Year of Publication



Martin School of Public Policy and Administration

Executive Summary

The Ryan White CARE Act of 1991 implemented a federal grant program to help individuals in the US with HIV/AIDS get access to healthcare and diminish barriers to care. Since its enactment, there have been many changes in the environment of HIV/AIDS, including a demographic shift in those most affected by the disease and a growing number of new infections, the introduction of Antiretroviral therapy, and most recently, the implementation of the Patient Protection and Affordable Care Act (PPACA).

The PPACA is expected to have a positive effect on patients with HIV in the US by increasing access to care, however it brings into question the future of the Ryan White grant, and the clinics, which have relied on Ryan White funds to provide comprehensive HIV care. Clinics are faced with the challenges of providing care and meeting public health goals in the middle of a changing healthcare system. The following paper asks and answers how the Ryan White funded Bluegrass Care Clinic is affected by changes in the US healthcare system and how its administrators must plan for an uncertain future while meeting national and local public health goals.

The known effects of healthcare reform on the Bluegrass Care Clinic include a significant change in coverage patterns. This change includes a decrease in uninsured patients, and an increase in insured patients through the PPACA’s exchange, and more patients enrolled in state Medicaid. Many other effects are yet to be fully realized, but projections exist. All of these known and projected effects warrant some planning by the clinic to respond to the changes, while continuing to fulfill its mission and striving to meet public health goals, such as lowering rates of transmission.