CARE ACT OVERVIEW
he AIDS epidemic has taken an unspeakable toll since its onset in the early 1980s. The epidemic has hit hardest among populations at high risk for poverty, lack of health insurance, and disenfranchisement from the health care system.
In response, Congress enacted the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in August 1990 to improve the quality and availability of care for low-income, uninsured, and underinsured individuals and families affected by HIV disease. The CARE Act was reauthorized in May 1996 and again in October 2000.
CARE ACT CLIENTS
The CARE Act reaches more than 500,000 people each year. People living with HIV disease are, on average, poorer than the general population, and CARE Act clients are poorer still. For them, the CARE Act is the payor of last resort—because they are uninsured or have inadequate insurance and cannot cover the costs of care on their own, and because no other source of payment for services, public or private, is available.
- Most CARE Act clients are from a racial or ethnic minority group. In 2004, more than 59 percent of clients served by the CARE Act were people of color.
- In 2004, 66 percent of CARE Act clients were male and 33 percent were female.
CARE ACT PROGRAMS
The U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau administers the CARE Act. The CARE Act funds several programs.
Title I provides grants to 51 Eligible Metropolitan Areas (EMAs) disproportionately affected by HIV/AIDS. Title I grants fund a variety of medical and support services. The FY 2006 appropriation was $611.6 million.
Title II provides grants to States and Territories to improve the quality, availability, and organization of HIV/AIDS health care and support services. Title II also provides access to medications through the AIDS Drug Assistance Program (ADAP). Congress designates, or “earmarks,” a portion of the Title II appropriation that must be used for this program. With the dramatic increase in the cost of treatment, the ADAP earmark is now the largest portion of Title II spending. Of the $1.13 billion appropriated to Title II in FY 2006, $790 million was for ADAP. Of the ADAP earmark, 3 percent is set aside to support a supplemental Drug Treatment Program that targets States in need of additional ADAP funds.
- $10 million in supplemental grants to States for Emerging Communities—cities reporting between 500 and 1,999 reported AIDS cases in the most recent 5 years.
- $50,000 awards to two newly eligible U.S. Pacific Territories (American Samoa and the Commonwealth of the Northern Mariana Islands) and three Associated Jurisdictions (the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau).*
Title III supports outpatient HIV early intervention services and ambulatory care. Unlike Title I and Title II grants, which are awarded to local and State governments that contract with organizations to deliver services, Title III grants are awarded directly to service providers such as ambulatory medical clinics. Title III also funds planning grants, which support organizations in more effectively delivering HIV/AIDS care and services. The FY 2006 Title III appropriation was $196.1 million.
Title IV grants provide family-centered comprehensive care to children, youth, women, and their families and help improve access to clinical trials and research. In FY 2006, Title IV programs received $72.7 million in appropriations.
The Special Projects of National Significance (SPNS) Program supports the demonstration and evaluation of innovative models of HIV/AIDS care delivery for hard-to-reach populations. A total of $25 million was set aside for the SPNS Program in FY 2006.
The AIDS Education and Training Centers (AETC) Program supports education and training of health care providers through a network of 11 regional and 4 national centers. In FY 2006, the AETC appropriation was $34.7 million.
The HIV/AIDS Dental Reimbursement Program provides reimbursements to dental schools, hospitals with postdoctoral dental education programs, and community colleges with dental hygiene programs* for uncompensated costs incurred in providing oral health treatment to patients with HIV disease. The FY 2006 appropriation was $13.1 million.
The Community-based Dental Partnership Program provides support to increase access to oral health care services for HIV-positive individualswhile providing education and clinical training for dental care providers, especially those located in community-based settings.
* A provision under the CARE Act Amendment enacted in October 2000.
