Congress 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. The stop-loss provision that you asked us to address was contained in a draft consolidated appropriations bill for fiscal year 2011.

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 draft bill contained a provision to ensure that decreases in total Part A funding for fiscal year 2010 for each EMA and TGA would not exceed specified levels. It would limit the total funding decrease for fiscal year 2010 to no more than 9.3 percent of what the EMA or TGA received 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 2011.