March 2, 2007
STRONG ISLAND STEPS UP
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LI is fighting back |
Long Island, NY is tops in the nation among suburban areas for the depth and intensity of its AIDS epidemic — over 3000 on the Island are living with AIDS, and thousands more live with HIV infection.
But under the "new" Ryan White Modernization Act as interpreted by the federal Health Resources & Services Administration (HRSA), Long Island is facing a potential loss of millions in funding and potential devastation of front-line HIV services.
Local activist were told to brace for 50% cuts in funding. And an emergency budget plan developed by the Nassau-Suffolk Ryan White planning council went into effect today, with significant cuts to treatment education, adherence, risk reduction and transportation services.
"You've got to understand the terrible effect this is going to have on the community — it's going to affect vulnerable populations like minority groups even more," said Dr. Jose Diaz, Executive Director of the Long Island Minority AIDS Coalition (LIMAC). "And this is not just an issue of disparate impact or representation, it's an issue of civil rights — these cuts were imposed on us and we didn't have an opportunity to respond."
Nassau County Executive Tom Suozzi said Tuesday that he'd go to federal court to block the cuts and force HRSA to straighten out its interpretation of the law. LIMAC is one of plaintiffs in the case.
"There may be a political solution, there may be a legal solution — but there are agencies that will go out of business if this sticks," said Jeff Reynolds, Vice President for Public Affairs at the Long Island Association for AIDS Care (LIAAC), which is not a party to the suit. "And that means a direct hit on the women, men and children who need help from those agencies to survive."
Reynolds praised officials from Nassau and Suffolk Counties — including Nassau County public health star and AIDS champion Simone Meeks — for stepping up to fight the cuts and protect people living with HIV/AIDS.
Cut amount not announced, but LI services suffer — is HRSA in chaos?
The scope of the cuts to Long Island aren't clear, as they're dependent on how HRSA moves funding around nationwide in the initial round of formula funding under the new law.
While advocates and service providers nationwide were poised for the news on distribution as the Update went to print today, there's been speculation that HRSA won't issue award amounts — either because of the LI lawsuit, or perhaps because of internal chaos at the agency.
On Long Island, advocates say they need the information. "It's a disaster — the problem is we don't know how much of disaster it is," says Reynolds.
LIMAC's Diaz says local groups have been directed to cut services based on the planning council's emergency plan. "As of today, service cuts are happening — unless your organization is able to float it, the services are cut."
The problem, says Diaz, is that "ultimately we don't know what amount of money we'll be getting — it makes local decision making uninformed and needlessly harsh."
Diaz pointed to Thursday's Child, a service provider in Patchogue as an example: "their funding is 80% Ryan White, they're losing 80% of their services and 80% of their staff."
Depends on what the meaning of 'and' is
Long Island got $6 million in Ryan White funding last year, and NY Senators Hillary Clinton and Chuck Schumer made sure funding would continue to flow under the new provisions of the RW Modernization Act.
Nassau County officials heard HRSA might be misinterpreting those provisions, and wrote them a letter in early February to inquire about a "core services" waiver and to confirm LI's status for continued funding as an Eligible Metropolitan Area (EMA).
HRSA lobbed back a bombshell — they said LI wouldn't be an EMA for 2007, but instead would be bumped down to a lower level of funding as a Transitional Grant Area (TGA) under new Modernization Act rules.
It seems pretty clear that HRSA mangled its interpretation of new EMA eligibility standards as applied to LI: localities get booted out of EMA status if they fail to report (1) 2000 new AIDS cases over the past five years; AND (2) have a cumulative total of more than 3000 living AIDS cases in the most recent reporting year.
Long Island hasn't reported 2000 new AIDS cases in the past five years (in large part due to improvements in health care access), but it was the home of more than 3000 people living with AIDS during 2005 and 2006. Officials, advocates and service providers thought they were in the clear — but HRSA read the statue as if the "and" was an "or" and moved to boot LI out of EMA status.
Political, legal & organizing support to stop the cuts
Nassau and Suffolk officials got political and public health backing for their position: Schumer, Clinton and House Members Steve Israel and Peter King weighed in with a letter to HRSA; and officials from New York State's AIDS Institute chimed in too.
With HRSA standing firm and the Island slated to lose millions, the lawsuit was filed this week in the U.S. District Court for the Eastern District in Central Islip.
According to the AP, the suit names as defendants the U.S. Department of Health and Human Services, Secretary Mike Leavitt and Elizabeth Duke, administrator of the Health Resources and Services Administration.
Saying they would drastically affect public health on Long Island, Suozzi called the cuts "drastic and unauthorized" and "completely unlawful, arbitrary and capricious."
The counties were to be joined in the lawsuit by AIDS-related nonprofit groups (LIMAC and FEGS) and four citizens who are AIDS patients and received services under the former Ryan White Act, officials said.
"This is not a short term battle," said LIAAC's Reynolds. "The stakes are high, because there are some agencies out here that have 60-70% of their budget based on Ryan White."
"It's a challenge organizing consumers, particularly because of transportation barriers," said Reynolds. "But we're doing it — my hope is we can keep the momentum going and protect the people who need the care."
Diaz says LIMAC will also be organizing a 'war room' to provide people living with HIV/AIDS and their family members a place to connect, get informed and carry out advocacy together. "We're not going to let this happen," he says; "we're helping the community fight back."
For more information on advocacy and services on Long Island visit the Long Island Minority AIDS Coalition at www.limacny.org or the Long Island Association for AIDS Care at www.liaac.org. For more information on federal issues, contact Christine Campbell at campbell@housingworks.org.