Ryan White CARE Act of 1990: Opportunities to Enhance Funding Equity

Highlights

Pursuant to a congressional request, GAO reviewed the funding formulas established under the Ryan White Care Act, focusing on: (1) whether the existing formulas distribute funds equitably to states and eligible metropolitan areas (EMA); (2) the factors that inhibit greater funding equity; and (3) formula changes that are needed to improve funding equity.

Recommendations

Matter for Congressional Consideration

Matter	Status	Comments
To achieve greater equity in the distribution of funds, Congress should modify the funding formulas to reduce the double counting of EMA cases so that comparable medical services funding is available for people with AIDS, regardless of where they live.	Closed – Implemented	Congress changed the law consistent with the recommendation.
To achieve greater equity in the distribution of funds, Congress should modify the funding formulas to adopt a caseload indicator that better reflects the number of people living with AIDS who are in need of services.	Closed – Implemented	Congress changed the law consistent with the recommendation.
To achieve greater equity in the distribution of funds, Congress should modify the funding formulas to include an indicator that reflects the relative differences across states and EMA in the cost of serving people with AIDS.	Closed – Not Implemented	Congress chose not to implement this recommendation when it reauthorized the program.
If Congress wishes to target more aid to states and EMA with limited fiscal capacity, then it may wish to consider adopting an indicator that reflects the relative strength of local tax bases and concentrations of people with AIDS. Alternatively, Congress may wish to discontinue the use of AIDS incidence rates in the title I formula and per capita income in the title II formula because of the funding inequities that these components produce.	Closed – Not Implemented	Congress chose not to implement the recommendation when it reauthorized the program.
To avoid possible disruption of service delivery, Congress may wish to consider phasing in formula modifications which should minimize, if not avoid, disruption for the service delivery networks the CARE Act has made possible over the last 5 years.	Closed – Implemented	Congress enacted the recommendation.

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Topics

Health Care

AIDSFederal aid to statesFormula grantsFunds managementHealth care costsHealth care programsHealth care servicesHealth resources utilizationIntergovernmental fiscal relationsPublic health legislation