If you are confused about Ryan White Program funding and how the sequester will affect our local HIV care system, you are not alone. I hope this post provides you with some information and resources that alleviate some uncertainty and provide context for the Planning Council's work.

Ryan White Reauthorization

The Ryan White HIV/AIDS Treatment Extension Act (2009) expires this fall, but this does not mean that the Ryan White Program will discontinue. Congress can (and will) appropriate funds to the Program, even if the Act is not reauthorized. The previous reauthorizations of the Act had sunset provisions, which meant that if the law was not reauthorized by a set date, Congress would not be able to appropriate funds and the program would end. The sunset provision is not a part of the current act.

Community advocates and federal partners agree this is not the best time to seek reauthorization, because of the current fiscal crisis and lack of bipartisan Congressional support of health reform. They feel it is too risky to call attention to an HIV-specific health care law; some members of Congress may believe such a program is no longer needed in the era of health reform. Congressional understanding of the program varies. Many members of Congress are new to the job this year (12 Senators and 67 representatives) and they need to be educated on the importance of the Ryan White Program before we can ask them to think about reauthorization. The CAEAR Coalition and NASTAD provide regular updates on Ryan White Program funding and policies.

Sequester 

Because Congress didn't compromise on federal budget reduction in January, the sequestration of funds or sequester was triggered. This means an automatic, across-the-board 5.1% cut to every discretionary line item in the federal budget, excluding entitlements like Social Security and Medicaid/Medicare. As outlined in a report issued by the White House, the sequester cuts funding for HIV testing, HIV treatment, and research efforts. It also cuts funding to the states (Pennsylvania and New Jersey fact sheet) and the Philadelphia EMA, in more programs than just Ryan White. We are anticipating at least a 5.1% cut to the Ryan White program, but this is not a certainty. We could lose more or less funding. We will not know until later this year (see the discussion below on the funding for FY2013 and the continuing resolution). The sequester will not go away after this year. It affects the next decade of federal budgets, unless Congress and President Obama come up with an alternative plan. The Bipartisan Policy Center has a great guide on the sequester.

Ryan White Funding FY2013 (started March 1, 2013)

Not only are we dealing with a sequester, but we also have a continuing resolution. A continuing resolution is a common way for Congress to avoid a formal appropriations process, and just carryover the budget from one year to the next. The continuing resolution can be for one year, six months, or any other period of time. We are currently working under a continuing resolution that ends on March 27th. If Congress does not pass another continuing resolution or pass appropriation bills before then, we could face a federal government shut down like we saw in 1996 and 1997. President Obama and Congressional leaders don’t want a shutdown, so it is likely we will have another continuing resolution. Funding might be "level" to the Ryan White Program for 2013, BUT would still have a 5.1% cut from the sequester. Level funding to the Ryan White Program nationally does not mean the Philadelphia Eligible Metropolitan Area (EMA) will receive a grant award equal to FY2012’s award. Our EMA’s Part A grant award is based on two awards - a formula award based on living HIV and AIDS cases and a supplemental award based on the grant application’s score. In planning for FY 2013 and beyond, we are anticipating AT LEAST a 5.1% ($1.1 million) decrease in Part A funding to the EMA.  This reduction in funding will carry over into the FY 2014 allocations process that we are just beginning. This is also why the Planning Council decided to base the EMA’s FY2013 budgets on the 5% decrease scenarios from last summer’s planning process. Matthew McClain’s presentation from the February 2013 Planning Council meeting offers additional information and resources about domestic HIV policy.