SCHA-LA

HIV $ Allocations in LA County

Posted in Uncategorized by SCHA-LA on January 14, 2010

notes from the Priorities and Planning subcommittee of the LA County HIV Commission.

Vote to accept the recommendations: unanimous approval

P&P Committee

Proposing provisions to year 20 (FY2010) allocations.

4 sets of allocations in past 12 months

Year 19 allocations: part A, part B very straightforward, simple. Then we started having budget crises. Nothing was decided, but we started to plan Y20 allocations – before we did the Y19 allocations. Then we had to revise Y19 b/c the state budget, last summer hit “and life changed as we knew it”

Now, faced with Y20 revisions. To conform changes in pieces which shifted.

Going to be dealing in percentages rather than dollars. The amount of $ in the pot has shifted dramatically. percentages shift. Committee attempts to stabilize things. Didn’t want to make new allocations, but rather make current allocations conform to existing situation. (categories lost – didn’t want to start allocating to again, so some changes).

Historically, part B come from state. Now state uses Single Allocation Model (SAM). Took a bunch of money. Actually more than part B alone to LA County. Looked like an increase. We could locally decide where this $ would best be suited. Good for LA County. With this model, they also eliminated direct $ agencies. LAC had to back-fill these programs.

Used to only deal with percentage allocations (as opposed to actual dollars). Now looking at actual dollar mounts. Allocated a “threshold” dollar amount.

Now back to percentages to aid OAPP in allocation.

In committee we translated % to $ and then added $ to the state. Considered additional funding/service obligations (formerly direct-funded by state which we had to back-fill/assume responsibility for). Then initially allocated by $ amounts, but then converted allocations back to percentages.

Recommendations:

Early Intervention Services: increase allocation from 0% to 3.2%. brings more HIV+ into medical care. Focus on unmet need (HRSA push), assumes commitments previously funded by the state.

Medical Outpatient: reduced from 59.5% to 58.5%. while % allocation decreased, $  allocation rose from $21m to $23m. allocation recognizes that there are additional tx, adherence, counseling, nutrition screening and TMP. Removes ‘threshold’ requirement

Medical Transportation: reduced from 2.7% to 1.7%. OAPP revising service guidelines and distributing bus passes only through medical providers.

Nutrition Therapy: reduced from 1% to 0%. Conforming to existing allocation level

Case Management Home Based: reduce from 1% to 0.8%. service previously directly state funded. OAPP using Net County Costs (NCC) to partially back-fill reductions. Allocation seeks to ID single stream of funding for the service.

Slides with all allocations available.

Many changes had to do with the “pie” changing, not the Commission wanting to make changes. Had we kept the same percentages, some programs would have been crippled beyond being about to perform.

This process used to be a once-a-year process. This is the 4th time it’s happened this year.

“We’re not moving forward as if anything has roots”.

There will be another revision in March once we have the award and know what we are actually dealing with.

In August when the plan was approved, it was not approved in percentages. We had to do the work in dollars to make it understandable, then convert it back to percentages to be in line with what was approved. Continuity.

Committee has no authority over NCC, but recommend to OAPP, and receive feedback that this is okay. (eg: home-based case management services).

The money we allocate is Part A & Part B.

Q: Residential & transitional housing should be a higher priority. Why is it 0%?

A: That’s how the priorities and percentages fell out in committee. Also, we know all of the other funding stream for programs. If there is another funding stream, we use our money where there is not other funding. Also, some priorities are unfundable through Ryan White (ie: permanent housing)

re: Home-based case managment: OAPP has been looking “very critically” at this service category. Medi-Cal waiver program, former state direct investment, OAPP investment. When state transitioned to SAM it left providers hanging and there was some re-commitment of $ by the state to allow providers to get through transition period. overall, the ctegory took a $2m cut on paper before the $1m 4-month back-fill by the state. Last year there was $1m less for this category, and this year we expect a $2m reduction to home-based. we do not expect to adjust our investment to home-based. All that is remaining is medi-cal waiver revenue and OAPP. there is an “impressive case load”. There is no guarantee that this will be the funding level starting July 1. Looking at making “refinements” (eligibility etc) as cost-saving to ensure that the category is of most benefit to most people.

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