Ryan White CARE Act: Estimated Effect of Draft Stop-Loss Provision Page: 1 of 10
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Accountability * Integrity * Reliability
United States Government Accountability Office
Washington, DC 20548
January 21, 2011
The Honorable Michael B. Enzi
United States Senate
Subject: Ryan White CARE Act: Estimated Effect of Draft Stop-Loss Provision
Dear Mr. Enzi:
You asked us to estimate the effect on Ryan White Comprehensive AIDS Resources
Emergency Act of 1990 (CARE Act) funding to urban areas if a certain stop-loss provision
was enacted. 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 2013.2 The stop-loss provision that you asked us to address was
contained in a draft consolidated appropriations bill for fiscal year 2011.3
Under the CARE Act, funding for urban areas-eligible metropolitan areas (EMA) and
transitional grant areas (TGA)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
'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.
2Pub. 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).
3For purposes of this report, we use "draft bill" when referring to this provision.
4In 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, 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.
GAO-11-322R CARE Act Draft Stop-Loss Provision
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United States. Government Accountability Office. Ryan White CARE Act: Estimated Effect of Draft Stop-Loss Provision, text, January 21, 2011; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc297862/m1/1/: accessed February 17, 2019), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.