From the beginning of the Ryan White Program, Part C, Early Intervention Services (formerly Title III), has been squarely focused on primary care services. Although its core mandate has remained intact over the years, Part C has experienced important changes as the services that Part C–funded agencies provide have evolved along with the epidemic.
Origins of Part C
Representative Henry Waxman (D-CA) was a key player in drafting the original version of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. The inclusion of Title III reflected his desire to create a funding stream to get more people tested for HIV and to help those in all stages of the disease access early intervention and medical care in hopes of slowing disease progression.1
Waxman originally hoped to accomplish this goal by giving States the option to expand Medicaid to include coverage for people with HIV and by providing funds to the Centers for Disease Control and Prevention to provide State grants for HIV counseling, testing, and treatment. Before final passage of the Ryan White CARE Act, however, the provisions changed quite a bit.
As ultimately established, Title III contained two major components aimed at providing testing and early intervention services: formula grants directly to States and categorical grants to public and nonprofit entities that provide primary medical care. The State component was never funded and was later repealed, but direct grants to primary care providers have been funded from the beginning. The number of sites has grown from 114 in 1991 to 350 in 2010.
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ABCs of Early Intervention Services
Part C grants are made directly to the funded entities, which include a wide range of primary care sites. Many of these primary care sites receive other Federal funds as Community and Migrant Health Centers, Federally Qualified Health Centers, hemophilia diagnosis and treatment centers, clinics for the homeless, and family planning providers. Early intervention services include
- HIV counseling and testing;
- monitoring of disease progression;
- treatment of HIV;
- diagnosis and treatment of related infections; and
- case management and assistance accessing other Federal, State, and local programs that could provide needed health and support services to people living with HIV/AIDS.
- ORGANIZATIONS ELIGIBLE FOR PART C
- Federally Qualified Health Centers as described in Title XIX, Section 1905, of the Social Security Act
- Family planning agencies, other than States, under Section 1001 of the PHS Act
- Comprehensive Hemophilia Diagnosis and Treatment Centers
- Rural health clinics
- Health facilities operated by or under contract with the Indian Health Service
- Community-based organizations, clinics, hospitals, and other health facilities that provide early intervention services to people infected with HIV/AIDS through intravenous drug use
- Nonprofit private entities that currently provide comprehensive primary care services to populations at risk of HIV/AIDS, including faith-based and community-based organizations