Minutes of the Meeting of the
Integration of Care Committee
Veronica Fortunato & Steve Hemraj, IOC Co-Chairs
Wednesday, May 21, 2025
10:05am-11:35pm
Minutes
M I N U T E S
Members Present: Steve Hemraj (Co-chair), Raffi Babakhanian, Mitchell Caponi, Dorothy Farley, Billy Fields, Deborah Greene, Christopher Joseph, David Klotz, Marcelo Maia, Jeff Natt, Cesar Nuñez, Leah Richberg, John Schoepp, Scott Spiegler (for Guadalupe Dominguez Plummer), Brenda Starks-Ross, Joel Zive
Staff Present: NYC DOHMH: Doienne Saab, Michael Navejas, Scott Spiegler, Adrianna Eppinger-Meiering, Johanna Acosta, Gina Gambone, Francis Silva, Arnelle Vincent, Emma Ramsdell, Abraham Omeyoma
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Mr. Hemraj opened the meeting followed by a roll call and a moment of silence. The draft minutes from the March 19th meeting were approved with no changes.
Mr. Klotz gave a quick update on federal funding issues. The 2026 budget proposes flat funding for Ryan White Parts A, B, C and D, but proposes eliminating Part F, MAI funding and numerous other health and social service programs.
Agenda Item #2: Food & Nutrition Services (FNS) Directive
Ms. Vincent presented an overview of the FNS service category, starting with the HRSA definition of the service. The program’s goals are to reduce food insecurity, provider medical nutritional therapy as needed, promote access to and maintenance in HIV-specific medical care, improve health outcomes and reduce health disparities. HRSA allows two difference FNS-related categories: Food Bank & Home Delivered Meals (FB, a non-core service), and Medical Nutritional Therapy (MNT, core). The former provides food or vouchers and the latter includes treatments and assessments by registered dieticians including supplements and education/counseling. Eligibility criteria are the general RWPA criteria (HIV status, residency, income), with a priority for those with food insecurity or a need for MNT.
Service types for include assessments and planning, food services (voucher, congregate means, home-delivered meals, pantry bags), and nutrition services (comprehensive nutritional assessment, counseling with supplements, education). Providers must demonstrate the ability to provide food/meals to PWH, work in areas with high concentrations of food insecurity and comply with government regulations and licensure. The staffing model was also described.
There are currently 11 programs in NYC (10 at CBOs) in all five boroughs. Challenges faced by programs include: COVID impacts on service delivery (e.g., suspension of congregate meals during lockdown), budgetary constraints due to inflation, and staffing. There has also been increased demand (e.g., from new arrivals), and an increase in wait lists. FNS programs have always been able to use funding enhancements from uncommitted funds. Program successes have included high spending rates, flexibility to use different service types, adoption of telehealth for counseling and assessments, and quality improvement projects that have focused on managing comorbidities.
Ms. Ramsdell presented a revised FNS Fact Sheet with data from 2021-2024. Eighty-five percent of clients are Black or Hispanic, and the Bronx has the most clients. Sixty-seven percent are over 50 years old, and almost half have a disability. The number of clients increased from 2560 in 2021 to 3256 in 2024. The most utilized service types were home-delivered meals (453,944 units in 2024) and congregate meals (63,452 units in 2024). Sixty-seven percent of clients reported moderate or severe food insufficiency in 2024 (an increase from previous years). Payor of last resort considerations were described, including SNAP and WIC programs, which are being targeted for cuts by the current administration.
A summary of the ensuing discussion follows:
- Not all programs provide vouchers and wait lists for those programs that do may be related to staffing issues or demand.
- Mr. Joseph offered to present information about EngageWell’s digital “food as Medicine” program.
- Past performance is a factor in considering programs for FNS contracts.
- Programs should incorporate into their client assessments unique factors that impact food insecurity, such as lack of appropriate appliances (RW cannot pay for those).
- Programs already try to ensure nutritional continuity for clients that experience a disruption in their ability to cook or store food. The revised directive can enshrine this.
- The directive can identify additional priority populations.
- Programs should be able to help clients enhance or leverage SNAP and other benefits (although it was noted that SNAP is under threat).
- Agencies assess if a client is enrolled in more than one FNS program and should monitor for payor of last resort, although it is not necessarily a negative thing for someone to receive food assistance from more than one source.
- Definitions for food insufficiency are based on validated scales.
At the next meeting, on Wednesday, June 18th, 10am-12pm, the Committee will continue review of the FNS service directive, starting with service category goals and the aligned Integrated Plan goals and objectives.
There being no further comment, the meeting was adjourned.
