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Part A: Continued

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New Priorities for Distributing Funds

The most notable change was to the formula for distributing Title I funds. Rather than rely on cumulative AIDS cases, the new formula relied on estimated living cases of AIDS to more accurately reflect the current impact of the epidemic on a community. Closely linked to that provision was another provision to ensure that no jurisdiction saw a drastic cut in resources as a result of this change. Funded services also now made explicit mention of prophylactic treatment for opportunistic infections, and Title I placed a new priority on women and children, emphasizing the prevention of perinatal transmission. The updated law also laid out new requirements for Planning Council membership and operations by mandating that they reflect affected communities, participate in statewide planning efforts, and maintain conflict-of-interest policies and grievance procedures.

Advent of HAART

“When. . . HAART8 came around, the difference was night and day. People who got on those meds, suddenly they looked healthy instead of ill, and they were able to participate and maybe even go back to work,” says Fiaño. The second reauthorization in 2000 reflected the new reality that learning one’s HIV status and getting into treatment as early as possible could slow disease progression. New service categories for outreach and early intervention were aimed at finding people with HIV who were not in care and linking them to the care system. Also added were requirements to ensure that care provided through Title I was consistent with Federal guidelines for the treatment of HIV and the prevention of related infections.

The 2006 reauthorization brought sweeping changes to Title I, as it did to other components of the program. Much of the change was rooted in the movement toward a more medically based model of HIV care. The new law mandated that 75 percent of all funded services meet the definition of core medical services and narrowed the definition of support services as those that help people living with HIV/AIDS achieve medical outcomes. It also changed the criteria for distributing formula funds from estimated living cases of AIDS to cases of HIV and stipulated new requirements related to the timely expenditure of funds. The subsequent reauthorization in 2009 kept these programatic requirements in place.

Transitional Grant Areas

In another major change, the new law divided funded jurisdictions into two categories: EMAs and transitional grant areas (TGAs). EMAs include cities with 2,000 AIDS cases in the most recent 5-year period, and TGAs include those with 1,000 to 1,999 AIDS cases in that period. The change caused anxiety in some jurisdictions that became TGAs. Under the new law, TGAs were no longer protected from dramatic annual funding shifts, and some faced the end of their Part A status at the end of the 3-year reauthorization. A change in qualifications for Part A status added five new jurisdictions to the program, but for the first time in the act’s history, Congress provided no new funds to support the addition of new service areas.

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SUMMARY OF LEGISLATIVE CHANGES: PART A
Ryan White Legislation 1990 Act Sixteen Eligible Metropolitan Areas (EMAs) were created.
EMA status was based on more than 2,000 AIDS cases in the most recent 5 years and a population of at least 50,000.
EMA funds were to be distributed by the chief elected official of the EMA.
HIV Planning Councils were composed of HIV-care providers and consumers.
Ryan White Reauthorization 1996 Act EMAs were required to prioritize funds for women, infants, children, youth, and their families to combat perinatal transmission and increase support services.
A severity-of-need provision was added to the supplemental grants to EMAs to take into account both the resource needs of people living with HIV/AIDS and the costs of care delivery.
Ryan White Reauthorization 2000 Early intervention services became eligible for funding.
Reauthorization required inclusion of people representing disproportionately affected communities, including providers of housing services and representatives of former inmates with HIV.
Ryan White Reauthorization 2006 Jurisdictions were divided into Transitional Grant Areas (TGAs) and EMAs.
TGA status was based on at least 1,000 but not more than 1,999 cumulative reported AIDS cases during the most recent 5 years, and a population of 50,000 or more.
75 percent of funds were to go to core medical services.
Ryan White Reauthorization 2009 Continuing use of code based reporting of living HIV status.
Directing efforts to identify those individuals who are unaware of their HIV status; persons who have never been tested as well as those who have been tested and never received results.
Returning to formula distributon of MAI funds that are synchronized with Part A and Part B award dates.

See Part A funding information by State.
Read more about Part A.

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