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GMHC Letter on Ryan White CARE Act Reauthorization
September 13, 2006
The following letter was sent to:
Senator Mike Enzi
Chairman, Health, Education, Labor and Pensions Committee |
Representative Joe Barton
Chairman, Energy and Commerce Committee |
Senator Edward Kennedy
Ranking Minority, Health, Education, Labor and Pensions Committee |
Representative John Dingell
Ranking Minority, Energy and Commerce Committee |
Dear Sirs:
As an organization that provides access to critically needed
medical care and supportive services to persons living with HIV/AIDS,
our organization remains very concerned about the current draft of
the HIV/AIDS Treatment Modernization Act of 2006 and its impact on
New York. As the bill now stands, we cannot support this legislation
and is urging all New York Members of Congress to remain united in
their opposition to this bill, unless significant changes are made.
New York is home to more persons living with HIV/AIDS than
any state in the nation, with approximately 110,000 New Yorkers
diagnosed with HIV/AIDS. One in five Americans living with HIV/AIDS
resides in New York.
Our major concerns with the pending legislation are listed
below. Please note that while we have a number of additional
concerns/issues with the legislation not mentioned in this letter,
the items below are critical.
Projected Cuts in Funding to All Three Eligible Metropolitan Areas (EMAs)
in New York
We continue to be concerned that proposed formula changes and the
inclusion of HIV data in the distribution of Title I funds will
result in significant shifts in funding. The data charts released
by the bicameral, bipartisan process indicate that all three EMAs
in New York State will experience some reduction in formula funding.
This merely highlights the need for a continued hold harmless that
is retained for the life of the act. (See comments later on hold harmless.)
Projected Cuts in Funding to New York's Title II Program
For many parts of New York State, persons living with HIV/AIDS rely
exclusively on Ryan White Title II funds to provide them with access
to primary medical care and supportive services. In addition, there
are over 16,000 New Yorkers who depend on the Title II funded AIDS Drug
Assistance Program (ADAP) for access to life saving HIV antiretrovirals.
Without the ADAP program, countless individuals in New York would be
unable to afford the cost of these expensive medications.
The projected cut in funding to the State's overall Title II
grant, based on the bicameral, bipartisan data recently released,
will be close to $9 million in FY 2007 alone. The cuts in future
years will only get worse and are projected to more than triple by
the fourth year of authorization. Once again, without a hold harmless
that exists for the life of the act, New York State is poised to lose
millions after FY 2009.
For the over 110,000 New Yorkers living with HIV/AIDS, this
scenario is not acceptable. A solution to the State's funding
challenges must be found; this legislation should make provisions
to keep whole the State's Title II funding. The current distribution
of funds proposed in this legislation needs to be amended. The thousands
of New Yorkers who rely on services provided through Title II funds can
not be left without access to critically needed services.
Threat to Title II HIV CARE Consortia's
It is through the consortia that states receive input from service providers
on the front lines and persons living with HIV/AIDS. The consortia are the
foundation of the Ryan White tradition of participatory planning. They give
regional representatives, providers, and consumers a voice in program and
policy development, and they play an important role in meeting legislative
mandates around needs assessments and state plans.
The current proposal to place the spending of Ryan White funds
under the State's administrative cap would mean the elimination of
this important planning mechanism in New York. We request that spending
on HIV CARE consortia's be moved to the supportive services category and
not considered administrative expenses of the grantee. This would give
states that chose to continue consortia's the flexibility to do so.
Lack of Title I or Title II Hold Harmless Beyond 2009
Without hold harmless, health care and supportive services funded
through these titles could be severely damaged by wide and unpredictable
fluctuations in grant awards. Hold harmless is meant to ensure that
service systems built over the past decade and a half with CARE Act
funds are not decimated. It is an important principle that should be
maintained during this reauthorization. Especially in light of a number
of other changes in the provision of formula funds, such as the new
inclusion of HIV case data, the role of hold harmless is even more
critical at this juncture.
The Creation of a Severity of Need Index Without Adequate Congressional Oversight
The Administration has not yet finalized the creation of a Severity
of Need Index (SONI). Because the redistribution of funds could be quite
severe, we respectfully request that the implementation of a Severity
of Need Index be delayed until the next reauthorization. The legislation
should direct the Administration to develop a SONI, with Congress making
the final determination on implementation.
Thank you for your consideration of these issues. Please remember that
thousands of New Yorkers living with HIV/AIDS rely on Ryan White funds to provide
critical medical and supportive services and access to life-saving medications.
The changes made in this legislation will have tremendous consequences.
Sincerely,
Marjorie Hill, Ph.D.
Interim Executive Director, GMHC
Cc: Senators Clinton and Schumer
NY Members of Congress
© 2006 Gay Men's Health Crisis
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