Department  of Health  and Human  Services 
OFFICE  OF 
INSPECTOR  GENERAL 
THE  RYAN  WHITE  CARE  ACT: 
H  1992
TITLE  1AND  TITLE  II EXPENDITURES 
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05-93-00331  OFFICE  OF INSPE~OR  GENERAL 
The  mission of the  Office of Inspector  General  (OIG),  as mandated  by Public  Law 95-452, as 
amended,  is to protect  the  inte@y  of the Department  of Health  and Human  Semites  (HHS) 
programs  as well as the  health  and welfare  of beneficiaries  send  by those  programs.  This 
statutory  mission is carried  out  through  a nationwide  network  of audita, investigations,  and 
inspections  conducted  by three  OIG  operating  components:  the  Offke  of Audit  Services,  the 
Office of Investigations,  and the  Offke  of Evaluation  and Inspections.  The  OIG  also informs 
the Secretary  of HHS  of program  and management  problems  and recommends  courses  to 
correct  them. 
OFFICE  OF AUDIT  SERVICES 
The  OIGS  Office of Audit  Semkes  (OAS)  provides  all auditing  semices  for HHS,  either  by 
conducting  audits  with its own audit resources  or by overseeing  audit work  done  by others. 
Audits  examine  the  performance  of HHS  programs  and/or  its grantees  and contractors  in 
carrying out  their  respective  responsibilities  and are intended  to provide  independent 
assessments  of HHS  programs  and operations  in order  to reduce  waste,  abuse,  and 
mismanagement  and to promote  economy  and efficiency throughout  the  Department. 
OFFICE  OF INVESTIGA~ONS 
The  OIGS  Office of Investigations  (01)  conducts  criminal,  civil, and administrative

investigations  of allegations  of wrongdoing  in HHS  programs  or to HHS  beneficiaries  and of

unjust  enrichment  by providers.  The  investigative  efforts  of 01  lead to criminal  convictions,

administrative  sanctions,  or civil money  penalties.  The  01  also oversees  State  Medicaid  fraud

control  units which investigate  and prosecute  fraud and patient  abuse  in the  Medicaid  program.

OFFICE OF EVALUATION  AND INSPECIIONS 
The  OIGS  Office of Evaluation  and Inspections  (OEI)  conducts  short-term  management  and

program  evaluations  (called  inspections)  that  focus on issues of concern  to the  Department,

the  Congress,  and the  public.  The  findings  and recommendations  contained  in these  inspection

reports  generate  rapid,  accurate,  and up-todate  information  on the  efilciency,  vulnerability,

and effectiveness  of departmental  programs.

This report  was prepared  under  the  direction  of William Moran,  the  Regional  Inspector

General,  and Natalie  Coen,  Deputy  Regional  lrtspector  General,  for the  Office  of Evaluation

and Inspections,  Region  V.  Participating  in this project  were the  following  people:

Retrion  V  Headquarters

Barbara  But~  Project  Leader  Alan  S. Levine

Jean  Dufresne

Ellen  Meara

Heather  Robertson

For  a copy of this report,  please  call (312) 3534124,
 Department  of Health  and Human  Services 
OFFICE  OF

INSPECTOR  GENERAL 
THE  RYAN  WHITE  CARE  ACT:

~ 
TITLE  I AND  TITLE  II EXPENDITURES 
1992 
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JUNE  GIBBS BROWN 
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05-93-00331  TABLE  OF  CONTENTS

PAGE 
~ODU~ON  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...1

FINDINGS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...4

Combined  Expenditures  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...5

Title  IExpwditures...  . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...8

Title  II Expenditures  . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  13

CONCLUSIONS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  19

APPENDICES

ASurnmary  Chart  of Expenditures  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-1

B:  Title  II Expenditures  by Option  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  B-1
 INTRODUCTION

PURPOSE

To  describe  grantee  expenditures  in Fiscal  Year  1992 for Title  I and  Title  II of the

Ryan  White  Act.

BACKGROUND

On August  18, 1990 Congress  passed  Public  Law  101-381 entitled  The  Ryan  White

Comprehensive  AIDS  Resources  Emergency  (CARE)  Act  of 1990 (the  Act).  The  Act

was created  as a comprehensive  response  to  the  Human  Immunodeficiency  Virus

(HIV)  epidemic  and  its impact  on individuals,  families,  communities,  cities,  and  States.

Its purpose  was to provide  emergency  assistance  to localities  ... disproportionately

affected  by the  Human  Irnmunodeficiency  Virus  epidemic  and  to make  financial

assistance  available  to States  and  other  public  or private  nonprofit  entities  to provide

for the  development,  organization,  coordination  and  operation  of more  effective  and

cost efficient  systems  for the  delivexy of essential  semices  to individuals  and  families

with  HIV  disease.

Congress  funded  the  Ryan  White  Act  at $221 million  for Fiscal  Year  (FY)  1991, $276

million  for FY  1992, $338 million  for FY  1993, and  $579.4 million  for FY  1994.  The

Health  Resources  and  Sewices  Administration  (HRSA)  within  the  Public  Health

Service  administers  the  Act.

Four  titles  direct  resources  to various  entities,  allowing  maximum  flexibility  to

grantees,  particularly  at the  local  level, in the  use  of funds.  The  first  two titles,  which

are  the  subject  of this repor$  constitute  88 percent  of Ryan  White  funding  for FY

1994.

Title  ~ funded  at $325.5 million  for FY  1994, comprises  56 percent  of Ryan  White

funding.  This  title  provides  emergency  relief  grants  to eligible  metropolitan  areas

(EMAs)  for HIV-related  outpatient  and  ambulatory  health  and  support  semices,

including  case  management  and  comprehensive  treatment  sexvices.  Public  or

nonprofit  private  organizations  are  eligible  for funding  to provide  services  on a

contract  basis with  the  EMA.

Half  of the  funds  are  distributed  to EMAs  through  formula  grants  and  half  through

competitive  supplemental  grants.  In FY  1992, the  year  addressed  in this report,  18

EMAs  received  about  $120 million  (formula  and  supplemental  fimds  combined).

Title  ~  funded  at $183.9 million  for FY  1994, comprises  32 percent  of Ryan  White

funding.  This  title  provides  formula  grants  to States  and  territories  to improve  the

quality,  availability  and  organization  of health  care  and  support  services  for individuals

1  and  families  with HIV  disease.  States  receive  a minimum  of $100,000. 
In FY  1992, the year  addressed  in this report,  HRSA  awarded  54 formula  grants  to 
States  and  territories  totaling  $99 million.  States  have  the  option  of using Title  II 
funds  in one  or more  of the  following ways. 
	 They  may establish  HIV  care  consortia  within  areas  most  affected  by HIV 
disease,  to provide  a comprehensive  continuum  of care.  Consortia  must: 
consist  of public  and  nonprofit  private,  health  care  and  support  semice 
providers,  and  community  based  organizations;  assist in the  planning, 
development,  and  delivery  of comprehensive  outpatient  health  and  support 
services;  conduct  a needs  assessment;  and  create  a mechanism  to periodically 
evaluate  their  major  duties.  States  that  report  1 percent  or more  of all 
AIDS  cases  reported  to CDC  nationally  must  use  50 percent  of their  funds 
to operate  consortia. 
	 They  may provide  home  and  community-based  care  services,  including 
outreach  services  to individuals  in rural  areas. 
	 They  may provide  treatments  (medications)  that  prolong  life or prevent 
serious  deterioration  of health. 
	 They  may provide  assistance  to assure  the  continuity  of health  insurance 
coverage. 
SCOPE  AND  METHODOLOGY 
The  Ryan  White  CARE  Act will come  up  for reauthorization  for FY  1996.  This  study 
is one  in a series  on the  implementation  of the  Act meant  to provide  information 
useful  for the  debate  surrounding  reauthorization.  The  other  reports  in the  series  are: 
Funding  Formulas  (OEI-05-93-O0330);  Special  Projects  of National  Significance  (OEI-
05-93-00332);  Consortia  Activities  (OEI-05-93-O0333).  Our  report  entitled  The Ryan 
White  CARE  Act:  Technical  Report  (OEI-05-93-00334)  is a companion  to this report. 
This  report  is a descriptive  analysis  of Title  I and  Title  II expenditures  for FY  1992. 
Our  study was not  an evaluation  of the  Ryan  White  program  or any individual  grantee. 
We  did not  ask for  explanations  from  grantees  of why funds  were  spent  as they were, 
or obtain  any description  of the  semices  provided,  including  their  quality  or 
effectiveness. 
We  examined  how  expenditures  were  distributed,  nationally  and  by  grantee,  across 
several  broad  categories.  Our  analysis  is based  on  data  presented  by  grantees  in year-
end  reports.  We  used  the  data  as  presented  and  did  not  attempt  to  veri~  its  accuracy. 
For  Title  I, HRSA  extracted,  and  then  gave  us for our  analysis,  expenditure  data  from 
year-end  reports  submitted  by most  of the  grantees.  We also  examined  a few Title  I 
2  year-end  reports  ourselves  and  contacted  two grantees  about  incomplete  or unclear 
information.  For  Title  II, we reviewed  year-end  reports  from  grantees  and 
subsequently  contacted  each  of them  about  missing  or unclear  information. 
This  inspection  was conducted  in accordance  with the  Standards for Impactions  issued 
by the  Presidents  Council  on Integrity  and  Efficiency. 
3
 FINDINGS

INTRODUCIION

This  report  describes  Ryan  White  Fiscal  Year  1992 expenditures  by semice  for Titles  1

and  II.

Grantees  are  required  in the  law to report  aggregate  expenditures  for  each  sewice.

However,  in the  process  of gathering  data  for this report,  we encountered  a number  of

problems  affecting  the  reliability  of the  data  as reported,  problems  of which  readers

should  be  aware.

First,  we found  that  Title  II data,  especially,  was often  incomplete  or unclear,  Some

grantees  reported  award  amounts  exceeding  the  amounts  reported  by HRSA,  in some

cases  the  difference  was due  to FY  1991 carryover  that  a grantee  had  not  reported  10

HRSA  as of summer  and  early  fall of 1993, when  we gathered  our  data.  As for

expenditures,  grantees  with consortia,  especially,  often  said it was difficult  to break

expenditures  down by service.  Some  were  dealing  with  a number  of consortia  and

lacked  a standard  reporting  format.  Others  said  that  consortia  reported  inforrnat ion

with vmying  degrees  of detail  or in different  formats.  Many  grantees  submitted  two or

more  versions  of expenditures  in an attempt  to reconcile  their  figures.

Secondly,  we also know, both  from  comments  in the  reports  themselves  and

discussions  with grantees,  that  many  grantees,  for both  titles,  provided  estimates  or

obligated  amounts  rather  than  expenditures.

Notwithstanding  these  problems,  we have  based  our  report  strictly  on the  figures  as

presented  to us by grantees.  We  consider  this to be  the  best  information  available  on

expenditures,  given  the  time  and  resources  available  to us to obtain  it.  The  HRSA  has

been  piloting  and will soon  implement  a new data  collection  system  for grantees.

They  expect  the  new  system  to provide  more  detailed,  timely,  and  accurate

information.

For  purposes  of analysis, we divided  expenditures  into  four  broad  categories:  medical

semi- pharmaceutical@  support  servi~  and  administration.  Both  the  medical

sexvices and  support  services  categories  are  comprised  of a number  of individual

semices  which we ident~  in the  narrative  of the  report.  We  discuss  pharmaceut  ica Is

immediately  following  medical  semices,  since  they are  directly  related  to the  provision

of health  care.

We  first  examine  Title  I and  Title  II expenditures  combined,  follow  with  separate 
sections  describing  expenditures  for  each  title,  and  conclude  with  a brief  summary 
comparison  of expenditures  by both  titles.  Throughout,  we  compare  expenditures 
both  across  and  within  the  four  broad  categories.  We  also  highlight  the  expenditures 
of the  grantees  that  accounted  for the  largest  proportion  of expenditures  for  each  tit It.  COMBINED  TITI.EIAND  TITLE  II EXl?ENDITURES 
Me&a/  servic~  and  support services each  accounted  for  about  35 percent  of combined 
*h,  phm=hah  for20per=n4  and  a&nb&rntiofi  about 10percent 
Collectively  Title  I and  Title  II grantees  reported  spending  $210,603,992.  This  is 93 
percent  of the  FY  1992 grant  awards  for the  two programs,  combined,  which  HRSA 
provided  to us as we collected  and  analyzed  the  data  for this study in the  summer  and 
fall of 1993.1 
Figure  1 shows the  breakdown  of FY  1992 expenditures  by category  for both  titles 
combined.  Appendix  A provides  a comprehensive  breakdown  of expenditures,  by 
major  category  and  by semice,  for both  titles  separately  and  combined. 
Combined Ryan White Expenditures - IT  1992 
HgU#l 
MfwPlan&Eval  (11 
1 
Grant awardsare adjusted byHRS~  however,throughout the programyear baaedon financialstatus 
reports submitted by grantee& Hence the tlnal grant award amounts for FY 1992 reported by HRSA may differ to 
some extent from the figures in this report. 
5  Medical  Services:  $67.1 Million 
Medical  semices  constituted  about  a third  of combined  expenditures.  In this category 
we placed  services  related  to the  direct  provision  of health  care.2  Table  1 shows the 
services  in this category. 
Almost  half  (46 percent)  of medical  semice  expenditures  went  for primary  medics) 
care.  Following  were  home health semices  (15 percent),  mentai  health  (14 percent), 
and substance abuse setices  (12 percent).  The  other  six sefices  collectively 
accounted  for the  remaining  13 percent  of medical  sexvice expenditures. 
Pharmaceuticals:  $45.3 Million 
Twenty-two  percent  of expenditures  went  for pharmaceuticals.  Expenditures  under 
the  We  IIprovision  of treatments option  ($32 million)  were  71 percent  of all 
pharmaceutical  expenditures.  Title I expenditures for pharmaceuticals  ($11 million) 
were  24 percent  of this categoxy.  The  remaining  $2 million  was spent  under  the  Tide 
II consortia and home- and community-based  care options. 
&ID13ort Services:  $75.6 Million 
Support  services  were  36 percent  of combined  expenditures,  slightly more  than  the 
proportion  spent  for medical  semices.  In this category  we included  case  management, 
services  listed  as support  services  in HRSA  application  guidances,  insurance 
continuation,  and  a few other  semices  listed  by grantees.  See  Table  1 for a list of the 
services  in this category. 
Case management  accounted  for the  largest  proportion  (42 percent)  of support  service 
expenditures.  Houszkg assistance, at  13 percent,  was the  second  largest;  $8 million  of 
this $10 million  was spent  under  Title  I.  About  $2 million  was spent  under  the  Title 11 
health insurance continuation  option,  amounting  to 3 percent  of all support  semice 
expenditures. 
Administration:  $22.3 Million 
Costs  for administration  were  about  11 percent  of combined  expenditures.  We  include 
in this category  expenditures  for admiruktrative costs and planning and evaluation. 
Also,  we include  expenditures  reported  both  at the  grantee  level  (State  or city) and  at 
the  Title  I planning  council  and  Title  II subcontractor  levels  (consortia  and  home- and 
community-based  care  options). 
2 
For th~ reaaon, we placed case management in the support setices category. 
6  The  Act  defines  adminktrative  costs as expenditures  for  administration,  accounting, 
reporting,  and  program  oversight  and,  for both  Titles,  requires  that  grantees  spend  no 
more  than  5 percent  of their  grants  for administrative  costs.  However,  in September, 
1993, HRSAS Office  of the  General  Counsel  issued  a legal  opinion  stating  that  this 
cap  applies  only to a city or State  as Ryan  White  Act  grantee  and  not to the 
individual  service  providers  who will be  the  ultimate  recipients  of the  grant  funds. 
Hence  additional  administrative  expenditures  are  allowed  pertaining  to the  Title  I 
planning  councils  and  Title  II subcontractors. 
Administrative  costs were  about  8 percent  of all FY  1992 expenditures.  Grantee  costs 
accounted  for 5 percent;  the  remainder  went  for costs  associated  with  planning 
councils  or consortia  administration. 
An  additional  3 percent  went  for planning and evaluation  expenditures. 
	 Some  Title  I grantees  reported  such expenditures  despite  the  fact  that  the 
Act makes  no mention  of allowances  for planning and evaluation  for Title  I. 
We  do not  know whether  these  expenditures  were  made  by at  the  grantee  or 
the  planning  council  level. 
	 For  Title  11, almost  all planning and evaluation  expenditures  were  reported  at 
the  State  level;  a small  amount  reported  under  the  Title  11consortia  or 
home- and  community-based  care  options. 
7
 TITI.E I EXPENDHUR= 
M-services  andsuppt  services  each conduted  about  40pem&  of lltle I 
qenddum.  Mannaceuticalr  were IOpemen& and adminkmtiq  9~m 
Information  about  Title  I expenditures  is based  on reports  from  17 of the  18 cities 
funded  in FY  1992?  Collectively  these  17 cities  reported  spending  $112,692,350, 
which  is 93 percent  of the  amount  they were  awarded,  or 88 percent  of Title  I funds 
awarded  (formula  and  supplemental)  to all 18 grantees  in FY  1992. 
The  three  largest  grantees  - New York  City, San Francisco,  and  Los Angeles  - spent 
about  $67 million,  or 60 percent  of all Title  I expenditures  reported. 
We  sometimes  refer  to Title  I grantees  in this report  as cities, and  our  analysis 
relates  strictly  to their  expenditures  of FY  1992 Title  I dollars.  Figure  2 shows the 
breakdown  of Title  I expenditures  by categoV.  Table  1 on the  next  page  shows these 
expenditures  broken  out by grantee. 
Title I Expenditures - FY 1992 
Medical Saulw6  (43%) 
Mmln/PM &Evd (9%) 
~  (lo% 
pput se-
3 
Newarkj New Jersey, had not submitted its rqxxt  10 I{RSAat the time we conducted this study. 
8  Table 1 
Title I 
Expenditures by Category 
as Percentof all l?qenditures 
%  %  %  70 
GRANTEE4  AWA@  SPENT  MED  PHARM  SUPP  ADMIN 
WV York city 36J90,210  ~45L),mo  33  21  35  11 
Ny.    ,:. 
$anF@@sco  CA  21,6Q418  21$62J75  61  I  o  31  8 
Los Angels CA  9,925,225  10,?59,820  50  0  40  11 
Metro Dade Cty  6,740,073  6,587,864  34  14  39  14 
FL (Miami) 
? 
Harris Cty TX  6>77,597  5S62300  51  1  46  L
(Houston) 
Washington DC  5,286,485  3,943343  48  2  45  5 
Chicago XL  4,431,632  4>27,152  54  0  37  9 
Philadelphia PA  4,238,608  2>69,502  40  0  49  11 
San Juan PR  3,579,982  3,579,983  20  46  19  15 
Boston MA  3369,149  2,940S2  20  0  80  0 
San Diego CA  397,916  3054,788  33  0  63  5 
Dallas Cty TX  3,203~0  3,1%320  45  1  48  6 
Fulton Cty GA  3,148,612  2,899,666  74  1  20  5 
(Atlanta) 
Broward Cty FL  3,097,663  3,058,920  45  20  28  6 
(Ft.Lauderdale) 
Hudson Cty NJ  2W,466  2306S81  27  0  68  5 
Oakland CA  2J23,466  1,975382  32  0  52  0 
Baltimore MD  1,898,561  918,072  36  0  64  0 
TOTAL    $121,189,283  $112,69Z350  na  na  na  na 

May not add to 100 due to rounding, 
4 N~rk  not included.

5 As of fall, 1993; formula and supplemental funds combined.

9  Medical  semice  expenditures,  reported  by all grantees,  were  43 percent  of all Title  I 
expenditures.  For  nine  cities, including  New York,  medical  services  constituted  a third 
to just  under  half  of all expenditures;  for five cities, including  San Francisco  and  Los 
tigeles,  medical  services  were  half or more  of all expenditures. 
&  shown  in Table  2, 4 of the  10 semices  in this category  made  up  the  vast  majority  of 
expenditures,  both  for  all grantees  combined  and  for the  three  largest  grantees.  The 
table  also shows, however,  that  between  the  three  largest  grantees,  the  proportion  of 
dollars  spent  for each  service  varied  considerably. 
Table2 
Title I 
Top Four Medical Services 
asProportionofAllMe&al  ServiceExpenditures ($48.7M) 
Substance  :,  16%  23%  22%  1270 
TOTAL  89% 
l?imary  medical  care expenditures  ($23.2 million)  were  reported  by 16 grantees. 
Seven  grantees  spent  between  25 and  49 percent  of their  medical  semice  dollars  on 
this service;  seven  spent  between  50 percent  and  97 percent.  This  semice  also 
represented  the  largest  proportion  of Title  I expenditures,  at  21 percent. 
Pharm aceuticals:  $10.7 Million 
Nine  percent  of Title  I expenditures  was for pharmaceuticals,  reported  by eight 
grantees.  The  four  top  spenders  proportionally  were  San Juan  (46 percent),  New 
6 W/MeNewYork spentproportionatelylessthan the other hvolargestgranteeaon primarymedicalcare,  it 
spentone fiRhofallitsTitleI dollarsfor pharmaceuticakxincomparison,the twoCaliforniagranteeshad no 
pharmaceutical expenditures. (See Table 1.) 
7 Justprior to issuingthisreport, welearnedthat SanDiegospent $751,850and Baltimorespent $766,522on 
primary medical care.  Ilwse figures are not included in the report. 
10  York  City (21 percent),  Fort  Lauderdale  (20 percent),  and  Miami  (14 percent).  The 
other  four  cities  each  spent  2 percent  or less on pharmaceuticals.  Two  of the  largest 
grantees,  San Francisco  and  Los Angeles,  reported  no expenditures  for 
pharmaceuticals. 
SurYDortServices:  $43.2 Million. 
Support  semices  expenditures,  reported  by all grantees,  constituted  38 percent  of all 
Title  I expenditures,  ranging  from  19 percent  (San  Juan)  to  80 percent  (Boston)  across 
grantees.  Nine  grantees,  including  the  three  largest,  spent  between  33  and  49 percent 
on  support  services.  The  five  grantees  with  the  highest  proportion  of Title  I 
expenditures  for  support  semices  (between  52 and  80 percent)  all  received  relatively 
small  Title  I grants  (less  than  $4 million).  (See  Table  1.) 
Table  3 shows the  five services  that  constituted  the  majority  of support  service

expenditures,  for all grantees  combined  and  for the  three  largest  grantees.  Unlike  the

medical  semice  category,  where  four  sexvices comprised  the  bulk  of expenditures,

expenditures  in this category  were  much  more  spread  out  across  services.  However,  as

with medical  setices,  the  three  largest  grantees  spent  considerably  different

proportions  of dollars  on each  sexvice.

Grantees  spent  the  highest  proportions  of support  service  dollars  on case management

($15 million)  and  housing assistance ($8 million).  These  two setices  comprised  one

i5fth of all Title  I expenditures.  Furthermore,  as Table  3 shows, they  comprised  over

half  of all support  semice  expenditures.

Table 3

Title I 
Top Support Services 
as Proportionof all Support SeMces (S43.2 M) 
 Ml  gralttees,  N*  San  Los 
Support Service  York  Francisco  Angeles 
Case Management  :  34%  33%  21%  2s% 
r-rousing  19%  18%  35%  31% 
Food .Assistance  11%  12%  13%  170 
Outreach/Info. & Ref.  ,  8%.  13%  3%  1070 
Other counseUnot  7%  8%  o%  14% 
mntl hlth 
TOTAL  79%  84%  72%8  81%

8 
San Francisco spent 10 percent each on advocacyand buddyJcompanionseMces. 
11  Sixteen  grantees  reported  case management  expenditures.g 
	 Case management  accounted  for  13 percent  of all Title  I expenditures, 
ranging  across  grantees  from  7 percent  (San  Francisco)  to 41 percent  (Jersey 
City). 
	 Case management  comprised  a third  of all Title  I support  sewice 
expenditures,  ranging  from  17 percent  (Boston)  to 81 percent  (San  Juan), 
spread  somewhat  evenly across  grantees. 
Housing assrktance expenditures  ($8  million),  reported  by  13 grantees,  comprised  7 
percent  of all Title  1 expenditures,  ranging  from  less  than  1 percent  (San  Diego)  to  20 
percent  (Boston). 
As  a proportion  of support  service  dollars,  only,  housingassistance expenditures  ranged 
from  under  1 percent  (San  Diego)  to 47 percent  (Ft.  Lauderdale),  with  10 of the  13 
grantees  spending  under  25 percent  of their  support  service  dollars  on this service. 
Administration:  $9.9 Million 
Expenditures  in this category  amounted  to 9 percent  of all Title  I expenditures. 
The  Act  allows Title  I grantees  to spend  up to 5 percent  of their  grant  awards  for 
athzinistrative  costs, with  additional  expenditures  allowed  related  to planning  councils 
per  HRSAS Office  of the  General  Counsel.  The  Act  does  not  address  expenditures 
for planning  and evaluation  relative  to Title  I; however  as noted  below,  some  grantees 
reported  expenditures  of this type  in addition  to administrative  costs. 
	 Seven  percent  of expenditures  were  for administrative  costs.  Three  grantees 
reported  no expenditures  for administrative  costs.  Grantee  expenditures 
reported  by the  remaining  14 cities  amounted  to 6 percent  of all Title  I 
expenditures.  As best  we can  determine  from  this self-reported,  unaudited 
data,  it appears  that  five grantees  exceeded  the  5 percent  cap. 
	 Six Title  I grantees  reported  spending  a total  of $1 million  in administrative 
expenditures  related  to planning  councils. 
	 An  additional  2 percent  went  for planning and evaluation  (including  needs 
assessment),  reported  by nine  grantees.  We  do not  know whether  these 
expenditures  were  made  at  the  grantee  or planning  council  level. 
9 
Just prior to issuing this report, we teamed that San Diego spent $651,393 on case management.  This figure 
is not included in the report. 
12  Mwrmaauticds  and  supyw?t sdet?s  each  accounted  for about 33pemer@ @all  llde  11 
.
u@m&UWX  Medical  St7ViC62$W~  19~~  and  a&nin&mtiow  13 percent 
Information  on Title  II expenditures  is based  on reports  from  all 54 State  and

territorial  grantees.  Collectively  these  grantees  reported  spending  $97,911,642.  This  is

98 percent  of the  total  Title  11 award  amount  reported  by HRSA.  $99,754,335.10

The  four  largest  grantees  - California,  New York,  Texas,  and  Florida  - spent  $51

million,  or  52 percent  of all Title  II expenditures.

We  sometimes  refer  to Title  II grantees  as States and  our  conclusions  relate  strictly

to their  expenditures  of N  1992 Title  II dollars.  Figure  3 shows the  breakdown  of

Title  II expenditures  by category.  Table  4 on the  next  page  shows these  expenditures

broken  out by grantee.  Appendix  B contains  tables  showing  expenditures  broken  out

by the  four  major  options  (as opposed  to the  four  categories,  which  constitute  the

discussion  here).

II Expenditures - FY1992 
Ttile 
R@#u 3 
ptl~  (s5%) 
10l%egranteeathemselvesreported total grant awardscxceedmgHRSASfigureslightly,at $100,205,97S. We 
do not knowwhether the differencebetweenthe figuresISdue 10errors bygrantees,carryovernot reported to 
HRSA as of the time we collected this data, or somethmg else. 
13  Title II 
Expenditures by Catego~ 
asPercentofallEqxmditurea* 
%  %  % % 
GRANTEE  AWARD  SPENT  MED  PHARM  SUPP  ADMIN 
NewYork  17#i93#58  16#59$H3  .14  41  31  14 
1 
California  16&7,%0  wfw69  14  30  41  16 
I 
Florida    17  49  24  I  10 
~~  8s%737  8,W7,832  24  36  52  7 
\ 
Puerto Rico  5,681,717  4,975,1%  21  46  25  8 
NewJersey  4,711,438  4,688,987  2s  35  23  17 
Georgia  3,201,172  3,155,728  28  37  30  6 
Illinois  2,829J36  3275,301  12  39  30  20 
Pennsylvania  2,536,697  2,702,830  9  42  35  13 
Maryland  2368,486  2~,486  49  4  30  17 
Massachusetts  1,793,707  - 1,837,845  2s  5  52  18 
North Carolina  1,684,757  1,169,266  24  20  53  3 
Louisiana  1,672S04  1,727,415  36  0  54  10 
Ohio  1,423,256  1~76,800  5  42  44  9 
Virginia  1,405,219  1,405,219  23  30  28  19 
Wash.D.C  1J85,438  1334,463  11  27  34  28 
Missouri  1330,774  1,289,726  38  43  12  8 
Washington  1322$95  1,418,902  50  23  12  14 
Michigan  1,213,083  1,213,083  9  11  73  7 
Cf.)nnecticut  999,652  1,068,399  9  34  41  16 
OYorado  838,453  857,391  15  20  49  15 
South Carolina  795,067  782,319  32  56  5  7 
Alabama  790,676  788,423  9  83  3  5 
Tennessee  737,498  737,498  0  99  0  1 
Indiana  728,781  898,781  19  61  0  19 
Arizona  687,616  687,616  26  36  32  5 
14  % %  70  % 
GIUNTEE  AWARD  SPENT  MED  PHARM  SUPP  ADMIN 
Oregon
 658351  679,447  9  51  32  8 
Misaiaaippi
 616,440  616,440  46  44  0  10 
Minnesota
 602,682  320,898  16  0  61  22 
Wisconsin
 539,014  526,602  26  0  48  26 
Kentucky
 528,039  299,009  3  73  23  1 
Arkattaaa
 497308  497308  20  49  15  17 
Oklahoma
 490,547  488,209  17  55  14  13 
Nevada
 443,483  443,483  17  52  20  10 
Hawaii
 366,974  442,934  10  45  36  9 
Utah
 329,083  327,846  27  62  11  0 
Kansas
 274,616  270,693  9  75  10  5 
NewMexico
 254,732  254,714  15  32  44  10 
Rhode Island
 194,400  203,048  0  59  32  10 
Delaware
 173,168  173,168  8  23  63  6 
WestVirginia
 168383  168383  6  36  50  8 
Iowa
 164,436  164,436  13  36  38  14 
Maine
 163,401  163,401  0  0  100  0 
NewHampahire
 149,133  186J56  15  81  1  3 
Nebraaka
 117,188  90,109  3  77  14  6 
Alaska
 100,OOO  123,955  18  13  54  16 
Idaho
 100,OOO  100,OOO  0  90  0  10 
Montana
 100,OOO  100,016  24  36  21  19 
North Dakota
 100,OOO  100,OOO  32  59  0  10 
South Dakota    100,OOO  103,386  9  86  0  5 
Vermont  100,OOO  92,405  0  57  0  43 
Wyoming  100,OOO  100,001  37  37  16  10 
Virgin Islands  28,087  26,890  7  86  0  7 
Guam  4323  4,618  0  100  0  0 

May not add to 100 due to rounding. 
15
 Medical  Semites:  $18.4 million 
Nineteen  percent  of Title  II expenditures  were  for medical  services.  Forty-eight  States 
reported  medical  sexvices expenditures,  either  under  the  consortia  option  (it was 34 
percent  of all consortia  expenditures)  or the  home-and  cornrnunity-bwed  care  option 
(87 percent). 
Expenditures  for medical  services  ranged  across  grantees  from  1 percent  (Kansas)  to 
63 percent  (Mississippi)  of total  expenditures.  However  most  grantees  (35 out  of 48, 
including  the  four  largest  grantees)  spent  a quarter  or less; 21 of the  48, including  New 
York  and  California,  spent  15 percent  or less. 
As shown in Table  5, four  services  accounted  for 90 percent  or more  of Title  II 
medical  semice  expenditures,  for all grantees  combined  and  for three  of the  four 
largest  grantees. 
Table S 
TitleII 
Top Four MedicalSeMcea 
as Proportion of AUMedical Scmice Eqenditures  (S18.3 M) 
?lorida  I  Texas  II 
MedicalCare 
Home Health    32%? 
Mental Health  :...79$ 
TOTAL  .;  ;g~%  ,. 
Primary medical  care expenditures  totalled  $8 million.  Almost  all were  reported  by 36 
of the  43 States  with  consortia  and  this service  comprised  15 percent  of all consortia 
expenditures. 
Twenty  States  reported  home  health care expenditures  ($6 million).  This  service 
comprised  71 percent  of all dollars  spent  under  the  home- and  community-based  care 
option,  compared  with  6 percent  of all consortia  expenditures. 
11 Texas spent more than the other three grantees on haspice (13 percent) and residential care (15 percent). 
16  Pharmaceuticals:  $34.6 Million 
Thirty-five  percent  of Title  II expenditures  went  for pharmaceuticals.  Expenditures 
ranged  across  grantees  from  4 to  100 percent  of total  expenditures;  for the  four  largest 
grantees  they ranged  from  17 percent  to 49 percent. 
Forty-seven  of the  54 grantees  adopted  the  pharmaceutical  option;  3 adopted  only this 
option.  These  47 grantees  collectively  spent  $32 million  on the  option  - one  third  of 
all Title  II expenditures.  For  16 States,  all with  awards  under  $1 million,  this option 
accounted  for half  or more  of their  total  expenditures;  for  8 of the  16, it accounted  for 
70 percent. 
For  three  of the  four  largest  grantees,  pharmaceutical  expenditures  made  up  30 to 50 
percent  of all expenditures;  for the  fourth  grantee  (Texas),  they were  16 percent. 
An  additional  $2 million  on pharmaceuticals  under  the  consortia  option  was spent  by 
slightly over  half  of the  States  with consortia. 
SUDDOI-t Services:  $32.4 Million 
Support  service  expenditures  were  33 percent  of Title  II expenditures,  considerably 
exceeding  the  19 percent  for medical  semices.  Forty-four  grantees  reported  support 
semice  expenditures.  For  9 States,  support  services  made  up  50 to  75 percent  of their 
expenditures;  for one  (Maine)  it accounted  for  100 percent.  For  the  four  largest 
grantees,  support  services  were  25 to 50 percent  of total  expenditures. 
Most  support  sedce  expenditures  were  reported  under  the  consortia  option,  and 
support  semices  were  58 percent  of all consortia  expenditures. 
Case management,  reported  by 36 grantees,  was the  service  that  accounted  for the 
greatest  proportion  of support  service  expenditures.  Grantees  spent  $17 million  on 
this service. 
(cid:31) Case management  constituted  54 percent  of all Title  II support  service 
expenditures  the  15 other  support  sexvices were  6 percent  or less, each. 
(cid:31) Proportionately,  case management  expenditures  were  not  evenly  distributed 
across  grantees.  The  four  largest  grantees  collectively  spent  57 percent  of all 
Title  II case management  dollars;  and  each  of these  grantees  spent  between 
45 and  66 percent  of their  support  sexvice dollars  on this  one  service. 
(cid:31) Almost  all case management  spending  was reported  under  the  consortia 
option.  Thirty-four  of the  43 States  with consortia  provided  case 
management,  and  this service  accounted  for a third  of all consortia 
expenditures. 
17
 Administration:  $12.7 Million 
The  Act  allows Title  II grantees  to spend  up  to 5 percent  of their  grant  awards  for 
adnzinkrazive  costs (administration,  accounting,  reporting  and  program  oversight 
functions),  and  up  to an additional  5 percent  for planning and evak.ztion.  According 
to HRSAS Office  of the  General  Counsel,  additional  expenditures  are  allowed  for 
subgrantees  (that  is, under  the  consortia  or the  home- and  community-based  care 
options). 
Administrative  expenditures  were  13 percent  of all Title  II expenditures:  8 percent  for 
adrninktrative  costs and  5 percent  for planning and evaluation. 
(cid:31) State  expenditures  for administrative  costs were  4 percent  of Title  II 
expenditures.  As best  we can  determine  from  this self-reported,  unaudited 
data,  it appears  that  two grantees  exceeded  the  5 percent  cap. 
Administrative  costs reported  under  the  consortia  and  (to  a much  lesser 
extent)  home- and  community-based  care  options  totalled  another  4 percent. 
(cid:31) State  expenditures  for planning and evaluation  also totalled  4 percent.  With 
the  caveat  noted  above  regarding  the  quality  of the  data,  we believe  that  two 
grantees  exceeded  the  5 percent  cap.  An additional  1 percent  was reported 
for planning and evaluation  under  the  consortia  and  home- and  community-
based  care  options. 
18
 CONCLUSIONS 
Medical  Semites 
This  category  accounted  for one  third  of all expenditures  for both  titles  combined. 
However  cities  outspent  States  more  than  two to one  on medical  semices.  This was 
true  for  the  category  as a whole  ( 43 percent  versus  19 percent,  respectively,  of all 
expenditures)  as well as for most  of the  individual  services  in the  category  (see 
Appendix  A), beginning  with prima?y medical  care.  The  exception  is home  healfh care 
(4 percent  for cities versus  6 percent  for States). 
Pharmaceuticals 
States  outspent  cities three  and  a half  to one  on pharmaceutical  expenditures  (35 
percent  versus  10 percent,  respectively,  of all expenditures). 
Surmort  Semites 
For  both  cities  and  States,  case management  accounted  for  about  15 percent  of all 
expenditures,  and  this service  accounted  for the  largest  proportion  of support  se mice 
expenditures.  However,  States  spent  more  of their  support  semice  dollars  on this 
sefice  than  cities  (54 percent  versus  34 percent);  also, cities  spent  higher  proportions 
on all other  semices  in the  category,  beginning  with housing  assistance. 
Administration 
&  best  as we can  determine  horn  the  self-reported,  unaudited  data  on administrate i~e 
expenditures  submitted  by grantees,  we believe  that  Title  I expenditures  overall  for 
admznkrafive costs slightly exceeded  the  Congressionally  established  cap  of 5 perce nr. 
although  most  of the  grantees  appear  not  to have  exceeded  the  cap.  Title  II 
expenditures  overall  were  below  the  cap, with  only two grantees  appearing  to exceed 
it. 
An additional  3 percent  of adminkazive  cost expenditures  were  made  by planning 
councils  and  consortia  or home- and  community-based  care  providers. 
Some  Title  I grantees  spent  funds  for planning and evaluation  which  amounted  to  1 
percent  of all FY  1992 expenditures.  Title  II expenditures  remained  under  the  cap.  at 
4 percent. 
19
 SUMMARY OF RYAN WHITE FY 1992 EXPENDITURES 
BY CATEGORY AND BY SERVICE WITHIN CATEGORY 
TITLE 1,TITLE 11,AND COMBINED 
I  TITLE I  % OF  I  TITLE II  % OF  I  COMBINED  % OF 
EXPEND.  TOTAL  I  EXPEND.  TOTAL  I  TOTAL  TOTAL 
TOTAL EXPENDITURES  ~  112,6S2,350  53.5%  I  97,911,642  46.5%  I  210,603,992  100.0% 
I %OF  % I  %OF  % I  %OF

I  TITLE I  TITLE I  OF  TITLE II  TITLE II  OF  I  COMBINED  COMBINE  :F

CATEGORY/Service  EXPEND.  EXPEND.  CATEGORY  I  EXPEND.  EXPEND.  CATEGORY  I  TOTAL  EXPEND.  CATEGORY 
MEDICAL SERVICES  I  48,746,018  43.3%  100.0%  I  t 8,406,760  18.8%  100.0%  I  67,152,778  31 .9%  100.0% 
Medical Care  I  23,229,170  20.6%  47.7%  I  7,624,836  8.0%  42.5%  I  31,054,006  14.7%  46.2% 
Dental Care  I  2,770,711  2.5%  5.7%  I  1,6S7,736  1.7%  @.2% I  4,468,447  2.1%  6.7% 
Substance Abuse  I  8,005,212  7.1%  16.4%  I  251,452  0.3%  1.4%  I  8,2 S6,664  3.9%  12.3% 
Mental Health  I  7,759,640  6.9%  15.9%  1,329,530  1.4%  7.2%  I  9,069,170  4.3%  13.5% 
Home Health  I  4,253,888  3.8%  8.7%  5,948,S40  6.1%  32.3%  I  10,202,528  4.6%  15.2% 
In-Home Hospice  1,013,316  0.9%  2.1%  373,223  0.4%  2.0%  1,386,539  0.7%  2.1% 
Rehab Care  /  968,704  0.s%  2.0%  44,760  0.0%  0.2%  1,034,484  0.5%  1.5% 
Residential Care  I  632,752  0.6%  1.3%  666,324  0.7%  3.6%  1,299,076  0.6%  1.9% 
Inpatient Personnel  91,625  0.1%  0.2%  0  0.0%  0.0%  91,625  0.0%  0.1% 
Dur. Med. Equip.  I  0  0.0%  0.0%  270,239  0.3%  1.5%  270,239  0.1%  0.4% 
PHARMACEUTICALS  I  10,745,819  9.5%  100.0%  34,632,562  35.4%  100.0%  45,378,381  21 .5%  100.0% 
I 
SUPPORT SERVICES  I  43,213,238  38.3%  100.0%  32,470,285  33.2%  100.0%  75,663,523  35.9%  100.0% 
Case Management  14,743,352  13.1%  34.1%  17,355,868  17.7%  53.5%  32,099,220  15.2%  42,4% 
Housing Asst.  I  8,026,538  7.1%  18.6%  2,077,637  2.1%  6.4%  10,104,175  4.8%  13,4% 
Food Bank/Home Meals  4,786,296  4.2%  11.1%  1,321,785  1.3%  4.1%  6,108,081  2.9%  8.1% 
Outrch/info & Ref.  /  3,456,689  3.1%  8.0%  768,S56  0.8%  2.4%  4,225,855  2.0%  5.6% 
Other Counsel.  I  2,827,464  2.5%  6.5%  1,169,980  1.2%  3.7%  4,017,444  1.9%  5.3% 
Othef/Not  SPOO.  2,204,441  2.0%  5.1%  2,663,737  2.7%  8.2%  4,874,178  2.3%  6.4% 
Client Advocacy  I  1,474,046  1.3%  3.4%  676,794  0.7%  2.1%  2,150,640  1.0%  2.8% 
Day-Respite Care  I  1,308,944  1.2%  3.0%  402,365  0.4%  1.2%  1,711,329  0.8%  2.3% 
Buddy/Companion  I  1,185,134  1,1%  2.7%  485,293  0.5%  1.5%  1,670,427  0.8%  2.2% 
Transpofi  I  1,029,559  0.9%  2.4%  1,959,289  2.0%  6.0%  2,988,848  1.4%  3.9% 
Volunteer Support  808,264  0.7%  1.9%  0.0%  0.0%  808,264  0.4%  1.1% 
Emerg. Financial  /  526,780  0.5%  1.2%  1,219,946  1.2%  3.8%  1,746,726  0.8%  2.3% 
Legal Services  313,359  0.3%  0.7%  0.0%  0.0%  313,359  0.1%  0.4% 
Adopwoster  Care  I  256,205  0.2%  0.6%  3Q,050  0.0%  0.1%  295,255  0.1%  0,4% 
Educ/Risk Reduc.  I  174,330  0.2%  0.4%  160,248  0.2%  0.5%  334,578  0.2%  0.4% 
Sign Lang/lnterp,  I  9f,627  0.1%  0.2%  12,000  0.0%  o.o%  103,627  0.0%  0.1% 
Insurance  I  o  0.0%  0.0%  2,131,317  2.2%  6.6%  2,131,317  1.0%  2.8% 
I 
ADMINISTRATION  I  9,987,275  8.9%  100.0%  12,402,035  12.7%  100.0%  I  22,369,310  10,6%  100.0% 
Admin. costs  I  7,738,368  6.9%  77.5%  8,037,122  8.2%  64.8%  I  15,775,490  7.5%  70.5% 
Plan/Eval  2,248,907  2.0%  22.5%  4,364,913  4.5%  35.2%  I  6,613,820  3.1%  29.5% 
I  I 
A-1
 APPENDIX  B

TITLE  II EXPENDHURES,  BY OPTION 
This  appendix  presents  a number  of tables  that  portray  Title  II expenditures  by option. 
The  four  options  are:  consortia,  treatment  (pharmaceuticals),  home- and  community-
based  care,  and  insurance  continuation. 
B-1
 Table 8  Grantee  Expenditures  by Option 
as Proportion of Toted Expenditures 
State  I  Pharma- I Home&  Comm. 
State  Expenditures  Consotia  %  ceuticals  %1  Based Care  %  Insuranoe  % 
I 
I 
AK  123,955  121,737  98%  o  o% ]  o  o% I  o  o% 
AL  766,423  54,888  7%  554,682  70% I  141,111  18%  I  0  o% 
AR  497,308  460,713  93%  o  0%1  o  o% I  0  o% 
AZ  687,616  464,227  70%  164,544  27% I  o  o% I  0  o% 
CA  15,862,488  7,607,254  48%  4,594,012  29%  917,295  6%  I  600,000  4% 
co  857,391  552,630  64%  174,662  20%  84,502  6%  0  o% 
CT  1,068,399  597,171  56% I  364,388  34%  o  o%  0  o% 
DC  1,334,463  664,970  51% I  366,054  27%  170,116  13%  0  o% 
DE  173,188  53,800  31% I  40,000  23%  25,000  14%  49,200  26% 
FL  10,754,102  5,633,059  54% I  4,455,121  41%  o  o%  0  o% 
GA  3,155,728  1,482,554  47% I  1,164,025  37%  45,000  1%  337,056  11% 
GU  4,878  0  o% I  4,618  100  o  o%  0  o% 
HI  442,934  f75,864  40% I  192,060  43%  o  o% I  75,000  17% 
1A  164,438  00,000  55% I  58,071  35%  o  o% I  0  o% 
ID  100%000  0  o% I  90,000  90%  o  o% I  0  o% 
IL  3,275,301  1,860,633  57% I  1,273,875  39%  o  o% I  0  o% 
IN  8Q8,781  308,194  34% I  551,945  61%  o  o% I  0  o% 
KS  270,883  0  o% !  203,S14  75%  25,532  9%  27,713  1o% 
KY  299,008  0  o% I  212,715  71%  14,016  5%  6e,646  23% 
u  1,727,415  1,124,648  65% I  o  o%  423,258  25%  12,857  1% 
MA  1,537,645  1,195,000  65% I  73,080  4%  386,000  21%  0  o% 
MD  2,388,488  1,828,532  77% I  100,000  4%  237,252  10%  0  o% 
ME  163,401  163,401  100 I  o  o%  o  o%  0  o% 
Ml  1,213,06S  012,929  75%  129,500  11%  90,000  7%  0  o% 
MN  320,888  199,3e9  62%  o  o%  o  o%  79,763  25% 
MO  1,288,726  636,442  49%  648,181  43%  o  o% 1  0  o% 
MS  616,440  0  o%  272,637  44%  264,645  46%  I  0  o% 
MT  100,016  57,970  S8%  30,63s  31%  o  0%1  4,286  4% 
NC  1,189,266  947,422  81%  221,644  19%  o  o%  I  0  o% 
ND  100,000  90,000  00%  o  o%  o  o%  1  0  o% 
NE  90,108  15,592  17%  89,297  77%  900  1%  1  0  o% 
NH  186,356  0  o%  150,393  81%  29,564  18%  I  0  o% 
NJ  4,686,987  2,407,708  51%  1,613,087  34%  205,602  4%  1  0  o% 
NM  254,714  63,000  25%  81,214  32%  38,000  15%  I  50,000  20% 
NV  443,463  0  o%  232,000  52%  165,230  37%  I  0  o% 
NY  18,269,813  8,179,780  50%  6,608,157  41%  o  o% I  0  o% 
OH  1,376,800  70S,92S  51%  571,478  42% I  o  o% 1  0  o% 
OK  488,208  160,000  33%  241,299  49% I  62,500  13%  [  0  o% 
OR  679,447  280,323  41%  341,680  50% I  o  o% 1  0  o% 
PA  2,702,630  1,495,888  55%  1,136,075  42% I  20,516  1% 1  0  o% 
PR  4,975,198  2,640,859  57%  1,e25,497  39% I  0  o% I  0  o% 
RI  203,048  0  o%  119,700  59% I  o  o% I  64,000  32% 
Sc  782,319  297,252  38%  368,404  47% I  60,000  8%  0  o% 
SD  103,386  u  o%  88,87e  64% I  32,507  31%  0  o% 
TN  737,498  o  o%  729,007  99% I  o  o%  0  o% 
TX  8,197,532  5,650,886  8s%  1,200,000  15% I  o  o%  757,422  9% 
UT  327,546  99,067  30%  202,719  62% I  26,060  8%  0  o% 
VA  1,405,219  871,219  62%  400,000  28% I  o  o%  0  o% 
VI  26,680  0  o%  22,680  66% I  2,000  7%  0  o% 
v-r  92,405  30,000  32%  52,405  57% I  o  o%  0  o% 
WA  1,418,902  712,451  50%  329,173  23% I  272,566  19%  I  0  o% 
WI  526,602  460,878  91%  o  o% I  o  o% 1  0  o% 
w  188,363  10S,016  65%  50,000  30% I  0  o% 1  0  o% 
WY  100,001  48.577  49%  37,249  37% I  0  o% 1  4,175  4% 
I 
TOTAL  97,911,642  51,970,653  53% ,  32,410,740  32% I  3,729,376  4%  I  2,131,317  2% 
 This  table  doea not show  adminislMmn,  u  evaluatirm  md  planning  expendwree  8tTCludedm told  State  expmditurea. 
B-2
 Table9 
Expenditures by Option 
All Grantees (N=54) 
Option  #  Grantees  Expend.on  Aa % of Total 
Providing  Owion  Exvend.[$97.9M) 
Consortia  I  43  $51.9M  53% 
Pharmauxticala  I  47  $32.4M  33% 
2s 
1 
Home-& Cmun.- $3.7M 
470 
BasedCare

Inauranee  I  13
 $2.1 M  2% 
Total All Options  I  na
 $90.2M  92% 
* Including expenditures for administration and ptanningkvaluation. 
Table 10 
Expenditures  by Option 
Four  Largest  Grantees 
as Percent of Each Grantees Total Expenditures 
Grantee  .  Total  % GxIsortia  % Pharm.  % H- 70 Inaur. 
Expend.*  CBC 
NewYork I  S16.2M 
California  S15.8 M 
! 
Florida  .  I  $10.7M 
Texaa  I  $8.1 M  69%  115%10%19% 
* Including expenditures for admuustratmrt and planningkvaluation. 
B-3
 I?mb1k1 
Percent of Title 11Expenditures

SpentbyFourLargestGranteesvsAllOther Grantees

@Option

Option  Expend.  % Largest Grantee3  % Other 
(N=4)  Grantees (N=50) 
All Options combmed  47% 
Consortia  $51.9 M  53%  47%
~ ~  ~ 
Pharmaceuticals  I  $324 M  I  52%  i  48% 
Home- & Community- $3.7 M  25%  75% 
Based Care 
InmramxContinuation[  $21  M  I  64%  [  36% 
B-4