Review of Ryan White Title II Funding in Pennsylvania

Pennsylvania did not always comply with Federal requirements in administering funds provided under Title II of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990. From April 1, 2004, through March 31, 2007, Pennsylvania claimed at least $3.2 million ($2.2 million Federal share) that did not comply with the Title II requirements that funds be used only for eligible clients and only for drugs that are not eligible for coverage by other Federal, State, or private health insurance plans. The $3.2 million consisted of at least $2.7 million ($1.8 million Federal share) in estimated unallowable payments based on our sample of payments made for clients under the age of 65 and $542,000 ($364,000 Federal share) for payments made for clients aged 65 or older.

Title II grants fund the purchase of medications through the AIDS Drug Assistance Program (ADAP) and other health care and support services for people who have HIV/AIDS and who have no health insurance or are underinsured. At the Federal level, the Health Resources and Services Administration administers the CARE Act.

We recommended that Pennsylvania (1) refund $2.2 million to the Federal Government, (2) review clients identified by this review as ineligible or having other health insurance to determine whether additional Title II payments made outside the audit period were improper, (3) review and validate information provided by clients on their ADAP applications before admitting clients to the program, and (4) ensure that the ADAP is considered the payer of last resort for clients who are enrolled in both the ADAP and the State's Pharmaceutical Assistance Contract for the Elderly program. The State generally agreed with our findings and outlined its actions to address our recommendations.