T he Ryan White HIV/AIDS Program makes federal funds available to eligible metropolitan areas, states and local community-based organizations to provide a number of health care services for HIV/AIDS patients, including medical care, drug treatments, dental care, home health care, and outpatient mental health and substance abuse treatment. The Ryan White HIV/AIDS Program reports that in 2014 it served 512,214 low-income people with HIV/AIDS, 25.4% of whom were uninsured and 64.2% of whom were living at or below 100% of the federal poverty level. 111-87 ). The program is administered by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau. The Patient Protection and Affordable Care Act of 2010 (ACA, P.L. 111-148 , as amended) contains general provisions to increase access to health insurance and is expected to increase coverage for people living with HIV/AIDS. These provisions include prohibitions on the cancellation of coverage by an insurer due to a preexisting condition, elimination of lifetime caps on insurance benefits and annual limits on coverage, and eligibility for tax subsidies to help low- and middle-income individuals purchase coverage from health insurance exchanges. In addition, states have the option to broaden Medicaid eligibility to include single adults. ACA phases out the Medicare Part D so-called "doughnut hole"—a gap in prescription drug coverage—for individuals who are Medicare-eligible, including individuals with HIV/AIDS. The long-range impact of the health care law on HRSA's Ryan White HIV/AIDS Program (in which the health and treatment services provided under Ryan White are likely to be replaced to some extent by access to such services through health coverage via ACA) remains to be determined and may be of interest to policymakers given that authorization for the Ryan White HIV/AIDS Program has lapsed. Part A currently provides grants to 24 EMAs. Part D—Women, Infants, Children, and Youth

Part D provides grants to public and nonprofit entities for family-centered care for women, infants, children, and youth with HIV/AIDS. Part F—Demonstration and Training

Part F provides support for the AIDS Dental Reimbursement (ADR) Program, the Community-Based Dental Partnership Program, the AIDS Education and Training Centers (AETCs), the Special Projects of National Significance (SPNS) Program, and the Minority AIDS Initiative (MAI). The Consolidated Appropriations Act, 2016 ( H.R. The $9 million increase over FY2016 is requested for a new SPNS initiative to expand screening for and treatment of hepatitis C in people living with HIV. ACA and the Ryan White HIV/AIDS Program

Prior to the implementation of the ACA ( P.L. For example, about half of ADAP clients would be Medicaid-eligible in expansion states, and the remainder would likely be eligible for premium subsidies to purchase health coverage on the exchange. HRSA and others note that Ryan White funds are increasingly being used for insurance premiums and cost sharing. ACA and the Future of the Ryan White HIV/AIDS Program

The long-range impact of ACA on the Ryan White HIV/AIDS Program—in which HIV care and treatment services provided under the Ryan White HIV/AIDS Program are replaced by access to such services through health coverage via ACA—remains to be determined. In those states that do not participate in the Medicaid expansion, the need for the full range of services under Ryan White would remain. However, even if all states decide to cover the new Medicaid-eligible group provided under ACA, there will be gaps that the Ryan White HIV/AIDS Program could continue to fill, such as coverage of those individuals with HIV/AIDS who are undocumented immigrants or legal immigrants within the five-year Medicaid ban. Ryan White also provides dental care and support services, such as medical transportation, that may not be provided under Medicaid or private health insurance. The program's authority is currently expired, but Congress continues to appropriate funds for the program to carry out Title XXVI and Title III of the PHS Act. 2029 , P.L. The measure provides a total of $2.323 billion for the Ryan White HIV/AIDS Program in FY2016, including the $25 million for SPNS, but did not agree to the consolidation of Parts C and D.

		FY2017

The Obama Administration requests $2.298 billion in budget authority and $34 million via the PHS evaluation tap—for SPNS—resulting in a total of $2.332 billion for the Ryan White HIV/AIDS Program in FY2017. The FY2017 budget request again proposes a consolidation of Part C and Part D, which was proposed in the FY2015 and FY2016 budget requests and rejected by Congress.
The Ryan White HIV/AIDS Program makes federal funds available to eligible metropolitan areas, states, and local community-based organizations to assist with health care costs and support services for individuals and families affected by the human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). The Ryan White HIV/AIDS Program reports that in 2014 it served 512,214 low-income people with HIV/AIDS in the United States, 25.4% of whom were uninsured and 64.2% of whom were living at or below 100% of the federal poverty level.
The Ryan White HIV/AIDS Program is administered by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS). Its statutory authority is Title XXVI of the Public Health Service (PHS) Act, originally enacted in 1990 and composed of four major parts and several other components. Part A provides grants to urban areas and mid-sized cities. Part B provides grants to states and territories; it also provides funds for the AIDS Drug Assistance Program (ADAP). Part C provides early intervention grants to public and private nonprofit entities. Part D provides grants to public and private nonprofit entities for family-centered care for women, infants, children, and youth with HIV/AIDS. The other components under Part F include the AIDS Dental Reimbursement (ADR) Program, the Community-Based Dental Partnership Program, the AIDS Education and Training Centers (AETCs), the Special Projects of National Significance (SPNS) Program, and the Minority AIDS Initiative (MAI). In October 2009, the 111th Congress passed and President Obama signed the Ryan White HIV/AIDS Treatment Extension Act of 2009 (P.L. 111-87), which reauthorized the Ryan White HIV/AIDS Program through September 30, 2013. The program's authority is currently expired, but Congress continues to appropriate funds for the program.
The Patient Protection and Affordable Care Act of 2010 (ACA, P.L. 111-148, as amended) contains general provisions to increase access to health insurance; therefore, the ACA has the potential to increase coverage for people living with HIV/AIDS. For example, ACA includes prohibitions on the cancellation of coverage by an insurer due to a preexisting condition, elimination of lifetime caps on insurance benefits and annual limits on coverage, and eligibility for tax subsidies to help low- and middle-income individuals purchase coverage from a health insurance exchange. ACA phases out the Medicare Part D "doughnut hole" (i.e., payment gap) for HIV/AIDS individuals who are Medicare eligible, which should increase coverage of HIV/AIDS drugs. Finally, the ACA permits states to broaden Medicaid eligibility to include non-elderly adults. There could be a significant impact on Ryan White ADAP clients in states that expand their Medicaid program; specifically, about half of ADAP clients would be Medicaid-eligible in expansion states, and the remainder would likely be eligible for premium subsidies to purchase health coverage on the exchange.
The long-range impact of ACA on the Ryan White HIV/AIDS Program—in which HIV care and treatment services provided under Ryan White are replaced by access to such services through health insurance coverage via ACA—remains to be determined. Prior to the ACA's implementation, many Ryan White patients were insured and used Ryan White funds to pay premiums and cost sharing, and this need for funds is likely to remain as some Ryan White patients transition to private insurance. In states that decide not to participate in the Medicaid expansion, the need for the full range of Ryan White services would remain. However, even if all states decide to cover the new Medicaid-eligible group, there will be gaps that the Ryan White HIV/AIDS Program could continue to fill, such as coverage of those individuals with HIV/AIDS who are undocumented immigrants, and training of health providers in HIV-related care. In addition, Ryan White provides dental care and support services, such as medical transportation, that may not be provided under Medicaid or private health insurance. The Ryan White HIV/AIDS Program serves a public health role by keeping people in treatment and thereby decreasing the risk of transmitting HIV to others.
Funding for the Ryan White HIV/AIDS Program in FY2016, provided in the Consolidated Appropriations Act, 2016 (H.R. 2029, P.L. 114-113), is $2.323 billion. For FY2017, the Obama Administration requests $2.298 billion in budget authority and $34 million via a PHS transfer for the SPNS program, resulting in an FY2017 total of $2.332 billion for the Ryan White HIV/AIDS Program. The $9 million increase over FY2016 is for a new SPNS initiative to expand screening for and treatment of hepatitis C in people living with HIV. The FY2017 budget request again proposes a consolidation of Part C and Part D, which was proposed in the FY2015 and FY2016 budget requests and rejected by Congress.