Letter: To Elizabeth M. Duke, Administrator, Health Resources & Services Administration

Letter

Dear Administrator Duke:

We are writing to express our strong support for the Hartford/Tolland/Middlesex Counties Transitional Grant Area (TGA) and the New Haven/Fairfield Counties TGA's request for supplemental Title I funding. Connecticut's TGAs have suffered a tremendous loss of Title I funding because of how P.L. 109-415, the Ryan White HIV/AIDS Treatment Modernization Act of 2006, has been administered and we urge you to factor in these losses when you make Title I supplemental funding decisions in the near future.

Under P.L. 109-415 both the Hartford/Tolland/Middlesex County Eligible Metropolitan Area (EMA) and the New Haven/Fairfield EMA were designated as TGAs. At the same time, P.L. 109-415 designated Connecticut as not having an HIV reporting system that was in operation as of December 31, 2005, that provided sufficiently accurate and reliable names-based reporting of such cases. As a result, HIV data from the Health Resources & Services Administration (HRSA) was to be used to determine prevalence rates for HIV/AIDS in Connecticut. However, it is our understanding that HRSA has treated Connecticut as if its HIV reporting system was sufficiently accurate and reliable as of December 31, 2005 for purposes of determining Title I formula awards for Fiscal Year 2007. As a result of HRSA actions, New Haven's formula award was reduced by $353,677 and Hartford's formula award was reduced by $370,732 - a total loss of at least $724,409 in funding for HIV/AIDS care in Connecticut.

We have reason to believe that the Centers for Disease Control and Prevention's (CDC) prevalence numbers for people living with HIV in Connecticut do not reflect the true impact of this disease in our state. Supporting this belief is that fact that Connecticut is not designated in P.L. 109-415 as a state which has a sufficiently accurate and reliable names-based reporting system. It will take time before Connecticut's new system for names-based reporting of HIV data is fully operational and mature. We would like to know what prevalence numbers HRSA used to determine Title I formula funding. If HRSA used prevalence numbers as reported by CDC, we would like to know why that occurred.

These formula changes will have a detrimental impact on people living with HIV/AIDS in Connecticut. Services supported by Title I grants include community-based outpatient medical and dental care, rehabilitative services, home health and hospice care, transportation and housing assistance, nutrition services, and respite care. Cuts in funding of this magnitude will create new and significant barriers to HIV/AIDS care and treatment and will doubtlessly jeopardize successful health outcomes for people living with HIV/AIDS.

Because the Title I formula grant announcement is so recent, Connecticut's TGAs will not have the opportunity to demonstrate need in their application for supplemental Title I Ryan White funding pursuant to section 103 of P.L. 109-415. We believe this precipitous loss in formula funding for Connecticut's TGAs will result in a significant reduction of services to residents living with HIV/AIDS. As such, we believe Connecticut's TGAs should receive priority in the supplemental grant-making process.

Thank you for your consideration of our request. We have sent a similar letter to Health and Human Services Secretary Michael Leavitt so that he is aware of the situation in Connecticut. We look forward to your response and want to continue to work with you to protect individuals living with HIV/AIDS in Connecticut.

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