Tri-County Steering Committee Minutes May 12, 2021



May 12, 2021, 10:05-11:20am

By Zoom Videoconference


Members Present:        S. Altaf (Co-chair), M. Diaz (Co-chair), D. Ahmed, L. Best, D. Dominguez, J. Gago, L. Hakim, G. Harriman, K. Mandel, C. Oldi, J. Palmer, M. Piazza, G. Plummer, L. Reid, S. Richmond, A. Ruggiero, K. Scott, S. Thomas  

Members Absent:         M. Acevedo, V. Alvarez, L. Bucknor, A. Contreras, M. G. Ferone, A. Hardman, P. Laqueur, A. Pizarro, D. Scholar, T. Seabrook, A. Simmons, D. Smith  

Staff Present:                 NYC DOHMH: D. Klotz, J. Thomas, J. Acosta, J. Colón-Berdecía, A. Guzman, D. Ferdinand; Public Health Solutions: D. Ortiz; CHAIN: M. Yamagido, D. Norman

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

Mr. Altaf and Ms. Diaz opened the meeting followed by introductions and a moment of silence.  The minutes of the April 14, 2021 meeting were approved with no changes.  

Ms. Ruggiero announced that Open Door Family Medical Center has available appointments for the COVID vaccine.  Mr. Colón-Berdecía invited everyone to a meeting to strategize about recruitment new members, particularly consumers, for the Steering Committee and full Council.  Ms. Best reported that the Consumers Committee co-sponsored an excellent virtual town hall on COVID and HIV vaccine science (a recording will be on the website).

Agenda Item #2: Updates

Consumer Update

Ms. Diaz reported that the members of Living Together are eagerly anticipating being able to see each other again in person.  The hope is for a restart of face-to-face meetings in July.

Planning Council Update

Mr. Harriman reported that the Executive Committee will be discussing reconvening the Policy Committee and also participating in a “super committee” along with representatives from State advisory boards, Nassau-Suffolk, the NYC HIV (Prevention) Planning Group and others to keep momentum going on Ending the Epidemic initiatives.    

The Needs Assessment Committee’s work on PWH with serious mental illness will continue through an ad hoc workgroup.  The Integration of Care Committee is continuing its work to revise the Framing Directive, which outlines minimum requirements for all service categories, with a focus on anti-racist and anti-stigma elements.

The Consumers Committee is continuing its work on HIV and Aging, with the next step a review of a draft service directive addressing older people with HIV (PWH) at the May 18th meeting in advance of a community forum on June 4th to obtain public input.

At the May 27th full Council meeting, there will be a presentation on the effects of the COVID-19 pandemic on non-profits by Eli Dvorkin of the Center for an Urban Future.  

Mr. Klotz reported that the Priority Setting & Resource Allocation Committee (PSRA) recruitment for membership on the Council and Steering Committee continues for terms beginning September 1st.  Barriers to membership have been eased as the Council approved a change to its Bylaws to allow for full participation (including voting) by phone or videoconference at all meetings, including in-person meetings, which the Council expects to resume in the fall.

Grantee Update

Ms. Dominguez Plummer reported that HRSA’s HIV/AIDS Bureau (HAB), allow greater flexibility during the COVID-19 pandemic, has waived penalties for going over the 5% cap on under-spending.  The PSRA and Council will develop a carry-over plan for the use of last year’s unspent funds in the current year.  The FY2022 RWHAP Part C Early Intervention Services Program notice of funding opportunity was released on April 2nd. The purpose of the program is to provide comprehensive primary health care and support services in an outpatient setting for low income, uninsured, and underserved people with HIV. 

As the Council was notified by email, the EMA received the full notice of award from HRSA on March 30th. The total grant award for FY 2021 is $90,652,054, a reduction of $2,250,388, or 2.2% (not including the CARES Act/COVID relief money from 2020).  The Tri-County allocations will be what was approved in the spending scenario, including the enhancements to Housing and Emergency Financial Assistance.  The EMA also received the FY 2021 Ryan White Part A grant application review and score from HRSA.  We received a score of 99 (out of 100) with no weaknesses cited. 

On April 12th, Public Health Solutions (PHS), on behalf of NYC DOHMH BHIV released the concept paper “PlaySure Network 2.0: Provision of a Comprehensive Health Package of HIV-Related Services in Healthcare and Non-Healthcare Settings Using an Equity-Focused One-Stop Shop and Holistic Client-Centered Model”. 

Ms. Acosta reported that all contracts for the current fiscal year have been executed and she has held meetings with all providers on removing barriers to service provision and getting quality improvement activities up and running.  All contractors are also on track for providing in-office services (while maintaining a telehealth option).  She has also worked with the providers to recruit clients for participation in this Committee and the Council. 

Agenda Item #3: Tri-County Enrollment Report

Mr. Harriman introduced Jacinthe Thomas, Manager of Data Quality and Informatics, BHIV, CTP Research & Evaluation Unit (REU).  He noted that the Steering Committee had never received detailed data on who is enrolled in the region’s RWPA programs.  This will help the Committee understand who is being served in the RWPA program in Tri-County.

Ms. Thomas presented on who is enrolled in Tri-County RWPA programs as of February 2020.  REU compiles reported for the EMA, NYC and Tri-County, and data includes: Client Demographics, HIV Risk Factor, Insurance Type by Enrollment Status (both generally and service category-specific), as well as Priority Populations by Enrollment Status and Service Category.  Data is reported in eSHARE for clients enrolled in RWPA programs, and is used to assess the numbers of clients enrolled and being served; look at changes in enrollment status in comparison to previous years; and assess the reach of the programs to particular populations.

The definition of “Newly enrolled” is clients who enrolled for the first time during the period; and “Active enrollment” is clients who were open and received at least one service during the period.  For the time period, there were 311 newly enrolled and 860 active clients in Tri-County (compared with 12,685 and 6.372 respectively in NYC).  Among active clients, 44% are aged 50-64, 34% are 30-49, and 13% are over 64.  Fifty-six percent are male, 42% female, and 2% TGNB.  Forty-six percent are Black, 40% Latinx.  Fifty-five percent are heterosexual, 31% MSM, 9% IDU.  Fifty percent have Medicaid, 41% ADAP, 16% Medicare, 11% private insurance.  

The most commonly used services in Tri-County are medical case management (26% of all active clients in Tri-County use this service), transportation 23%), and food and nutrition (22%).  Most of the new enrollments were in medical case management and emergency financial services (which was a new program that year). 

Active clients served in Tri-County by Priority Populations are: Older PWH (57%), Cisgender women of color (39%), Black and Latino cisgender MSM (26%), People with a disability (24%), Young cisgender MSM (5%) and TGNB (2%).  A breakdown of priority population enrollment by service category was provided (e.g., 51% of Food & Nutrition clients are Older PWH and 52% are Cisgender women of color).

The key takeaways from the data are: 1) Among both newly enrolled and active clients, most Tri-County clients were 50 years or older, male, Black or Latinx, and reported to have heterosexual HIV transmission risk.  2) Newly enrolled clients were more likely to be on Medicaid while active clients were more likely to be on Medicare, ADAP/ADAP+, or private insurance; 3) Young cisgender MSM and transgender women represented the lowest percentages of Tri-County clients served; 4) The most common new enrollments were under medical case management and emergency financial services; 5) The most common service categories (by priority population) were: Food and nutrition and transportation among older people living with HIV, cisgender women of color, and people with a disability; and Medical case management among Black or Latino cisgender MSM.

A summary of the discussion follows:

  • It is generally better for the Council to look at active clients, rather than open enrollments, as open enrollments may include people who have had no contact with the program for a while.  It would require a deeper analysis to see why some clients are enrolled but do not use services.
  • The high percentage of EFA clients who are newly enrolled reflects the newness of this category.
  • The percentage of Tri-County clients among all RWPA clients in the EMA is 7%, which is more than the percentage of PWH in the EMA from the region (about 4%).  The higher proportion of TC clients is understandable given that there is no equivalent of HASA in the region, and as Medical Transportation is a unique service there.
  • The three counties in the region are made up of many unique cities, villages and towns, which makes service delivery less coordinated than a single jurisdiction like NYC.
  • A comparison between Tri-County and NYC would be helpful to see the relative differences.

Agenda Item #4: Policy Update

Mr. Guzman presented an update on State and local policy issues.  On April 8, 2021, the CDC issued a statement declaring racism a serious public health threat and highlighting several new agency efforts, including Expanding the body of evidence on how racism affects health, and developing and implementing solutions.  Last month New York State passed a series of bills necessary to implement the 2021-2022 state budget. Select health and mental hygiene provisions include: Restore $415 million in proposed Medicaid cuts for hospitals and health care providers; and Push back the carveout of the Medicaid prescription drug benefit for two years (through April 2023) to support 340B providers and community health care providers.

On March 31, 2021, Governor Cuomo signed into law A1248A/S854A, the Marihuana Regulation and Taxation Act, making New York the 15th state to legalize recreational cannabis use.  The law creates a social and economic equity program to assist people disproportionately affected by cannabis enforcement who are interested in participating in the industry.  people with a previous marijuana conviction that would now be legal will see automatic expungement of their criminal record or resentencing. 

New York State extended protections prohibiting residential and commercial evictions, foreclosure proceedings, credit discrimination, and negative credit reporting related to the COVID-19 public health emergency until August 31, 2021.  Statewide, total vaccine doses administered are 16,938,242, and 49% of all adults are fully vaccinated.  Finally, Westchester County Executive George Latimer is giving his State of the County address on May 20th.  The community should keep an eye on COVID legislation, as it may translate to HIV and other infectious diseases.

In response to a question, it was noted that NYC, NYS and business associations have resources about safe reopening.

The next Committee meeting will be held by Zoom on June 9th, 10am.

There being no further business, the meeting was adjourned.