Ending the Epidemic: The Role le of HRSA Programs and Funding September 2019
Learnin ing Obje jectiv ives • Understand the role HRSA programs can have in the proposed plan to End the HIV Epidemic through existing funding distribution and new funding opportunities • Learn the status of state and national progress towards key 2020 indicators • Discuss how programs can be developed and funding can be directed to optimize success and meet the goals of the EtE
Why This is Matters • HRSA programs provide critical prevention, care, and treatment services that can be expanded upon to make an impact in the plan to EtE by 2030 • The RWHAP serves more than 500,000 people living with HIV • CHCs have an extensive network of 12,000 delivery sites • Specific geographical areas continue to bear the burden of high incidence of HIV and can benefit from targeted resources and strategic planning • The HRSA programs have been successful, but new funding is needed and innovative approaches to programs and policies to achieve the ambitious goals of the EtE plan
Endin ing the Epid idemic ic Key Strategie ies
Geographical Im Impact and Targeted Areas • The Ending the Epidemic Plan will target 48 counties with the highest burden of HIV along with Washington, D.C. and San Juan, Puerto Rico; and 7 States with substantial rural burden • In 2017, southern states accounted for more than half of all new HIV diagnosis and 46% of all people living with HIV, despite making up 38% of national population • Of the 48 targeted counties: • South 48%; West 23%; North East 17%; Midwest 13%
Geographical Im Impact and Target Areas Rates o f Persons living with HIV by County Targeted Counties and States for the EtE Plan
2018 Ryan White HIV/AIDS Program Funding Analysis
Current Funding Framework • Formula awards to cities and states based on case counts • Competitive grants based on demonstrated need • Other competitive grants: • Minority AIDS Initiative, ADAP Emergency Relief, Special Programs of National Significance, other programs
Purpose • Examine where current Ryan White Program funding is distributed to determine if it is following the epidemic • Inform and motivate a discussion about how Ryan White Program funding is being distributed and how it can be better allocated in the future to achieve the goals of ending the HIV epidemic
Methodolo logy • Examined FY 2018 funding awards: • Analyzed the funding: • by program part 1. Parts A&B per case above/below median • per HIV/AIDS case count 2. Part B ADAP per case above/below • nationwide by states median • Excluded 6 jurisdictions with low 3. Total Part B & ADAP Supplementals case counts: Guam, Palau, American Samoa, Northern Mariana Islands, 4. Total Part C & total Part D Federated States of Micronesia, & 5. Parts A-D funding per case Marshall Islands above/below median 6. Parts A-D funding per case above/below median, multiplied by total number of cases
Methodolo logy • Ranked states 3 ways: 1. A-D including ADAP funding per case 2. A-D including ADAP funding per case multiplied by total cases 3. A&B including ADAP funding per case • Medicaid Expansion noted • Data Limitation: • Do not have data breaking down Part A awards and Part B Emerging Community awards distributed to multiple states • Credited such awards to only one state; so some state funding amounts shown are higher than actually received while others are lower than actual
1000 1500 2000 2500 3000 3500 4000 4500 500 0 Illinois Median Funding per Case $1890 Wisconsin Missouri Florida Georgia Parts A & B in New York Massachusetts Nebraska California Minnesota (Above th (A Alaska South Carolina including ADAP the Median) Tennessee Alabama Wyoming Rhode Island U.S. Virgin Islands District of Columbia Utah Maine Indiana North Dakota Puerto Rico Montana Iowa Idaho
-750 -650 -550 -450 -350 -250 -150 -50 Kansas New Hampshire Median Funding per Case $1890 West Virginia Arkansas New Mexico Parts A & B in Hawaii Oklahoma Kentucky Delaware Maryland (Below th (B Ohio North Carolina including ADAP the Median) Washington Oregon Michigan Louisiana Arizona Colorado South Dakota New Jersey Texas Pennsylvania Vermont Mississippi Nevada Connecticut Virginia
Part B ADAP (A (Above/Below th the Median) $2,000 $1,500 $1,000 $500 Median Funding per Case $815 $0 District of Columbia Illinois California North Carolina Indiana Georgia Virginia Tennessee Utah Puerto Rico Idaho Montana -$500 *States that received median funding amount per case not shown
$10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 $5,000,000 $0 North Dakota Alaska Part B Montana Parts B & ADAP Supplementals Missouri ADAP U.S. Virgin Islands New Jersey Nebraska Maine Texas Utah Minnesota Rhode Island Wisconsin North Carolina Illinois Idaho Mississippi Massachusetts Iowa Georgia South Carolina Alabama Indiana Puerto Rico Florida California New York
10000000 15000000 20000000 25000000 5000000 0 North Dakota U.S. Virgin… Wyoming Part C Hawaii South Dakota Vermont Montana Part D Alaska New Hampshire Minnesota Maine Idaho West Virginia Nebraska Indiana Utah Kansas Delaware Oregon Parts C & Iowa Rhode Island New Mexico Washington Oklahoma Nevada Arizona District of… & D Colorado Wisconsin Arkansas Tennessee Virginia Kentucky Maryland Mississippi Missouri Michigan Ohio Connecticut Alabama South Carolina New Jersey Puerto Rico Louisiana Massachusetts Illinois North Carolina Georgia Texas Pennsylvania Florida California New York
$1,000.00 $2,000.00 $3,000.00 $4,000.00 $5,000.00 $6,000.00 $0.00 Median Funding per Case $2247 California New York Connecticut Missouri Georgia South Dakota Wisconsin Tennessee Massachusetts Parts A-D above the median (Above th (A South Carolina Parts A - D Nebraska District of Columbia the Median) Vermont Alabama U.S. Virgin Islands Indiana North Dakota Utah Wyoming Rhode Island Alaska Maine Puerto Rico Iowa Montana Idaho
-$700.00 -$600.00 -$500.00 -$400.00 -$300.00 -$200.00 -$100.00 $0.00 Kansas Hawaii Maryland Median Funding per Case $2247 Ohio Washington Oklahoma Arizona Oregon Delaware Texas (Below th (B Parts A - D New Hampshire Michigan the Median) New Jersey Colorado North Carolina Arkansas West Virginia New Mexico Kentucky Virginia Louisiana Nevada Florida Illinois Pennsylvania Minnesota Mississippi
$10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 $5,000,000 $0 Median Funding per Case $2247 South Dakota North Dakota Wyoming Vermont U.S. Virgin Islands Parts A – D x Total Cases Connecticut Alaska Missouri Nebraska (Above th (A Wisconsin Maine Montana the Median) Rhode Island Utah Georgia Tennessee Idaho Massachusetts South Carolina California New York Indiana Alabama District of Columbia Iowa Puerto Rico
-$28,000,000 -$23,000,000 -$18,000,000 -$13,000,000 -$8,000,000 -$3,000,000 Texas Maryland Median Funding per Case $2247 Florida New Jersey Ohio North Carolina Parts A – D x Total Cases Washington Arizona Michigan Virginia (Below th (B Louisiana Colorado the Median) Illinois Oklahoma Kansas Oregon Hawaii Pennsylvania Arkansas Kentucky Delaware Nevada New Mexico West Virginia New Hampshire Minnesota Mississippi
State Funding Rankings ( Parts A-D Ab Above/Below th the Median, Multiplied by Total Cases)
State Rankings + State receives Part A and/or Part B funding also distributed to other jurisdictions - State receives Part A and/or Part B funding from another jurisdiction Note: A state may receive more than one funding award that crosses jurisdictions, noted by multiple + and -
Observ rvatio ions • Important to consider all Part A, B, C and D funding together Indiana Florida A&B: #6 A&B: #23 ADAP +Median ADAP =Median B&ADAP Supplemental: #5 B&ADAP Supplemental: #3 C&D: #39 C&D: #3 A-D/ case: #11 A-D / case: #31 A-D / case X total cases: #5 A-D / case X total cases: #51 New York Texas A&B: #21 A&B: #33 ADAP =Median ADAP =Median B&ADAP Supplemental: #1 B&ADAP Supplemental: #19 C&D: #1 C&D: #5 A-D / case: #25 A-D / case: #44 A-D / case X total cases: #6 A-D / case X total cases: #53
Observ rvatio ions • When the funding per case is examined in relation to the median amount, and then multiplied by the total number of cases, the magnitude of funding differentials is amplified Examples: • New York receives $2,304 dollars per case, $56 more than the median amount. When you multiple $56 by the total number of cases, that adds up to $7.4M • Florida receives $2,149 dollars per case, $97 less than the median amount. When multiplied by the total number of cases in the state that amounts to $10.7M below the median • If states received funding equitably per case, states like Florida and Texas would have the most to gain
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