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Part A - Grants to Emerging Metropolitan & Transitional Grant Areas

Part A of the Ryan White HIV/AIDS Treatment Extension Act of 2009 provides assistance to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs)-locales that are most severely affected by the HIV/AIDS epidemic.

Eligibility

To qualify for EMA designation, an area must have reported at least 2,000 AIDS cases in the most recent 5 years and have a population of at least 50,000. To be eligible for TGA status, an area must have reported 1,000 to 1,999 new AIDS cases in the most recent 5 years and have a population of at least 50,000 persons.

EMAs and TGAs range in size from one city or county to more than 26 different political entities; some span more than one State. The boundaries of EMAs and TGAs are based on the U.S. Census designation of Metropolitan Statistical Areas.

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Funding

Part A grants to EMAs and TGAs include formula and supplemental components as well as Minority AIDS Initiative (MAI) funds, which supports services targeting minority populations.

Formula grants are based on reported living HIV/AIDS cases as of December 31 in the most recent calendar year for which data are available.

Supplemental grants are awarded competitively on the basis of demonstrated need and other criteria.

MAI funding is awarded using a formula that is based on the distribution of living HIV/AIDS cases among racial and ethnic minorities.

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Services

Part A funds may be used to provide a continuum of care (i.e., medical and support services) for people living with HIV disease.

Core services are limited to

• outpatient and ambulatory medical care;
• AIDS drug assistance program
• AIDS pharmaceutical assistance;
• oral health;
• early intervention services;
• health insurance premium and cost sharing assistance for low-income individuals;
• medical nutrition therapy;
• hospice services;
• home and community-based health services;
• mental health services;
• substance abuse outpatient care;
• home health care; and
• medical case management, including treatment adherence services.

Support services must be linked to medical outcomes and may include outreach, medical transportation, linguistic services, respite care for caregivers of people with HIV/AIDS, referrals for health care and other support services, case management, and substance abuse residential services.

Grantees are required to spend at least 75 percent of the award on core medical services and no more than 25 percent on support services.

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Implementation: HIV Health Services Planning Councils

In each EMA, local Planning Councils set priorities and allocate Part A funds on the basis of the size, demographics, and needs of the population living with or affected by HIV. Particular attention is given to people who know their HIV status but are not in care. Planning Councils are required to develop a comprehensive plan for the provision of services; the plan must include strategies for identifying HIV-positive persons not in care and strategies for coordinating services to be funded through existing HIV prevention and substance abuse treatment programs.
New requirements contained in the 2009 Ryan White HIV/AIDS Treatment Extension Act now require Planning Councils to include in their comprehensive plan a strategy for the identification, diagnosis, and referral to care, all those who are unaware of their HIV status.

Planning Council membership must demographically reflect the local epidemic and include members who have specific expertise in areas such as health care planning, housing for the homeless, health care for incarcerated populations, and substance abuse and mental health treatment or who represent other Ryan White and Federal programs. At least 33 percent of the members must be people living with HIV who are consumers of Ryan White HIV/AIDS Program services.

TGAs are required to use a community planning process; use of Planning Councils is optional.

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Grantees

Grants are awarded to the chief elected official (CEO) of the city or county that provides health care services to the greatest number of people living with AIDS in the EMA or TGA.