Audit of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, Title II Administered by the State of Connecticut

EXECUTIVE SUMMARY:

The State of Connecticut (State) should improve its management system to ensure that (1) reliable information is used in reporting that the State maintains its required level-of-effort for HIV- related activities, and (2) Ryan White Comprehensive AIDS Resources Emergency Act of 1990, Title II (CARE Act) funds are used as the payor of last resort.

Reporting State HIV-Related Activities: Level-of-Effort

Annually, the Governor provided the required assurances that the State will maintain its required level-of-effort for HIV-related activities. The Department of Public Health (DPH), however, could not support the Governor's assurances that the State would maintain its required level-of-effort for HIV-related activities. In this respect, DPH's reports of State funded HIV-related expenditures were not based on reliable information. This occurred because DPH did not provide State departments with guidance nor did DPH review and verify submitted data. As such, DPH has no assurance that the State has or will maintain HIV-related activities at the required level.

Care Act Funds as Payor of Last Resort

Contrary to Federal requirements, DPH utilized CARE Act funds to pay for items or services when other funds were available. For the five years ended June 30, 1995, DPH used CARE Act funds to pay $995,000 for drug assistance (Connecticut AIDS Drug Assistance Program) when State funds were available. Further, data provided by the Connecticut Department of Correction (DoC) indicates a significant portion of another $635,000 (fiscal years 1995 and 1996 only) was used for case management services provided to inmates who were the responsibility of DoC or the parole board. This occurred because the DPH did not: (1) provide specific guidance to State departments specifying that the departments are required to use available State funds before using CARE Act funds, (2) monitor the implementation of the payor of last resort requirement, and (3) establish a mechanism whereby the State pays for the services provided to inmates who remain under the custody of the DoC or the parole board.

By utilizing CARE Act funds when other funding is available, the DPH is not maximizing the possible services available to individuals with HIV. The DPH could have possibly provided additional HIV-related services to meet gaps in services identified by local or statewide HIV CARE Consortium.

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