States where most cases live in EMAs receive the largest amounts per case, since larger proportions of their caseloads are double counted. 1). 2). This results in a higher level of per-case funding for states with EMAs because the EMA cases are double counted. 3). Specifically, funding equity could be improved by modifying the existing caseload and fiscal capacity measures, and by including a cost measure. An important purpose of the Ryan White CARE Act was to target emergency funding to areas of greatest need. Recommendations to the Congress

To achieve greater equity in the distribution of funds, we recommend that the Congress modify the funding formulas to reduce the double counting of EMA cases so that comparable medical services funding is available for people with AIDS, regardless of where they live, adopt a caseload indicator that better reflects the number of people living with AIDS who are in need of services, and include an indicator that reflects the relative differences across states and EMAs in the cost of serving people with AIDS. Existing Formulas

Title I funds are distributed on the basis of the cumulative number of AIDS cases EMAs report and their cumulative AIDS incidence rate. III.3). Consolidated Grants

The simplest way to improve funding equity is to consolidate titles I and II into a single grant and distribute funds to the state governments through an equity-based formula. IV.1). A number of mechanisms could be employed, however, to avoid EMA and state funding losses when funding equity is improved. Older Americans Act: Funding Formula Could Better Reflect State Needs (GAO/HEHS-04-41, May 12, 1994). 2, 1992).
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the funding formulas established under the Ryan White Care Act, focusing on: (1) whether the existing formulas distribute funds equitably to states and eligible metropolitan areas (EMA); (2) the factors that inhibit greater funding equity; and (3) formula changes that are needed to improve funding equity.

What GAO Found

GAO found that: (1) although Ryan White Care Act funding formulas include factors used in equity-based formulas, they result in per-case funding discrepancies because EMA cases are double counted; (2) states without EMA do not benefit from double counting and receive significantly less funding; (3) the indicators used to target funds to needy states and EMA fail to take geographic cost differences into consideration; (4) EMA funding levels are based on the cumulative number of reported acquired immunodeficiency syndrome (AIDS) cases, resulting in the oldest EMA receiving the most funding; (5) better cost indicators could be used to target more funds to states and EMA where resources are the most needed; and (6) funding equity could be improved by eliminating the inappropriate double counting of AIDS cases and by using more appropriate measures of EMA and state funding needs.