COUNTY OF SAN MATEO

Inter-Departmental Correspondence

County Manager’s Office

DATE:

February 21, 2006

BOARD MEETING DATE:

February 28, 2006

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

John L. Maltbie, County Manager

SUBJECT:

County Manager’s Report #3—Reauthorization of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (RWCA)

RECOMMENDATION:

Adopt a resolution to support a reauthorization of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (RWCA) that meets the concepts established in California’s nine Local Planning Councils Title I EMA Consolidated Statement on the Reauthorization of the Ryan White CARE Act.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goal(s): Residents have access to health care and preventative care.

BACKGROUND:

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act (RWCA) was established in 1990 to address the health and support needs of people living with HIV. An Indiana teenager who died in 1990, Ryan White brought national attention to the HIV/AIDS crisis. Reauthorized in 1996 and 2000, RWCA provides over $2 billion annually to serve over 500,000 people, more than any other federal program targeted specifically toward people living with HIV.

RWCA was originally scheduled for reauthorization in September 2005. However, reauthorization is expected in early 2006. In July 2005, President Bush issued the Administration’s RWCA Reauthorization principles, which are divided into five broad categories: Serve the neediest first; Focus on life-saving and life-extending services; Increase prevention efforts; Increase accountability; Increase flexibility.

In the proposed FFY07 Federal Budget, the Administration proposes $2.1 billion ($95 million more than in FFY06) for Ryan White HIV/AIDS related activities.

DISCUSSION:

At the request of the San Mateo County AIDS Program Community Advisory Board, Supervisor Rose Jacobs Gibson has referred this matter to the Legislative Committee. The AIDS Program Community Advisory Board has asked that the Board of Supervisors adopt a resolution in support of the consolidated statement of California’s nine Title I EMAs. San Mateo, San Francisco and Marin Counties comprise the San Francisco EMA.

While the U.S. Department of Health and Human Services principles have rhetorically benign titles, many California interest groups have responded with caution. All nine of California’s Title I Planning Councils have joined, for the first time ever, to issue the Consolidated Statement. Of the six key issues identified in the Consolidated Statement two felt to be most significant are highlighted below:

Oppose efforts to eliminate the “Held Harmless” provisions (Increase Accountability).

The Administration proposes to eliminate the “held harmless” provisions, which prevent the rapid delivery of funding in areas deemed of greatest need. While the Administration’s proposal may result in better meeting service needs in certain areas, it will likely come at the expense of areas with long histories of need—destabilizing existing health care systems. In recognition of the need to balance emerging needs with maintaining stability in existing health systems, the current RWCA includes hold harmless “protection provisions” that phase in funding reductions. This phased in approach, which has been included in both the 1996 and 2000 reauthorizations of RWCA, protects existing systems while funding emerging areas of need. The Consolidated Statement recommends opposing any effort to eliminate the “held harmless” provisions. According to San Francisco, the elimination of this protection could result in the loss of over $7 million to the San Francisco EMA—equivalent to approximately 30,000 primary care visits.

Take caution with the use of HIV incidence and local and state funds in determining an area’s severity of need (Serve the Neediest First)

In determining the areas of greatest need, the President proposes using a formula that considers HIV incidence, levels of poverty, and availability of other resources such as local, state and private funds. This measure may address those areas with great needs. However, it highlights a conundrum between those EMAs that dedicate state and local resources to meet needs and those that do not. In considering the use of local and state funds, the funding formula would foster bad policy. Those communities that dedicate state and local funds would be punished for meeting local needs while EMAs that fail to dedicate local funds (irrespective of their financial ability) would be rewarded for their inaction. In short, EMAs would be encouraged to make no local effort with the expectation and reward that federal funds will meet their needs. California and especially the San Francisco EMA have dedicated large amount of state and local resources to HIV/AIDS and would likely be disadvantaged for their local funding support.

In addition, the use of HIV incidence rather than prevalence creates a disincentive to invest in HIV prevention. HIV incidence, the number of new infections, does not recognize the overall number of existing cases, HIV prevalence. In determining the severity of need for federal resources, the formula must account for an EMA’s true demand for services.

FISCAL IMPACT:

San Mateo County’s current share of funding from the San Francisco EMA is $2,100,000. Staff estimates that the cut in Federal dollars to the San Francisco EMA will be about 5%. That 5% cut to the County’s allocation by about $105,000.