Improving Ryan White HIV/AIDS Program Part A and B Formula Awards Using Most Recent Address Data

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

Improving Ryan White HIV/AIDS Program Part A and B Formula Awards Using Most Recent Address Data

AGENCY:

Health Resources and Services Administration (HRSA), Department of Health and Human Services

ACTION:

Notice.

SUMMARY:

The Ryan White HIV/AIDS Program (RWHAP) Part A and B funding formulas are defined by the Public Health Service (PHS) Act and rely on the living HIV/AIDS cases reported to and confirmed by the Centers for Disease Control and Prevention (CDC). Advancements in HIV surveillance have improved the mapping of the epidemic, leading to better care strategies. Since 2017, CDC has shifted to using the most recent addresses of people with HIV for reporting, raising questions about whether RWHAP funds follow clients or remain in the jurisdiction of diagnosis. HRSA has analyzed the effects of this updated methodology on formula funding and is now seeking public feedback on proposed changes to better direct resources to where clients currently live and receive care.

DATES:

Submit comments no later than December 10, 2025.

ADDRESSES:

Written or electronic comments should be submitted to Division of Policy and Data, HRSA, HIV/AIDS Bureau, 5600 Fishers Lane, Rockville, MD 20857, or

RyanWhiteComments@hrsa.gov

.

FOR FURTHER INFORMATION CONTACT:

Paul Mandsager, Senior Public Health Analyst, Division of Policy and Data, HRSA, HIV/AIDS Bureau, 5600 Fishers Lane, Rockville, MD 20857, Phone 301-594-4055, Email

RyanWhiteComments@hrsa.gov

.

SUPPLEMENTARY INFORMATION:

The RWHAP Part A formula is set forth in the RWHAP authorizing statute at § 2603(a) of the PHS Act, 42 U.S.C. 300ff-13(a), and is based on the relative distribution of living HIV/AIDS cases within a statutorily specified metropolitan area reported to and confirmed by CDC. The RWHAP Part B formulas are found in §§ 2618(a)(2) and (a)(2)(F) of the PHS Act, 42 U.S.C. 300ff-28(a)(2) and (a)(2)(F) and use weighted or relative distribution of living HIV/AIDS cases within the state reported to and confirmed by CDC.

Recent advancements in HIV surveillance data have resulted in more accurate mapping of the HIV epidemic, allowing for more efficient and effective HIV care and treatment efforts at the state, local, and national levels. As a result of these advancements, beginning in 2014, CDC began the transition to reporting surveillance data based on the most recent address of a person with HIV, usually reported via CD4/viral load lab reports, rather than residence at HIV diagnosis. Since that time, HRSA has received several inquiries about whether RWHAP funds follow clients as they move or if the funds stay in the jurisdiction in which the clients were originally diagnosed.

HRSA conducted multiple analyses on the impact the updated HIV surveillance data would have on the RWHAP Part A and B formula award funding after maturation of the CDC methodology and when all jurisdictions were reporting most recent address to CDC. Now that this transition has been fully realized, to better allocate resources to the jurisdictions where clients currently reside and receive care, HRSA is seeking public comment on this proposed change in methodology and timing.

Proposed Methodology

The funding methodology used to calculate RWHAP Part A and B formula awards would use living HIV and AIDS case data based on most recent address, rather than residence at diagnosis, with a phase-in timeline and use of appropriate action to minimize funding fluctuations.

The methodology for determining RWHAP Part A and B eligibility would remain unchanged.

Proposed Timing of Implementation

The statute requires the use of “distribution factor” but the distribution factor requires only that the data be reported to and confirmed by CDC. Once CDC certifies that the data are sufficiently robust to confirm, HRSA has the authority to accept those data based on the most recent address. It does not, however, have the authority to phase in that change without providing the public with notice and an opportunity to comment.

HRSA determined that using most recent address data without a phased approach would lead to a disruption in the HIV care and treatment system across RWHAP Part A and Part B jurisdictions as some would experience substantial funding increases or decreases. HRSA is therefore proposing a phased approach over a 5-year period (fiscal year (FY) 2026 to FY 2030) to allow for a gradual transition. Any funding increase or decrease that occurs in year one (FY 2026) as a result of the new methodology will be spread out over a 5-year period (see Tables 1 and 2). This will minimize disruption and ensure that recipients and systems of care have the time and resources to adapt. By gradually phasing in the changes, RWHAP recipients can better manage potential increases or decreases in funding and adjust their resource allocation strategies accordingly.

The RWHAP statute included a phased approach for implementation of a similar change from code-based HIV case surveillance reporting to name-based reporting in prior RWHAP reauthorizations. The statutory language permitted a phased approach to minimize disruption, allow for implementation on the local level, and for CDC verification of data. This prior approach is codified at § 2603(a)(3)(C) of the PHS Act, 42 U.S.C. 300ff-13(a)(3)(C), and § 2618(a)(2)(D) of the PHS Act, 42 U.S.C. 300ff-28(a)(2)(D). HRSA proposes to use the same phased approach as was used in the transition from code-based to name-based HIV reporting and seeks public comment on this proposal.

Table 1—Estimated Future Part A Total Awards, 5-Year Transition

[Based on the FY 2025 Appropriation, not any future appropriations]

Part A jurisdiction

FY 2025

final

FY 2026

FY 2027

FY 2028

FY 2029

FY 2030

Est. % change

FY 2025-

FY 2030

Atlanta, GA

$32,339,493

$32,974,435

$33,609,378

$34,244,320

$34,879,263

$35,514,205

10

Austin, TX

5,702,606

5,769,180

5,835,753

5,902,327

5,968,900

6,035,474

6

Baltimore, MD

15,660,695

15,631,048

15,601,402

15,571,755

15,542,109

15,512,462

−1

Baton Rouge, LA

4,551,433

4,540,914

4,530,395

4,519,876

4,509,357

4,498,838

−1

Boston, MA

15,183,838

15,195,167

15,206,495

15,217,824

15,229,152

15,240,481

0

Charlotte, NC

6,913,452

6,897,092

6,880,732

6,864,371

6,848,011

6,831,651

−1

Chicago, IL

27,666,573

27,284,549

26,902,525

26,520,500

26,138,476

25,756,452

−7

Cleveland, OH

4,772,432

4,773,163

4,773,894

4,774,625

4,775,356

4,776,087

0

Columbus, OH

5,006,629

4,994,876

4,983,123

4,971,369

4,959,616

4,947,863

−1

Dallas, TX

21,184,061

21,442,742

21,701,423

21,960,103

22,218,784

22,477,465

6

Denver, CO

7,340,580

7,368,672

7,396,764

7,424,857

7,452,949

7,481,041

2

Detroit, MI

10,075,549

9,998,181

9,920,813

9,843,444

9,766,076

9,688,708

−4

Fort Lauderdale, FL

16,023,456

16,393,018

16,762,580

17,132,143

17,501,705

17,871,267

12

Fort Worth, TX

5,547,578

5,642,526

5,737,474

5,832,422

5,927,370

6,022,318

9

Hartford, CT

2,944,998

2,951,034

2,957,070

2,963,107

2,969,143

2,975,179

1

Houston, TX

27,558,403

27,795,071

28,031,740

28,268,408

28,505,077

28,741,745

4

Indianapolis, IN

4,910,030

4,898,222

4,886,414

4,874,605

4,862,797

4,850,989

−1

Jacksonville, FL

6,108,505

6,117,798

6,127,091

6,136,385

6,145,678

6,154,971

1

Kansas City, MO

4,513,410

4,415,080

4,316,750

4,218,421

4,120,091

4,021,761

−11

Las Vegas, NV

7,551,492

7,755,684

7,959,876

8,164,067

8,368,259

8,572,451

14

Los Angeles, CA

46,295,740

45,729,574

45,163,409

44,597,243

44,031,078

43,464,912

−6

Memphis, TN

6,902,702

6,886,126

6,869,550

6,852,973

6,836,397

6,819,821

−1

Miami, FL

26,788,349

26,566,917

26,345,485

26,124,054

25,902,622

25,681,190

−4

Mineola, NY

5,653,528

5,638,727

5,623,925

5,609,124

5,594,322

5,579,521

−1

Minneapolis, MN

6,129,008

6,180,187

6,231,366

6,282,546

6,333,725

6,384,904

4

Nashville, TN

4,443,640

4,432,440

4,421,239

4,410,039

4,398,838

4,387,638

−1

New Brunswick, NJ

2,803,890

2,764,620

2,725,349

2,686,079

2,646,808

2,607,538

−7

New Haven, CT

5,273,601

5,275,392

5,277,183

5,278,974

5,280,765

5,282,556

0

New Orleans, LA

8,058,405

7,911,429

7,764,453

7,617,477

7,470,501

7,323,525

−9

New York, NY

89,662,231

90,053,722

90,445,213

90,836,703

91,228,194

91,619,685

2

Newark, NJ

12,277,381

12,122,018

11,966,656

11,811,293

11,655,931

11,500,568

−6

Norfolk, VA

5,990,787

5,892,750

5,794,712

5,696,675

5,598,637

5,500,600

−8

Oakland, CA

7,360,883

7,304,436

7,247,989

7,191,542

7,135,095

7,078,648

−4

Orlando, FL

10,939,376

11,032,797

11,126,219

11,219,640

11,313,062

11,406,483

4

Paterson, NJ

3,918,044

3,864,059

3,810,075

3,756,090

3,702,106

3,648,121

−7

Philadelphia, PA

22,766,093

22,594,485

22,422,877

22,251,268

22,079,660

21,908,052

−4

Phoenix, AZ

11,049,463

11,194,456

11,339,448

11,484,441

11,629,433

11,774,426

7

Portland, OR

4,088,295

4,182,057

4,275,820

4,369,582

4,463,345

4,557,107

11

Sacramento, CA

3,832,752

3,919,081

4,005,410

4,091,739

4,178,068

4,264,397

11

Saint Louis, MO

6,388,344

6,243,701

6,099,057

5,954,414

5,809,770

5,665,127

−11

San Antonio, TX

6,221,586

6,228,572

6,235,558

6,242,543

6,249,529

6,256,515

1

San Bernardino, CA

9,283,666

9,971,030

10,658,395

11,345,759

12,033,124

12,720,488

37

San Diego, CA

12,325,778

12,221,689

12,117,599

12,013,510

11,909,420

11,805,331

−4

San Francisco, CA

14,841,000

14,267,393

13,693,786

13,120,180

12,546,573

11,972,966

−19

San Jose, CA

3,496,090

3,418,963

3,341,836

3,264,708

3,187,581

3,110,454

−11

San Juan, PR

10,360,633

10,045,103

9,729,573

9,414,043

9,098,513

8,782,983

−15

Santa Ana, CA

6,679,132

6,523,893

6,368,654

6,213,416

6,058,177

5,902,938

−12

Seattle, WA

7,189,780

7,135,849

7,081,919

7,027,988

6,974,058

6,920,127

−4

Secaucus, NJ

4,797,408

4,679,436

4,561,464

4,443,491

4,325,519

4,207,547

−12

Tampa, FL

10,650,266

10,961,615

11,272,965

11,584,314

11,895,664

12,207,013

15

Washington, DC

32,044,482

31,995,758

31,947,034

31,898,309

31,849,585

31,800,861

−1

West Palm Beach, FL

7,428,827

7,419,646

7,410,465

7,401,284

7,392,103

7,382,922

−1

Table 2—Estimated Future Part B Total Awards, 5-Year Transition

[Based on the FY 2025 Appropriation, not any future appropriations]

Part B grantee

FY 2025

final *

FY 2026

FY 2027

FY 2028

FY 2029

FY 2030

Est. % change

FY 2025-

FY 2030

Alabama

$20,126,410

$19,941,311

$19,756,212

$19,571,114

$19,386,015

$19,200,916

−5

Alaska

1,057,741

1,055,218

1,052,695

1,050,173

1,047,650

1,045,127

−1

Arizona

17,593,880

17,802,676

18,011,473

18,220,269

18,429,066

18,637,862

6

Arkansas

8,467,112

8,412,595

8,358,077

8,303,560

8,249,042

8,194,525

−3

California

140,896,380

139,520,418

138,144,456

136,768,493

135,392,531

134,016,569

−5

Colorado

13,159,341

13,301,576

13,443,811

13,586,047

13,728,282

13,870,517

5

Connecticut

10,028,100

10,018,521

10,008,941

9,999,362

9,989,782

9,980,203

0

Delaware

4,559,579

4,643,438

4,727,296

4,811,155

4,895,013

4,978,872

9

District of Columbia

15,877,251

15,577,494

15,277,736

14,977,979

14,678,221

14,378,464

−9

Florida

117,953,889

118,297,990

118,642,091

118,986,193

119,330,294

119,674,395

1

Georgia

65,937,492

66,625,016

67,312,540

68,000,063

68,687,587

69,375,111

5

Hawaii

3,352,217

3,285,288

3,218,358

3,151,429

3,084,499

3,017,570

−10

Idaho

1,567,448

1,639,775

1,712,102

1,784,428

1,856,755

1,929,082

23

Illinois

43,632,706

42,894,324

42,155,943

41,417,561

40,679,180

39,940,798

−8

Indiana

14,826,971

14,923,455

15,019,939

15,116,423

15,212,907

15,309,391

3

Iowa

3,671,105

3,783,456

3,895,806

4,008,157

4,120,507

4,232,858

15

Kansas

3,874,733

3,864,859

3,854,986

3,845,112

3,835,239

3,825,365

−1

Kentucky

10,928,564

11,047,437

11,166,309

11,285,182

11,404,054

11,522,927

5

Louisiana

23,907,778

23,576,125

23,244,472

22,912,820

22,581,167

22,249,514

−7

Maine

1,744,812

1,866,696

1,988,579

2,110,463

2,232,346

2,354,230

35

Maryland

31,501,279

31,596,615

31,691,952

31,787,288

31,882,625

31,977,961

2

Massachusetts

20,049,557

20,111,599

20,173,642

20,235,684

20,297,727

20,359,769

2

Michigan

18,646,797

18,494,389

18,341,980

18,189,572

18,037,163

17,884,755

−4

Minnesota

8,739,953

8,871,333

9,002,713

9,134,092

9,265,472

9,396,852

8

Mississippi *

14,270,758

14,037,073

13,803,388

13,569,703

13,336,018

13,102,333

−8

Missouri

13,771,559

13,679,499

13,587,439

13,495,380

13,403,320

13,311,260

−3

Montana

868,081

897,158

926,235

955,311

984,388

1,013,465

17

Nebraska

3,366,792

3,400,072

3,433,352

3,466,632

3,499,912

3,533,192

5

Nevada

10,233,918

10,494,661

10,755,404

11,016,148

11,276,891

11,537,634

13

New Hampshire

1,408,963

1,453,490

1,498,017

1,542,545

1,587,072

1,631,599

16

New Jersey

36,785,442

36,225,650

35,665,857

35,106,065

34,546,272

33,986,480

−8

New Mexico

4,461,845

4,593,522

4,725,199

4,856,877

4,988,554

5,120,231

15

New York

121,693,828

121,502,862

121,311,896

121,120,931

120,929,965

120,738,999

−1

North Carolina

36,933,968

37,344,393

37,754,819

38,165,244

38,575,670

38,986,095

6

North Dakota

865,271

870,269

875,267

880,265

885,263

890,261

3

Ohio

25,253,858

25,312,408

25,370,959

25,429,509

25,488,060

25,546,610

1

Oklahoma *

9,505,525

9,559,364

9,613,203

9,667,041

9,720,880

9,774,719

3

Oregon

6,647,795

6,823,869

6,999,943

7,176,016

7,352,090

7,528,164

13

Pennsylvania

41,565,377

42,048,395

42,531,413

43,014,432

43,497,450

43,980,468

6

Puerto Rico

20,773,717

20,155,207

19,536,697

18,918,186

18,299,676

17,681,166

−15

Rhode Island

3,586,062

3,617,595

3,649,129

3,680,662

3,712,196

3,743,729

4

South Carolina

25,101,893

25,026,412

24,950,930

24,875,449

24,799,967

24,724,486

−2

South Dakota

1,018,404

1,028,291

1,038,178

1,048,066

1,057,953

1,067,840

5

Tennessee

19,798,995

19,775,561

19,752,126

19,728,692

19,705,257

19,681,823

−1

Texas

118,321,330

118,926,803

119,532,276

120,137,749

120,743,222

121,348,695

3

Utah

5,084,544

5,130,773

5,177,003

5,223,232

5,269,462

5,315,691

5

Vermont

863,866

895,162

926,459

957,755

989,052

1,020,348

18

Virginia

25,905,308

25,818,054

25,730,801

25,643,547

25,556,294

25,469,040

−2

Washington

15,920,820

16,212,199

16,503,578

16,794,956

17,086,335

17,377,714

9

West Virginia

2,779,989

2,808,260

2,836,530

2,864,801

2,893,071

2,921,342

5

Wisconsin

8,976,297

9,042,676

9,109,055

9,175,435

9,241,814

9,308,193

4

Wyoming

759,202

763,113

767,024

770,936

774,847

778,758

3

Guam

280,781

279,217

277,652

276,088

274,523

272,959

−3

Virgin Islands

966,648

951,454

936,259

921,065

905,870

890,676

−8

American Samoa

50,001

50,004

50,007

50,009

50,012

50,015

0

Marshall Islands

50,702

50,699

50,696

50,694

50,691

50,688

0

Mariana Island

59,834

59,794

59,755

59,715

59,676

59,636

0

Republic of Palau *

56,322

56,297

56,271

56,246

56,220

56,195

0

F. States Micronesia

50,702

50,975

51,247

51,520

51,792

52,065

3

Note:

Mississippi, Oklahoma, and Palau FY 2025 amounts are estimates that do not include penalties assessed in FY 2025 and as such do not reflect actual FY 2025 funding amounts.

Thomas J. Engels,

Administrator.

[FR Doc. 2025-19838 Filed 11-7-25; 8:45 am]

BILLING CODE 4165-15-P