Priority Setting & Resource Allocation Committee Minutes October 18, 2021

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Meeting of the Priority Setting & Resource Allocation Committee

Monday, October 18, 2021

By Zoom Videoconference

2:35 – 4:30

Members Present: Marya Gilborn (Co-chair), Jeff Natt (Co-chair), Fulvia Alvelo, Eunice Casey, Broni Cockrell, Joan Edwards, Billy Fields, Graham Harriman, Matthew Lesieur, Henry Nguyen, Guadalupe Dominguez Plummer, Michael Rifkin, Leo Ruiz, Victor Velazquez, Dorella Walters

Members Absent: Matt Baney, Randall Bruce, Paul Carr, Claire Simon, Terry Troia

Staff Present: David Klotz, Melanie Lawrence, Scott Spiegler, Jennifer Carmona, Clare Biging, Cristina Rodriguez-Hart, Nadine Alexander, Jacinthe Thomas, Frances Silva, Arnelle Vincent, Giovanna Navoa, Roland Torres (NYC DOHMH); Gemma Ashby-Barclay (Public Health Solutions)

Guests Present: Jose Abrigo (Manhattan Legal Services),Cathy Bowman (Brooklyn Legal Services), Grace Holihen (GMHC), Alex Hughes (Project Hospitality), Emily Sharpe (Project Hospitality), Sophia Welbeck (Legal Aid Society), Lisa Zullig (God’s Love We Deliver)

Agenda Item #1: Welcome/Introductions/Minutes

Mr. Natt and Ms. Gilborn opened the meeting, followed by introductions and a moment of silence in honor of HIV housing advocate Shawn Lang and HIV researcher and advocate Dr. Steve Karpiak.  The minutes of the July 13, 2021 meeting were approved with no changes.  

Agenda Item #2: Review of the Service Portfolio, Continued

Food & Nutrition Services (FNS)

Ms. Biging presented the new FNS Fact Sheet.  The goal of FNS is to address nutritional needs and food insecurity among RWPA clients in the EMA by providing nutritionally and culturally appropriate food and nutrition services that meet their dietary needs.  FNS services must be client-centered, non-judgmental, guided by harm reduction principles, trauma-informed, culturally- and age-appropriate, sensitive to physical and sensory impairments, and tailored to the population served. There are 11 FNS contracts in NYC.  The total spending allocation for FNS programs in grant year (GY) 2020 was $7,639,611.  In GY 2020, there were 2371 active clients.  The program spent above it allocation every year, even when the allocation was increased substantially by the Council to cover rate increases and enhance programs to respond to COVID.

Client demographics were described by borough or residence, risk factor, age, gender and priority population.  The Bronx, Brooklyn and Manhattan have the most clients, a large majority (72%) were over 50 years old, half were Black and over a third Latinx, and almost equal numbers of clients were MSM or heterosexual.  

A breakdown of clients and service units by service type was given.  The largest service provided by far was home-delivered meals (279K delivered in GY2020), followed by congregate meals and pantry bags.    

Food insufficiency data was gathered from clients, which showed that only about 39% of clients were food sufficient, and as many as 10% were severely food insufficient.  Food insufficiency status is determined based on responses to three questions asked on both the Intake Assessment and Reassessment forms (e.g., In the past three months, how often has it happened that there was not enough money in the household for food?).  

Medicaid offers nutritional counseling for some chronic conditions (e.g., diabetes), but not for PWH.  NYC Department for the Aging provides services, but only for those >60 years old. NYS offers one adult and child program, as well as separate programs for pregnant or post-partum women and those >60 years. For individuals eligible for HASA, a small supplement is provided for transportation and food.  Currently, there are no large federal payers for food and nutrition services specifically for PWH.  

Supplemental Nutrition Assistance Program (SNAP, AKA “FOOD STAMPS”) issues electronic benefits that can be used like cash to purchase food. Congress is currently proposing legislative changes to the SNAP program that will need to be monitored to assess impact to RWPA services. Women, Infants, and Children Program (WIC) provides tailored nutrition assistance and breastfeeding support to new moms, infants and children for their first five years of life.  Unfortunately, the share of eligible families participating in WIC has declined over the past decade. President Biden has called on Congress to make a significant investment in WIC.

A summary of the discussion follows:

  • The percentage of clients in Queens seems low, given the high proportion of Queens residents who are not eligible for SNAP due to immigration status.
  • It seems counter intuitive that food insufficiency would still be high for clients who are receiving FNS.  Food insufficiency measures are based on self-assessment.  Tracking food sufficiency would help understand clients’ needs.  
  • Several insurers are piloting short-term programs to pay for medically supported meals.  An analysis of these programs would help understand payer of last resort issues.  An analysis of client medical issues would also help to see where food assistance can be targeted.
  • Additional food assistance was added by NYC and other governmental and private organizations during COVID, but much of that is ending or lowering eligibility criteria.  RWPA FNS programs might see an increase in demand as the additional COVID assistance ends.
  • NYS SNPs and Medicaid Managed Care programs may start offering medically tailored meals.
  • FNS programs do not assist with employment or other issues that would lessen the underlying need for food assistance.  
  • Food prices have increased, which could affect demand for FNS.

Legal Services (LSN)

Ms. Biging presented THE LSN Fact Sheet prepared in GY2020.  LSN provides culturally and linguistically appropriate comprehensive civil, legal and health-related advocacy services that assist clients in removing barriers and gaining access to primary care. Legal services are limited to those which are directly necessitated by a person’s HIV status.  There are nine current contracts, which were last rebid in 2016.  The allocation for 2019 was $4,056,044. Eligible clients must be PWH who currently live in the NY EMA and have a household income <500% of federal poverty level.  Client demographics were described by borough or residence, risk factor, age, gender and priority population.  Brooklyn, Bronx and Manhattan have the most clients, and a majority (59%) were over 50 years old, 84% were Black or Latinx.  

A breakdown of clients and service units by service type was given.  The largest service provided by far was direct legal advocacy (28K units delivered in GY2019), followed by service plan development and intake assessment.  There was a total of 1,570 clients in GY2019.  The program spent 100% of its allocation every year.

There are no other large federal payers available for comprehensive legal services for PWH.  Other payers are limited to legal aid that focuses primarily on advocacy for mental health, housing, and family stability.  Part B funds family stabilization services to help HIV-affected families cope with the emotional and physical needs of living with HIV, with a focus on working with families to make decisions for future care and custody planning.  Medical-Legal Partnership embeds lawyers as specialists in health care settings to consult with clinical and non-clinical staff about system and policy barriers to care.  

Ms. Carmona solicited input from LSN providers about the meaning of case resolution, and about the new NYC Right to Counsel law, which guarantees all renters the right to legal representation if they are facing eviction.

A summary of the discussion follows:

  • LSN practices in multiple areas of law.  A successful resolution could mean that the legal service was completed (a power of attorney executed or a housing case seen to completion).  It can also mean an adversarial case (e.g., an eviction defense) was won in favor of the client.
  • The expanded Right to Counsel law means a lot of new resources to housing cases (which comprise the largest type of case that LSN providers work on).  While LSN clients will have new default access to housing court, there will still be a need for specialized HIV-focused representation from LSN providers.
  • Supportive housing has different rules that most regular housing lawyers are not familiar with.  LSN providers will have to work out how to coordinate with housing lawyers without duplicating services.
  • HIV-positive clients also tend to have greater needs and are poorer than the general population in housing court.
  • Regular housing lawyers will need training on HIV-related issues.  This would be allowable under the current LSN service directive.
  • The NYS eviction moratorium brought down the number of hours spent on housing cases and there have been a lot of referrals to ERAP, but most cases are still open, just suspended.
  • There is potential for a huge number of eviction cases once the moratorium is lifted (scheduled now for January 2022).
  • LSN providers are already one-stop shops for multiple issues, both housing and non-housing related.

There being no further business, the meeting was adjourned.