HRSA Administrator Thomas J. Engels Issues Dear Colleague Letter to RWCs

HRSA Administrator Thomas J. Engels issued a letter to Ryan White Clinic HIV/AIDS Program awardees and stakeholders on April 7, 2025.  The letter touts the Administration’s commitment to the Ending the HIV Epidemic (EHE) initiative, as well as its commitment to HRSA’s HIV/AIDS Bureau (HAB) and to the Ryan White HIV/AIDS Program (RWHAP), while also clarifying the Administration’s view on using RWHAP funds for gender affirming care. 

The letter – posted on HRSA’s website as “HRSA HIV/AIDS Bureau Update: Special Bulletin – states that HRSA will leverage RWHAP to “Make America Healthy Again” (MAHA). The letter chastises the Biden administration for “co-opt(ing) the program’s patient-centered mission in favor of radical ideological agendas and policies.”  Engels argues that “Congress envisioned RWHAP as a lifeline for those battling HIV and AIDS, not as a vehicle for broader social or medical experimentation” or to divert resources away from HIV/AIDS patients.

The letter reaffirms that RWHAP funds should be used exclusively for “evidence-based interventions proven to combat HIV, sustain viral suppression, and improve the quality of life for those living with the disease.”  The letter further states that “funds are not authorized for procedures or interventions beyond the scope of outpatient care, as expressly delineated in Policy Clarification Notice #16-02.3.”

The letter purports to be a restatement of HAB’s existing policy that RWHAP funds can only be used exclusively for “outpatient care, antiretroviral therapies, and essential support services such as case management, housing assistance, and substance use disorder treatment,” and cannot be used to provide “surgeries and inpatient care, irrespective of setting or anesthesia.”

The letter also notes that “(w)here disparities persist, particularly among underserved populations, our response shall be targeted, evidence-driven enhancements to HIV care delivery, not a broadening of scope that risks undermining this progress.”

Administrator Engels describes this notice as a “realignment” and advises awardees and stakeholders that it will be providing training and technical assistance through the AIDS Education and Training Centers.