29,333,904;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $29,604,044.
Eligible metropolitan area (EMA): Dallas, Texas;
Fiscal year 2006 funding: 13,196,377;
92.4 percent of fiscal year 2006 funding[A]: $12,193,452;
Fiscal year 2010 funding: $15,112,117;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $16,202,728;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $16,202,728;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $16,356,626.
Eligible metropolitan area (EMA): Detroit, Michigan;
Fiscal year 2006 funding: $8,428,477;
92.4 percent of fiscal year 2006 funding[A]: $7,787,913;
Fiscal year 2010 funding: $8,640,138;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $9,313,547;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $9,313,547;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $9,391,806.
Eligible metropolitan area (EMA): Fort Lauderdale, Florida;
Fiscal year 2006 funding: $14,963,638;
92.4 percent of fiscal year 2006 funding[A]: $13,826,402;
Fiscal year 2010 funding: $15,395,253;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $16,521,986;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $16,521,986;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $16,674,217.
Eligible metropolitan area (EMA): Houston, Texas;
Fiscal year 2006 funding: $19,953,520;
92.4 percent of fiscal year 2006 funding[A]: $18,437,052;
Fiscal year 2010 funding: $20,048,271;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $21,486,793;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $21,486,793;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $21,686,584.
Eligible metropolitan area (EMA): Los Angeles, California;
Fiscal year 2006 funding: $34,895,377;
92.4 percent of fiscal year 2006 funding[A]: $32,243,328;
Fiscal year 2010 funding: $39,677,933;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $43,071,858;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $43,071,858;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $43,485,462.
Eligible metropolitan area (EMA): Miami, Florida.
Fiscal year 2006 funding: $23,999,914;
92.4 percent of fiscal year 2006 funding[A]: $22,175,921;
Fiscal year 2010 funding: $25,699,349;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $27,461,444;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $27,461,444;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $27,722,247.
Eligible metropolitan area (EMA): Nassau-Suffolk, New York;
Fiscal year 2006 funding: $6,148,307;
92.4 percent of fiscal year 2006 funding[A]: $5,681,036;
Fiscal year 2010 funding: $6,314,514;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $6,154,680;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $6,154,680;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $6,208,297.
Eligible metropolitan area (EMA): New Haven, Connecticut;
Fiscal year 2006 funding: $6,684,594;
92.4 percent of fiscal year 2006 funding[A]: $6,176,565;
Fiscal year 2010 funding: $7,227,221;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $7,046,027;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $7,046,027;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $7,106,824.
Eligible metropolitan area (EMA): New Orleans, Louisiana;
Fiscal year 2006 funding: $7,434,812;
92.4 percent of fiscal year 2006 funding[A]: $6,869,766;
Fiscal year 2010 funding: $7,557,633;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $8,085,939;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $8,085,939;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $8,161,600.
Eligible metropolitan area (EMA): New York, New York;
Fiscal year 2006 funding: $120,423,326;
92.4 percent of fiscal year 2006 funding[A]: $111,271,153;
Fiscal year 2010 funding: $120,636,514;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $117,689,702;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $117,689,702;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $118,689,556.
Eligible metropolitan area (EMA): Newark, New Jersey;
Fiscal year 2006 funding: $14,752,254;
92.4 percent of fiscal year 2006 funding[A]: $13,631,083;
Fiscal year 2010 funding: $14,416,548;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $14,224,523;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $14,224,523;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $14,360,053.
Eligible metropolitan area (EMA): Orlando, Florida;
Fiscal year 2006 funding: $8,561,273;
92.4 percent of fiscal year 2006 funding[A]: $7,910,616;
Fiscal year 2010 funding: $9,089,179;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $9,746,217;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $9,746,217;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $9,837,429.
Eligible metropolitan area (EMA): Philadelphia, Pennsylvania;
Fiscal year 2006 funding: $22,384,551;
92.4 percent of fiscal year 2006 funding[A]: $20,683,325;
Fiscal year 2010 funding: $24,299,388;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $26,018,321;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $26,018,321;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $26,262,765.
Eligible metropolitan area (EMA): Phoenix, Arizona;
Fiscal year 2006 funding: $6,519,338;
92.4 percent of fiscal year 2006 funding[A]: $6,023,868;
Fiscal year 2010 funding: $8,372,580;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $8,999,249;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $8,999,249;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $9,083,813.
Eligible metropolitan area (EMA): San Diego, California;
Fiscal year 2006 funding: $9,269,256;
92.4 percent of fiscal year 2006 funding[A]: $8,564,793;
Fiscal year 2010 funding: $11,582,541;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $12,561,849;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $12,561,849;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $12,681,950.
Eligible metropolitan area (EMA): San Francisco, California;
Fiscal year 2006 funding: $27,964,864;
92.4 percent of fiscal year 2006 funding[A]: $25,839,534;
Fiscal year 2010 funding: $21,120,073;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $20,565,731;
Estimated stop loss under 2010 stop-loss provision: $4,719,461;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $25,285,192;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $20,747,058.
Eligible metropolitan area (EMA): San Juan, Puerto Rico;
Fiscal year 2006 funding: $13,470,347;
92.4 percent of fiscal year 2006 funding[A]: $12,446,601;
Fiscal year 2010 funding: $15,195,501;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $14,909,895;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $14,909,895;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $15,009,844.
Eligible metropolitan area (EMA): Tampa-St. Petersburg, Florida;
Fiscal year 2006 funding: $9,571,830;
92.4 percent of fiscal year 2006 funding[A]: $8,844,371;
Fiscal year 2010 funding: $9,403,477;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $10,092,982;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $10,092,982;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $10,180,455.
Eligible metropolitan area (EMA): Washington, District of Columbia;
Fiscal year 2006 funding: $26,923,066;
92.4 percent of fiscal year 2006 funding[A]: $24,876,913;
Fiscal year 2010 funding: $31,452,528;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $35,169,640;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $35,169,640;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $35,495,196.
Eligible metropolitan area (EMA): West Palm Beach, Florida;
Fiscal year 2006 funding: $8,276,018;
92.4 percent of fiscal year 2006 funding[A]: $7,647,041;
Fiscal year 2010 funding: $9,157,848;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $8,940,243;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $8,940,243;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $9,014,045.
Eligible metropolitan area (EMA): Total;
Fiscal year 2006 funding: $481,703,369;
92.4 percent of fiscal year 2006 funding[A]: $445,093,913;
Fiscal year 2010 funding: $503,748,837;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $524,351,752;
Estimated stop loss under 2010 stop-loss provision: $4,719,461;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $529,071,213;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $529,071,213.
Source: GAO analysis of Department of Health and Human Services' data
and 2010 stop-loss provision.
Notes: The 2010 stop-loss provision was contained in the Consolidated
Appropriations Act, 2010.
The projected fiscal year 2011 funding in this table is based on the
funding amount for urban areas and states (Parts A and B,
respectively) provided by the Consolidated Appropriations Act, 2010.
The amount identified for Parts A and B and the amount identified for
the stop-loss provision in that act were identical to the amounts
identified in H.R. 3293, the Departments of Labor, Health and Human
Services, and Education, and Related Agencies Appropriations Act, 2010
which was passed by the House of Representatives on July 24, 2009.
H.R. 3293,111TH Cong. (2009). Accordingly, we assumed that the funding
for Parts A and B, respectively, would be the same as the amounts
identified in the report of the House Committee on Appropriations
accompanying H.R. 3293. H.R. Rep. No. 111-220 (2009). The total
identified for Part A funding was $679,074,000. We further assumed
that the percentage of Part A funding for EMAs and the percentage for
transitional grant areas (TGA) in fiscal year 2011 would be the same
as the percentages allotted to each in fiscal year 2010.
Because updated human immunodeficiency virus/acquired immunodeficiency
syndrome (HIV/AIDS) case counts were not available, we used the HIV/
AIDS case counts that the Health Resources and Services Administration
(HRSA) used to determine fiscal year 2010 funding.
To estimate fiscal year 2011 supplemental funding for EMAs, we
calculated the percentage of fiscal year 2010 total funding that each
area's fiscal year 2010 supplemental funding represented. We then
multiplied that percentage by the estimated total supplemental funding
to be available for distribution in fiscal year 2011 under 2010
funding levels. For example, if an EMA received 2 percent of the total
supplemental funding available for distribution to EMAs in fiscal year
2010, then we estimated that area's supplemental funding in fiscal
year 2011 to be 2 percent of the amount of supplemental funding
available for distribution to EMAs.
We developed our estimate of fiscal year 2011 Minority AIDS Initiative
(MAI) funding for EMAs by applying the percentage increase in MAI
funding from 2009 to 2010 at the EMA level.
Under the hold-harmless provision in the most recent reauthorization
act, an EMA is ensured that its formula grant funding under Part A for
fiscal year 2011 would be at least 100 percent of what is received for
fiscal year 2010.
Individual entries may not sum to totals because of rounding.
[A] Under the stop-loss provision, an EMA is ensured that its total
formula, supplemental, and MAI grants for fiscal year 2010 would not
be less than 92.4 percent of what it received for fiscal year 2006.
[B] The total funding that an EMA would receive in fiscal year 2011
with the stop-loss provision in place can be found by adding the
amount in this column to the amount in the column titled "Estimated
stop loss under 2010 stop-loss provision."
[C] The total funding that is available to be distributed to EMAs in
fiscal year 2011 remains the same with and without the stop-loss
provision. It is the distribution of available funding across the EMAs
that changes with and without the inclusion of the stop-loss provision.
[End of table] End of section]
Enclosure II: Total Transitional Grant Area Formula, Supplemental, and
Minority AIDS Initiative Grants for Fiscal Year 2006 and Fiscal Year
2010 and Estimated Funding for Fiscal Year 2011 Assuming the 2010 Stop-
Loss Provision Is Applied:
Transitional grant area (TGA): Austin, Texas;
Fiscal year 2006 funding: $3,719,076;
92.4 percent of fiscal year 2006 funding[A]: $3,436,426;
Fiscal year 2010 funding: $4,348,975;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $4,455,436;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $4,455,436;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $4,474,678.
Transitional grant area (TGA): Baton Rouge, Louisiana;
Fiscal year 2006 funding: [Empty];
92.4 percent of fiscal year 2006 funding[A]: [Empty];
Fiscal year 2010 funding: $4,083,037;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $4,182,519;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $4,182,519;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $4,199,542.
Transitional grant area (TGA): Bergen-Passaic, New Jersey;
Fiscal year 2006 funding: $4,485,650;
92.4 percent of fiscal year 2006 funding[A]: $4,144,741;
Fiscal year 2010 funding: $4,273,783;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $4,378,469;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $4,378,469;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $4,397,127.
Transitional grant area (TGA): Caguas, Puerto Rico;
Fiscal year 2006 funding: $1,648,356;
92.4 percent of fiscal year 2006 funding[A]: $1,523,081;
Fiscal year 2010 funding: $1,373,187;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $1,406,528;
Estimated stop loss under 2010 stop-loss provision: $149,894;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $1,556,422;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $1,412,033.
Transitional grant area (TGA): Charlotte-Gastonia, North Carolina-
South Carolina
Fiscal year 2006 funding: [Empty];
92.4 percent of fiscal year 2006 funding[A]: [Empty];
Fiscal year 2010 funding: $5,418,647;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $5,548,749;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $5,548,749;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $5,569,421.
Transitional grant area (TGA): Cleveland, Ohio;
Fiscal year 2006 funding: $3,349,096;
92.4 percent of fiscal year 2006 funding[A]: $3,094,565;
Fiscal year 2010 funding: $4,488,525;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $4,598,390;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $4,598,390;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $4,617,997.
Transitional grant area (TGA): Denver, Colorado;
Fiscal year 2006 funding: $4,283,042;
92.4 percent of fiscal year 2006 funding[A]: $3,957,531;
Fiscal year 2010 funding: $7,944,842;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $8,136,191;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $8,136,191;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $8,168,550.
Transitional grant area (TGA): Dutchess County, New York;
Fiscal year 2006 funding: $1,367,584;
92.4 percent of fiscal year 2006 funding[A]: $1,263,648;
Fiscal year 2010 funding: $1,347,313;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $1,380,318;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $1,380,318;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $1,386,162.
Transitional grant area (TGA): Fort Worth, Texas;
Fiscal year 2006 funding: $3,409,819;
92.4 percent of fiscal year 2006 funding[A]: $3,150,673;
Fiscal year 2010 funding: $4,049,388;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $4,148,875;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $4,148,875;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $4,167,122.
Transitional grant area (TGA): Hartford, Connecticut;
Fiscal year 2006 funding: $4,666,281;
92.4 percent of fiscal year 2006 funding[A]: $4,311,644;
Fiscal year 2010 funding: $3,898,157;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $3,914,200;
Estimated stop loss under 2010 stop-loss provision: $413,487;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $4,327,687;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $3,930,478.
Transitional grant area (TGA): Indianapolis, Indiana;
Fiscal year 2006 funding: [Empty];
92.4 percent of fiscal year 2006 funding[A]:[Empty];
Fiscal year 2010 funding: $3,908,426;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $4,003,831;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $4,003,831;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $4,020,902.
Transitional grant area (TGA): Jacksonville, Florida;
Fiscal year 2006 funding: $4,913,816;
92.4 percent of fiscal year 2006 funding[A]: $4,540,366;
Fiscal year 2010 funding: $5,581,086;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $5,716,911;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $5,716,911;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $5,740,302.
Transitional grant area (TGA): Jersey City, New Jersey;
Fiscal year 2006 funding: $5,145,142;
92.4 percent of fiscal year 2006 funding[A]: $4,754,111;
Fiscal year 2010 funding: $5,140,624;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $5,267,487;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $5,267,487;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $5,290,802.
Transitional grant area (TGA): Kansas City, Missouri;
Fiscal year 2006 funding: $2,916,485;
92.4 percent of fiscal year 2006 funding[A]: $2,694,832;
Fiscal year 2010 funding: $4,475,793;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $4,585,350;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $4,585,350;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $4,605,245.
Transitional grant area (TGA): Las Vegas, Nevada;
Fiscal year 2006 funding: $4,323,627;
92.4 percent of fiscal year 2006 funding[A]: $3,995,031;
Fiscal year 2010 funding: $5,640,348;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $5,776,837;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $5,776,837;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $5,800,161.
Transitional grant area (TGA): Memphis, Tennessee;
Fiscal year 2006 funding: [Empty];
92.4 percent of fiscal year 2006 funding[A]: [Empty];
Fiscal year 2010 funding: $6,798,445;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $6,964,741;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $6,964,741;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $6,993,774.
Transitional grant area (TGA): Middlesex-Somerset-Hunterdon, New
Jersey;
Fiscal year 2006 funding: $2,595,663;
92.4 percent of fiscal year 2006 funding[A]: $2,398,393;
Fiscal year 2010 funding: $2,790,752;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $2,858,535;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $2,858,535;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $2,870,135.
Transitional grant area (TGA): Minneapolis-St. Paul, Minnesota;
Fiscal year 2006 funding: $3,046,512;
92.4 percent of fiscal year 2006 funding[A]: $2,814,977;
Fiscal year 2010 funding: $5,416,982;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $5,549,431;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $5,549,431;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $5,573,336.
Transitional grant area (TGA): Nashville, Tennessee;
Fiscal year 2006 funding: [Empty];
92.4 percent of fiscal year 2006 funding[A]: [Empty];
Fiscal year 2010 funding: $4,611,727;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $4,724,997;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $4,724,997;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $4,745,795.
Transitional grant area (TGA): Norfolk, Virginia;
Fiscal year 2006 funding: $4,414,760;
92.4 percent of fiscal year 2006 funding[A]: $4,079,238;
Fiscal year 2010 funding: $6,256,023;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $6,409,181;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $6,409,181;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $6,436,246.
Transitional grant area (TGA): Oakland, California;
Fiscal year 2006 funding: $5,735,837;
92.4 percent of fiscal year 2006 funding[A]: $5,299,913;
Fiscal year 2010 funding: $6,707,373;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $7,600,309;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $7,600,309;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $7,634,394.
Transitional grant area (TGA): Orange County, California;
Fiscal year 2006 funding: $4,858,579;
92.4 percent of fiscal year 2006 funding[A]: $4,489,327;
Fiscal year 2010 funding: $5,634,708;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $6,356,418;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $6,356,418;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $6,382,610.
Transitional grant area (TGA): Ponce, Puerto Rico;
Fiscal year 2006 funding: $2,391,444;
92.4 percent of fiscal year 2006 funding[A]: $2,209,694;
Fiscal year 2010 funding: $2,142,002;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $2,194,052;
Estimated stop loss under 2010 stop-loss provision: $67,692;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $2,261,744;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $2,202,684.
Transitional grant area (TGA): Portland, Oregon;
Fiscal year 2006 funding: $3,401,956;
92.4 percent of fiscal year 2006 funding[A]: $3,143,407;
Fiscal year 2010 funding: $3,599,540;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $3,971,840;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $3,971,840;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $3,989,386.
Transitional grant area (TGA): Riverside-San Bernardino, California;
Fiscal year 2006 funding: $7,074,521;
92.4 percent of fiscal year 2006 funding[A]: $6,536,857;
Fiscal year 2010 funding: $7,429,065;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $8,395,752;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $8,395,752;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $8,431,108.
Transitional grant area (TGA): Sacramento, California;
Fiscal year 2006 funding: $2,778,729;
92.4 percent of fiscal year 2006 funding[A]: $2,567,546;
Fiscal year 2010 funding: $2,629,282;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $3,033,483;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $3,033,483;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $3,047,015.
Transitional grant area (TGA): San Antonio, Texas;
Fiscal year 2006 funding: $3,325,881;
92.4 percent of fiscal year 2006 funding[A]: $3,073,114;
Fiscal year 2010 funding: $4,580,898;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $4,693,303;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $4,693,303;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $4,713,503.
Transitional grant area (TGA): San Jose, California;
Fiscal year 2006 funding: $2,304,762;
92.4 percent of fiscal year 2006 funding[A]: $2,129,600;
Fiscal year 2010 funding: $2,859,484;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $3,277,702;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $3,277,702;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $3,291,865.
Transitional grant area (TGA): Santa Rosa, California;
Fiscal year 2006 funding: $1,028,634;
92.4 percent of fiscal year 2006 funding[A]: $950,458;
Fiscal year 2010 funding: $1,169,051;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $1,310,251;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $1,310,251;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $1,315,787.
Transitional grant area (TGA): Seattle, Washington;
Fiscal year 2006 funding: $5,445,484;
92.4 percent of fiscal year 2006 funding[A]: $5,031,627;
Fiscal year 2010 funding: $7,053,642;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $7,226,841;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $7,226,841;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $7,259,214.
Transitional grant area (TGA): St. Louis, Missouri;
Fiscal year 2006 funding: $4,502,572;
92.4 percent of fiscal year 2006 funding[A]: $4,160,377;
Fiscal year 2010 funding: $6,233,155;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $6,385,122;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $6,385,122;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $6,411,858.
Transitional grant area (TGA): Vineland-Millville-Bridgeton, New
Jersey;
Fiscal year 2006 funding: $849,715;
92.4 percent of fiscal year 2006 funding[A]: $785,137;
Fiscal year 2010 funding: $897,656;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $919,664;
Estimated stop loss under 2010 stop-loss provision: $0;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $919,664;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $923,550.
Transitional grant area (TGA): Total;
Fiscal year 2006 funding: $97,983,023;
92.4 percent of fiscal year 2006 funding[A]: $90,536,313;
Fiscal year 2010 funding: $142,781,916;
Estimated fiscal year 2011 funding before applying 2010 stop-loss
provision[B]: $149,371,711;
Estimated stop loss under 2010 stop-loss provision: $631,073;
Estimated fiscal year 2011 funding after applying 2010 stop-loss
provision[C]: $150,002,784;
Estimated fiscal year 2011 funding without 2010 stop-loss
provision[C]: $150,002,784.
Source: GAO analysis of Department of Health and Human Services' data
and 2010 stop-loss provision.
Notes: The 2010 stop-loss provision was contained in the Consolidated
Appropriations Act, 2010.
The projected fiscal year 2011 funding in this table is based on the
funding amount for urban areas and states (Parts A and B,
respectively) provided by the Consolidated Appropriations Act, 2010.
The amount identified for Parts A and B and the amount identified for
the stop-loss provision in that act were identical to the amounts
identified in H.R. 3293, the Departments of Labor, Health and Human
Services, and Education, and Related Agencies Appropriations Act, 2010
which was passed by the House of Representatives on July 24, 2009.
H.R. 3293, 111TH Cong. (2009). Accordingly, we assumed that the
funding for Parts A and B, respectively, would be the same as the
amounts identified in the report of the House Committee on
Appropriations accompanying H.R. 3293. H.R. Rep. No. 111-220 (2009).
The total identified for Part A funding was $679,074,000. We further
assumed that the percentage of Part A funding for eligible
metropolitan areas and the percentage for TGAs in fiscal year 2011
would be the same as the percentages allotted to each in fiscal year
2010.
Because updated human immunodeficiency virus/acquired immunodeficiency
syndrome (HIV/AIDS) case counts were not available, we used the HIV/
AIDS case counts that the Health Resources and Services Administration
(HRSA) used to determine fiscal year 2010 funding.
To estimate fiscal year 2011 supplemental funding for TGAs, we
calculated the percentage of fiscal year 2010 total funding that each
area's fiscal year 2010 supplemental funding represented. We then
multiplied that percentage by the estimated total supplemental funding
to be available for distribution in fiscal year 2011 under 2010
funding levels. For example, if a TGA received 2 percent of the total
supplemental funding available for distribution to TGAs in fiscal year
2010, then we estimated that area's supplemental funding in fiscal
year 2011 to be 2 percent of the amount of supplemental funding
available for distribution to EMAs.
We developed our estimate of fiscal year 2011 Minority AIDS Initiative
(MAI) funding for TGAs by applying the percentage increase in MAI
funding from 2009 to 2010 at the TGA level.
Individual entries may not sum to totals because of rounding.
[A] Under the stop-loss provision, a TGA is ensured that its total
formula, supplemental, and MAI grants for fiscal year 2010 would not
be less than 92.4 percent of what it received for fiscal year 2006.
[B] The total funding that a TGA would receive in fiscal year 2011
with the stop-loss provision in place can be found by adding the
amount in this column to the amount in the column titled "Estimated
stop loss under 2010 stop-loss provision."
[C] The total funding that is available to be distributed to TGAs in
fiscal year 2011 remains the same with and without the stop-loss
provision. It is the distribution of available funding across the TGAs
that changes with and without the inclusion of the stop-loss provision.
[End of table]
[End of section]
Enclosure III: GAO Contact and Staff Acknowledgments:
GAO Contact:
Marcia Crosse, (202) 512-7114 or crossem@gao.gov:
Staff Acknowledgments:
In addition to the contact above, major contributors to this report
were Robert Copeland, Assistant Director; Martha Kelly, Assistant
Director; Suzanne Worth, Assistant Director; Helen Desaulniers;
Shannon Legeer; and Jennifer Whitworth.
[End of section]
Footnotes:
[1] Pub. L. No. 101-381, 104 Stat. 576 (codified as amended at 42
U.S.C. §§ 300ff through 300ff-121). The 1990 CARE Act added title XXVI
to the Public Health Service Act. Unless otherwise indicated,
references to the CARE Act refer to current title XXVI.
[2] Pub. L. No. 111-87, 123 Stat. 2885. 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), the Ryan White CARE Act
Amendments of 2000 (Pub. L. No. 106-345, 114 Stat. 1319), and the Ryan
White HIV/AIDS Treatment Modernization Act of 2006 (Pub. L. No. 109-
415, 120 Stat. 2767).
[3] In this report, we use "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 2010, there were
24 EMAs, according to HRSA. 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. Urban areas that were
eligible for EMA funding in fiscal year 2010 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. RWTEA permits a new margin of
error exception to the second criterion. In the case of a TGA that has
a total of 1,400 to 1,499 living cases of AIDS as of December 31 of
the most recent calendar year for which such data are available, the
TGA maintains its eligibility if not more than 5 percent of the total
from grants awarded is unobligated at the end of the most recent
fiscal year for which such data are available. In fiscal year 2010,
there were 32 TGAs, according to HRSA.
[4] The stop-loss provision stated that "within the amounts provided
for Part A ..., $6,021,000 shall be available ... for increasing
supplemental grants for fiscal year 2010 to metropolitan and
transitional areas that received grant funding in fiscal year 2009 ...
to ensure that an area's total funding under [Part A to an EMA or TGA]
for fiscal year 2009, together with the amount of this additional
funding, is not less than 92.4 percent of the amount of such area's
total funding under Part A for fiscal year 2006." Pub. L. No. 111-117,
div. D, tit. II, 123 Stat. 3240 (2009). Because this provision would
apply to an EMA or TGA's "total funding" under Part A, we consider the
amount subject to the stop-loss provision to be formula, supplemental,
and MAI grants. MAI grants are authorized by 42 U.S.C. § 300ff-121,
which specifically directs HHS to provide funding under Part A.
[5] We previously provided similar estimates for prior legislation.
See GAO, Ryan White CARE Act: Estimated Effect of Proposed Stop-Loss
Provision on Urban Areas, [hyperlink,
http://www.gao.gov/products/GAO-09-472R] (Washington, D.C.: Mar. 6,
2009), Ryan White CARE Act: Estimated Effect of Proposed Stop-Loss
Provision in H.R. 3293 on Urban Areas, [hyperlink,
http://www.gao.gov/products/GAO-09-947R] (Washington, D.C.: Aug. 3,
2009), and Ryan White CARE Act: Estimated Effect of Draft Stop-Loss
Provision, [hyperlink, http://www.gao.gov/products/GAO-11-322R]
(Washington, D.C.: Jan. 21, 2011).
[End of section]
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