U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration's HIV/AIDS Bureau

Ryan White CARE Act 2001 Data Report for:
Title I
Title II
AIDS Drug Assistance Program
Health Insurance Program

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Table of Contents

Executive Summary

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 (Public Law 101-381), as reauthorized in 1996 and 2000, provides funding to States and other public or private nonprofit entities to develop, organize, coordinate, and operate health systems for the delivery of essential health care and support services to medically underserved individuals and families affected by HIV disease.

Title I of the CARE Act provides emergency assistance to eligible metropolitan areas (EMAs) most severely affected by the HIV/AIDS epidemic.  Title I funds may be used to provide a wide range of community-based services for persons living with HIV disease.  Title II grants are awarded to States, the District of Columbia, Puerto Rico, and eligible U.S. Territories using a formula based on the estimated number of living AIDS cases [1] to provide health care and supportive services for people living with HIV disease (PLWH). 

In addition to the Title II base award, all 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and the Marshall and Northern Marianna Island also receive Title II funding earmarked to support the operation of AIDS Drug Assistance Programs (ADAPs).  ADAPs provide medications to low-income individuals with HIV disease that have limited or no coverage from private insurance or Medicaid.  The Health Insurance Program (HIP) uses Title II funding to provide health insurance coverage for PLWH by purchasing insurance services or by extending an individual’s existing health insurance through COBRA (Consolidated Omnibus Reconciliation Act). Health insurance under HIP includes ongoing coverage for health care and pharmaceuticals as well as shorter-term coverage while Medicaid or Medicare eligibility is being determined.  Eligible metropolitan areas (EMAs), funded under Title I, may also elect to support HIP programs.

Title I and Title II grantees are expected to have mechanisms in place to collect and analyze data for reporting and to guide program management.  Part of each grantee and provider’s data collection activities includes the submitting annual program data to HRSA ’s HIV/AIDS Bureau (HAB) by March of each year. This report includes descriptive information from the annual program data report regarding: 1) characteristics of Title I and Title II grantees and providers; 2) program/organizational information of providers; 3) client demographics; and 4) services provided.

Several caveats must be considered in reading this report. Readers of this report should note that Title I and II client counts are duplicated.  Title I and Title II grantees have numerous providers under subcontract and each of these providers completes the same annual administrative report.  The providers report data to the grantees and grantees then submit that data to HRSA/HAB.  Each grantee submits all of its providers’ reports to HRSA/HAB along with its own data.  While data are unduplicated at the provider level, any summary of the total number of clients served and their demographic characteristics at the grantee or national level results in duplicated client counts. It also must be noted that clients may receive some services funded by Title I and others provided with Title II funding. ADAP and HIP data are unduplicated since each grantee submits a single unduplicated annual report for these programs.

In addition to these duplicated client counts, providers have the option of reporting on eligible or funded services. If grantees and providers report on eligible services, they are reporting on any service permitted under Title I and Title II, regardless of whether or not they use CARE Act Title I and/or Title II funding to pay for these services.  Conversely, if grantees and providers report on funded services, the data they report only includes those services that were actually paid for using Title I and II grant funds.  Providers are encouraged to report on all clients who received services eligible for Title I or II funding, regardless of the actual funding source used to pay for these services.  Reporting services in this broad manner provides a comprehensive picture of the services being delivered to HIV-positive clients.

Title I

Grantee/Provider Characteristics

In 2001, 1,513 agencies/organizations were under contract with the 51 Ryan White CARE Act Title I eligible metropolitan areas (EMAs) to provide CARE Act eligible services to HIV-positive individuals.  Ninety-six percent or 1,460 of these organizations completed the Annual Administrative Report (AAR) for calendar year 2001.  A majority of provider agencies among reporting grantees were private nonprofit community-based organizations (61 percent).  Sixty percent of Title I providers (n=878) in 2001 reported that members of minority racial/ethnic groups constituted a majority of the board members and/or professional staff in their organization.

Clients Served

Ryan White CARE Act Title I Programs served a total of 629,289 duplicated clients and 266,141 duplicated new clients in 2001.  Sixty-eight percent of the duplicated clients receiving services from CARE Act-funded Title I providers in 2001 were males.  A majority of clients receiving Title I in 2001 were members of racial/ethnic minority groups; 47 percent were African American, not Hispanic and 23 percent were Hispanic.  Asian/Native Hawaiian/other Pacific Islanders accounted for one percent and American Indian/Alaska Native, people of other races, and people of two or more races accounted for two percent of the duplicated clients served in 2001.  A vast majority of the duplicated clients served by Title I providers in 2001 were 20 years of age or older; 65 percent were 20 to 44 years of age and 29 percent were age 45 years or older.

Services Provided

In 2001, clients of CARE Act Title I Programs made more than 1.07 million visits to providers for medical care services.  There were 136,728 dental care visits across the 51 EMAs and 480,095 visits for mental health counseling and treatment were reported.  Substance abuse counseling and treatment resulted in 711,045 visits; including both outpatient and residential treatment.  Providers of rehabilitation services reported 17,610 visits and home health care providers provided clients with 256,254 visits.  Face-to-face case management visits accounted for more visits than any other single type of service with 1.11 million visits in 2001.

Among Title I medical care providers, the average number of visits per client in 2001 was 8.8 with a median of 5.4 visits.  Clients receiving dental care had an average of 3.0 visits.  The average number of visits among clients receiving mental health counseling and treatment was 9.6.  Clients receiving substance abuse counseling and treatment had an average of 28.3 visits per client.  Clients served by face-to-face case management providers had an average of 10.7 visits during the 2001 reporting period. The average number of visits per client remained relatively constant for dental care mental health services and case management over a three year period, 1998 to 2001.  The number of medical care visits has increased over the same period.  Visits for substance abuse treatment services have declined.

Title I Medical Care Providers: Provider, Client, Service, and Clinical Characteristics

Thirty-six percent of the 403 Title I medical care providers that reported providing services to clients in 2001 were hospitals or hospital-based clinics and 32 percent of the medical care providers were other community-based organizations [2] .  Health departments comprised 14 percent of the agencies providing medical care in 2001 and 12 percent of the medical care providers were identified as community health centers.  Sixty percent of Title I medical care providers (n=241) reported that members of minority racial/ethnic groups constituted a majority of the board members and/or professional staff in their organization. 

In 2001, the medical care providers receiving Ryan White CARE Act Title I funding served a total of 253,061 duplicated clients.  As in the total population of clients served by Title I, a majority of clients receiving medical care services were males (68 percent), racial/ethnic minorities (75 percent), and 20 years of age or older (95 percent).

Organizations providing Title I medical care services also reported offering a variety of other services to clients.  Sixty-seven percent of medical care providers reported providing face-to-face case management services to clients. Other services frequently provided to clients by medical care providers include mental health counseling and treatment (51 percent), substance abuse counseling and treatment (30 percent), and dental care (32 percent).  Support services that were most frequently provided include other counseling, not mental health (33 percent), transportation (34 percent), client advocacy (25 percent), emergency financial assistance (22 percent), food bank/home delivered meals (19 percent), education risk reduction (22 percent), and housing assistance (16 percent).

Four hundred and sixteen medical care providers or other authorized providers with access to clinical information provided optional medical outcome information about HIV exposure, HIV/AIDS diagnosis, and opportunistic infections.  Ninety-six percent of these providers were medical care providers.  Ninety-three percent of duplicated medical clients were HIV-positive.  HIV status was unknown for five percent.  A majority of duplicated medical clients were exposed to HIV/AIDS through MSM and/or IDU (47 percent) or heterosexual contact (35 percent).

Title II

Grantee/Provider Characteristics

In 2001, 1,251 organizations/agencies in 54 States and U.S. Territories funded by Ryan White CARE Act Title II to provide services to HIV-positive individuals completed the Annual Administrative Report (AAR).  Fifty percent of the reporting agencies were other community-based organizations and members of minority racial/ethnic groups constituted a majority of the board members and/or professional staff in 38 percent of Title II service organizations.

Clients Served

Title II service providers served a total of 413,608 duplicated clients in 2001.  The number of duplicated new clients served was 131,465.  Sixty-eight percent of the duplicated clients receiving services from CARE Act-funded Title II providers were males.  In 2001, African Americans, not of Hispanic heritage, comprised 48 percent of the duplicated clients receiving Title II services.  Thirty-two percent of the duplicated clients served by Title II were White, non-Hispanic, and 18 percent were Hispanic.  Asian/Native Hawaiian/other Pacific Islanders, American Indians/Alaska Natives, people of other races, and people of two or more races accounted for two percent of the duplicated clients served.  A vast majority of the duplicated clients served by Title II in 2001 were 20 years of age or older (95 percent).

Services Provided

In 2001, there were 1,121,877 visits by clients for face-to-face case management in Title II programs; more visits than any other single type of service.  Clients receiving medical care services from CARE Act Title II providers had 833,366 visits and dental care visits totaled 95,790.  Grantees and their providers reported 244,680 visits by clients for mental health counseling and treatment and the provision of substance abuse counseling and treatment, including both outpatient and residential treatment, resulted in 198,632 visits.  Providers of rehabilitation services reported 5,748 visits and there were 85,403 visits for home health care. 

Among Title II medical care providers the average number of visits per client was 6.1.  Dental care providers averaged 2.3 visits per client and among clients receiving mental health counseling and treatment services, the average number of visits per client was 7.1.  Clients receiving services from case management providers had an average of 8.4 visits per client and substance abuse counseling and treatment providers had an average of 20.1 visits per client.

Title II Medical Care Providers: Provider, Client, Service, and Clinical Characteristics

Thirty-three percent of the 437 Title II organizations providing medical care in 2001 were other community-based organizations.  Health departments comprised 30 percent of the agencies providing medical care, 19 percent were hospitals or hospital-based clinics, and eight percent were Community Health/Mental Health Centers.  Thirty-seven percent of Title II medical care providers reported that members of minority racial/ethnic groups constituted a majority of the board members and/or professional staff in their organization. 

A total of 213,707 duplicated clients received medical care services from Title II funded-providers in 2001.  Males comprised 68 percent of these duplicated clients.  In addition, a majority of the duplicated clients receiving medical care services from Title II providers in 2001 (68 percent) were racial/ethnic minorities.  Ninety-six percent of the duplicated clients receiving medical care services were 20 years of age or older.

Organizations providing Title II medical care services reported offering a variety of other services to clients.  Medical care providers were mostly likely to report providing face-to-face case management services to clients (83 percent).  Other services frequently provided to clients by medical care providers include mental health counseling and treatment (53 percent), substance abuse counseling and treatment (27 percent), and dental care (54 percent).  Support services that were most frequently provided include other counseling, not mental health (39 percent), transportation (59 percent), client advocacy (42 percent), emergency financial assistance (46 percent), food bank/home delivered meals (39 percent), housing assistance (40 percent), and educational risk reduction services (30 percent).

In 2001, 436 Title II medical care providers or other authorized provider with access to clinical information provided optional medical outcome information about HIV exposure, HIV/AIDS diagnosis, and opportunistic infections.  Ninety-one percent of these providers were medical care providers.  A majority of duplicated medical clients were HIV-positive (94 percent).  Forty-seven percent of duplicated medical clients were exposed to HIV/AIDS through MSM and/or IDU and 34 percent via heterosexual contact.

AIDS Drug Assistance Program (ADAP)

Clients Served

In 2001, State AIDS Drug Assistance Programs (ADAPs) served 136,875 enrolled clients, an increase of seven percent from the 128,078 clients served in 2000.  Twenty-two percent of the clients served by ADAP were first enrolled in 2001.  A majority of clients served by ADAP were males (78 percent).  A total of 107,028 males received assistance from ADAP representing a nine percent increase in the number of males served in 2000.  In 2001, 62 percent of the clients enrolled in ADAP were racial/ethnic minorities.  The number of African Americans served by ADAP increased 10 percent from 2000 to 2001.  Increases in the number of clients enrolled in ADAP also were noted for Hispanic and White, non-Hispanic clients.  Further, 99 percent of clients enrolled in ADAP were 20 years of age or older.

Funding and Expenditures

Total funding available for ADAP as reported by grantees in their 2001 Annual Administrative Report increased 64 percent from approximately $338 million in 1998 to nearly $556 million in 2001.  In 2001, approximately 95 percent of all State ADAP expenditures were for drugs.  The remaining 5 percent was spent on Health Insurance Programs, administration and ancillary devices (e.g., tubing, nebulizers, etc.), adherence, access, and monitoring policy needed to administer these therapies.

State ADAPs spent 88 percent of the $717,099,955 in total drug expenditures on antiretroviral medications, a slight increase from 2000 when 87 percent of total drug expenditures were for antiretroviral drugs.

Health Insurance Program (HIP)

Providers and Funding

The largest expansion of the Health Insurance Program (HIP) occurred in 1999 and the number of participating entities continues to grow.  An increase in the total number of States participating in HIP is also reflected in the rise in funding allocated to this program.  From FY 1998 to FY 2002, HIP funding increased by 28 percent among states.  EMAs funds have fluctuated over the years.  During calendar year 2001, a total of 38 States/U.S. Territories and 8 Title I EMAs provided clients with a HIP.

Client Characteristics

A total of 17,588 clients received assistance through HIP in 2001; 30 percent of these clients participated in HIP for the first time in 2001.  Since 2000, the total number of clients benefiting from HIP increased by 38 percent.

Thirty-eight percent of HIP clients served were comprised of minority populations.  African American, non-Hispanic and Hispanic clients comprised 20 percent, and 15 percent of the clients served by HIPs, respectively.  Although the majority of HIP clients identified themselves as White, non-Hispanic, (62 percent) this group experienced the smallest growth over time.  Increases in the number of clients served by HIP were noted across all racial/ethnic groups.  The number of White, non-Hispanic clients served by HIP has increased by 37 percent since 2000 and the number of African American and Hispanic clients increased by 35 percent and 39 percent, respectively.  Furthermore, 84 percent of the clients served were male and approximately 99 percent of the clients served were greater than 19 years of age.

Introduction

CARE Act Overview

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 (Public Law 101-381), as reauthorized in 1996 and 2000, provides funding to States and other public or private nonprofit entities to develop, organize, coordinate, and operate health systems for the delivery of essential health care and support services to medically underserved individuals and families affected by HIV disease.

The CARE Act includes the following major components:

• Title I: funding to eligible metropolitan areas (EMAs) hardest hit by the HIV/AIDS epidemic;
• Title II: formula funding to States and U.S. Territories to improve the quality, availability, and organization of health care and support services for people living with HIV disease;
• Title III: funding to public and private nonprofit organizations for outpatient HIV early intervention services;
• Title IV: funding to public and private nonprofit organizations for the coordination of services and enhanced access to research by women, infants, children, youths, and families infected or affected by HIV disease; and
• Part F: funding for the AIDS Education and Training Centers (AETCs); the Dental Reimbursement Program; and Special Projects of National Significance (SPNS) research and demonstration programs.

Administered by the Health Resources and Services Administration’s (HRSA), HIV/AIDS Bureau (HAB), all CARE Act programs are managed within the context of four major characteristics of the Nation’s health care system.  These observations include the following:

• The HIV/AIDS epidemic is growing among traditionally underserved and hard-to-reach populations;
• The quality of emerging HIV/AIDS therapies can make a difference to the lives of people living with HIV disease;
• Changes in the economics of health care are affecting the HIV/AIDS care network; and
• Outcomes are a critical component of program performance.
  

• Title I

Title I of the CARE Act provides emergency assistance to eligible metropolitan areas (EMAs) most severely affected by the HIV/AIDS epidemic.  To be eligible, an area must have reported more than 2,000 cumulative AIDS cases during the past 5 years; and have a population of at least 500,000 [3] people.

Title I grants are awarded to the Chief Elected Official (CEO) of the city or county that is administrator for the health agency providing services to the greatest number of people living with HIV in the EMA.  The CEO usually designates an administrative agent (often the local health department) to select service providers and administer contracts.  The CEO or grantee establishes intergovernmental agreements with other political subdivisions within the EMA that provide HIV services and include ten percent or more of the EMA’s total AIDS cases.

Title I funds may be used to provide a wide range of community-based services for persons living with HIV disease, including the following:

• Outpatient and ambulatory health services, including medical and dental care as well as substance abuse and mental health counseling and treatment;
• Outreach activities necessary to identify persons with HIV/AIDS who are aware of their HIV status but are not receiving care and early intervention services that include counseling and testing and referral services for populations at high risk for HIV and provide care linkages;
• Support services such as case management, housing and transportation assistance, nutrition services, and day/respite care to the extent that these support services facilitate, enhance, support or sustain delivery, continuity or benefits of health services; and

Providers may include public or nonprofit entities; private for-profit entities are eligible only if they are the only available provider of quality HIV care in the area.

Title I funding includes formula and supplemental components:

1)     Formula grants, awarded based on the estimated number of people living with AIDS in the EMA over the most recent 10-year period; and

2)     Supplemental grants, awarded competitively based on a demonstration of severe need and other criteria. 

EMAs along with other CARE Act programs may also receive supplemental funding from the Minority AIDS Initiative (MAI).  This funding was appropriated in recognition of the ever-increasing impact of the HIV/AIDS epidemic among communities of color.  Supplemental funds for the Title I portion of the MAI was $34 million in FY 2001.

Since FY 1991, more than $4.6 billion has been appropriated to the Title I program; in FY 2001, the 51 EMAs were awarded $604 million in formula and supplemental funds.

Title II

Title II grants are awarded to States, the District of Columbia, Puerto Rico, and eligible U.S. Territories to provide health care and supportive services for people living with HIV disease.  Title II grant amounts are determined using a formula based on the estimated number of living AIDS cases.  Grants are awarded to the State agency designated by the governor to administer Title II, usually the state health department.

States with more than one percent of the total AIDS cases reported nationally during the previous 2 years are required to contribute their own resources to match the Federal grant based on a formula outlined in the legislation.  Title II funds may be used to support a wide range of services:

• Direct health and support services;
• Home and community-based health care and supportive services;
• Continuum of health insurance coverage, through either a Health Insurance Program (HIP) or provision of medical benefits under a HIP, including high risk pools;
• Pharmaceutical treatments, through the ADAP Program; and
• HIV care consortia that assess needs, organize and deliver HIV services in consultation with service providers, and contract for services.
• Like Title I grantees, Title II grantees may support early intervention services as well as outreach activities for HIV-positive persons who know their status but are not in care.

Providers may be public or nonprofit entities; private for-profit entities are eligible only if they are the only available provider of quality HIV care in the area.  Most states provide some services directly and others through subcontracts with Title II HIV care consortia.  A consortium is an association of public and nonprofit health care and supportive service providers and community-based organizations as well as people living with HIV/AIDS (PLWHA).  Collectively, members of the consortium plan, develop, and deliver services for people living with HIV disease.

ADAP

In addition to the base award, all 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and eligible U.S. Territories also receive Title II funding earmarked to support the operation of AIDS Drug Assistance Programs (ADAPs).  ADAPs provide medications to low-income individuals with HIV disease that have limited or no coverage from private insurance or Medicaid.  A formula based on the estimated number of living AIDS cases is used to award ADAP funds to States and U.S. Territories.  Three percent of the ADAP earmark is reserved for supplemental grants to States and U.S. Territories with demonstrated severe need that prevents them from providing HIV medications to clients that are consistent with Public Health Service Guidelines.  ADAP funds may also be used to purchase health insurance for eligible persons.  States may also elect to use Title II base funds for their ADAP.

Each State and U.S. Territorial ADAP decides which antiretroviral and other HIV-related medications will be included in its formulary and how medications will be distributed.  In addition, individual State and U.S. Territorial ADAPs establish their own eligibility criteria.  Documentation of HIV status is a requirement of all ADAPs.  The use of other clinical criteria and income levels to determine ADAP eligibility vary by State.

HIP

The Health Insurance Program (HIP) uses Title II funding to provide health insurance coverage for people living with HIV disease (PLWH) by purchasing insurance services or by extending an individual’s existing health insurance coverage through COBRA (Consolidated Omnibus Reconciliation Act).  Health insurance under HIP includes ongoing coverage for health care and pharmaceuticals as well as shorter-term coverage while Medicaid or Medicare eligibility is being determined.  Eligible metropolitan areas (EMAs), funded under Title I, may also elect to support HIP programs.

Under HIP, Title I and Title II grantees may use funds to pay family health insurance premiums to ensure health insurance continuation for a family member and pay for public or private health insurance co-payments and deductibles for PLWH.  HIPs often work closely with public programs to transition clients as they become eligible for public benefits.

HIP plays an important role in enhancing the continuity and comprehensiveness of care for persons living with HIV/AIDS by allowing Title II ADAPs to purchase health insurance services that include the full range of HIV treatment (pharmaceuticals) and primary care services.  HIP maintains a continuum of health care services coverage for participants, which enables them to receive early and ongoing clinical treatment for HIV.  HIP also promotes the sharing of costs associated with providing care to HIV-positive persons across private and public health insurance programs, thus reducing the fiscal impact on publicly funded programs.

HIP is beneficial to clients; it forestalls or possibly eliminates the necessity of clients who are eligible for COBRA using all of their resources before becoming Medicaid-eligible.  In addition, the program allows clients to continue working part-time without risking a loss of insurance coverage.  This is in contrast to public health insurance (e.g., Medicaid) where rising income results in a loss of eligibility and services.  Finally, HIP provides assistance until persons disabled by HIV disease can qualify for Medicaid or Medicare.

Many HIPs share the following characteristics:

• Eligibility criteria include an HIV diagnosis, maximum income (as a percentage of the Federal poverty level), a cap on assets, and residency within a State;
• Coverage of HIV-related care and prescription drug costs;
• Coverage of COBRA premiums;
• Continuation of premium payments when COBRA group coverage expires; and
• Exclusion of Medicaid-eligible individuals since the Ryan White CARE Act is the payer of last resort.

The implementation criteria for HIP may vary from State to State because State law primarily governs health insurance.

Since FY 1991, more than $5.3 billion in Title II funding has been appropriated.  This includes $2.72 billion in funds earmarked for ADAP.  Title II grantees received a total of $911 million in FY 2001, which includes $598 million in ADAP funding.

Data Collection, Submission Process, and Limitations

Title I and Title II grantees are expected to have mechanisms in place to collect and analyze data for reporting and to guide program management.  Part of each grantee and provider’s data collection activities include submitting annual program data to HRSA ’s HIV/AIDS Bureau (HAB) by March of each year.

Information submitted by grantees via their annual aggregate program data reports currently includes the following:

• Contact information for providers receiving funds from Title I and/or Title II grantees;
• Provider program and organizational information (e.g., type of organization, ownership status);
• Number of clients served and client demographics;
• Services information (e.g., number of clients receiving eligible or funded services and number of health care visits by type of service);
• Optional clinical information (e.g., number of medical clients by HIV status, HIV exposure, morbidity, and opportunistic infection); and
• Fiscal information.

When reporting the number of clients served and the number of client visits by type of service, providers have the option of reporting on eligible or funded services. If grantees and providers report on eligible services (Table 1), they are reporting on any service permitted under Title I and Title II, regardless of whether or not they use CARE Act Title I and Title II funding to pay for these services.  Conversely, if grantees and providers report on funded services, the data they report only includes those services permitted or eligible services under Title I and II that were actually paid for using Title I and II grant funds.

Table 1.  Ryan White CARE Act Eligible Services, 2001

Providers are encouraged to report on all clients who received services eligible for Title I or II funding, regardless of the actual funding source used to pay for these services.  Reporting services in this broad manner provides a comprehensive picture of the services being delivered to HIV-positive clients.

Readers of this report should note that Title I and II client counts are duplicated.  Title I and Title II grantees have numerous providers under subcontract and each of these providers completes the same annual administrative report.  The providers report data to the grantees and grantees then submit that data to HRSA/HAB.  Each grantee submits all of its providers’ reports to HRSA/HAB along with its own data.  While data are unduplicated at the provider level, any summary of the total number of clients served and their demographic characteristics at the grantee or national level results in duplicated client counts. ADPA and HIP data are unduplicated since each grantee submits a single unduplicated annual report for these programs.

This report includes descriptive information regarding:

1)     Characteristics of Title I and Title II grantees and providers;
2)     Program/organizational information for providers;
3)     Client demographics; and
4)     Services provided.

Title I

Grantee/Provider Characteristics

In 2001, the 51 Ryan White CARE Act Title I eligible metropolitan areas (EMAs) contracted with 1,513 agencies/organizations to provide CARE Act eligible services to HIV-positive individuals.  Ninety-six percent or 1,460 of the organizations funded to provide services under Title I completed the Annual Administrative Report (AAR) for calendar year 2001.

As represented in Table 2, 61 percent of the reporting agencies were community-based organizations other than Community Health and Community Mental Health Centers.  Approximately 14 percent of the provider organizations serving HIV-positive clients in 2001 were hospitals or hospital-based clinics and seven percent were health departments.  Community Health Centers comprised five percent of the Title I providers reporting AAR data in 2001 and Community Mental Health Centers represented another one percent of reporting provider organizations.  Data on provider characteristics by EMA are presented in appendix Table I-1.

Table 2. Types of Title I Provider Organizations/Agencies Serving Clients, 2001

* Types of provider organization/agency data are unknown for one reporting provider.
** Less than 1 percent.

The vast majority of organizations providing client services in 2001 were private nonprofit entities (Table 3).  Eighty percent of the 1,453 organizations reporting ownership status were private nonprofit corporations.  Public agencies at the local, state, and federal level account for approximately 17 percent (n=244) of the providers serving clients through Title I funding.  Private for-profit organizations comprised two percent of the service providers in 2001.  Grantees may contract with for-profit entities only when nonprofit providers are not available for a given service.

Table 3. Ownership Status of Title I Provider Organizations/Agencies, 2001

* Ownership status data are missing or unknown for seven reporting providers.
** Less than 1 percent.
*** The sum of percentages may not equal 100 percent due to rounding errors.

Ninety-eight percent of the community-based organizations (CBOs) providing services for clients in 2001 were private nonprofit entities.  Twelve CBOs were public entities and four were for-profit organizations.  Hospital or hospital-based clinics were predominately private nonprofit (64 percent) or publicly owned (34 percent) organizations.  Only four hospitals were private for-profit facilities.  Community health centers and community mental health centers were more likely to be private nonprofit agencies, 76 percent and 67 percent, respectively.  Fifty percent of the 12 solo/group private practice providers reported private nonprofit ownership status; 33 percent were public entities (n=4); and 17 percent (n=2) of the solo/group private practice providers were private for-profit providers.

In 2001, sixty percent of Title I providers (n=878) reported that members of minority racial/ethnic groups constituted a majority of the board members and/or professional staff in their organization.  As seen in Table 4, 77 percent of the Community Health Centers, 66 percent of the other community-based organizations, and 53 percent of the hospital/hospital-based clinics reporting data in 2001 indicated that members of minority racial/ethnic groups constituted a majority of the board members and/or professional staff in their organization.

Table 4. Types of Title I Provider Organizations Serving Clients by Minority Status, 2001

The average number of paid full-time employees (FTEs) on staff at Title I provider organizations was 16.3 in 2001.  The number of paid FTEs ranged from 0 to 900 full-time employee equivalents with a median of 5.0  (Table 5).  On average, Title I organizations reported having 7.6 FTEs as volunteer staff with a median of 0 and a range of 0 to 4,000.

Table 5. Average Number of Paid and Volunteer Staff FTEs Per Title I Provider, 2001

*Paid FTE data are unknown for three providers and volunteer FTE data are unknown for one hundred ten providers.

In 2001, 57 percent of provider organizations (n=838) reported data on all clients receiving services eligible for Title I funding, regardless of whether or not they used CARE Act Title I funds to pay for these services.  Forty-two percent (n=615) reported on funded services only and the reporting scope was unknown for less than 1 percent of providers (n=7).

Clients Served

In 2001, the 51 EMAs receiving Ryan White CARE Act Title I funding served a total of 629,289 duplicated clients [4] .  Ninety-five percent of the 1,460 providers reporting 2001 AAR data (n =1,393) provided direct client services.  Among the organizations providing direct client services, the number of clients served ranged from 1 to 31,255.  The number of duplicated new clients served was 266,141.  Among the organizations providing direct client services, the number of new clients ranged from 0 to 30,732.

Client Characteristics

Gender

Sixty-eight percent of the duplicated clients receiving services from CARE Act-funded Title I providers in 2001 were males (Table 6).  The percentage of duplicated female clients served has increased over time, from 31 percent in 1996 to 32 percent in 2001 (Figure 1).

Table 6. Characteristics of Duplicated Clients Served by Title I Providers, 2001

* Clients with unknown or missing data are excluded from this Table; therefore, the sum of each characteristic may be less than the total number of clients served.
** The sum of percentages may not equal 100 percent due to rounding errors.
*** Less than 1 percent.

Figure 1. Percentage Distribution of Duplicated Title I Clients Served by Gender, 1996-2001

Clients with unknown or missing gender data are excluded from this graph.

Race/Ethnicity

In 2001, 47 percent of the duplicated clients receiving Title I services were African American/Black (non-Hispanic), 28 percent were White (non-Hispanic), and 23 percent were Hispanic.  Asian, Native Hawaiian, and other Pacific Islanders accounted for one percent and American Indians, Alaska Natives, persons of another race, and persons of two or more races together accounted for two percent of the duplicated clients served in 2001 (Table 6).

The racial/ethnic percentage distribution of duplicated clients served by Title I funded providers has changed over time (Figure 2).  The percentage of duplicated clients served who are identified as African American increased from 41 percent in 1996 to 47 percent in 2001.  Over the same time period, the percentage of White duplicated clients served declined slightly from 34 percent to 28 percent.  The percentage of Hispanic duplicated clients remained relatively constant from 1996 to 2001.

Figure 2. Percentage Distribution of Duplicated Title I Clients Served by Race/Ethnicity, 1996-2001

** Other is defined as American Indian, Alaskan Native, other race, or 2 or more races.
Clients with unknown or missing race/ethnicity data are excluded from this graph.
The sum of percentages may not equal 100 percent due to rounding errors.

Age

As seen in Table 6, a vast majority of duplicated clients served by Title I providers in 2001 were 20 to 44 years of age (65 percent).  This age group has decreased since 1998 (Figure 3).  People 45 years or older accounted for 29 percent of the duplicated clients served by the 51 Title I EMAs in 2001, an increase since 1998.  This shift in the distribution of age among clients served may be an indicator that people are living longer with HIV/AIDS.

Figure 3. Percentage Distribution of Duplicated Title I Clients Served by Age Group, 1996-2001

* This age group includes duplicated clients age 20+ years of age.
Clients with unknown or missing age data are excluded from this graph.
The sum of percentages may not equal 100 percent due to rounding errors.

Table I-2 through Table I-5 in the appendix present the number of duplicated clients served and their demographic characteristics served by EMA.

Service Characteristics

Organizations providing one or more health care and/or case management service report the number of clients receiving each service as well as the total number of visits per service.  As previously discussed, providers have the option of reporting on eligible or funded services when reporting these data.  The number and percent of service organizations providing health care and case management services is presented by reporting scope in Table 7.  This distinction will be important as some of the 2001 service utilization data are presented.

In 2001, 403 organizations reported providing medical care to HIV-infected persons.  Among providers reporting scope, 57 percent of these providers reported data on all services eligible for Title I funding regardless of whether or not they used CARE Act Title I funds to pay for these services (Table 7).  Among the 189 organizations providing dental care, 56 percent reported data on all eligible services.  Mental health counseling and treatment was provided by 461 organizations with 58 percent reporting on all eligible services.  Three hundred and fifteen organizations provided substance abuse counseling and treatment services; 58 percent of providers reporting scope reported on eligible services.  Sixty-three percent of case management service providers, 63 percent of home health service providers and 47 percent of rehabilitation service providers reported data on all eligible services.

Table 7. Number and Percent of Title I Providers by Reporting Scope for Health Care and Case Management Services, 2001

* Providers may offer multiple services; a provider may be included in more than one service category.
** Not all service providers reported scope, therefore the sum of eligible and funded may not equal the total number of service providers.

Clients of CARE Act Title I programs made more than 1.0 million visits to providers of medical care services in 2001 (Figure 4).  There were 136,728 dental care visits in 2001 across the 51 EMAs.  Grantees and their providers reported 480,095 visits by clients for mental health counseling and treatment.  Substance abuse counseling and treatment resulted in 711,045 visits; including both outpatient and residential treatment.  Face-to-face case management visits accounted for more visits than any other single type of service with more than 1.1 million visits in 2001.  Providers of home health care served clients with 256,254 visits and rehabilitation services reported 17,610 visits.

Figure 4. Number of Visits for Title I Health Care and Case Management Services, 2001

The average number of visits per client by type of service is presented in Table 8.  For each service type, the actual number of providers serving clients is higher.  However, the average number of visits per client was calculated only for those providers reporting valid data for both number of clients served and number of visits.  Providers may offer multiple services; thus, a provider may be included in more than one service category.

Among the 382 medical care providers with valid number [5] of clients and visit data, the average number of visits per client in 2001 was 8.8 with a median of 5.4 visits  (Table 8).  The average number of medical care visits ranged from 1.0 to 365.0 visits.  Clients receiving dental care had an average of 3.0 visits.  The median number of dental visits was 2.6 and among the 177 providers of dental care with valid data, the number of visits per client ranged from 1 to 14.1.  In 2001, the average number of visits among clients receiving mental health counseling and treatment was 9.6 with a median of 6.3 visits and a range of 1.0 to 124.0 visits per client.  Among clients receiving substance abuse counseling and treatment, the average number of visits was 28.3.  This figure must be interpreted with caution; visits for substance abuse services include both outpatient and residential care.  In a residential treatment setting, visits are often counted in terms of inpatient days.  The median number of visits for substance abuse treatment was 8.7, and the number of visits per client ranged from 1.0 to 344.9.  Clients served by case management providers had an average of 10.7 visits with a median of 5.6 visits and a range of 1.0 to 495.8 visits per client.

Table 8. Average Number of Visits Per Client by Type of Title I Service, 2001

* Data reported in this Table are based on valid reports only.  Valid data is defined as providers reporting complete data for both the number of clients served and the number of visits.

Providers may offer multiple services; thus, a provider may be included in more than one service category.

A comparison of the average number of visits per client by type of service from 1999 to 2001 is presented in Figure 5.  The average number of visits per client for dental care, mental health services, and case management services remained constant over a three year period.  The average number of visits per client for substance abuse treatment declined slightly and the average visits per client for medical care increased slightly.

Figure 5. Average Number of Visits per Client by Type of Title I Service, 1999-2001

* Data reported in this Table are based on valid reports only.  Valid data is defined as providers reporting complete data for both the number of clients and the number of visits.

Providers of support services report the number of clients served during the reporting year.  The number of organizations or agencies providing each eligible support service as well as the number of duplicated clients served is provided in Table 9.  Tables I-6 and I-7 in the appendix present service characteristics by EMA.

Table 9. Number of Duplicated Clients Served by Type of Title I Support Service, 2001

* Data reported in this Table are based on valid reports only.  Valid data is defined as the number providers that reported support service clients served and the number served does not exceed the number of total clients.

Title I Medical Care Providers: Provider, Client, and Service Characteristics

As previously noted, a total of 403 medical care providers serving to clients in 2001.

Grantee/Provider Characteristics

One hundred and forty-seven (36 percent) of the organizations providing medical care were hospitals or hospital-based clinics (Table 10).  Thirty-two percent of the medical care providers were other community-based organizations.  Health departments comprised 14 percent of the agencies providing medical care in 2001 and an additional 12 percent of the medical care providers were identified as community health centers.

Table 10. Types of Title I Medical Care Providers Serving Clients, 2001

In 2001, 66 percent of the organizations/agencies providing medical care services were private nonprofit entities (Table 11).  Public agencies at the local, state, and federal level accounted for 33 percent (n=132) of the Title I funded-providers of medical care. 

Table 11. Ownership Status of Title I Medical Care Providers, 2001

* Ownership status data are missing or unknown for two medical care providers.
** The sum of the percentages may not equal 100 percent due to rounding error.

Sixty percent of Title I medical care providers (n=241) in 2001 reported that members of minority racial/ethnic groups constituted a majority of the board members and/or professional staff in their organization.

The average number of paid full time employees (FTEs) on staff among the 402 providers of medical care services was 22.5 (Table 12).  This is higher than the average of 16.5 paid FTEs found among all Title I service providers (Table 5).  Among organizations providing medical care, the number of paid FTEs ranged from 0 to 900 with a median of eight.  On average, medical care providers reported having 2.5 FTEs in volunteer staff compared to the 7.6 volunteer staff FTEs found among all Title I service providers (Table 5). The number of volunteer staff FTEs ranged from 0 to 150 with a median of 0 among 366 medical care providers.

Table 12. Average Number of Paid and Volunteer Staff FTEs Per Title I Funded Medical Care Providers, 2001

*Paid FTE data are unknown for one medical care provider and volunteer FTE data are unknown for thirty-seven medical care providers.

Clients Receiving Medical Care Services

In 2001, medical care providers receiving Ryan White CARE Act Title I funding served a total of 253,061 duplicated clients.  The number of clients served by these medical care providers ranged from 2 to 13,753.  The number of duplicated new clients served was 84,601.  Among the organizations providing medical care services, the number of new clients ranged from 0 to 9,065.

As represented in Figure 6, 68 percent of the duplicated clients who received medical care services from Ryan White Title I funded-providers in 2001 were males.  This is a slight increase from 2000 where 66 percent of the duplicated clients that received medical care services were male.

Figure 6. Gender of Duplicated Clients Receiving Medical Care Services from Title I Funded Providers, 2001

N=251,672
Gender data are unknown or missing for 1,389 clients and excluded from this graph.

A vast majority of the duplicated clients receiving medical care services from Title I providers in 2001 were racial/ethnic minorities.  Seventy-five percent of the duplicated clients seen for medical care were minorities; 49 percent were African American and 23 percent were Hispanic (Figure 7).  Asian, Native Hawaiian, other Pacific Islanders, and other races accounted for three percent of duplicated clients seen for medical care.

Figure 7. Race/Ethnicity of Duplicated Clients Receiving Medical Care Services from Title I Funded Providers, 2001

N=248,864
Race/ethnicity data are unknown or missing for 4,197 clients and excluded from this graph.
* Other is defined as American Indian, Alaskan Native, other race/ethnicity, or 2 or more races.

Sixty-six percent of the duplicated clients receiving medical care services from Title I funded-providers in 2001 were 20 to 44 years of age (Figure 8).  This is a slight decrease from the previous year.  Clients less than 20 years old accounted for five percent of those receiving medical care; three percent were 0 to 12 years of age and two percent were between 13 and 19 years old.  Duplicated clients age 45 years or older comprised 29 percent of those receiving medical care from a Title I-funded organization.

Figure 8. Age of Duplicated Clients Receiving Medical Care Services from Title I Funded Providers, 2001

N=252,188

Age data are unknown or missing for 873 clients and are excluded from this graph.

Service Delivered by Medical Care Providers

The other types of services being provided by medical care providers can be examined by reporting scope.  In 2001, 57 percent of organizations providing medical care (n=230) reported data on all clients receiving services eligible for Title I funding, regardless of whether or not they used CARE Act Title I funds to pay for these services.  Forty-two percent (n=171) reported on funded services only.  Two medical care providers did not report scope.

The number of services provided by the medical care providers reporting on all eligible services ranged from one service only (medical care) to 16 services with an average of 5.7 eligible services provided and a median of five eligible services.  Ninety percent of the medical care providers reporting on eligible services provided one or more eligible services in addition to medical care services (Table 13).  Among medical care providers reporting funded services only, the number of services provided ranged from one service only (medical care) to 18 services with an average of six services and a median of five.

Table 13. Total Number of Services Provided by Title I Medical Care Providers by Reporting Scope, 2001