Tri-County Steering Committee Minutes January 11, 2023



January 11, 2023, 10:05-12:05am

By Zoom Videoconference

Members Present:       S. Altaf (Co-chair), J. Palmer (Co-chair), D. Ahmed, V. Alvarez, L. Bucknor, A. Contreras, M. Diaz, J. Gago, L. Hakim, G. Harriman, B. Malloy, K. Mandel, M. Piazza, G. Plummer, L. Reid, S. Richmond, A. Ruggiero, V. Schneider, K. Scott, S. Thomas

Members Absent:        M. Acevedo, L. Beal, L. Best, A. Hardman, C. Oldi, A. Pizarro

Staff Present:              NYC DOHMH: D. Klotz, S. Spiegler, J. Acosta, D. Saab, S. Barton, G. Navoa, A. Eppinger-Meiering

Agenda Item 1: Opening/Moment of Silence/Minutes/Announcements/Public Comment

Mr. Altaf and Mr. Palmer opened the meeting followed by introductions and a moment of silence.  The minutes of the December 14, 2022 meeting were approved with no changes.   

Ms. Schneider encouraged everyone to get the word out about the availability of Emergency Financial Assistance.

Agenda Item #2: Updates

Consumer Update

Ms. Diaz and Mr. Alvarez reported that most issues with SNAP recertifications through Westchester Dept. of Social Services have been resolved, and HVCS helped fill the gaps with food assistance.  There has been a surge of respiratory illnesses, including one that resulted in the death of a Living Together member’s grandchild.  Continued mask wearing was encouraged.  Finally, it is good to see the increasing emphasis on aging, considering all of the aging-related issues that PWH are facing.

Planning Council Update

Mr. Harriman reported that at the December Council meeting, there was a presentation on the 2021 NYC HIV surveillance report, which showed continued progress in reducing new infections and linking people to care and treatment.  Tri-County data is collected by the NY State DOH and will be presented to the Steering Committee in March.  The Council also approved the annual estimated unobligated balance request, which HRSA requires for the EMA to submit a carryover request later this year.  The Recipient also presented the 2nd quarter expenditure report, which shows that the EMA is on track to have much less underspending this year compared to 2021 and 2020.  At the next meeting, there will be updates on the implementation of two relatively new programs in NYC (Psychosocial Support and TGNB, Oral Health), and the implementation of the Council’s recommendations on improving access to Ryan White Part A (RWPA) services for people with disabilities.  

The Consumers Committee had an informative presentation on benefits navigation for Medicaid and Medicare and other programs and hopes to have a follow-up session.  They will soon start discussing youth and HIV-related service issues.  The Integration of Care Committee is continuing review of a draft of the new Behavioral Health service directive.  The Data Collection Workgroup hopes to have its recommendations in early spring.

Mr. Klotz reported that the Priority Setting & Resource Allocation Committee has approved a preliminary methodology for a possible reduction in the GY 2023 grant award of up to 3.5% of the Base award.  Even at flat funding, there will be a deficit of $1.8M to make up due to obligations to fund a full year of Oral Health and to fund the new Outpatient Ambulatory Services for Aging & HIV.  With the exception of GY 2022 when Congress increased the RWPA appropriation nationally, the EMA has lost money every year for over a decade due to the decreasing proportion of PWH in the EMA compared to EMAs in other parts of the country. 

Mr. Spiegler noted that the January Recipient report will be sent by email soon.

Agenda Item #3: GY 2023 Tri-County Spending Scenario

Mr. Klotz provided an overview of the Planning Council’s conflicts of interest guidelines.  Anyone with a financial stake in an issue (employees and board of directors, but not clients or members of a community advisory board) must disclose that interest.  They can still participate in discussion, but must recuse themselves from voting.  Anyone can vote on an entire spending plan.  It was added that the Recipient will determine how to implement any changes in allocations (e.g., which contracts within a service category should be adjusted). 

Mr. Klotz reviewed the GY 2022 spending plan, which had $4,682,804 in programs funds.  This is 6.1% of all programs funds in the EMA (more if you count the proportion of Emergency Financial Assistance that goes to Tri-County clients), compared to 3.9% of the EMA’s PWH population.  Over a decade of reductions to the award, Tri-County has been held harmless from cuts, while NYC programs have absorbed major reductions.  The data from the service category fact sheets showed two categories with anomalous expenditure and enrollment rates: Early Intervention Services (EIT) and Medical Case Management (MCT).  With a very low number of HIV tests performed in EIT in 2021 (even accounting for COVID-19), Council staff asked for additional updated information. 

Ms. Barton presented updates on the EIT program.  Starting June 2022, program staff began HIV testing out of the local syringe exchange and expanded their hours at the White Plains clinic.  They are in contact with the county jail and plan to conduct HIV testing there in early 2023, and are looking into the potential of testing at the local methadone clinic and on a mobile unit with their outreach team.  They now have two in-kind data entry staff members to help back enter 2022 data and continue entering data for 2023.  For March-December 2022, there have been an average of 25-35 tests/month, with 8 positives (6 linked to care).  Given the high positivity rate and plans for expansion to areas with high risk populations, it is not recommended to defund this program.

Ms. Hakim added that as a program within a county health department, they have other resources for testing (e.g., AIDS Institute for a PrEP initiative), but that there is no duplication of services.  Clients tested under the RWPA program might be referred to the AI-funded PrEP service.  Also, many new arrivals have been sent by the US Dept., of Homeland Security for referrals. 

The MCT fact sheet was reviewed, showing a lack of rebound in spending in 2021, flat client enrollment and service utilization, and the overlap with Medicaid Health Homes.  An option was presented to fund MCT at its 2021 expenditure level, which would be a reduction of about $233,000 from the current allocation.

A summary of the ensuing discussion follows:

  • Health Homes requires Medicaid enrollment, which means that people not eligible for Medicaid (e.g., undocumented) must rely on MCT.  Health Homes also have other strict eligibility criteria (e.g., proof of unsuppressed viral load) that make it a higher bar for enrollment.  There should be no dually enrolled clients.
  • MCT is an important entry point for those newly in care and its geographic reach is important.
  • An option for a phasing in a reduction was offered, to allow programs to plan for reductions over the course of the year.
  • The use of carryover to restore a reduction was discussed.  Carryover funds do not typically become available until October and run out in February.  Also, the Recipient is trying to maximize spending, thus less carryover will be available.
  • Some programs may serve more clients that they are reimbursed for.  HRSA has relaxed the 6-month recertification requirement, and so programs can adjust the service types that they perform to fit within their maximum reimbursable amount.
  • The PSRA Committee’s strategy always involves making targeted cuts where feasible, then implementing a weighted across-the-board reduction.
  • The Psychosocial Support Services program performs many case management-type services and can absorb some MCT clients who need a less intensive form of case management.
  • Before the program was re-bid in 2015, the programs had the same allocation and served twice as many clients.
  • A reduction to Housing could mean not being able to maintain some clients in the rental assistance program or to enroll new clients.
  • MCT can be as essential to access to health care as housing and food services and serves vulnerable populations who may not be eligible for government programs.

A motion was made and seconded to reduce the overall TC allocation by $233,000.  $117,000 would come from a targeted reduction to MCT, and the rest would come from an across-the-board reduction to the rest of the portfolio weighted by priority rank score.  The motion was adopted 16Y-0N.

Mr. Klotz thanked the Committee members as well as the Recipient staff who provided the extensive data needed throughout this process. 

The next meeting will be on Wednesday, March 8th @10am with the annual epi update from Wendy Patterson of the AIDS Institute.

There being no further business, the meeting was adjourned.