The javascript used on this site for creative design effects is not supported by your browser. Please note that this will not affect access to the content on this web site.

Legislation

Enactment

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.

Read more...

Reauthorization

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.

Read more...

Funding

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.

Administration

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.

Read more...

Funding Levels: Then and Now

As AIDS has spread to every corner of the United States, funding for the Ryan White HIV/AIDS Program has increased dramatically. Today, the program funds care in all 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and five U.S. Pacific territories and associated jurisdictions.

Funding resources have increased every year since enactment. Beginning in FY 1997, a surge of funding began: The total program budget went from $738.5 million in 1996 to $996.3 million in 1997, an increase of 35 percent. Highly active antiretroviral therapy was becoming widely available, and Congress and the administration wanted to ensure that this powerful yet costly therapy was accessible to as many underserved people as possible. Thus, 65 percent of the large 1997 increase went to the Ryan White HIV/AIDS Program Part B AIDS Drug Assistance Program (ADAP) in each State and territory. By 2002, ADAP became the largest funding category of the Ryan White HIV/AIDS Program.

During the most recent decade, total Ryan White HIV/AIDS Program funding has remained relatively constant. Throughout this period, the administration and, in particular, the U.S. Department of Health and Human Services, have worked with grantees and providers to improve program efficiency and quality through priority-driven decision making. The results of these interventions have been positive. However, Ryan White HIV/AIDS Program services—like all health care services today—are being delivered in an environment of higher costs, higher rates of uninsured Americans and, in the case of HIV/AIDS, higher disease prevalence. The result is that organizations serving the underserved must increasingly do more with less.

Ryan White HIV/AIDS Program Appropriations History
View the data
Ryan White HIV/AIDS Program Appropriations History
Fiscal Year Amount
1991 $220,553,000
1992 $279,086,000
1993 $348,013,000
1994 $579,365,000
1995 $632,965,000
1996 $738,465,000
1997 $996,252,000
1998 $1,150,200,000
1999 $1,410,851,000
2000 $1,594,235,000
2001 $1,807,609,000
2002 $1,910,204,000
2003 $2,017,966,000
2004 $2,004,861,000
2005 $2,073,296,000
2006 $2,062,713,000
2007 $2,112,795,000
2008 $2,141,792,000
2009 $2,240,000,000
2010 $2,290,000,000

Funding Strategy Components

One seminal component of the Ryan White HIV/AIDS Program funding strategy has been that as many resources as possible should be used to provide core medical services and treatments. This strategy is reflected in the new requirement that 75 percent of Part A, B, and C resources be used for core medical services as well as by the large Federal budget allocation to ADAP.

The basic Ryan White funding strategy has other essential components, as follows:

  • Funding goes to organizations serving PLWHA and their family members, not to individual PLWHA.
  • Unlike Medicaid or Social Security, the Ryan White HIV/AIDS Program is not an entitlement that people are guaranteed if they meet qualifications. Instead, the Ryan White HIV/AIDS Program is a discretionary program to which Federal budget resources are allocated each year. Once those resources are used, new ones are not available until the next Federal budget cycle.
  • The Program ensures maximum reach by funding organizations that are diverse in terms of
    • (1) type of entity (e.g., community-based organizations, State and local government agencies, clinics, social services agencies, faith-based organizations),
    • (2) target population (e.g., men, women, young people, people with histories of substance abuse, minorities), and
    • (3) location (e.g., urban AIDS epicenters, rural areas, suburban regions, areas with increasing HIV/AIDS prevalence, underresourced communities).
  • The Program uses a variety of service delivery strategies to ensure efficiency and to guarantee access to as many people as possible. This priority is reflected in the legislation's division into Parts A, B, C, D, and F. Read more

  • The Program is the payor of last resort. The Ryan White HIV/AIDS Program covers costs of care when no other source of payment for services, either public or private, is available.
Funding by Type of Provider
View the data
Funding by Type of Provider
Type of Povider Number of Providers
Community-based service organizations 923 (43%)
Substance abuse treatment centers 71 (3%)
Health departments 297 (14%)
Other facilities* 237 (11%)
Hospitals or university-based clinics 370 (17%)
Publicly funded community
health and mental health centers
259 (12%)
Source: Health Resources and Services Administration HIV/AIDS Bureau. Going the Distance the Ryan White HIV/AIDS Program, 20 Years of Leadership, a Legacy of Care. August 2010. Rockville, MD: Health Resources and Services Administration.
*Other facilities include substance abuse treatment centers, solo/group private medical practices, providers reporting for multiple fee-for-service providers, coalitions of people living with HIV/AIDS, VA facilities, and provider type reported as ‘other’.
Percentages may not sum to 100 due to rounding.

Funding of Grantees

Application for the Ryan White HIV/AIDS Program must be made directly to one of the Program Parts (A, B, C, D, or F). The funding process is administered by the Health Resources and Services Administration HIV/AIDS Bureau. Please visit this page for information about eligibility, application guidelines, and funding schedules.

The Federal Government has streamlined the funding of grantees, yet the application process remains both rigorous and complex to ensure that resources are allocated where there is the greatest need. Regardless of the Ryan White HIV/AIDS Program Part for which applicants apply, they must illustrate the capacity of their organization to deliver services covered under the legislation and must illustrate unmet need for services in the geographic area they intend to cover. They must also demonstrate that they will serve populations disproportionately affected by HIV/AIDS. In addition to these basic requirements, a host of technical and administrative guidelines are designed to ensure oversight, quality of care, and efficiency.

Chart: Aids Cases and Deaths
View the data
Total Spending by Program, FY 2010
Program Funding
Part A $679,100,000
Part B, State $418,800,000
Part B, ADAP $835,000,000
Part C, EIS $206,800,000
Part D $77,800,000
Part F, AETC $34,800,000
Part F, Dental Reimbursement $13,600,000
Source: Health Resources and Services Administration HIV/AIDS Bureau. Going the Distance the Ryan White HIV/AIDS Program, 20 Years of Leadership, a Legacy of Care. August 2010. Rockville, MD: Health Resources and Services Administration.