From the outset, administration of the Ryan White CARE Act has been unusually collaborative. Governments, providers, and consumers all play a significant role in implementation.

Enactment
Reauthorization
Funding
Administration

Enactment

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.

Reauthorization

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.

Funding

In 1991, the first year of the Ryan White HIV/AIDS Program, the Federal budget appropriation was $220.6 million. Today it has grown to more than $2 billion.

Administration

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.

Collaboration Marks Administration of New Act

From its outset in 1990, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was never a typical Federal government program. The CARE act received a high level of bipartisan support and was not an entitlement like many other health programs. In addition, it provided grant recipients of latitude in how to use their grant funds.

The manner in which the CARE Act program was to be administered was unique as well. Both Federal and city governments played a role in Title I (Ryan White HIV/AIDS Program Part A) administration, which funds metropolitan areas. For Title II (Ryan White HIV/AIDS Program Part B), which funds States and territories, administrative roles involved both Federal and state governments. For other programs, there was only a Federal role. This operational infrastructure continues today.

Role of the Federal Government

The agency implementing the program—the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA)—has significant responsibility for working with Ryan White HIV/AIDS Program recipients and providers. Specifically, the Federal role in local implementation of the Ryan White HIV/AIDS Program statutes is to ensure compliance with Federal policy, adherence to contracting and financial regulations, and successful implementation of programs at the local level.

Although Federal roles have remained fundamentally as conceived in 1990, some changes have been introduced since the program began. From 1990 to 1997, the Ryan White HIV/AIDS Program was managed by HRSA. In FY 1991, Congress made budget appropriations for three programs authorized in the CARE Act: Title I (Part A) received $87,831,000; Title II (Part B) received the same amount; and Title III (Part C) received $44,891,000. Unlike today, the three programs were not administered by the same bureaus within HRSA. Title I and Title II were administered by the Bureau of Health Resources, and Title III was administered by the Bureau of Primary Health Care.

Although these were the only AIDS programs to which funds were appropriated through the CARE Act in FY 1991, they were not the only AIDS programs at HRSA. In 1991, Title IV (Part D) was administered through the Bureau of Maternal and Child Health, and the AIDS Education and Training Centers program was administered by the Bureau of Health Professions. All of these programs have been funded through the Ryan White HIV/AIDS Program budget since 1997.

1997–Today

The HIV/AIDS Bureau (HAB) was created in 1997. Since then, all of HRSA’s HIV/AIDS programs have been administered by HAB, thereby reducing administrative costs and ensuring a concentrated, united front to end the HIV epidemic in the United States..