LegiStorm

Summary:

The Ryan White HIV/AIDS Program makes federal funds available to metropolitan areas and states to assist in health care costs and support services for individuals and families affected by the human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). The Ryan White program currently serves more than half a million low-income people with HIV/AIDS in the United States; 29% of those served are uninsured, and an additional 56% are underinsured. The program is administered by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS). Its statutory authority is Title XXVI of the Public Health Service (PHS) Act, originally enacted in 1990. The Ryan White program is composed of four major parts and several other components. Part A provides grants to urban areas and mid-sized cities. Part B provides grants to states and territories; it also provides funds for the AIDS Drug Assistance Program (ADAP). Part C provides early intervention grants to public and private nonprofit entities. Part D provides grants to public and private nonprofit entities for family-centered care for women, infants, children, and youth with HIV/AIDS. The other components, sometimes referred to as Part F, include the AIDS Dental Reimbursement (ADR) Program, the Community-Based Dental Partnership Program, the AIDS Education and Training Centers (AETCs), the Special Projects of National Significance (SPNS) Program, and the Minority AIDS Initiative (MAI). The Patient Protection and Affordable Care Act of 2010 (ACA, P.L. 111-148, as amended) contains general provisions to increase access to health insurance and which, therefore, should increase coverage for people living with HIV/AIDS. ACA includes prohibitions on the cancellation of coverage by an insurer due to a preexisting condition, elimination of lifetime caps on insurance benefits and annual limits on coverage, and eligibility for tax subsidies to assist low- and middle-income individuals in the purchase of coverage from state health insurance exchanges. ACA phases out the Medicare Part D doughnut hole for HIV/AIDS individuals who are Medicare eligible, and, at state option, Medicaid eligibility will be broadened to include single adults. There could be a significant impact on Ryan White ADAP clients in those states that decide to cover the new Medicaid eligible group; 56% of ADAP clients served in June 2011 would be eligible for Medicaid in 2014 if their states choose to participate in the expansion, and the remainder would likely receive assistance in purchasing health coverage on the exchange. In October 2009, the 111th Congress passed and President Obama signed the Ryan White HIV/AIDS Treatment Extension Act of 2009 (P.L. 111-87), which reauthorized the Ryan White program through September 30, 2013. The long-range impact of ACA on the Ryan White program—meaning the replacement of health and treatment services provided under Ryan White with access to such services through health coverage via ACA—remains to be determined. In states that decide not to participate in the Medicaid expansion, the need for the full range of Ryan White services would remain. However, even if all states decide to cover the new Medicaid eligible group, there will be gaps that the Ryan White program could continue to fill, such as coverage of those individuals with HIV/AIDS who are undocumented immigrants. In addition, Ryan White provides dental care and support services, such as transportation, that may not be provided under Medicaid or private health insurance. For FY2013, the Obama Administration requested a total of $2.447 billion for the Ryan White program, an increase of $80 million compared with FY2012; most of the increase ($66.7 million) would go to the ADAP program. Congress provided temporary funding, through March 27, 2013, for the Ryan White program in P.L. 112-175, the Continuing Appropriations Resolution, 2013. Funding is at the FY2012 rate plus a very slight increase (less than 1%). The Budget Control Act of 2011 (P.L. 112-25) sequestration, scheduled to occur on January 2, 2013, could cut HRSA discretionary programs, such as Ryan White, by 8.2%.