Key Issues for California's Congressional Delegation

The HIV/AIDS epidemic continues to be one of the most serious public health challenges facing California and the nation.

• California has the second highest AIDS incidence of any state in the nation, with 12 percent of the nation's population and 14 percent of AIDS cases.
• As of December 2004 over 135,900 cumulative AIDS cases and 35,500 cumulative HIV cases have been reported in California. Since 1981, over 79,500 Californians have died from HIV/AIDS.

The Ryan White CARE Act is set to expire this year and needs to be reauthorized.

• The Ryan White CARE Act plays an essential role in the ability of our state and localities to meet the health care needs of persons living with HIV/AIDS. Nationally, the CARE Act provides critical, life-saving health care services to over 500,000 low-income, uninsured or underinsured individuals.
• In Fiscal Year 2003-04, California received over $243 million in CARE Act funding, under all five titles or parts of the CARE Act, including $102 million for the nine Title I metropolitan areas in California hardest hit by the disease and approximately $97.6 million for the AIDS Drug Assistance Program (ADAP).
• There are nine eligible metropolitan areas (EMA's) in California that receive Title I funding from the CARE Act to provide essential care services to people living with HIV/AIDS. These include Sonoma, Sacramento, San Francisco, Oakland, Santa Clara, Los Angeles, Riverside/San Bernardino, Orange County and San Diego.
• Reauthorization of the CARE Act is critical to the HIV/AIDS community in California and should be strongly supported by all California Congressional members. We urge you to encourage Congressional leadership and members of key committees (including the House Energy and Commerce Committee and the Senate Health, Education, Labor, and Pensions Committee) to swiftly reauthorize the CARE Act.

There are specific provisions of the CARE Act that are critical to California that need to be acted on by members of the California Congressional delegation. Specifically:

• Update the formulas used to determine CARE Act funding allocations to California, which significantly disadvantage our state. Currently, funding is distributed based on an estimated count of AIDS cases that underestimates the number of AIDS cases in our state and localities compared to the rest of the country. It is critical that the bill be changed so that funds are instead based on actual living AIDS cases and more accurately reflect California's HIV/AIDS disease burden compared to the rest of the country. (See attached fact sheet for more information on this issue).
• Oppose proposals that would assure annual increases for ADAP by taking funds from other CARE Act programs. It has been suggested that the AIDS Drug Assistance Program must be guaranteed increased resources every year and if Congress does not appropriate sufficient resources, these additional funds should come from other titles of the CARE Act, such as the allocation for Title I metropolitan areas. This would result in cuts to primary medical care and other critical services at the local level and would greatly undermine our efforts to provide care and treatment for those in need. ADAP needs increased resources, but these should not come at the expense of the other critical components of the CARE Act.
• Oppose potential changes to the legislation that would limit the ability of local areas to determine the best use of these funds to meet the local needs of people living with HIV/AIDS. Localities are best able to determine the service needs of their population and should have the flexibility to make these determinations. Congress should avoid approaches that mandate that specific percentages of funding be allocated toward particular service categories. 
• Support local planning processes for determining needs and the allocation of resources. California Congressional members should oppose efforts that would reduce the role of local planning councils in shaping HIV/AIDS services in their jurisdictions.

In addition to reauthorization of the CARE Act, appropriations for the CARE Act must be increased in FY 2006.

• For the past two years, most of the titles of the CARE Act have experienced decreases in funding, while the number of people living with HIV/AIDS continues to grow. This has resulted in reduced access to medical care, drugs, and critical support services for thousands of people living with HIV/AIDS.
• In his Fiscal Year (FY) 2006 budget, the President has requested flat funding for the CARE Act, with the exception of a small $10 million increase for ADAP, which is far less than the $300 million increase needed for just that program alone. Congress must improve upon these numbers and ensure an appropriate government response to the ongoing HIV/AIDS crisis in the United States.
• In FY 2005, eight of the California's nine Title I metropolitan areas experienced a cut in their Title I awards. Overall, California's nine EMA's dropped from over $102 million in FY 2004 to $98.7 million in FY 2005, resulting in service cuts at a time when case loads and service needs are growing. That comes on top of a $9 million cut the year before. In FY 2006, we urge Congress to increase Title I appropriation from $610 million to $725 million million, an increase of $115 million.