Meeting of the Priority Setting & Resource Allocation Committee
Monday, February 10, 2025
By Zoom Videoconference
3:05 – 5:00
Members Present: Paul Carr (Co-chair), Marya Gilborn (Co-chair), Raffi Babakhanian, Matt Baney, Joan Edwards, Billy Fields, David Klotz, Marcelo Maia, Guadalupe Dominguez Plummer (ex-officio), John Schoepp, Terry Troia
Members Absent: Steve Hemraj, Stella Safo, MD
Staff Present: Michael Navejas, Doienne Saab, Scott Spiegler, Adrianna Eppinger-Meiering, Johanna Acosta, PhD, Gina Gambone, Abraham Omeyoma, Deborah Noble, Frances Silva, Renee James (DOHMH); Barbara Silver, Arya Shahi (Public Health Solutions)
Agenda Item #1: Welcome/Introductions/Minutes
Ms. Gilborn and Mr. Carr opened the meeting, followed by a roll call and a moment of silence. The Council’s new community coordinator, Abraham Omeyoma, introduced himself. The minutes of the January 13, 2025 meeting were approved with no changes.
Agenda Item #2: GY 2025 Spending Scenario Plan
Mr. Klotz reviewed GY 2025 spending scenario with decisions made to date. At last month’s meeting, the Committee voted to approve a permanent enhancement to Housing Services of $1,212,656. In a flat-funding scenario, with the savings in carrying costs for programs there would still be $642,191 available to reallocate to high priority service categories. As discussed last month, the Council already prioritized Housing and Food & Nutrition Services (FNS), as well as a modest amount for Legal Services in an increase scenario.
There was discussion on the uncertainty of the national Ryan White appropriation, with the federal government funded through mid-March and Congressional budget negotiations just starting. Mr. Babakhanian raised the possible impact on spending if RWPA was no longer able to serve certain special populations. DOHMH has reaffirmed its commitment to serving all populations and addressing health equity. Ms. Plummer added that, with the partial GY 2025 grant award already received (about 16% of GY 2024 funds, enough to keep programs running through late April), the Recipient is committed to ensuring that the most important, life-saving services are prioritized. There was consensus that, given the existing enhancement to Housing, the rising costs of food and the possibility of cutbacks to SNAP benefits, that any available uncommitted funds in a flat funding or small reduction scenario should be committed to Food & Nutrition Services (FNS).
A motion was made, seconded and approved 10Y-0N to allocate any uncommitted funds to FNS in a scenario where the reduction to the grant award is $642,197 or less.
Mr. Klotz noted the high level of uncertainty around federal funding. At a recent meeting, someone from the national advocacy group AIDS United expressed their concern that the entire MAI program may be eliminated. Given the implications, the PSRA Committee needs to plan for a worst-case scenario where the entire $7.9M MAI portion of the grant is eliminated, on top of the usual reductions in Base formula funding.
In planning for a larger reduction, in addition to the $642,191 available to absorb a reduction to the award from savings in carrying costs, an additional offset of up to $1.5M from the ADAP allocation is available, meaning that the EMA can absorb up to $2,142,191 without further reductions to programs. In the event of a reduction to the award larger than $2,142,191 (savings in carrying cost and reduction to ADAP, minus the Housing enhancement), the most logical place for a cut would be a targeted decrease to lowest ranked category, Early Intervention Services (EIS), currently funded at $3,729,234. It was noted that the EIS allocation was reduced about 10 years ago due to the few positives that were identified, and because the HIV testing landscape had changed with the implementation of routine testing in NY State. The category has a single provider as of GY 2025, who has informed the Recipient that they could operate a viable program with as little as $1.9M. That means that EIS could absorb up to an additional $1,829,234 of a cut to program funds.
A motion was made, seconded and approved 10Y-0N that in a reduction scenario of program funds over $2,142,197 and no more than $3,971,431, the remaining deficit will be absorbed by reducing the EIS allocation (up to a minimum EIS allocation of $1.9M).
If the reduction to the award is larger than $3,971,431, EIS would be under the viability threshold. The PSRA Committee could then eliminate the EIS category. That means that if the total cut is higher than $3.97M and no larger than $5,752,399 (that figure accounts for EIS being zeroed out), there would have some uncommitted funds to reallocate from the EIS category.
A motion was made, seconded and approved 8Y-1N in a scenario of a reduction of programs funds higher than $3,971,431 but lower than $5,752,399, to allocate $642,197 to FNS and allocate any remaining uncommitted funds to Housing.
If the cut is larger than $5.75M and EIS was zeroed out, the Committee could cover the remaining deficit by cutting the Behavioral Health category, which would be reflected on the spreadsheet through a proportionate reduction to the Mental Health, Harm Reduction and Supportive Counseling line items. Mr. Klotz showed a spreadsheet with a worst-case scenario showing a complete elimination of the MAI award, plus a 3.5% cut to the Base award for a total cut of $10.8M (11.7%). This spreadsheet shows the elimination of EIS and a cut of $3.9M to Behavioral Health (from a total of $13.2M to $9.3M). Behavioral Health programs are in the final stages of contract negotiations for programs to start on March 1st, and all potential providers are aware that contracts are dependent on the availability of funding. No potential BH provider has withdrawn from contract negotiations due to the uncertainty of funding.
It was noted that, as approved by PSRA last month, in any reduction scenario above 3.5% of program funds ($2,653,059), Tri-County will take a proportionate reduction according to their approved spending scenario. Any offset to the reduction in the NYC portfolio will be applied in the above scenarios. Also, the portion of the grant used for administration is fixed at 10%, thus in any reduction scenario, there would be a proportionate cut to that budget, which pays for the Recipient’s staff, the Public Health Solutions subcontract, Planning Council staff and support, the CHAIN study and all other administrative activities.
There was discussion of potential scenarios that reduce other service categories proportionally. It was noted that the priority setting process ranked the categories according to the PSRA’s ranking tool to reflect the relative importance of each service. There was a discussion of holding the most critical services such as Housing and FNS harmless. There was discussion of the importance of advocacy efforts focused on members of Congress. It was noted that nationwide efforts are being undertaken by groups such as NASTAD and the CAEAR Coalition, but that is important for members of Congress to hear directly from their constituents.
A motion was made, seconded and approved 10Y-0N that in a reduction scenario of program funds over $5,752,399 up to $10,804,256, 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 MH, Harm Reduction and Supportive Counseling). If the cut is larger than $10,804,256, PSRA will reconvene to develop a plan to make further reductions.
Mr. Klotz thanked the Committee members and chairs for their thoughtful deliberations in a very challenging environment. The next PSRA Committee meeting will be on April 14th. There being no further business, the meeting was adjourned.
