Vito Russo and his friend, fellow activist Larry Kramer

Author and film critic Vito Russo is comforted by his friend, fellow activist Larry Kramer. Russo died in 1990 of AIDS-related complications a few months after meeting with Kramer in his California home.

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.

Renewing the Commitment to Advance HIV Care and Treatment

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act legislation was first enacted in 1990. It has been amended and reauthorized four times in 1996, 2000, 2006, and 2009. The Ryan White HIV/AIDS Program legislation has been amended with each reauthorization to accommodate new and emerging needs, such as an increased emphasis on funding core medical services and changes in funding formulas.

View the Ryan White HIV/AIDS Program legislation (PDF - 1.3 MB). The full Ryan White HIV/AIDS Program legislation is codified at title XXVI of the Public Health Service (PHS) Act (PDF - 465 KB).

Ryan White HIV/AIDS Program Legislation Overview

The legislation is divided into several portions called Parts. The purpose is to provide a flexible structure under which this national program can address HIV care needs on the basis of:

Different geographic areas (metropolitan areas, states, and communities across the nation)
Varying populations hit hardest by the HIV epidemic
Types of HIV-related services
Service system needs (for example, technical assistance for programs, training of clinicians, or research on innovative models of care).

Legislative provisions (called Sections) address planning and decision-making, types of grants that are available, how funds may be used, requirements for entities submitting applications for funding, and available technical assistance to help programs run more effectively.

The Ryan White HIV/AIDS Program is administered by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB).

Ryan White HIV/AIDS Program Legislation Highlights as Amended in 2009

Following is a summary of select provisions in the 2009 legislation:

The 2009 Ryan White HIV/AIDS Program legislation continues the Ryan White HIV/AIDS Program through fiscal year 2013 and beyond, so long as Congress appropriates funds.
Minority AIDS Initiative (MAI) funds under Parts A and B are distributed according to a formula (based on the distribution of populations disproportionately impacted by HIV/AIDS) and coincide with grant cycles under each Part.
Part A authorizes grant awards to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs). When TGAs lose their eligibility status, the state in which the former TGA is located shall receive a one-time transfer of funds.
Part A recipients are required to determine not only the size and demographics of HIV infected individuals but also those individuals who are unaware of their HIV status. One-third of Part A supplemental grants are to be based on the area's ability to demonstrate its success in identifying individuals with HIV who are unaware of their status and bringing attention to their status.
Part A and Part B grant recipients must develop comprehensive plans that include a strategy for identifying individuals with HIV who do not know their status and help them seek medical services. The strategy must focus on reducing barriers to routine testing and disparities in access to services for minorities and underserved communities.
The law eliminates hold harmless protections for Part A and Part B grant recipients after fiscal year 2013.
The law retains Part A and Part B unobligated balances (UOB) provisions, with the trigger for the penalty provisions set at 5 percent of unobligated formula funds.
Part D funds may not be used for primary care services if payments for such services can be provided from other sources (including titles XVIII, XIX, and XXI of the Social Security Act). Public and nonprofit private entities funded under Part D can provide care through memoranda of understanding in addition to contracts.