Executive Committee Meeting Minutes January 18, 2024

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By Zoom

3:05 – 4:25pm

Members Present: David Klotz (Governmental Co-chair), David Martin (Community Co-chair), Billy Fields (Finance Officer), Saqib Altaf, Raffi Babakhanian, Paul Carr, Marya Gilborn, Charmaine Graham, Emma Kaywin, Matthew Lesieur, Freddy Molano, MD, Julian Palmer, Guadalupe Dominguez Plummer (ex-officio), Claire Simon (for Joan Edwards), Marcelo Maia Soares, Marcy Thompson

Members Absent: Steve Hemraj, Ronnie Fortunato
Staff Present: NYC DOHMH: Doienne Saab, Scott Spiegler, Kimbirly Mack, Patrick Chan

Agenda Item #1: Welcome/Introductions/Minutes/Public Comment

Mr. Klotz and Mr. Martin opened the meeting followed by introductions.  The minutes from the October 19, 2023 meeting were approved with no changes.

Mr. Maia noted the importance of client advisory boards, which the Consumers Committee will address at its next meeting.  Mr. Carr added that migrants who need services may be more likely to be connected to care through other consumers.

Mr. Fields reported about yesterday’s Fast Track Cities/Ending the HIV Epidemic Summit at Gracie Mansion, noting that the space should have been more accessible to people with disabilities.

Mr. Lesieur reported that the Governor’s proposed 2024 budget slashes funding for Health Homes by almost half (about $200M), which would be devastating to the population that relies on the program for retention in care services, and would put a heavy strain on Ryan White Part A (RWPA) programs. 

Agenda Item #2: GY 2024 Spending Scenario Plan

Mr. Carr presented the GY 2024 spending scenario plan, which is a methodology for implementing the final award, from a worst-case scenario of a 3.5% reduction to an increase.  The plan was approved by the Priority Setting & Resource Allocation Committee last week.  The draft federal budget has no change proposed for RWPA nationally, which means that any potential reduction should be much less than worst-case scenario.  In any funding scenario, the PSRA Committee recommends:

  1. Flat funding for Tri-County, with $117,982 in uncommitted funds (from the Legal Services category due to a rescinded contract) reallocated to Medical Case Management.  
  2. $931,957 in one-time additional funding for NYC Housing Programs to transition clients in two programs that are ending on February 29 due to the rebid of the NYC RWPA programs.
  3. Funding the Health Education and Risk Reduction (HER) service category for 6 months for a savings of $292,695 (the service model will be incorporated into new Behavioral Health Programs in GY 2025).

There are uncommitted funds available to offset a reduction in the award from four service categories: Harm Reduction, Supportive Counseling, Legal Services and HER.  In a reduction scenario the uncommitted funds will be used to offset a reduction, with ADAP absorbing any reduction beyond the uncommitted funds.  In a flat funding scenario, any available uncommitted funds will be used to restore the baseline allocation of the Behavioral Health Categories (Hard Reduction, Mental Health, Supportive Counseling) in anticipation of the rebid of those programs for GY 2025.  If there are still uncommitted funds available after restoring the BH categories, it will be allocated to Food & Nutrition Services, as per the application spending plan.

Ms. Gilborn, on behalf of the PSRA Committee, moved that the Executive Committee approve the GY 2024 spending scenario plan as presented. 

Highlights of the ensuing discussion follows:

  • The ADAP allocation has diminished from a high of over $16M to its current $4M due to using the category to absorb reductions to the award in order to preserve other RWPA programs.  The ADAP program is always able to maintain their level of service when RWPA funds are reduced.  The RWPA allocation only pays for the ADAP prescription component of the NYS HIV Uninsured Care Program.
  • The PSRA Committee is mindful of the need to preserve a level of ADAP funding that can be used to absorb future reductions to the award.
  • It is possible that no agencies that apply for funding under the BH RFP will opt to include an HIV self-management component, but it was noted that there will be over $13M available in those categories with around 20 programs funded.  Inclusion of a self-care component can be incentivized in the RFP.  The programs will also be much better placed to reach the target population who are coming in for BH services.
  • While it is always a difficult decision to eliminate any programs, the Council needs to take into consideration the fact that there is limited grant funding and competing priorities, some of which the Council has ranked as higher needs.

A vote was taken and the motion was adopted 14Y-1N.

Agenda Item #3: Prioritized Next Steps from the Council/Recipient Retreat

Mr. Martin presentedthe list of next steps from the Council/Recipient retreat, refined and prioritized by an ad hoc committee of Council members and Recipient staff.  The next steps were grouped into categories of “easy”, “moderate” and “difficult”.  Mr. Klotz noted that some of the easy steps have already been taken or are in progress, such as sending out the HRSA RWPA Primer, holding briefings before votes on complex issues, providing committee updates, and involving the Recipient in the early stages of planning.  Committee members discussed the next steps and made suggestions, such as assessing the progress of meeting the retreat goals continually and doing formal check ins more frequently than once a year.  

Agenda Item #4: Public Comment

Ms. Graham talked about a recent difficulty with the ADAP program.  Ms. Edwards noted that the program is usually able to enroll someone within one day and offered assistance to Mr. Graham.

Mr. Fields stressed the need for data on the needs of newly arrived migrant with HIV, as there are only anecdotal reports now.

Mr. Carr reported that the State’s Medicaid 1115 waiver, which expands eligibility and services, may have an impact of RWPA payor of last resort issues.  Mr. Lesieur added that the State is still rolling out the program enhancements and many details are still unknown.

There being no further comment, the meeting was adjourned.