PI Action alerts & updates ... 2006
PI Comments on Proposed Ryan White CARE Act
Reauthorization Legislation
May 12, 2006
TO: Senators Enzis and Kennedy and Representatives Barton
and Dingell
FROM: Ryan Clary, Associate Director of Health Care Advocacy, Project
Inform
On behalf of Project Inform, a national HIV/AIDS treatment and
health care advocacy organization, I want to thank you and your
staffs for your hard work in producing bipartisan, bicameral legislation
to reauthorize the Ryan White CARE Act. We greatly appreciate the
thoughtful process you undertook to craft a bill that maintains
the current structure of the program, while responding to changes
in the HIV epidemic without destabilizing systems of care. We also
appreciate this opportunity to provide feedback on your proposed
legislation before it is considered by your colleagues in the House
and Senate.
As a member of the Communities Advocating Emergency AIDS Relief
(CAEAR) Coalition, we endorse all of the recommendations offered
in CAEAR’s formal response to your reauthorization proposal.
In particular, we urge that the Title I hold harmless provision
be maintained for four years, instead of the three proposed in your
legislation, at the percentages of 90, 85, 80, and 75. This will
allow jurisdictions to maintain stability in the provision of care
while transitioning to the new funding criteria.
We also strongly urge the creation of a Title II supplemental mechanism
that directs funding through a formula to states without Title I
EMAs and the two states (Ohio and Louisiana) with more than 50 percent
of their cases outside their EMAs. We support an authorization level
of $70 million for this supplemental, and directing the $70 million
increase to Title II base -- as proposed by the President in his
Fiscal Year 2007 budget -- to this fund. A sign-on letter supported
by a broad range of HIV/AIDS advocacy organizations endorsing the
$70 million Title II supplemental is being sent to you separately.
Separate from the recommendations that are included in CAEAR’s
response, Project Inform agrees with the National Alliance of State
and Territorial AIDS Directors (NASTAD) that ADAP Supplemental Grants
should be strengthened in order to help states provide a minimal
level of service to those in need. To that end, the ADAP Supplemental
should be expanded from 3% to 5% of the ADAP appropriation.
We agree with your recommendation not to tie eligibility for the
ADAP Supplemental to what was available on January 1, 2000. We support
NASTAD’s recommendation on new eligibility requirements for
the Supplemental:
1. Gross income eligibility criteria of at or less than 300 percent
of Federal Poverty Level (FPL);
2. Inadequate formulary (lack of coverage of any FDA-approved antiretroviral
drugs or the PHS-recommended drugs for treatment and prophylaxis
of opportunistic infections for individuals with incomes at or less
than 300 percent of FPL; or
3. Waiting lists of ADAP applicants with incomes at or less than
300 percent of FPL.
Additionally, we support the elimination of the match requirement
for the ADAP Supplemental. While we strongly encourage state contributions,
we know that this state match can be a major barrier for some of
the states most in need.
We believe that the inclusion of a formula-based, $70 million Title
II supplemental, the extension of the ADAP Supplemental from 3%
to 5%, and allowing Title I hold-harmless to remain for four years
will help reach your goals of responding to changes in the epidemic
without dismantling systems of care, while maintaining the structure
of the CARE Act.
Thank you for considering our comments as you finalize legislation,
and for your hard work and leadership on behalf of people living
with HIV/AIDS. If you have any questions, please contact me at 415-558-8669
x224 or rclary@projectinform.org.
