Between FY 1990 and FY 1991, HRSA spending on HIV/AIDS increased more than 13-fold, from $16.5 million for AIDS Service Demonstration Grants, to $220.6 million for the Ryan White CARE Act as a whole.
Between 1996, ADAP’s first year, and reauthorization in 2000, program funding increased from $52 million to $528 million. Funding rose another 50 percent in 2006 in a continued commitment to reach all the underserved. In the 2009 reauthorization, funding levels hit an all-time high.
In 1991, the first year of the Ryan White HIV/AIDS Program, the Federal budget appropriation was $220.6 million. In FY 2010, it had grown to $2.29 billion.
Since 1990, grants under the Ryan White CARE Act have been administered by the Health Resources and Services Administration (HRSA). The HIV/AIDS Bureau was created under HRSA in 1997 to streamline the administration of all Ryan White funds.
Collaboration Marks Administration of New Act
From its outset in 1990, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was never a typical Federal government program. For one thing, the act received a high level of bipartisan support. For another, the CARE Act program was not an entitlement like many other health programs. And it gave grantees an unusual degree of latitude in how to use their grant funds.
The manner in which the CARE Act program was to be administered was unique, too. Both Federal and city governments played a role in Title I (now Part A) administration, which funds metropolitan areas. For Title II (now Part B), which funds States and territories, administrative roles involved both Federal and State governments. For other programs, there was only a Federal role. This operational infrastructure continues today.
Role of the Federal Government
The Federal Government’s administrative role in the Ryan White HIV/AIDS Program is complex. The agency implementing the program has significant responsibility for working with the executive branch to implement the legislation according to the spirit of the law and in keeping with Federal policy. It also prepares the Administration’s reports to Congress and crafts responses to Congressional inquiries. In addition, it is responsible for preparing the program budget on behalf of the Administration.
The agency implementing the program—the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA)—has significant responsibility for working with grantees and providers. Specifically, the Federal role in local implementation of the Ryan White HIV/AIDS Program statutes is to ensure compliance with Federal policy, adherence to contracting and financial regulations, and successful implementation of programs at the local level.
Although Federal roles have remained fundamentally as conceived in 1990, some changes have been introduced since the program began. From 1990 to 1997, the Ryan White HIV/AIDS Program was managed by HRSA. In FY 1991, Congress made budget appropriations for three programs authorized in the CARE Act: Title I (Part A) received $87,831,000; Title II (Part B) received the same amount; and Title III (Part C) received $44,891,000. Unlike today, the three programs were not administered by the same bureaus within HRSA. Title I and Title II were administered by the Bureau of Health Resources, and Title III was administered by the Bureau of Primary Health Care.