Improving Ryan White HIV/AIDS Program Part A and B Formula Awards Using Most Recent Address Data
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 co...
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.
( printed page 50748)
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
( printed page 50749)
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
( printed page 50750)
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.
Use this for formal legal and research references to the published document.
90 FR 50747
Web Citation
Suggested Web Citation
Use this when citing the archival web version of the document.
“Improving Ryan White HIV/AIDS Program Part A and B Formula Awards Using Most Recent Address Data,” thefederalregister.org (November 10, 2025), https://thefederalregister.org/documents/2025-19838/improving-ryan-white-hiv-aids-program-part-a-and-b-formula-awards-using-most-recent-address-data.