By Crystal D. Swann
August 8, 2005

The U.S. Department Health and Human Services Secretary Michael O. Leavitt outlined the Administration’s core principles for reauthorizing the Ryan White CARE Act July 27. The three-page broad concept paper seeks to restructure the funding formula and redefine services available to people living with HIV and AIDS. Several mayors including New York City Mayor Michael Bloomberg and San Francisco Mayor Gavin Newsom have registered their deep concerns about several provisions in the principles document. “As mayor of the city with the largest and most diverse HIV epidemic in the United States, I am deeply concerned about the recently released principles for Ryan White CARE Act Reauthorization,” stated Bloomberg in a July 29 letter to Senator Michael B. Enzi (WY) and Senator Edward Kennedy (MA). Summarized below are the Administrations principles:

Administration’s Core Principles:

Principle 1. Serve the Neediest First, the Administration proposes to “establish objective indicators to determine severity of need for funding core medical service by establishing a “severity of need” for core services index (SNCI). The SNCI would used to determine formula allocations among states and eligible metropolitan areas.

Principle 2. Focus on Life Saving and Life Extending Services, the Administration proposes establish a set of core medical services; require 75 percent of funds for Titles I-IV be used for core medical services; and maintain a federal list of AIDS Drug Assistance Plan (ADAP) Core Medications.

Principle 3. Increase Prevention Efforts, would require states to implement routine voluntary HIV Testing in public facilities and work with private healthcare providers to that same end.

Principle 4. Increase Accountability, the Administration proposes maintain the current statutory requirement that all states submit HIV data by the start of fiscal Year 2007; hold grantees accountable for reporting on system and client-level data and progress; maximize investments through more specific Payer-Of-Last-Resort Provisions and require grantees to seek alternative payment sources before using Ryan White Funds; require state and local care delivery coordination; eliminate double counting of HIV/AIDS cases between major metropolitan areas and the states; and eliminate current provisions that entitle cities to be “Held Harmless” in funding reductions.

Principle 5. Increase Flexibility, the Administration proposes to allow the Secretary of HHS so redistribute unallocated balances based on need as determined by “Severity of Need” measures; and would allow planning councils to serve as voluntary and advisory bodies to mayors.

The CARE Act, which expires September 30, is the nation’s largest investment in the care of people with HIV/AIDS. It has dramatically improved the quality of life of people living with HIV-disease and their families, reduced use of costly inpatient care, and increased access to care for low-income, underserved populations, including people of color.

The Conference of Mayors recently passed policy urges the Congress and the Administration to quickly reauthorize Ryan White CARE Act and urges that Congress, in reauthorizing the Act, modify it to give cities and their communities the proper tools to address new challenges confronting the HIV/AIDS epidemic while maintaining the Act’s successful structure, strong local control, and a continuity of care so that life'saving health services are not interrupted.