Meeting of the Priority Setting & Resource Allocation Committee
Monday, December 11, 2023
By Zoom Videoconference
3:05 – 4:55
Members Present: Paul Carr (Co-chair), Marya Gilborn (Co-chair), Raffi Babakhanian, Matt Baney, Kyron Banks, Billy Fields, David Klotz, Matthew Lesieur, Guadalupe Dominguez Plummer, Claire Simon
Members Absent: Fulvia Alvelo, Joan Edwards, Steve Hemraj, John Schoepp, Terry Troia
Staff Present: Doienne Saab, Scott Spiegler, Johanna Acosta, PhD, Adrianna Eppinger-Meiring, Gina Gambone, Frances Silva (DOHMH); Gemma Ashby-Barclay, Rosemarie Santos (Public Health Solutions)
Agenda Item #1: Welcome/Introductions/Minutes
Mr. Carr and Ms. Gilborn opened the meeting, followed by introductions and a moment of silence. The minutes of the December 11, 2023 meeting were approved with no changes.
Agenda Item #2: GY 2024 Spending Scenario Plan
Mr. Klotz presented the GY 2024 Tri-County (TC) Spending Plan, approved by the Tri-County Steering Committee. The TC portfolio took a reduction in GY 2023 of about $234K, half of which came from the Medical Case Management service category. For GY 2024, there was $117K in uncommitted funds from a rescinded contract in Legal Services. The former Legal Services provider will continue to serve their former RWPA clients through other funding sources. The TC Committee proposed reallocating the uncommitted funds to MCM, which was reporting challenges due to the reduction.
There was a consensus to approve the GY 2024 TC spending plan as presented.
Health Education & Risk Reduction (HER)
Mr. Klotz summarized the options for the HER service category, offers an HIV self-management training model known as the Positive Life Workshop (TPLW). The program’s target population is those who do not have a suppressed viral load or who do not consistently remain in HIV treatment and care, which comprise a small number of active clients. The number of active clients fell from 602 in 2020 (a drop from the previous year due to COVID) to 498 in 2022. In an outcome evaluation, clients saw increases in ART, but little change in VLS (except for small number from target population). HIV self-management programs will be rolled into the new Behavioral Health (BH) programs starting March 1, 2025. Options for the service category in GY 2024 include: 1) End HER as of 2/29/24 (savings of $585,390); 2) Fund HER for 6 months (savings of $292,695), allowing programs to wind down and complete scheduled trainings; 3) Fund HER for GY 2024, roll service into Behavioral Health categories in GY 2025 (no savings).
A summary of the discussion follows:
- When RWPA funding ends, sub-recipients can try to find alternate funding to keep their employees, but termination is possible. This is common when agencies lose grant funds, but decisions of allocations should be based on PWH need and service priorities, not the employment status of program staff.
- The total number of active clients includes more than just those who have completed the workshop (e.g., those enrolled and not completed, participants in alumni programming). The best proxy for clients is those who completed the post-test, which dropped dramatically after COVID and has only partially rebounded.
- There are qualitative outcomes for participants in the program that have not been measured.
- The Committee should weigh competing priorities, keeping in mind that HER is near the bottom of the service category rankings. There is an opportunity cost for funding this category in not having those funds available for a higher ranked category.
- Given the fact that there are competing priorities and that programs will begin in a more robust form in March 2025, there was a consensus that a six-month extension of the category would balance the need for funding for other priorities and allow the current programs adequate time for transition planning.
A motion was made and seconded to fund HER for six months in GY 2024 at $292,695. The motion was approved 9Y-0N.
Spending Scenario Plan
Mr. Klotz summarized the discussion on the remaining portions of the GY 2024 spending scenario plans. Due to the rebid of the RWPA Housing portfolio (with programs starting March 1, 2024), a two-month extension is needed for three Housing programs whose contracts end on February 29, 2024 in order to transition their clients to new programs and secure their rent payments and lease agreements. The amount needed for this is $931,956. With the additional savings from HER, there is a total of $1,721,373 in uncommitted funds.
In a 3.5% reduction scenario, taking into account the need to fund the Housing extension and the savings in carrying costs, there would still be a $2,151,789 deficit. Julie Vara, Director of the HIV Uninsured Care Programs at the NYSDOH AIDS Institute, has assured the Council that ADAP can absorb the remainder of the reduction, given that ADAP will be mostly restored through reprogramming and carryover during the year. It was noted that, given the flat funding in the national RWPA appropriation and that the application score does not change this year, any cut will likely be in Base Formula and/or MAI funding, which should be no more than in recent years. It was also noted that reducing ADAP will make the baseline allocation much smaller and thus there would be far less available in subsequent years to absorb future award reductions. ADAP’s RWPA allocation has been reduced to under $4M from a high of over $16M. ADAP is needed as a cushion to absorb future cuts to the award, as well as balancing the Base and MAI portfolios.
In a flat funding or small reduction scenario, after allocating funds for the Housing extension, there would be up to $789,416 available from the uncommitted funding. One option is to go a one-year enhancement to the Behavioral Health categories (Harm Reduction, Mental Health, Supportive Counseling) so that the allocation for the BH rebid for GY 2025 remains closer to the current allocations for those categories. Another option is a targeted increase based on the GY 2024 application spending request, which allocated additional funds in an increase scenario to Food & Nutrition Services (FNS). There was a consensus to select option one to restore BH allocations in Harm Reduction, Mental Health and Supportive Counseling to their GY 2023 baseline, and to use any additional uncommitted funds to enhance FNS.
A motion was made and seconded to approve the GY spending scenario plan as follows:
- Allocate $931,956 to Housing to transition clients from programs not funded in GY 2024 (this will be one-time funding that will not appear in the baseline Housing allocation in GY 2025)
- Use uncommitted funds (including an additional savings from 6 months of HER funds) to absorb a reduction to the award.
- Use ADAP to absorb any additional deficit.
- Use any available uncommitted funds to restore the BH categories to their GY 2023 baseline ($14,119,145), and to use any additional uncommitted funds to enhance FNS.
The motion was approved 9Y-0N.
Agenda Item #3: Public Comment
Mr. Babakhanian reported that ActUp is seeking a large number of members to attend a meeting tonight for a vote concerning a lawsuit brought by a former member.
There being no further business, the meeting was adjourned.