HIV Care Formula Grants

The purpose of this program is to assist states and territories in developing and/or enhancing access to a comprehensive continuum of high-quality HIV care and treatment for low-income people with HIV.

The purpose of this program is to assist states and territories in developing and/or enhancing access to a comprehensive continuum of high-quality HIV care and treatment for low-income people with HIV.

Eligible applicants are: The 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Individuals with HIV.

Not less than 75 percent of grant funds remaining after reserving funds for administration and clinical quality management must be used to provide core medical services. Core medical services include outpatient ambulatory health services, AIDS Drug Assistance Program (ADAP), local pharmaceutical assistance, oral health care, health insurance premium and cost-sharing, home health care, home and community-based health services, hospice services, early intervention services, medical nutritional therapy, substance abuse outpatient care, mental health services, and medical case management, including treatment adherence services. The remaining 25percent may be used for support services, including non-medical case management, childcare services, emergency financial assistance, food bank/home delivered meals, health education/risk reduction, housing services, linguistic services, psychosocial support services, rehabilitation services, respite care, and transportation that support a person with HIV to achieve better health outcomes. Funds may be used to establish and operate HIV Care Consortia that shall conduct planning, funding, monitoring, and reporting on behalf of the recipient. HIV Care Consortia are categorized under the support services category. A State/Territory shall use a percentage of the grant, determined by the percentage of women, infants, children, and youth with HIV/AIDS in the State, to provide core medical and support services to infants, children, youth, and women with HIV. Funds may not be used to make payments for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or service under any State compensation program, insurance policy, Federal or State health benefits program or by any entity that provides health services on a prepaid basis (except for a program administered by or providing the services to the Indian Health Service). Funds may not be used to purchase or improve land, or to purchase, construct or make permanent improvement to any building except for minor remodeling. Funds may not be used to make cash payments to intended recipients of Ryan White HIV/AIDS Program (RWHAP) services. Funds may not be used for pre-exposure prophylaxis (PrEP) or non-occupational post-exposure prophylaxis (nPEP) medications or the related medical services. Additionally, the purchase of sterile needles or syringes for the purposes of hypodermic injection of any illegal drug is not allowable. Some aspects of Syringe Services Programs are allowable with HRSA's prior approval and in compliance with HHS and HRSA policy (see: https://www.hiv.gov/federal-response/policies-issues/syringe-services-programs). A State/Territory may not use more than 10 percent of amounts received under this grant for administration. However, if a State/Territory receives the minimum allotment, it may use more than 10% of the award if it is required to support one full-time equivalent employee for these activities. A State/Territory may not use more than 10 percent of amounts received under the grant for planning and evaluation activities. When combined, a State/Territory may not use more than 15 percent on administration, planning and evaluation. Clinical quality management (CQM) expenditures are not included in the administrative or planning and evaluation costs but are subject to a cap of the lesser of 5 percent of amounts received under the grant or $3,000,000. In addition, the aggregate total of administrative expenditures for subrecipients, including all indirect costs, may not exceed ten (10) percent of the aggregate amount of all subawards. Seventy-five (75) percent of grant funds must be obligated within 120 days of the budget period start date.

Not less than 75 percent of grant funds remaining after reserving funds for administration and clinical quality management must be used to provide core medical services. Core medical services include outpatient ambulatory health services, AIDS Drug Assistance Program (ADAP), local pharmaceutical assistance, oral health care, health insurance premium and cost-sharing, home health care, home and community-based health services, hospice services, early intervention services, medical nutritional therapy, substance abuse outpatient care, mental health services, and medical case management, including treatment adherence services. The remaining 25percent may be used for support services, including non-medical case management, childcare services, emergency financial assistance, food bank/home delivered meals, health education/risk reduction, housing services, linguistic services, psychosocial support services, rehabilitation services, respite care, and transportation that support a person with HIV to achieve better health outcomes. Funds may be used to establish and operate HIV Care Consortia that shall conduct planning, funding, monitoring, and reporting on behalf of the recipient. HIV Care Consortia are categorized under the support services category. A State/Territory shall use a percentage of the grant, determined by the percentage of women, infants, children, and youth with HIV/AIDS in the State, to provide core medical and support services to infants, children, youth, and women with HIV. Funds may not be used to make payments for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or service under any State compensation program, insurance policy, Federal or State health benefits program or by any entity that provides health services on a prepaid basis (except for a program administered by or providing the services to the Indian Health Service). Funds may not be used to purchase or improve land, or to purchase, construct or make permanent improvement to any building except for minor remodeling. Funds may not be used to make cash payments to intended recipients of Ryan White HIV/AIDS Program (RWHAP) services. Funds may not be used for pre-exposure prophylaxis (PrEP) or non-occupational post-exposure prophylaxis (nPEP) medications or the related medical services. Additionally, the purchase of sterile needles or syringes for the purposes of hypodermic injection of any illegal drug is not allowable. Some aspects of Syringe Services Programs are allowable with HRSA's prior approval and in compliance with HHS and HRSA policy (see: https://www.hiv.gov/federal-response/policies-issues/syringe-services-programs). A State/Territory may not use more than 10 percent of amounts received under this grant for administration. However, if a State/Territory receives the minimum allotment, it may use more than 10% of the award if it is required to support one full-time equivalent employee for these activities. A State/Territory may not use more than 10 percent of amounts received under the grant for planning and evaluation activities. When combined, a State/Territory may not use more than 15 percent on administration, planning and evaluation. Clinical quality management (CQM) expenditures are not included in the administrative or planning and evaluation costs but are subject to a cap of the lesser of 5 percent of amounts received under the grant or $3,000,000. In addition, the aggregate total of administrative expenditures for subrecipients, including all indirect costs, may not exceed ten (10) percent of the aggregate amount of all subawards. Seventy-five (75) percent of grant funds must be obligated within 120 days of the budget period start date.

Grants are awarded for a five-year period of performance composed of five 12-month budget periods.

Grants will be awarded to applicants that submit: (1) an acceptable detailed description of the HIV-related services provided in the State to individuals and families with HIV disease during the year preceding the year for which the grant is requested, and the number of individuals and families receiving such services; (2) a comprehensive plan for the organization and delivery of HIV health care and support services to be funded with assistance received under this part that shall include a description of the purposes for which the State intends to use such assistance; (3) an assurance that the public health agency administering the grant for the State will periodically convene a meeting of individuals with HIV, representatives of recipients receiving both HIV Emergency Relief and HIV CARE Grants, providers, and public agency representatives to develop a statewide coordinated statement of need; and (4) an assurance by the State that; (A) the public health agency that is administering the grant for the State will conduct public hearings concerning the proposed use and distribution of the assistance to be received; and (B) the State will (a) to the maximum extent practicable, ensure that HIV-related health care and support services delivered pursuant to a program established with assistance provided under this part will be provided without regard to the ability of the individual to pay for such services and without regard to the current or past health condition of the individual with HIV disease, (b) ensure that such services will be provided in a setting that is accessible to low-income individuals with HIV disease, (c) provide outreach to low-income individuals with HIV disease to inform such individuals of the services available, (d) for continuum of health insurance coverage, submit a plan to the Secretary that demonstrates that the State has established a program that assures that (d.1) such amounts will be targeted to individuals who would not otherwise be able to afford health insurance coverage and (d.2) income, asset, and medical expense criteria will be established and applied by the State to identify those individuals who qualify for assistance under such program, and information concerning such criteria shall be made available to the public, (e) provide for periodic independent peer review to assess that quality and appropriateness of health and support services provided by entities that receive funds from the State, (f) permit and cooperate with any Federal investigations undertaken regarding programs, (g) maintain HIV-related activities at a level that is equal to not less than the level of such expenditures by the State for the 1-year period preceding the fiscal year for which the State is applying to receive a grant, and (h) ensure that grant funds are not utilized to make payments for any item or service to the extent that payment has been made.

As required by the legislation, RWHAP Part B Base, ADAP Base, and Emerging Communities formula awards are based on the number of reported living cases of HIV/AIDS in the State or Territory in the most recent calendar year as confirmed by CDC and submitted to HRSA. Similarly, for recipients applying for Minority AIDS Initiative (MAI) formula funds, awards are based on the number of reported living minority HIV/AIDS cases for the most recent calendar year as confirmed by CDC and submitted to HRSA. ADAP Supplemental grants are awarded by formula based on living HIV/AIDS cases to states which meet any of the criteria listed in that section of the NOFO for the purpose of providing medications or insurance assistance for people with HIV. The ADAP Emergency Relief Funds (ERF) awards, for the purpose of cost containment activities for preventing, reducing or eliminating ADAP waiting lists, are disbursed via a formula based on a competitive application process with need-based criteria listed in the NOFO. In a separate, competitive application process, RWHAP Part B Supplemental funds are disbursed based on criteria specified by the legislation. All qualified applications for ADAP ERF and Part B Supplemental funds will be forwarded to an objective review committee (ORC). Based on the recommendations of the ORC, the HRSA program official with delegated authority is responsible for final selection and funding decisions. Notification is made in writing by a Notice of Award (NOA).