Thursday, February 27, 2025
3:05-5:30 PM
By Zoom Videoconference
Members Present: D. Klotz (Governmental Co-chair), D. Martin (Community Co-chair), B. Fields (Finance Officer), R. Babakhanian, M. Baney, G. Bruckno, P. Carr, L. Cyrus, J. Edwards, R. Ford, R. Fortunato, L. Francis, M. Gilborn, S. Hemraj, R. Henderson, E. Kaywin, M. Maia Soares, L. F. Molano, MD, B. Montes, J, Natt, C. Nuñez, J. Palmer, G. Plummer (ex-officio), L. Richberg, M. Rodriguez, , L. Sabashvili, J. Schoepp, M. Sedlacek, S. Stallings, A. Tomlin, G. Ty
Members Absent: M. Bacon, R. Brown, M. Caponi, V. Decamps, J. Dudley, J. Goldenbridge, F. Laraque, W. LaRock, H. Martinez, N. Martin, J. Roman, S. Safo, MD, T. Troia
Staff Present: DOHMH: M. Morse, MD, MPH, C. Quinn, MD, MPH, S. Braunstein, PhD, M. Navejas, D. Saab, S. Spiegler, J. Acosta, A. Eppinger-Meiering, A. Guzman, S. Kramer, A. Omeyoma, K. Mack, P. Padgen, A. Drab, H. K. Mok; Public Health Solutions: A. Shahi
Agenda Item #1: Welcome/Introductions/Minutes/Announcements
Mr. Martin and Mr. Klotz opened the meeting followed by a roll call and a moment of silence. in honor of Black History Month, Ms. Saab presented on pioneering Black-led organizations in the fight against HIV. The minutes from the January 23, 2024 meeting were approved with no changes.
Agenda Item #2: Public Comment, Part I
Mr. Maia expressed concerns about the new administration’s actions that affect access to services for immigrants. Guidelines for organizations on how to handle non-local law enforcement in their facilities must also address consumers.
M. Lopez (Einstein College of Medicine) spoke of her journey as a formerly undocumented immigrant mother with HIV who worked with the Planning Council in her early advocacy years.
Mr. Carr reported that HASA is missing rent payments when a client moves.
Agenda Item #3: Recipient Report
Ms. Eppinger-Meiering reported on the observance of National Black HIV Awareness Day and a newly released State of HIV & Aging National Survey findings. HRSA and SAMHSA released a letter encouraging recipients of Ryan White and Recovery Services grants the public health and substance use disorder (SUD) treatment communities to address the dual challenges of HIV and substance use disorders.
Last month, the Recipient received the Partial Notice of Award for Grant Year (GY) 2025. The total amount received was $16,210,677 ($14,788,666 Formula and $1,422,011 MAI). This funding is based on a continuation of GY 2024 program requirements and funding levels. Please note that HRSA is operating under a Continuing Resolution; final awards will be processed as soon as HRSA’s HIV/AIDS Bureau receives the full GY 2025 appropriation amount for this program. At a prorated amount, the partial award would cover expenditures through late April, but the Recipient is prioritizing funding for program services.
The DOHMH BHHS Research and Evaluation Unit released the GY 2023 Enrollment Reports for the RWPA EMA. The annual reports provide a breakdown of clients by enrollment status, demographic makeup, and priority population. RWPA subrecipients reported on their 2024-25 quality improvement projects, which focused on: increasing participation and engagement in program services; expanding access to referrals/additional supportive services; reengaging participants lost to follow-up or disconnected to care; increasing or maintaining viral load suppression; and new client recruitment efforts. The Quality Management and Program Implementation unit recently developed an assessment focused on gathering input on subrecipient experiences focused on learning more about assistance and guidance on program implementation and service delivery, training needs, and experiences in developing and implementing quality improvement methods.
On February 12th, DOHMH BHHS Assistant Commissioner Dr. Braunstein joined a New York City Council Health Committee oversight hearing on the HIV/AIDS Services Administration (HASA) program, fielding questions from Council Members on RWPA- and Housing Opportunities for Persons with AIDS (HOPWA)-funded housing services for income-eligible PWH in New York City, as well as on our recently released 2023 HIV surveillance data. BHHS also released HIV in NYC 2023, a newly created one-pager summarizing select data from the 2023 HIV Surveillance Annual Report released on December 4th. On February 5th, BHHS and Voces Latinas hosted approximately 14 community partners representing six organizations and coalitions serving sex workers for a second roundtable discussion on the health and safety needs of sex workers. BHHS launched a new webpage on congenital syphilis, which includes a link to the 2023 STI Surveillance Report.
Agenda Item #4: GY 2025 Spending Scenario Plans
Mr. Klotz opened the presentation of the PSRA Committee’s approved GY 2025 spending scenario plan by noting the great uncertainty around next year’s grant award. The federal government is funded through mid-March and Congressional budget negotiations are just starting. The EMA has received a partial award equal to about 16% of GY 2024 funding, but there is concern in the community about potentially huge cuts to Ryan White appropriations, including the possible elimination of Minority AIDS Initiative (MAI) funding. In order to be prepared for a catastrophic reduction in funding, the PSRA Committee considered scenarios to account for up to a reduction of $10,804,256 (11.7%), which would account for the end of the MAI portion of the award and the customary potential reduction of Base funding up to 3.5%. He reported that at a HRSA webinar yesterday, the HRSA HIV/AIDS Bureau announced several funding opportunities for 2025-26, which demonstrated their current belief that Ryan White programs will continue at some unknown funding level for at least another year.
Mr. Carr explained that the spending scenario is a methodology that allows the final award amount to be applied immediately upon receipt from HRSA, which avoids a month or more delay in executing contracts. The spending scenario for the Tri-County portion of the award is to hold TC programs harmless up to a 3.5% reduction to the award. Should the award reduction be higher than 3.5%, the TC Steering Committee recommends an across-the-board reduction (weighted by ranking score) for the four lowest ranked categories (Legal, Oral Health, Mental Health, and Early Intervention Services). This plan protects the highest ranked service priorities: Housing, Medical Transportation, Psychosocial Support Services, Medical Case Management, and Food/Nutrition.
In 2024, NYC RWPA Housing programs were re-bid and the PC allocated $931,957 as a one-time enhancement to transition clients. The Health Education category was eliminated (model incorporated into new Behavioral Health category), and the Psychosocial Services for TGNB category was right-sized (savings of $486,495). There is an additional savings in carrying costs of $392,348 due to reduction in Non-Medical Case Management/Rikers as the program no longer needs to pay salaries of corrections officers to accompany inmates to medical and service appointments. This results in a total savings in carrying costs of $1,854,853.
Ms. Gilborn explained that in all scenarios, the PSRA Committee approved a permanent increase to the Housing category of $1,212,656 to maintain current service levels given HRSA guidance allowing the use of RWPA funds to pay for security deposits, NYC laws on brokers fees, and increases in fair market rents. After accounting for the Housing enhancement, there would be $642,197 available to absorb a reduction in the award. PSRA recommends that if the reduction to the award is less than that amount, that any uncommitted funds be allocated to FNS, in accordance with the application spending plan approved in July 2024.
In a scenario where the reduction is more than $642,197, the NYS DOH AIDS Institute has agreed to take an upfront reduction to the ADAP allocation up to $1.5M (to be restored during the year through reprogramming and carryover). Thus, there is a total of $2,142,197 (2.3%) available to absorb a reduction in the grant award with no cuts to other programs. Should the reduction be larger than $2,142,197, PSRA recommends a reduction to the allocation of the lowest ranked category, Early Intervention Services (the lowest ranked category due to the wide availability of testing and the fact that this is a new program beginning GY 2025 with no staff hired yet). The current EIS allocation is $3,729,234, and the new provider has informed the Recipient that the minimum level for a viable program is $1.9M. Thus, an additional $1,829,234 is available to absorb a larger reduction. If there is a reduction of program funds between $3,971,431 and $5,752,399, the EIS category will fall below the viability level and be eliminated and any uncommitted funds will be allocated to FNS and Housing, with the first $642,197 to FNS and any remaining funds to Housing.
In a reduction scenario of program funds over $5,752,399 up to $10,804,256 (11.7%), EIS would be eliminated and any remaining deficit will be covered by reducing the Behavioral Health categories (to be reflected on the spending plan proportionately between Mental Health, Harm Reduction and Supportive Counseling). If the reduction is over 11.7%, PSRA will reconvene to determine additional methods to cover a deficit.
Mr. Carr stated that any reduction to services is difficult to contemplate, but the proposed scenario plan preserves the most essential, life-saving services (e.g., medications, housing, food), and advocacy is needed on all levels to help preserve critical funding for HIV and other public-health programs.
Mr. Klotz reviewed spreadsheets that reflect the above recommendations. There was a discussion on the possible impact of severe federal cuts to Medicaid, which would create further strain on RWPA programs as payor of last resort services. There was also discussion on how ADAP would absorb clients who no longer qualify for Medicaid and how dually-enrolled people can get coverage during a Medicaid spend-down period. Also the RWPA Emergency Financial Assistance program can cover one-time co-pays, but not as a recurring expense. Ms. Plummer added that BHHS and PHS met with sub-recipients yesterday to apprise them of the funding situation and the Council’s scenario plan.
A motion was made on behalf of the PSRA Committee to approve the GY 2025 spending scenario plans as presented. The motion was adopted 25Y-0N.
The PSRA members and chairs were thanked for their effort and the Council members for their thoughtful deliberations.
Agenda Item #5: Remarks from Acting Commissioner of Health Dr. Michelle Morse
Mr. Klotz introduced Dr. Michelle Morse, Acting NYC Commissioner of Health, who leads the agency’s work in bridging public health and health care to reduce health inequities. Dr. Morse is an internal medicine and public health doctor who works to achieve health equity through global solidarity, social medicine and anti-racism education, and activism.
Dr. Morse thanked the Council for inviting her and commended their work creating an effective system of care and planning thoughtfully and democratically in uncertain times. She talked about her recent round of meetings in Washington, DC with public health officials from across the country and related the many types of mobilization and advocacy being done to preserve the public health infrastructure. Dr. Morse stated her commitment for DOHMH science- and data-based public health practices that serve all New Yorkers, and to continue working collaboratively and collectively to address health equity, racial gaps in health outcomes and social determinants of health.
Dr. Morse answered questions about DOHMH incorporating more community planning in other parts of the agency and efforts to ensure that health and services are available regardless of immigration status. Other issues discussed included increased access to fentanyl test strips and greater visibility for people with disabilities in public health programs.
The Council thanked Dr. Morse for her commitment and extended an open invitation to join future Council meetings.
Agenda Item #6: Policy Update
Mr. Guzman reported on current federal policy and funding issues that affect health care, particularly HIV- and Ryan White-related services. Topics included: executive orders pausing federal funding, banning gender affirming care for youth, “rejecting gender ideology” and pausing foreign aid (including PEPFAR, which provides lifesaving medication to millions in developing countries). He explained that Congress has funded the government at 2024 levels through March 14th through a continuing resolution, and expressed the view that, given disagreements between the House and Senate, they may fund the rest of the year through a continuing resolution, which would preserve 2025-26 funding levels.
The Council discussed various avenues for advocacy, including communicating with elected representatives. Advocacy toolkits and other resources will be shared with Council members.
Agenda Item #7: Public Comment, Part II
Mr. Maia announced that the Consumers Committee’s planned Town Hall on Client Advisory Boards will take place on April 15th at the LGBT Center and will promote consumer participation in CABs and encourage advocacy by consumers at RWPA agencies and beyond to create and support effective CABs. He also encouraged people to attend an ACT-UP town hall on March 11th. There being no further business, the meeting was adjourned.
