San Diego is bracing for further cuts to funding from the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which is on its way to being reauthorized for the first time since 2000.

After numerous delays, the House agreed by voice vote on Dec. 9 to renew the $2.1 billion-annual law. The Ryan White Treatment Modernization Act (HR 6143) is a compromise bill that calls for strengthening “hold harmless” provisions for maintaining funding levels so that states would not receive less than 95 percent of their 2006 funding levels and counting all HIV-positive people for funding regardless of where they live or how the data is reported, according to the Kaiser Network’s Dec. 11 daily HIV/AIDS report. HR 6143 now sits before President Bush, and he is expected to sign it.

Earlier this year, five senators blocked Senate consideration of a House-approved bill sponsored by Rep. Mary Bono, R-Calif., that would change CARE Act funding formulas so that rural areas experiencing increasing numbers of HIV/AIDS cases would receive higher funding amounts and urban areas’ funding would decrease, according to the Kaiser Network.

“It [the bill] basically did damage to some of the infrastructure of the areas that have been dealing with the epidemic the longest,” said Terry Cunningham, chief of San Diego County’s Health and Human Services Agency, HIV, STD and Hepatitis Branch. “This way, it’s a more equitable distribution and will allow some time for areas to really investigate the needs in the various areas.”

CARE Act funds are distributed to many GLBT-related organizations within San Diego County.

Mama’s Kitchen executive director Alberto Cortes said CARE Act funds are the largest single source of funding for the nonprofit meal delivery service dedicated to San Diegans affected by HIV/AIDS and other critical illnesses.

“As a service provider, I know that and I suspect that other service providers would likely feel the same way – that these dollars are significant for our capacity to provide our services,” Cortes said. “Ryan White dollars for Mama’s Kitchen represent about 17 percent of our annual budget. The reduction or elimination of those dollars would have an impact on the services that we provide.”

The Center’s chief executive officer, Delores Jacobs, said that although it took Congress a long time to agree to a reauthorization, she hopes the agreed upon three-year time frame doesn’t pose a reauthorization problem in the future.

“There are some changes in this reauthorization that might be wise to re-evaluate sooner than later, once we can see how it is [or] is not working,” she said.

Jacobs said The Center receives CARE Act funds through San Diego County, comprising about 30 percent of The Center’s overall budget. She said funds are used for mental health/behavioral health care services for people living with HIV/AIDS and support for the San Diego HIV Planning Council.

Earlier this year, the continued federal HIV/AIDS funding cuts to the CARE Act Title I/II monies have forced the San Diego HIV Planning Council to make cuts for the third consecutive year, reducing services for HIV/AIDS consumers in San Diego County by $476,914 (approximately 5.2 percent.) This made the total operating budget stand at a little more than $9 million for the contract year, which began March 1 and ends Feb. 28.

According to The Associated Press, California gets $260 million annually under the CARE Act and legislators had urged passage of the compromise.

Cunningham said he anticipates another cut in CARE Act funding to San Diego County.

“We planned for a 5-percent decrease just in case. I don’t know exactly how with the new language whether that will hold true or not,” he said. “It’s quite possible we’ll see a 5-percent decrease.”

After Gov. Arnold Schwarzenegger signed Senate Bill 699 into law on April 17, HIV infections are now tracked by name in California. The bill changed the current HIV tracking system from one based on an alphanumeric code assigned to each patient to one based on patient names.

Earlier this year, Schwarzenegger said maximizing CARE Act funding is a high priority for his administration and is critical to maintaining needed services, including access to life-saving medications for more than 25,000 Californians living with HIV or AIDS.

Cunningham said the formula part of the reauthorized CARE Act award to each state will be based on a two-thirds full-blown AIDS case count and a one-third HIV case count.

“The Centers for Disease Control really dictated that we had to have HIV names reporting by 2007, and so we knew the legislation was going to go toward HIV names reporting,” Cunningham said. “In San Diego, the first year of the CARE Act is going to be difficult for us because we didn’t have any HIV numbers to turn in as of June 30. We will get a decrease with that, but I think that we need to look at the benefits of counting HIV overall. That will give us a lot clearer picture of where the epidemic is going.”

The CARE Act was originally supposed to be reauthorized by Sept. 30, 2005, when it expired.

The Senate passed the revised bill earlier this month after the five senators from New York and New Jersey dropped their opposition, accepting this compromise that settled months of dispute just as Congress adjourned for the year, according to AP.

Sen. Hillary Rodham Clinton, D-N.Y., and other New York and New Jersey lawmakers agreed to the proposal crafted by Sen. Edward Kennedy, D-Mass., ranking Democrat on the Health, Education, Labor and Pension (HELP) Committee.

“We have addressed the epidemic of today, not yesterday, by modernizing the Ryan White CARE Act to ensure federal funds follow the person being treated – wherever they live,” HELP chair Michael Enzi, R-Wyo., told AP.