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Ryan White Reauthorization

Ryan White Reauthorization. New York City HIV Health and Human Services Planning Council April 16, 2009 Humberto Cruz, Director AIDS Institute. The 2006 Reauthorization. Ryan White HIV/AIDS Treatment Modernization Act is a three-year law that expires on 9/30/09.

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Ryan White Reauthorization

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

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

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

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

  5. 2009 Reauthorization Recommendations • Federal AIDS Policy Partnership Ryan White Work Group is a coalition of national HIV/AIDS organizations, providers, advocates, and persons living with HIV/AIDS. • Participants include NASTAD, CAEAR Coalition, NAPWA, NMAC, HIVMA, AAHIVM. • The Work Group has developed a community consensus on the future of the Ryan White Law. The consensus statement has been signed by 154 organizations as of April 1, 2009.

  6. 2009 Reauthorization Recommendations • Rationale for consensus recommendations: • The 2006 reauthorization included many significant changes. The impact of the changes has not been fully assessed. For example: • New distribution formulas • New case data • New core services requirement • New requirements related to unobligated funds • New Part B supplemental • Policy discussions that are underway could affect the Ryan White program. For example: • National AIDS strategy • Health care reform • CDC estimates that there will not be mature HIV data for all states until 2012.

  7. 2009 Reauthorization Recommendations Consensus Recommendations: • Extend the RWHATMA for three years (i.e., re-start the clock on the current three-year authorization). • Continued protection for states with maturing HIV case data. • Extension of TGA eligibility. • Extension of hold harmless provisions. • Confirm that Part A and Part B funds will continue to be allocated through existing mechanisms, rather than through a SONI.

  8. 2009 Reauthorization Recommendations Consensus Recommendations (continued): • Recommended modifications: • Increase the penalty threshold for unobligated funds from two percent to five percent, and suspend penalties to enable grantees to access supplemental funding and avoid reductions in awards. • Remove the qualifier “medical” from transportation in the support services category. Include “medical transportation” as a core medical service. • Allow the provision of food pursuant to a doctor’s prescription as a core medical service. • Eliminate requirement for Part D grantees to include medical expenses in their program budgets.

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

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