Ryan White CARE Act
The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is Federal legislation that addresses the unmet health needs of persons living with HIV disease (PLWH) by funding primary health care and support services. The CARE Act was named after Ryan White, an Indiana teenager whose courageous struggle with HIV/AIDS and against AIDS-related discrimination helped educate the nation. Some areas that receive funding through the CARE Act use Ryan White dollars to assist clients with emergency and transitional housing need. NAHC strongly supports the continued ability of CARE Act grantees to use CARE resources to provide housing referrals and transitional and emergency housing assistance. The CARE Act was reauthorized at the end of 2006.
The 2006 reauthorized program contains a variety of changes to the Act, including formula revision and a requirement that 75% of CARE Act funds be reserved for “core medical services.” Emergency housing assistance remains a fundable service under the CARE Act, but funding available for housing will be restricted to the remaining 25% (after the core medical service set-aside).
Following the reauthorization, the Department of Health and Human Services Health Resources and Services Administration (HRSA) which administers the program, issued a proposed housing policy amendment in December 2006 which included a retroactive, cumulative 24 month lifetime cap per household for emergency and transitional housing. Recognizing the importance of the availability of this housing assistance in communities which have prioritized housing need, people with HIV/AIDS, AIDS service organizations and housing and health advocates along with a number of members of Congress submitted comments in opposition to the proposed housing policy amendment to HRSA. Over 200 comments were submitted with only a handful in favor of the policy. This grassroots led effort resulted in withdrawal of the proposed policy.
Recently, HRSA reinstated the policy as final via a Final Policy Notice on the Use of Ryan White HIV/AIDS Program Funds for Housing Referral Services and Short-Term or Emergency Housing Needs (HRSA HIV/AIDS Bureau (HAB)) Policy Notice 99-02 Amendment 1 (73 Federal Register 10260, February 26, 2008). The Policy amendment, in its published final form, omits the retroactivity feature. Grantees became responsible for tracking the 24 month cumulative period of eligibility on March 27, 2008, the effective date of the policy amendment. NAHC, along with numerous service providers and members of Congress, believes the policy notice should be withdrawn. Permanent housing options are simply not available in most of the country and lack of affordable housing is exacerbated for more vulnerable households such as low income people with HIV/AIDS. Ryan White grantees do not have systems in place to track clients from jurisdiction to jurisdiction and sub grantee to sub grantee as implementation of the policy would require. Most importantly, with the provision for a waiver to permit lifting of the cap for physician-certified medical necessity, the policy fails to provide the appropriate and reasonable flexibility for medical professionals and grantees required in making decisions about individual patient needs.
HRSA Housing Policy Call to Action
Housing and the CARE Act – NAHC Factsheet (PDF)
CAEAR Coalition’s Overview of the CARE Act (PDF)
FY 2007 Ryan White Program Guidance (PDF)
NAHC Ryan White CARE Act FY06 Housing Allocation & Expenditure Chart