Part B: Continued
Part B Launches With Speed and Flexibility
Noting the desire to get people into treatment and to serve as many people as possible, HRSA’s Sheila McCarthy recalls the swiftness with which the program was launched in 1987 and the flexibility program managers had to reallocate unspent funds quickly. “When HRSA sent letters to notify States about the program, the returned letter with a signature at the bottom of the page constituted a proposal for funding. Once the program started, we kept a running tab of unspent dollars, and any extra funds would be moved to other States with just a phone call.”3
In later reauthorizations, Title II evolved, continuing to offer service delivery while increasingly focusing on AIDS therapies. One resource-related issue that surfaced early was the concern that States without Title I jurisdictions (i.e., Eligible Metropollitan Areas [EMAs]) were receiving fewer funds to care for their cases than those that had EMAs. The 1996 reauthorization included a provision that favored States without Title I jurisdictions in the allocation of Title II funds, a provision that was further strengthened in the 2006 reauthorization and reinforced in the 2009 reauthorization. These changes were accompanied by a “hold harmless” provision to prevent dramatic shifts in funding from year to year.
The 1996 reauthorization also included extensive language related to counseling and voluntary testing of pregnant women, following on the heels of research on the efficacy of AZT in preventing mother-to-child transmission. Another key change was the inclusion of the emerging communities program in 2000 to provide supplemental grants to States with metropolitan areas with between 500 and 1,999 reported AIDS cases in the most recent 5 years. The program was modified to support cities with 500 to 999 cases in the 2006 reauthorization, reflecting the expansion of the criteria for Part A/Title I jurisdictions. The 2009 reauthorization kept this component in tact.
TYPES of PART B GRANTEES
Base and Supplemental
Funds are distributed by formula to States and Territories according to their share of living HIV and AIDS cases. Funding is also weighted to reflect the presence or absence of Part A grantees in the State. Part B supplemental grants are available for States with demonstrated severe need that prevents them from providing medications consistent with Public Health Service guidelines.
ADAP and ADAP Supplemental
Funds are earmarked by Congress for State AIDS Drug Assistance Programs (ADAPs) to provide medications to people living with HIV/AIDS. ADAP supplemental grants are available to States with severe need (5 percent of the earmark is reserved).
A portion of Part B base grants funds set-asides for emerging communities, which are metropolitan areas that do not yet qualify as Part A grantees but have between 500 and 999 cumulative reported AIDS cases over the most recent 5 years. All funding is distributed via formula.
Meeting the Costs Head On
The most dramatic change to Title II was the expansion of ADAP beginning in 1996 in response to the availability of combination therapy (known as highly active antiretroviral therapy or HAART). Although the new drugs were hailed as a medical breakthrough, they were enormously expensive, particularly for underserved populations such as those served by the Ryan White CARE Act.
“Many of us in the community had been working on research funding for so many years, and once treatments were working, we recognized that the prohibitive costs meant that something had to happen, or folks were not going to get these medications,” says Anne Donnelly of Project Inform about the early community efforts to build support for increased ADAP funding. “The State AIDS directors had the same realization at the same time, and we worked in partnership for increased resources.”7