Recommendations to Guide the 2005 Reauthorization of the Ryan White CARE Act

The National Alliance of State and Territorial AIDS Directors (NASTAD) strongly supports the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act -- a critical component in the nation's HIV/AIDS prevention, education, and treatment efforts. The CARE Act is a federal-state partnership to provide comprehensive care and treatment to low income, uninsured and underinsured people living with HIV/AIDS.

State and territorial HIV/AIDS programs administer the Title II programs of the CARE Act, including the state AIDS Drug Assistance Program (ADAP). Title II provides funds to all states, the District of Columbia, Puerto Rico, the Virgin Islands and U.S. Territories to improve the quality, availability and organization of care services for people living with HIV.

Title II is designed to assure that people living with HIV have access to quality HIV care, regardless of whether they live in rural, suburban or urban areas. $1.1 billion in federal funds were appropriated to Title II in FY2005, including $797 million in dedicated funds for ADAP. In 2004, over 136,000 individuals received ADAP services.

There continue to be low-income persons living with HIV/AIDS that are unable to access Title II services due to funding limitations of the program. NASTAD supports full funding for the CARE Act to ensure that all low-income HIV-positive individuals have access to primary care, life-saving therapy, and support services that are essential to keeping persons in care and adherent to their treatment regimen. NASTAD supports the inclusion of an authorizing level for Title II that addresses these unmet needs, at a minimum of $1.4 billion for FY2006.

NASTAD has extensively examined the effectiveness of the CARE Act over the past two years. Further, NASTAD has developed five structural and financing proposals and 30 issue-specific profiles, which inform this position paper.

NASTAD supports the existing structure of the law. NASTAD has two major financing proposals to provide additional resources to states in need -- one through the ADAP Supplemental Grants and one through the Title II Base Emerging Communities Supplemental Grants.

NASTAD has identified six major themes that should frame the 2005 CARE Act Reauthorization. They include: strengthening state program capacity; maintaining program infrastructure; CARE Act simplification and flexibility; enhancing state's ability to coordinate HIV/AIDS health systems; CARE Act mandates; and CARE Act accountability.

The number of people living with HIV/AIDS is growing, therefore, increasing the number of individuals expected to be served by CARE Act programs. The epidemic continues to grow disproportionately among people of color, women and young people. State AIDS directors believe that we need to reexamine our programs and our approaches to ensure that the CARE Act provides funding in an equitable manner to assure that individuals throughout the United States, regardless of state or jurisdiction of residence, have access to comprehensive HIV/AIDS health and medical care of the highest quality.