HIV Policy Experts Offer Recommendations for Updating the Ryan White HIV/AIDS Program

By: Jeffrey S. Crowley, program director of the National HIV/AIDS Initiative at the O’Neill Institute for National and Global Health Law at Georgetown University Law Center

The O’Neill Institute for National & Global Health Law, along with other leading HIV/AIDS experts, have issued recommendations for ensuring that the Ryan White HIV/AIDS Program is updated to be maximally effective in a changing health care environment. The series of three policy briefs (http://bit.ly/ryanwhitepolicyproject) are designed to help the Obama Administration and Congressional leaders conceptualize structural changes to the program, and also to help HIV community stakeholders identify opportunities for improving engagement in care by adapting the critical program.

The Ryan White HIV/AIDS Program, enacted by Congress in 1990 and most recently reauthorized on a bipartisan basis in 2009, is a federally funded program that provides lifesaving HIV treatment and critical health services to uninsured and underinsured people living with HIV in the United States. Administered by the Health Resources and Services Administration in the U.S. Department of Health and Human Services, the program supports an estimated 536,000 people with HIV each year. The program was funded at $2.32 billion in fiscal year 2014.

Source: White House Photo

The Ryan White program is the glue that holds together the disparate parts of the HIV care response in the United States. A common question is whether this care and treatment program is still needed now that access to insurance has been expanded, and the resounding response is: yes.

This is a time of perhaps unprecedented opportunity to increase engagement in care in a way that better supports all people with HIV in the U.S. to access treatment and achieve effective suppression of the HIV virus. By doing so, it keeps people healthy and also reduces HIV transmission. Congress is expected to consider the program’s reauthorization and future direction in the coming years.

Research shows that insurance coverage matters, but, in 2010, more than 70 percent of Ryan White Program clients had Medicaid, Medicare or private insurance. They needed support from the Ryan White program because of financial gaps and inadequate coverage for case management, transportation and other critical services to help keep people with HIV engaged in care.

The reports, the first of three for the ongoing Ryan White Policy Project at the O’Neill Institute, addressed three critical topics:

• Aligning the Ryan White HIV/AIDS Program with Insurance Coverage

 Originally built as a standalone system, the Ryan White program has evolved to a complement to the insurance system. Nonetheless, as the health system seeks to better integrate services and design more effective and efficient care delivery models, this report offers strategies for better aligning the Ryan White program with insurance to ensure that people with HIV do not get left behind.

• Refining Ryan White HIV/AIDS Program Administrative Activities to Increase Population-Level Impact

The Ryan White program has always looked and acted differently than other parts of the health system.  This report provides recommendations for ways to streamline existing planning and monitoring activities to retain critical aspects of community engagement. It also forcefully calls for increased Ryan White program investments to build health department data management systems and capacity to better partner with Medicaid, Medicare, health plans, and HIV prevention programs to monitor engagement in care and intervene when care is interrupted.

• Bolstering the HIV Clinical and Non-Clinical Workforce

Generations of dedicated HIV care providers and community partners have built today’s HIV care system. While more must be done to better reach underserved populations and communities, the need is great to bolster and sustain the existing HIV care workforce. This report offers recommendations for building upon recent changes to the AIDS Education and Training Center (AETC) program and other efforts to support clinical and non-clinical providers.

Editor's Note: These reports were informed by consultations with people living with HIV, HIV medical and non-medical providers, Ryan White grantees, and federal HIV policy and program staff. The Ryan White Policy Project is supported by funding from Gilead Sciences, Inc. The report was prepared by Jeff Crowley and Connie Garner. Crowley reports no recent personal financial interests related to the report. Garner is policy director for Foley Hoag representing Gilead Sciences.

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