Ryan White Funding Formulas

Pursuant to a congressional request, GAO provided information on whether the the Ryan White Comprehensive AIDS Resources Emergency Act's title I and II funding formulas equitably distribute funds to states and eligible metropolitan areas (EMA). GAO found that: (1) although the title I and II funding formulas include some equity-based factors, funding disparities persist; (2) the EMA factors in title I and II formulas may penalize states that do not have EMA, or whose EMA contain a relatively small share of the state's acquired immunodeficiency syndrome (AIDS) caseload; (3) states and EMA that have recently experienced the most rapid growth in caseloads may be unduly penalized because the act's funding formula is based on cumulative numbers of AIDS cases reported since 1981; (4) neither formula reflects the differences in EMA and state costs of provide AIDS-related services; (5) although the title I formula uses incidence rates to measure EMA funding capacity, it does not account for local tax bases, which can result in overstated state funding capabilities; and (6) although the title II formula uses per capita income to measure states' funding capacity, it does not measure how high concentrations of AIDS cases affect states' funding capability.