Priority Setting & Resource Allocation Committee Minutes January 11, 2020

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Meeting of the Priority Setting & Resource Allocation Committee

Monday, January 11, 2021

By Zoom Videoconference

3:05 – 4:30

M I N U T E S

Members Present: Marya Gilborn (Co-chair), Jeff Natt (Co-chair), Fulvia Alvelo, Matt Baney, Paul Carr, Broni Cockrell, Billy Fields, Graham Harriman, Guadalupe Dominguez Plummer, Michael Rifkin, Leo Ruiz, John Schoepp, Claire Simon, Dorella Walters

Members Absent: Randall Bruce, Joan Edwards, Terry Troia, Rob Walker

Staff Present: David Klotz, Melanie Lawrence, Eleonora Jimenez-Levi, Giovanna Navoa,  Johanna Acosta, Scott Spiegler, Ashley Azor, José Colón-Berdecía, Dave Ferdinand  (NYC DOHMH); Jeanette Moy, Gucci Kaloo, Kathy Fitzpatrick, Rosemarie Santos (Public Health Solutions)

Guest Present: Julie Vara (NYSDOH AIDS Institute Uninsured Care Program)

Agenda Item #1: Welcome/Introductions/Minutes

Mr. Natt and Ms. Gilborn opened the meeting, followed by introductions and a moment of silence.  The minutes of the December 14, 2020 meeting were approved with no changes.

Agenda Item #2: FY 2021 Ryan White Appropriations

Mr. Harriman reported that Congress passed an omnibus appropriations bill that funds Ryan White nationally in FY 2021 at the same level as FY 2020 (with the exception of a small increase Ending the Epidemic funds, which will benefit NYC as that award is formulaic).  This means that, with the continued reduction in the NY EMA’s proportion of cases nationally, we should expect a similar reduction in the Part A formula award for FY 2021 as we have seen in recent years.  It was reiterated that the new COVID-related stimulus bill does not include any funding for Ryan White programs, which means that the $1M in CARES funding will not be available in FY 2021.  President-elect Biden has pledged to “fully fund” the Ryan White program, which may mean an increase for his first full-year budget for FY 2022.

Agenda Item #3: FY 2021 Spending Scenario Planning

Mr. Klotz reviewed that PSRA, in planning for a possible reduction in the grant award, asked for more data in order to determine how much to fund categories that received enhancements in FY 2020 to respond to COVID-19.  Also, the NYSDOH Uninsured Care Program was asked to present on their services and discuss how much the Council can reduce their allocation to absorb a cut to the award and fund enhancement and new initiatives.

ADAP 

Ms. Vara reported that due to COVID, the ADAP program experienced a significant increase in enrollment in FY 2020.  Many were former enrollees who had experienced economic difficulties due to the pandemic.  Some were transitioned off the program when they were able to secure other forms of insurance.  APIC (the portion of the Uninsured Care Program that pays to help people stay on existing insurance) was heavily used.  Also, the fact that NYS allowed open enrollment all year in ACA plans helped keep some people from needing ADAP.  Total enrollment in the program for FY 2020 was about 25,000, 76% of them in the EMA, and 74% people of color.  There was an increase in the percentage of enrollees over the age of 50 and the program is reviewing its formulary to ensure that the needs of that population is met. 

In response to COVID, the program started allowing 90-day prescriptions and expanded reimbursement for telehealth services.  The program has also taken steps to ensure rapid initiation of ART, and now 93% of applications are approved within a few days, if not on the same day.

ADAP is able to reduce its allocation again this year to cover a cut to the award.  The program is also able to absorb carry-over near the end of the year.  Mr. Klotz added that for many years, the Council reduced ADAP in order to absorb a cut to the award with the pledge to restore ADAP with carry-over dollars.  In recent years, there has been very little carry-over, but a higher amount than usual is expected this year due to COVID-related challenges.

Housing

Ms. Jimenez-Levi reported on the RWPA Housing programs (HOU).  She reviewed the program goals (decrease homelessness, reduce HIV transmission, improve health outcomes), and reviewed the three component parts of the service: Short-term Housing (STH), Housing Placement Assistance (HPA), and Short-term Rental Assistance (SRA).  Clients must meet all RWPA eligibility requirements, plus be homeless/at risk of homelessness, and must pay 30% of household income towards rent (an amount set by US HUD; if income goes down, so does contribution, and if the client has no income, the full rent is covered). 

STH: At the beginning of FY 2020, STH (serving 284 clients) received $6,158,658 of the HOU allocation, then received $98,844 in COVID enhancements (of the total $1.85M).  As of November 2020, it was 66% spent.  Due to COVID, STH experienced challenges in securing and housing clients after NY State went on PAUSE in March.  Recruitment efforts to fill vacancies suffered during the PAUSE, and filling staff vacancies was also difficult.  Many households continued to receive fixed income (SSI/SSD) and/or had access to HASA.  The program received some FY 2019 carry-over funds, which were used to help provide rental subsidies for clients who lost income, and pay for increased costs related to PPE and other new expenses (particularly high in congregate settings with shared spaces).  In FY 2021 an additional $180K would support increased costs of operating congregate facilities, personnel costs to staff facilities 24/7, PPE and cleaning supplies, and the increased costs of program operations (i.e., office rent/utilities, finance, staff salaries/fringe, teleworking, etc.).  In order to serve an additional 20 eligible HH, another $340,000 is needed.

HPA: At the beginning of FY 2020, HPA (serving 237 clients) was funded at $1,213,937.  An additional $3,160 was allocated from carry-over.  As of November 2020, it was 74% spent.  Due to COVID-19, placement and recruitment activities declined significantly after NYS went on PAUSE.  Filling staff vacancies was also difficult.  For HASA eligible clients, there were delays in getting HASA approval for new units.  The service category changed to cost-based, which allowed agencies to cover expenses, including COVID-19 expenses.  Current funding is sufficient to support ongoing housing placements.  The ability to continue as a cost-based service will allow the service category to maximize spending and be responsive to ongoing COVID-19 needs.

SRA: At the beginning of FY 2020, SRA (serving 250 clients) received $4,199,873.  The entire CARES and reallocated ADAP funding was used to enhance the program by $1,855,000 (not including $45,000 for Tri-county Housing).  As of November 2020, it was 54% spent (the RWPA and CARES Act spending rates were broken down; all CARES Act funds will be fully expended by March 31st, when they expire).  Financially, SRA clients have been most affected by the pandemic in terms of income loss, as they are not eligible for federal stimulus checks or other housing subsidies.  As with all HOU programs, SRA operates as payer of last resort.  During the PAUSE, consumers were afraid to seek housing assistance/leave home, landlords were unwilling to show apartments, and staffing vacancies posed challenges to scaling up services.  The eviction moratorium prevented hundreds of evictions which would have resulted in increased costs to service category but never materialized.  

In September, the SRA program scaled up to 240 households.  If enrollments reach 250, many enrollees would be disenrolled by March 2021 because rent costs are no longer sustainable when funding resets to base award of $4,199,873.  With CARES funding expiring in 2021, it would be unethical to enroll new households for less than 6 months and then terminate rental assistance.  Even at 240, the base award for FY21 would not cover the rental assistance need for one year for 240 households.  In order to provide ongoing rental assistance to 250 households, an additional $865,000 is needed.  Average rental cost per household is $1,429 a month, based on HUD-determined fair market value (based on location and size of unit).  Rental costs are not stagnant and while most 1-year renewals were not subject to an increase in FY20, we do anticipate increases in rent for renewals moving forward.  Non-HASA eligible populations who benefited most from CARES funding will not have access to other resources to keep them stably housed.  Though anticipated underspending is $950,000 for FY20, the need very much continues through FY 2021.  Tri-county HOU programs will also need enhancement to continue to meet their needs; a proposed amount will be presented to the TC Steering Committee, then brought to the PSRA in February.

In summary, the COVID-19 pandemic impact is significant and ongoing.  Housing need will not expire in March 2021.  A continuation of additional monies is needed to keep current households stably housed. The BHIV Housing Unit recommends that PSRA maintain its commitment to keep both staff and clients safe as we enter year two of the pandemic.  The combined enhancement needed for STH and SRA above the original FY 2020 allocation is $865,000 (which is substantially less than the $1.85M added in April). 

A summary of the ensuing discussion follows:

  • Some congregate facilities are not providing the appropriate level of service, particularly in regards to COVID safety and cleaning. 
  • COVID made it more difficult to refer clients to fill STH vacancies, especially as in-person outreach was curtailed (e.g., in shelters, ERs).
  • The Housing Unit surveyed providers, who maintain wait lists, on how many clients they were not able to enroll due to funding limits.  Also, providers have staff and resource capacity issues that limit the number of clients they can emrol and support.
  • Housing programs will have a role in the COVID vaccine roll-out (details TBD).  Residents of congregate facilities are already eligible under the NYS guidelines to receive the vaccine.
  • All units have to abide by quality standards so that clients are not placed in unacceptable conditions.

Emergency Financial Assistance (EFA)

Ms. Acosta presented on the EFA program, which is short-term assistance intended to support continuity of care and treatment for PWH.  Details of the program were provided e.g., (no direct cash payments, 12-month cap of $2000 as per the Council’s directive).  EFA was originally funded at $250,000 and intended to serve Tri-County (while open to all eligible EMA residents), and which received an enhancement of $499,825 with the intention of expanding the program to meet the needs of NYC residents.  In March 2020, nearly 144,000 unemployment claims were made in New York City, a 2,637 percent increase from 2019.  There are approximately 12,659 (89.2%) RWPA clients in the NY EMA living at or below 138% Federal Poverty Level (FPL). 

In July, the Grantee released a memo to Ryan White Part A funded programs informing them of the extension of EFA services throughout the NY EMA, including instructions on how programs can enroll clients in the EFA program.  Since August, the EFA program has seen a steady increase in spending and unduplicated client enrollments.  The program provided services to 176 clients throughout the NY EMA.

Funding was used to support emergency needs for housing, food, transportation, utility bills, medications, personal and protective equipment (masks, gloves, cleaning supplies, etc.) in response to COVID-19.  In September 2020, $59,164 was utilized to assist acute and emergent client needs, the largest monthly expenditure to date.  The increase in number of intakes has led the EFA program to hire a full-time Program Coordinator, enhance outreach efforts, and increase overall clients receiving EFA.  If the EFA category continues to receive $749,825 in FY 2021, the program will be able to serve approximately 250 clients in both the Tri-County and NYC region.

A summary of the ensuing discussion follows:

  • The program expects to receive more self-referrals going forward.
  • The program is responsible for ensuring payer of last resort and that clients have exhausted all other means of obtaining financial support.
  • The funds are expended as clients request assistance.  Unlike HOU services, the program does not maintain enrollment indefinitely.    

Mr. Klotz explained that the Committee will need to conclude its scenario planning at the February meeting Housing, making final determinations on the Housing and EFA allocations.  Also, there will be information on changes in the carrying costs of program, which should result in some additional savings.  This will determine how much of the ADAP allocation will be needed to cover enhancements and absorb a cut to the award.

There being no further business, the meeting was adjourned.