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.
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.
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.
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.
Renewing the Commitment and Advancing Care
The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (now the Ryan White HIV/AIDS Treatment Extension Act of 2009) was passed in 1990, and the first grants were distributed in 1991. In the two decades since then, four reauthorizations of the Act have reflected the evolution of HIV/AIDS into a chronic disease that is generally manageable with appropriate treatment and high quality health care. The 1996 Act ensured access to highly active antiretroviral therapy (HAART) through ADAP funding. The 2000 reauthorization continued this tradition and also targeted those not in care by providing funds for technical assistance and key points of entry into the medical system. The reauthorization in 2006 sought to mitigate the high impact of the disease on African-American and other minority communities by codifying the minority AIDS Initiative in the legislation; the reauthorization also placed increased emphasis on medical care treatment. The most recent reauthorization, in 2009, created new incentives to find HIV-infected persons and link them into care.
From the beginning, the Act (and the Ryan White HIV/AIDS Program) has not been an entitlement program like Medicaid and Medicare. Instead, the program is a completely discretionary budget item that funds
- Part A grants to eligible metropolitan areas and transitional grant areas,
- Part B grants to U.S. States and territories, and
- Part C, D, and F grants directly to organizations.
Authorizing legislation, like the Ryan White HIV/AIDS Program, is done on a short timeline to allow for congressional oversight to change program components and review funding allocations. Therefore, the Ryan White HIV/AIDS Program sunsets thereby necessitating further legislative action to extend it. Since inception, four reauthorizations have taken place: In 1996, 2000, 2006, and 2009. The current legislation sunsets in 2013. Each reauthorization has presented the Nation with the opportunity to adopt and modify the law to reflect changes in the HIV/AIDS epidemic, changes in external conditions, drug treatment research, and shifts in the health care landscape in the United States.
See also The Henry J. Kaiser Family Foundation's
Side-by-Side Comparison of Prior Law to the Newly Reauthorized CARE Act