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The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act

HHS FACT SHEET December 18, 1998 Contact:HRSA Press Office (301) 443-337


Overview:The Ryan White program was created in 1990 to help states, communities and families cope with the growing impact of the AIDS epidemic. On May 20, 1996, President Clinton signed a five-year extension of the Act. The program, which is administered by the HHS Health Resources and Services Administration (HRSA), supports systems of care for people with AIDS who do not have adequate health insurance or other resources.

The CARE Act has been a top priority of the Clinton Administration. Annual funding for the program has grown by $1 billion since 1993 -- an increase of 260 percent. The FY 1999 budget includes $1.4 billion for Ryan White activities, an increase of 23 percent over FY 1998. For the ADAP program, the budget has $461 million, a 61 percent increase over FY 1998.

Since 1991, when the first CARE Act grants were awarded, $6.4 billion in federal funds has been appropriated under the Act. In total, HRSA estimates that the Ryan White CARE Act programs serve approximately 500,000 individuals with HIV and AIDS in a given year.


On August 18, 1990, Congress passed Public Law 101-381, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act by wide, bipartisan margins in both houses. Enactment followed reports of severe distress in major U.S. metropolitan areas that were becoming overburdened by the cost of care for a growing number of Americans living with AIDS who had little or no health insurance. The AIDS epidemic, which began in 1981, had created a need for primary medical care that was exceeding the capacity of local health departments, hospital emergency rooms, and other health care institutions. Individuals and families affected by HIV/AIDS were struggling to obtain desperately needed medical care.

The Ryan White CARE Act supports the development of systems of care that are responsive to local needs and resources. It is founded on strong partnerships between the federal government, states, and local communities in need, and emphasizes less-costly outpatient, primary care to prevent costly emergency room visits and hospitalizations.

The CARE Act is named in honor of Ryan White, an Indiana teenager whose struggle with AIDS and against AIDS-related discrimination who helped to educate our nation about the needs of people with AIDS. Mr. White died on April 8, 1990, at the age of 19, just a few months before Congress passed the Act that bears his name.

A Record of Caring

The CARE Act is divided into the following:

Title I. Provides emergency relief grants to cities for health and support services for low-income and under- or uninsured persons living with HIV and AIDS and their families. Services include health care and support services such as medical and dental care, prescription drugs, transportation, counseling, and home and hospice care.

A total of 50 cities are now eligible for Title I formula grants. All cities that are eligible for formula grants are also eligible for supplemental grants, which are awarded to cities demonstrating additional critical needs. Since 1991, nearly $3 billion in Title I funding has been appropriated.

Title II. Provides formula grants to all 50 states, the District of Columbia, Puerto Rico, and U.S. territories to improve the quality, accessibility, and organization of health care and support for those with HIV and AIDS. Services include direct health care and support, home and community-based care, assistance in continuing private health insurance coverage, and treatments and drugs that prolong life and/or prevent hospitalization through AIDS drug assistance programs.

Since 1991, more than $2.7 billion in Title II funding has been appropriated, including $965.5 million for the AIDS Drug Assistance Program.

Title III. Provides grants for comprehensive primary health care services for people living with AIDS and at-risk populations, including women, the homeless, and substance abusers to slow transmission of the disease and provide early intervention through education, counseling, testing, and treatment. To qualify for funds, organizations must be public or nonprofit private entities.

Currently, 174 HIV early intervention and primary care services programs are funded in 37 States, the District of Columbia, and Puerto Rico. From 1991 through 1998, a total of $539 million has been appropriated.

Title IV. Provides grants for coordinated HIV services and access to research for children, youth, women, and families. Applicants must demonstrate the ability to provide access to clinical trials or to establish links with providers offering clinical trials or other research.

Since 1994, $199.8 million has been appropriated under Title IV, with 55 organizations in 23 States, Puerto Rico, and the District of Columbia receiving support so far.

Part F. Added in 1996 to combine previously existing programs, this part includes: (1) 15 AIDS Education and Training Centers (AETCs) that provide training for health care professionals in early diagnosis and treatment of HIV infection; (2) the Dental Reimbursement Program, which assists dental schools and post-doctoral dental programs through grants for uncompensated costs incurred in providing oral health treatment to patients with HIV disease; and (3) the Special Projects of National Significance Program, which supports, through competitive grants, time-limited projects that demonstrate and evaluate innovative service delivery models for special populations with HIV disease.

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