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Funding

Key Considerations

  • Health departments use a variety of funding sources to support D2C activities. Some jurisdictions fund their programs completely through a single funding stream, and some use a mix of sources or braided funding. The document chart below is divided into programmatic funding streams.
  • Because D2C is a cross-program effort, a single D2C program may be supported through a blend of care, prevention, and surveillance funding streams for different staff and program components.
  • This document resource is not exhaustive of all funding sources and does not include a menu of D2C activities but serves to identify possible sources of funding that jurisdictions may want to explore.
  • Some funding sources under the Ryan White HIV/AIDS Program (RWHAP) Part B program require jurisdictions to apply for funds that be awarded separately. These funds may require that clients’ meet program eligibility requirements.
  • Federal guidance is always changing. Please visit the included websites often for updates.
  • The decision about which funding stream(s) to use for a D2C program depends on many factors including the health department’s organizational structure, the type of D2C model, which staff members will be dedicating time to D2C activities, and other variables specific to your jurisdiction.

Funding Opportunities

Some examples of funding opportunities health departments can explore to support their D2C programming, along with the benefits and limitations of each, are below. We encourage that jurisdictions work closely with their respective federal program project officer to ensure compliance with federal and state policy in funding D2C activities in their jurisdiction.

HIV Surveillance and Prevention Funding (Integrated)

Source Benefits Limitations
Integrated HIV Surveillance and Prevention Funding PS18-1802 (Component A & B)
  • Funding can support staff positions.
  • Integrated funding may allow greater coordination between prevention and surveillance programs.
  • Programs must adhere to PS18-1802 reporting requirements.
  • Resource: Please refer to PS18-1802 for additional information.

HIV Care Funding (Non-ADAP Specific RWHAP Part B funding)

  • All activities supported under RWHAP Part B must be reported through The Ryan White HIV/AIDS Program Services Report (RSR).
  • Activities under RWHAP Part B must fit under an allowable service category and activity through HRSA. Please refer to HRSA HAB PCN 16-02 for the RWHAP service category definitions to ensure the D2C activity is allowable.
Source Benefits Limitations

RWHAP Part B Base
  • RWHAP Part B recipients can use funds to support linkage positions and activities.
  • Funds can support staffing and infrastructure investments through Early Intervention Service (EIS) (e.g., staffing, data systems). RWHAP funds may be used for Disease Intervention Specialist (DIS) work which can support D2C activities.

AIDS Drug Assistance Program (ADAP) Rebates

*Rebates can be earned through medication purchasing using any RWHAP Part B/ADAP funds, including state funds.
  • Funds are not subject to 10% administrative cap.
  • Rebates can be used for staffing and salaries (e.g. surveillance/data manager/re-engagement specialist staff, linkage to care coordinator). Funds may also support DIS work, D2C activities, and surveillance activities directly.
  • Federal regulations require that rebate funds are spent within the year they are received. If rebates are received at the end of a grant year, PCN 15-04 states that recipients can spend those rebates in the subsequent grant year prior to the expenditure of new RWHAP funds.
  • Jurisdictions should work with finance departments to take into consideration potential year-to-year changes in manufacturer rebate agreement terms and lag time in submitting and receiving rebate funds.
  • ADAP client enrollment and utilization may vary (i.e., insured/full-pay or insured/partial pay). ADAPs also conduct drug purchasing through different mechanisms which may result in potential fluctuation in rebate funds.

Resources:

RWHAP Part B Minority AIDS Initiative (MAI)

  • Funds can be used to provide outreach and education services to increase participation of communities of color in ADAP.
  • Programs must apply and receive RWHAP Part B MAI funding.
  • A 10% cap on administrative cost applies.
  • The award amount is formula-based on the number of reported people of color living with HIV/AIDS for the most recent calendar year.

Resources:

RWHAP Part B Supplemental
  • This is an additional funding opportunity for recipients with demonstrated need that choose to apply.
  • Funds can support Part B Program structural or operational changes.
  • Programs must receive/apply for RWHAP Part B Supplemental funding.
  • Funds are awarded to jurisdictions that demonstrate the need for additional RWHAP funds.
  • A 10% cap on administrative cost applies.

Resources:

Other “Outside of the Box” Funding Considerations:

  • Consider collaboration (or integrating funding) with RWHAP Part A or RWHAP Part C jurisdictions. Funds must be allocated to RWHAP Part B eligible activities and RWHAP Part B rules apply. HRSA project officers have authorized fund sharing with Part RWHAP Part As and layering/braiding RWHAP Part A and RWHAP Part B funding together.
  • Some jurisdictions may be able to utilize Medicaid 1115 waiver funds for service linkage or re-linkage.
  • Explore using program income. In the context of the RWHAP, program income is most commonly generated by recipients and subrecipients as a result of charging for services and receiving payment from third-party reimbursement. Recipients are required to track and account for all program income in accordance with 45 CFR § 75.302(b)(3). Recipients must report program income on their Federal Financial Report (FFRs). For more information, please refer to PCN 15-03: Clarifications Regarding the Ryan White HIV/AIDS Program and Program Income.
  • State/local general revenue funds may be allocated to RWHAP Part B, surveillance, or prevention. State rules the allocation funds and may govern how they may be used if they are general funds. Funds may be earmarked for a specific activity by the state legislature.

D2C State Funding Examples1

1 Health Departments provided their approval and permission to share these examples.

Additional resources and references for D2C funding:

Identifying and Addressing Funding Barriers

Jurisdictions may face additional barriers in funding activities. Some health departments may have restrictive or complicated administrative policies around hiring that present hurdles to acquiring new staff positions for D2C, even if funding is available. Jurisdictions may find it helpful to explore ways to address these barriers. Some solutions may involve subcontracting with other entities, exploring whether state laws allow extension of public health authority to subrecipients, and other options to enable a D2C program to operate effectively. Managing multiple funding streams can also pose challenges. For example, determining differing eligibility and reporting requirements from each source can become burdensome for the health department or grantees. Various funding streams may be managed in different offices or even at different agencies within the state which can be challenging. For low prevalence health departments with small numbers of staff, the burden associated with using several funding streams for one activity may be too laborious to be beneficial. It is important for your program to know what types of resources and activities are allowable under each service category (e.g., linkage to care, transportation, etc.) to be able to shift which activities are funded through which categories. Programs should also plan for sustainability when deciding how to fund their program. This includes attempting to forecast and plan for any anticipated changes in future funding when possible.

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