Ryan White Planning Council - Community Health Planning & Strategies (chps) Committee - Regular Meeting

We've reached quorum with five out of five. The meeting begins at 12:01. I invite planning council support to begin the introduction of declarations and conflict of interest. Thank you, Eva. So, for today's conflict of interest, um if you are a voting member of the chips committee or if you are scheduled to speak on today's agenda, when I call your name, please state your name and any conflicts of interest that you have. And we will start with Eva Glendo. No conflicts of interest. Eva Gwendo, chair. Eric Een. Eric E. No conflict. Um, co-chair. Randall Furrow. Randall Furrow. Planning council chair. No conflict.

Erica Tamp. Erica Tamp. Care directions committee chair. Conflicts with medical and non-medical case management. Referral for healthcare and support services. Medical Transportation and HIPSA. Catherine Barbara. Good afternoon. Cat Barbara. Alternate for Jason Bel Cruz. Conflict of interest is part C, primary medical, substance use, mental health, HIPSA, and referral for healthcare and support services. Shante Coleman. Shante Coleman, Maricopa County. Reen Hoyen Hoy, Maricopa County.

Gina Alan Williams. Gina Alan Williams, Maroba County. Deborah Bearden Maynard. Hi, Deborah Bearden Maynard. Um, Arizona Department of Health Services. Um, conflicts with Ryan White Part B and ADAP. Elena Pitman. Elena Pitman. Um, ADHS. No conflicts. Thank you everyone. So, that's everyone who's on the committee or scheduled to speak. And before we move on, I wanted to give um Bradley Reese a chance to declare um interest in joining the committee. Um Bradley, if you were still interested, I just wanted to give you that time to um yeah, declare your interest in joining.

Thank you, Gwen. And yeah, I'm happy to be here today. I am definitely interested in um joining the committee. So um I will be here for the next uh two meetings before I'm actually a member, but I look forward to kind of listening in today and um hearing what's going on and reviewing all the materials. So, thank you for having me. Perfect. Thank you so much. And we can go ahead and move on to the next agenda item.

Thank you. Um, next is the review and acceptance of the agenda. Hopefully, everyone has had an opportunity to look it over. Um, we may not change the order or we may change the order of the uh agenda items, but may not add any new items with the open meeting laws. Um, hopefully everyone has Oh, there it is on the screen if you guys want to look over it really quick. Uh next we'll go on to the review and approval of our minutes um for the last meeting that was on November 18th of 2025. Uh we'll review the summary of the minutes of the previous meeting. Hopefully everyone has had an opportunity to do that. Um and then share any adjustments or revisions if you need and then we will need a vote on this to accept them. This is Erica. I move to accept the minutes from the November 18th, 2025 meeting.

Thank you, Erica. Do we have a second? Second. Thank you, Randall. Thank you. We have any discussion before we launch the poll. Wendelline, if you want to go ahead and launch that. Yeah, so we do have to um do a roll call vote today. We still don't have polls, so I'll just start with Eva Galindo. Uh, four. Yes. Eric E. Yes. Randall Furrow. Yes. Erica Tamp. Yes. Pat Barbaro. Yes.

Motion carries. Thank you. Sorry. Uh, next we're going to go into my update. Um, I don't have any update at the moment. Um, if Eric has anything that he wants to update on, uh, please feel free, but I do not have anything currently. As of today, I have no updates. Right. Thank you, Eric. Um, we're going to move on to agenda item number six. Ryan White HIV AIDS Part A recipient uh Shanti Coleman is here and she's going to take it away.

Thank you. Um so just uh good afternoon everyone. Just some brief quick updates before we get into the business updates. Um, so I just wanted to announce that uh you have me today because Jeremy was accepted into the National Association of City and County Health Officials Adaptive Leadership Academy, which is is a mouthful, and is attending his virtual orientation orientation right now. So, um, kudos to him. Also, another update about Jeremy. He uh he was invited yesterday to present on the Ryan White program uh for the Maropa County Department of Public Health board further raising awareness for uh the importance of the program planning council and our providers to end the HIV epidemic in our community. So again uh that was amazing uh an amazing presentation yesterday. He had tons of questions afterwards, people coming up very interested in our program. Um, as we always joke that we are the special secret that that's wellkept and so, um, folks were actually agreeing because there was a couple people that never heard of Ryan White. So, um, Jeremy did an excellent presentation yesterday, but now moving on to official, um, business, starting with the part A site visit cap. We have completed all activities related to the HERSA site visit cap and submitted the documentation to HERSA on January 15th. they have acknowledged receipt and we are waiting to um waiting for them to complete their review. Now once it's approved by HERSA we will be releasing some policy changes to providers like our contract policy that has been updated related to subreient monitoring program income and 340B monitoring. Thank you again for the council all for all your work with reviewing, editing and approving the pieces for our standards whether it was the bylaw standards process or uh the chips with the PSA process. So thank you

again for those. Moving on, we have some upcoming outreach events scheduled. Um positively you outreach team which also includes Gwen will be following community events in the coming months. Gwen will be re reaching out to the council for any volunteer spots we need assistance with. Um so we have February 14th and 15th are the ar is the Arizona gay rodeo and then we have March 21st is the AIDS walk Arizona and then March 28th and 29th is the Rainbows Festival. Okay. So now to the meat. Let's go over the allocation updates and directives. if Gwen can put that up for us. Perfect. Um, so as of January 22nd, HERSA does not have any anticipated timelines for the release of grant year 2026 notices of award. As we hear more, we will keep the council posted, including forwarding any and ways to all of you all once we receive. Um, now looking at this allocation and expenditures report. Hold on. All right. Computer wants to do an update. Let me get this window out the way. Okay. Um, so this shows our grant year 2025 allocations year-to- date expenditures through November and our current forecast for year end spending across direct service categories. Overall, the budget remains well aligned with service utilization and we expect to close out the year with minimal adjustments needed. Um you'll see in the summary section that we are currently projecting about 470,000 in underspent across part A and MEI combined. It's important to clarify that carryover limits um apply only to part A formula funding not to MI. The projected part A carryover is capped

at 348,73 which is 5% of the formula funding portion of the award. Um, and just so for your reference, MAI funds do not have a carryover limit and 100% of any unspent MAI funds can be carried forward to the next grant year. So, while the total projected underspent may look higher at first glance, it doesn't mean we're exceeding allowable carryover. Um, scrolling down, uh, focusing just on the direct services, the good news is that aside from primary medical care, all other service categories are currently forecasted to spend within about 2 to 3% of what the plan council has approved. This includes that allocations are generally well aligned with actual client need and use and the changes were we made earlier in this year had the intended impact. So talk speaking about primary medical care is currently projected projected to be under budget. What we typically see during clo closeout is that monthly invoices increase as providers submit um remaining claims for services already delivered because of the claims patterns. We expect the primary medical care to under uh med we expect excuse me we expect the medical primary medical care to underspend to continue to narrow over the next few months. Um and then speaking about health insurance premiums um which include dental insurance are expected to increase since late December we paused the dental weight list and have been enrolling all eligible clients into dental coverage. As those enrollments enrollments move through billing, we expect higher expenditures to appear in upcoming months. Um, so and I also want to also mention I I forgot to mention that we you that we also have part B rebate funds earmarked for this as well. So as those claims come in, we have some part B funding for

that. As a reminder, the planning council approved rapid reallocation authority at the December 16th meeting. We had not yet needed to move um funding between service categories, but we expect to be using the authority in early February if needed. Based on how final expenditures come and um the flexibility the flexibility helps ensure funds are fully utilized as we close out this year. I'm sorry guys, this my computer is keeps on jumping up on the screen. Um but overall expenditures expenditures across direct services continue to trend in the right direction and we anticipate only a minimal reallocations will be needed to support full utilization by year end. Uh we will continue monitoring of course um spending closely and we'll keep the planning council informed as we move towards close out. And do you does anyone have any questions related to this allocation pieces prior before I start moving on to the next item? hearing none. These are all my updates. Um, and I'm going to turn it back over to Eva. Thank you for all that. We're going to move on to agenda item number seven, planning for needs assessment. Um, we have Alina Pitman, EDHS representative, and Rean, and I believe Deborah, who is going to take it over from here.

Yeah, thank you so much, Eva. So, um, at our last meeting, we kind of were brainstorming different populations for the needs assessment. And as a follow-up to that discussion, we've asked Elena Pitman and Deborah Braden Maynard from ADHS to provide some data around um insurance and Medicaid clients to kind of help us um pick a population and then after their presentation, Reagan will share some data as well. So I will hand it over to Elena and Deborah now to um share their data. Okay. Uh perfect. Let me start sharing. Okay. Um Okay. Yep. I'm off mute. So, okay. Um good afternoon everyone. My name is Lena Pitman and um I'm going to be be presenting on the needs assessment today. Um so just the agenda some some introductions setting the stage expectations and group discussion. So introductions um as previously stated uh Deborah Birden Maynard and I are both on the planning team um for the um needs assessment and uh yeah the needs assessment survey. So let's get started. Um, some basic information is that the survey did close last year, almost a year ago, which is kind of crazy to think about. So, last year in February, the survey closed. Um, however, um, we did have some hiccups along the way because of AI and chat bots. We did have to air on the side of caution and we did have to remove a significant amount of surveys just because um we knew that they weren't

real respondents. So that was a new thing that we had to deal with last year. And then yeah, that's basically most of it. And then we I do have some data for you. And um this presentation is basically going to be based off of insurance and the Medicaid questions that were asked in the survey last year. So it's not everything. It's just a piece of it. So summary. Uh so our quick summary is that uh there was a total of 945 surveys and it represented all 15 counties in Arizona. 78 of them were taken in English and 165 respondents took them in Spanish. And then the top five counties uh with respondents was of course Maricopa at 71%, Puma at 16, Kenal at 4.2%, Yavapai at 2, and then Coochis at 1.5. So let's get into the questions. The first question um was do you have health insurance? So 400 respondents said yes they did and they either had access Medicare, VA or IHS. Around 300 said yes they have it through work. 122% said that yes they have it through Ryan White. And then uh about 60 and below said either yes they had it through work, no they didn't. And then 10% said they weren't sure. Okay. So I also wanted to say um that I forgot to say in the beginning even though 945 respondents took the survey not every question was required. So people were

able to skip through questions. So for instance this question 146 people answered this one. So not the complete 945 just so that um I just wanted to be clear. So this question was my insurance. So sorry this question was is there any barriers to getting syphilis treatment and specifically the my insurance covered my my syphilis treatment. Uh 67% said that they agreed. Uh 17% said that they were neutral. 9% said that they disagreed and about 7.5% said nothing available. Okay. And then for the next question was uh the barriers that were stopping people from taking prep. Uh 62 respondents said that the costs were too high and 29 respondents said that the insurance didn't cover it. And then sorry also to note this question itself was a select up to five and the highest question did receive 77 responses. So the 62 is on the high range. I do want to note that. So it seems low but of the 77 responses 62 said that the costs were too high. So that is significant. Now um for this one it's the same. It was a select up to five and the highest question received sorry the highest question received 29 responses. So the question was what are the barriers to taking and staying on prep? 25 of the 29 respondents said that the costs were too high. 18 said that their insurance didn't cover prep and four respondents said that it's hard to get insurance to cover the prep.

So um 82 respondents uh responded to this question and it was the experience with heepsi treatment and the question was does your insurance cover your heepsi treatment/cure? 64% said that they agreed. Uh 17% said they were neutral. About 10% said that they disagreed and NA was at 8.5%. Okay, so this next question is uh the barriers to getting or taking your HIV medication. In purple, it was cost of meds and then in blue it was insurance coverage. So for people saying that they never have any barriers getting or taking their HIV meds, it was around 300 for never. a little under 100 for sometimes and then below 100 was always and NA. So it seems like cost of meds at least and um the insurance did cover most of the time. Okay. And then for this question uh 522 respondents responded and the question was have you ever been enrolled in Ryan White and or ADAP? Um 52% said yes they were enrolled in both Ryan White and ADAP. 35% said yes only Ryan White. Um 7.9% said no. And then 2.5% said unsure. And then in the other the brown I forgot to label was yes but it was only ADAP. So that was also about 2.5%. And then 522 respondents also responded to this

question and it was how important is health insurance to you? Um no surprise 393 respondents said that it was very important. 81 said that it was somewhat important and 48 said that it was not important at all. And we're almost to the end. Um this question was a select all that apply. So people could select as many as they wanted to. And the question was, have you experienced any of these situations in the last year? I'm going to go through the situations first. So the first situation was that they delayed medical care due to the cost and that was 225 um respondents. Uh 179 said that their insurance didn't cover the medical costs. 158 said that their insurance didn't cover meds or and or the pharmacy costs. 150 said paying for medical care meant that they could not pay for necessities. 131 said that they skipped their meds due to the cost and 129 respondents said that paying for meds they also couldn't pay for necessities. And then from that 550 respondents said that none of these instances happened to them and that was it. Is there any questions? Okay. As Oh, sorry. Did someone say something? No. Okay. Um, so, um, as always, uh, Michael Brown.

Yeah. Yeah. Thank you for that information. It was real informative. I was wondering if that presentation will be sent to us or is there a way to find it online? Um, it isn't online yet. We haven't published it yet. Uh, Deb, are you on the call? Are we able to share the presentation or does it have to wait? Sorry. We can share this presentation so we can send it over to Gwen to be sent out. I will do that after the call. Thank you.

Of course. Thank you for the questions and here is our contact information and I will hand it back off to Gwen. Thank you so much Elena for sharing that. Um our next presentation will be from Reagan and she's going to share some data as well and then after that we will reconvene and the committee can talk about um which population they'd like to move forward with. So Reagan I can go ahead and pull up your slides on my screen and then whenever you're ready we can start.

Great. Thank you Ben. All right. Um so I'm going to be talking about part A Medicaid and uninsured client data. Um, so similar to Deborah and Elena's presentation, but ours is going to cover more specifically our clients um, who have Medicaid and uninsured or are uninsured. A quick note here, some technicalities to get out of the way. Um, when we refer to uninsured clients, we're also counting underinsured clients. So, the way it works is when a client applies for eligibility, um there are some clients who have some coverage, maybe like $2,500 from a temp job, but we consider that to be not adequate. So, you will just mark them in the system as uninsured. So, note that when I refer to uninsured, there's also underinsured clients there, and it's difficult to parse them out from that group. I also just want to know if I just refer to this group as underinsured instead of specifically saying Medicaid and uninsured, just know that that's what I'm referring to and I was just trying to keep it brief there in our presentation. All right, so for the purposes of this presentation, I dug into an older needs assessment. Um, this assessment closed in March 2023, so do know it's a little bit older. That's almost 3 years ago, which is crazy. I don't want to think of 2023 as 3 years ago, but we're coming up on that now. Um, we got 359 total responses. 44% of those responses were from clients with Medicaid or no insurance, and then 56% were from clients with other types of insurance. So, maybe private, um, maybe VA and other types of insurance like that. 83% of the respondents were virally suppressed. And the demographics that were spotted were fairly reflective of the clients we serve. Um something to

keep in mind, young people were a little under reppresented in this survey. And then something that's relevant for this is that clients with Medicaid were a little bit underrepresented. So clients with Medicaid accounted for about 33% of our clients that we actually served, but only 27% of survey respondents had Medicaid. So the question I primarily dug into on this needs assessment was in the last 12 months did you need and or receive the following HIV medical or support services. So respondents could either say they did not need the services they needed and receive the services or they needed them but they did not receive them. This list below is just examples of the services they asked about. They asked about every single one of these. Um, it was a total of 28 different services and that includes ones we fund and we don't. Um, so you guys are familiar with these services, medical care, mental health, MCM, etc., etc. So, these are some of the results we got. So, I wanted to look at the percent of clients with Medicaid or who didn't have insurance who needed the service versus the percentage of other clients who needed the service. And what I found is that it came back that clients with Medicaid or no insurance across nearly every service category except HIPSA um indicated that they needed the services more than the other clients. Usually it was a difference of like 5 to 15% but I chose to highlight on this slide either the ones that were over a 20% difference. So a very significantly larger difference than the other service categories or ones that were just interesting. Um so MCM, nutrition, housing, transportation, and food assistance all had a percent difference

of over 20%. And then substance use it had a smaller difference only at 12%. But um that's a pretty small need percentage in general. So even though it's only a 12% difference, that's still significant. And then HIPSA is unique because it's the only one where um un underinsured clients indicated they needed it less than other clients. And just another note on this, that's kind of what we would expect. Um, clients with Medicaid or no insurance generally have lower FPLs, so we would expect them to need the services more. So, this is kind of when I dug into the data what I expected to see.

I see Michael has a question. Yes, Michael. Yeah, sorry for interrupting. I hope it's okay to ask questions on that previous slide. Yeah, for sure.

Uh, the question I had was Hipska. Um, I know that probably could be confusing because I think included with that is our dental insurance premium. And I know speaking for myself, I know how important dental insurance is as part of my overall health. I was wondering was that broken out or was it dis HIPSA? Because I think now we have it broken out. Yeah, on this particular survey they were actually combined um on this question unfortunately. So yes, that includes both dental and medical. Okay, thank you. And Erica,

uh that was a great question from Michael. I when I read HIPSA, since I'm a HIPSA provider, I always think about cost sharing assistance. So that number makes sense to me when you think about that. it doesn't really make sense when you think about dental. So, I I I do think that's that's interesting to look into more or consider. Um, on this chart, combining the clients with Medicaid or no insurance that they're just such population in terms of what resources they have available to them. I I feel like in future anything like keeping those separate would be important.

Yeah, keep that in mind. I will just that was what I was asked to look into. So that's why it's broken out that way. Um but I can definitely take a look at them separately as well. Yeah. And I and the blue column then is basically like people with some kind of coverage like Medicare, private FFM. Is that what that is? Okay. It's literally everything other than Medicaid or no insurance. Yeah. Okay. Yeah. I I I think no having that broken out is is important for the future. Thank you. Thank you. And Jimmy,

I was just going to ask Erica, this was 2022, 2023. Was Hipska and dental combined back then? That's a great thought. That's more a Shante or Gwen question, but you know what? It may not have been right. That's why I was thinking at that back to Michael's question that it wasn't. So that would definitely then it would make sense. Yeah. I don't is do you remember when that happened Shante or I don't recall when but I want to say 20 if this was 2023 I feel like it was combined in 23.

I will say on other questions on this survey for whatever reason they were separated and it's just this one where they were combined. Um like they asked how important do you think each service category is and they separated out dental and medical. Um, and they actually said that dental was more important than the other clients did. Um, so that's just an interesting thing I saw. It wasn't like that much higher, but it just it was something that I saw.

Yeah. And and I think um, you know, most of the time clients don't know that dental is funded via HIPSA. So, I'm assuming dental is referred to as dental insurance or dental coverage, not HIPSA, right? Just moving forward, I would want to make sure of that because I don't think most clients know that. Okay. Are there any other questions or are we good to move on? All right, I'm not seeing any. Thank you for your questions. Uh, I appreciate them. So, I did want to dig into if these clients were receiving the services they needed because if you recall on the question, they could mark I needed it and I got it or I needed it and I didn't get it. So, I wanted to look at the percentage of clients that marked that they needed it but they didn't get it. So, that is what these percentages are. So actually what I found is that clients with Medicaid or no insurance indicated a higher need for the services but they also reported higher rates of receiving those services. Um and this was across every single service category except nutrition and substance abuse. Substance abuse was only a different about difference of about 1% so I didn't put it on here. Um but an example of what I mean with housing and food assistance. So 44% of underinsured clients who said that they needed the service, wait 44% of clients who said that they needed the service didn't get it. Whereas 65% of other clients who said they needed the service didn't get it. So that's about 21% lower. Food assistance, same thing, just the difference is a little bit lower. And then nutrition was the one exception where a higher percentage of clients that needed it didn't get it that were underinsured than the other group of clients.

Yes, Erica. I I'm confused how the word underinsured is being used. Is that being used for Medicaid and no insurance? Yeah, sorry. I did mention that with Medicaid or overinsured. I know. It's just um it's because that Medicaid or no insurance phrase is so long and I didn't want to make the table obscenely long. So, that's the only reason. Um, and I did try to mention that on the first slide, but yes, if I mention it again in this presentation, that is also what I'm referring to.

Okay, great. I just think another reason to keep them separate. I'm sorry to keep like harping on the same thing, but like here's a perfect another perfect example. Medicaid individuals have so much coverage, which is great. I'm glad like that's why we try and get everyone on Medicaid that could be eligible. So it really needs to be a separate group, you know, than from people with no insurance for the future. Erica, I agree. It Yeah, it's very confusing and somewhat misleading. So

well and just even the definition of underinsured I mean in some ways yeah I just think that's even that that word can be you know we have clients who have insurance but it's really not adequate or minimal coverage you know that would we consider them underinsured you know that's why we have things like assist and hip scan um so just even that term I think is challenging. Anyway, totally agree, Jimmy.

I was just going to add I think here, and I definitely agree with keeping the two the two cohorts separate because it's easier for just teasing out the information. But I think here looking at the services, those aren't access covered services. So I think it speaks volumes that even folks with access are struggling to get housing, food, nutrition and that was then we're not even at the current level which we know those three things are even worse today than they were two years ago or three years ago now. So just adding that in.

And one more thing with this there was another question on the assessment which was if you didn't get the service why was that and the response is pretty much overwhelmingly they didn't know it existed. Um, so I didn't go into the specific details on that question, but that was the response we got.

And I think that teases, we could tease in, well, we only do eligibility now once a year. So the touch points with clients are greatly, greatly, greatly minimized. And then the only time we hear between of clients in between is if something changes that impacts their service delivery, whether it's prescriptions or what have you. Okay, if there aren't any more questions, I think we're good to move on. I'm going to switch gears a little bit here. Still looking at Medicaid no insurance as one group. Um, but I decided to look at service utilization. Um, so that is the percentage of the clients in each one of these groups who are utilizing certain services. And um the service utilization was very similar across both groups for most service categories. OS is the big exception which I did not put on here because the reason for that is that medical care is only offered to clients um when it's payer of last resort. So that was a huge difference there that I did not put on this slide. But for MCM 56% of Medicaid and no insurance clients use that service versus 40% of 47% of other clients. And then dental, we had 39% for Medicaid and no insurance um versus 46% for other clients. So they're actually utilizing it less. And this data, this data set's actually a different time period. This is from um annual 2024 data. So that's our most recent complete set of data, I would say. So the time period is a little bit different.

Next up, I looked at viral suppression by service category. Again, this was very similar for almost every service category. These were the two exceptions that I thought worth pointing out. That would be food bank, which is 86% suppression for Medicaid and no insurance clients versus 92%. And then housing was 89% versus 95%. And these were two of those service categories that um Medicaid and no insurance clients indicated they needed far more than the other um clients did. So that could be connected to this perhaps. Um but yeah, these are just the two service categories that seem to have a big difference in viral suppression. So final takeaways, Medicaid no insurance clients indicate a higher need for each service category except HIPSA. Um but they also report getting the services they need at a higher rate than other clients. So that's great to see. And then finally, service utilization and suppression is similar for both groups. Underinsured, sorry, bad word to use. Um, but with a handful of exceptions. So, those ones that I highlighted on the previous two slides. And that is all the data I have for you. Um, I can definitely look into these as separate groups after all your feedback. Um, but obviously I don't have that ready for you right now. So, I would need more time to put it together. Thank you so much Reagan and Elena and everyone for their questions. Um so now that we've seen all the data I will hand it over to the committee for you all to discuss what population you would like to focus on and move forward with for the needs assessment. So I will just take the screen down but I if anyone has more questions um or wants to look at the uh slides again I can pull those up. But yeah I will now um hand it over to you all to brainstorm or um ask questions.

I actually have a few guiding questions too if that would be helpful. Um I'll pull those up on the screen. Thank you. Didn't want to forget those. Okay, let me now present. Yeah. So just based on today's discussion and the data um what population should the upcoming needs assessment focus on? And then after that, um, are there any other specific questions or challenges that we want the needs assessment to help us better understand? So, yeah, like what do we want the needs assessment to do? So, these, um, I'll keep these on the screen for everyone to um, think about for this discussion.

Rean, how long do you think it would take to get those categories separated and be able to present that data? Um, not very long. Honestly, I've done like most of the work. I just have to change a few filters for anybody who's an Excel fan in here. Um, so it shouldn't take me that long. Do you have the time to do it or I can make time for you? I just for me it would it would help. I think based off the conversation, yeah, I think it would be important.

Do we have the information um from our last meeting where we started talking about like can we pull up the minutes? Did we do we have that much detail? I know we kind of were talking about some things last time.

Just refresh. Um I so the minutes were kind I kept them like kind of high level just like the committee discussed potential populations um and those populations were obviously either Medicaid clients or clients who are under or uninsured. Um also a few folks had mentioned um looking at SNAP clients although there wasn't a lot of discussion around that. So it was mostly just yeah those uh Medicaid and insurance were the potential populations that we had discussed at the last meeting. Um, yeah. Thank you.

Yeah, we didn't review any data at the last meeting. It was more just brainstorming. So, I wish we had Dr. Ramen with us, our new access member. Is there a way to get questions to her? Yeah, absolutely. If we have specific questions, I can um write those down and um get those over to Dr. Ramen for sure. Yeah.

I do want to ask for um separating the groups. Do you want to see Medicaid as its own group and then no insurance or are we just looking at the no insurance clients? Um Medicaid as a standalone. Okay. I would like to see three columns. Medicaid, the no insurance, and then the kind of other insured or other coverage or whatever we want to call it.

Very fair. I think we brought up the Medicaid crowd last time because that's potentially, you know, the group that could be impacted at some point moving forward. I don't I don't know if we have any sense of a timeline there.

That was my question was I know that I want to say that summertime. Don't hold me to that though. Yeah. I just haven't I mean, we've heard of all these things that could happen. I just don't know when that's There's a lot of could. Yeah. And And I don't know if it's like I don't know what we're waiting on. Are we waiting on the state to determine things? like are these federal decisions that are made but now the state has time to implement or

you know I just haven't kept up enough to know like men maybe that's something Dr. Rama knows or someone else here knows. Jimmy's it's a Fed decision that they're waiting on the definition of uh medical frail to see if HIV will be included having conversations with various folks in various political steps. I

can say that again. It's a federal decision on the definition of medical frail and if it will include HIV. If they allow folks to check HIV and it's considered medical frail, they will not have to go through the the work requirements. If they do not include HIV as a definition, as part of the medical frail definition, then folks will have to go through the work requirements. So that's what it's waiting on the feds to make the determination of what is a federal uh what is um medical frail includes HIV. Yeah. Yep.

And sadly I think that a little bit ends up within our Medicaid column. It's almost like we could potentially need further breakout. I mean we could some demographics we could break out this moment in the sense of knowing that you know we know we can break out people who meet kind of the definition for exemptions already right like on disability of a certain age like some of that could pull out and then we're looking at the people who don't meet those criteria and then it's the like Jimmy said waiting on What is the definition going to be?

Correct. And then that's also contingent that they do not lock the government down come this Friday. What? Um, so there's no it's looking like it's heading that way because of the whole funding drama. So yeah. No, I'm just saying like yeah, throw that in the mix, too. I mean, there's like so much. But I guess I'm just thinking for our longer term planning. It's almost like I don't know that we have all the information we need yet to um to make a decision. I guess to know. Yeah.

Do we know Gwen? Do we have like a timeline of when we need to make the decision on what we're going to do as far as the survey? Yeah. So Jeremy and I had talked and we were thinking that a timeline would be presented at the March meeting. So, we do not have one at this time. We were going to kind of use today's discussion to help inform a timeline. So, we don't have dates picked out yet, but those would probably be voted on in March.

Okay. So, then if Reagan could get us some information and then see what we might be able to get from Dr. Ramen um on her thought process. She seems like she's very interested in working with the planning council to keep us informed. Is there an overall though like it has to happen within a certain fiscal year or or something like I'm sorry I'm not up to date on the needs assessment like timelines and things? So like is there a big overall timeline like it has to be done by you know December 2026 or something like that? Let me pull up the timeline from our last chips or the last time we did the needs assessment just so we can kind of use that as like a reference point if I can find that.

Michael's got his a question. Yeah, Michael's first in Q and then Jimmy is second in Q.

Awesome. Uh I just had a question. And I know uh on the data that was presented um there was a blue column and I think the blue column represented like Medicare and maybe people with maybe uh other insuranceances like maybe their work or maybe other insuranceances. Is there a way to look at the people that are on affordable care act? Is there any way maybe to that that seems like a concern of me with the subsidies going and people not being able to afford that. what's going to happen to those people if they're working and also don't u meet the requirements for Medicaid. Um I just was wondering if there's any place that data is if we have any data on it

um on the data set I was referencing that's not um included and I don't think I'll be able to get it because this data set is from um 2023. So, I would need like a snapshot of what clients were using at that time, which I don't think we have access to. So, unfortunately, if I'm going to use this data set, I don't think that's something I can do. Thank you. Thank you. But they would be included in that blue category, that blue shaded category. Mhm. Okay. Thank you.

I think Jimmy was next. Randall, I just had a question maybe for Shante. Um, what's driving the you guys are focusing on a unique population. Is that something the planning council's deciding to do? Did Hersa tell you? And the reason I'm asking is we got we had to rechange our whole part B contract or current grant application to remove any special populations because of the current administration's executive orders. So, I was just trying to make sure you guys aren't going to walk into a similar situation where your project officer says, "Why are you focusing on X when the executive order says not to kind of thing?"

It's an excellent point, Deborah. Anyone? We we had done the same with the integrated plan which I know some of you are on the the workg groups and some of you have attended the engagement sessions but we were doing the same thing of really kind of toning down our language to so that we don't get squashed um with the executive orders and that our language will still pass through all of the approval levels. Um so I don't know how that kind of helps with needs assessment but

but I can share that information if needed. Yeah, it's a requirement that we do the needs assessment on a regular basis, but yeah, have we been told that there's certain things that we can or cannot address? I haven't heard anything about that. No, we haven't had any guidance, formal guidance yet.

Um, just just like what Randall mentioned, we are required to do a needs assessment every year. um that is a HERSA requirement. Um every three is the big comp uh comprehensive one and the off years we do those mini ones. Um we do the smaller focus groups. So that's that's what uh we do at our in our EMA and that's what's been approved by HERSA. But no further guidelines as far as like the executive orders and those worries. And one of the major differences this year is we're not farming it out to someone else. We're doing it inhouse. All of the needs assessments. Is that correct, Shante?

Yes. And then whatever needs assessments or anything that we do at ADHDs, but yeah, we are not, it doesn't appear that we will be outsourcing that,

right? Okay. Um I don't think we looks like we can come to any consensus on a decision without getting more information at this time. And um that's just my thought process. So, in terms of action items to take away from today's meeting, um I've written down that we will um separate out those columns for review for the next meeting. Um and then, um in terms of having questions for Dr. Ramen, did we have specific questions that that you all had in mind for me to write down or did you want me to maybe send those to me over the next couple of days or how did we want to do that part?

Um would it be okay if we got them to you by tomorrow? Absolutely. Yeah. Yeah. Whatever um works best for you. Yeah. Just if you have um any ideas for how we can um yeah include Dr. Ramen, I will be writing those down and then reaching out to her. Okay. And then you're back Monday. Yes. Okay. And then also we will work on preparing a timeline too to present at the March meeting so we can give folks an idea of when um different parts will be happening.

Which Thank you, Miss Erica. I feel like we kind of know who we want to focus on in the sense of we're concerned about the people losing access. Absolutely. I guess we we kind of know that. I I mean

I don't know. I like and we're not going to totally know who that is uh from the data that we'll get. I mean, I still want to get the data broken out, but um yeah, I don't know. My mind is stuck. I think we know the general group we want to focus on. So, I I I don't know. Jimmy, just a question for you just off the record. Um, there's not any chance that we're going to end up looking like Florida as far as people's.

You know where I'm going. Oh, yeah. I know where you're going. Uh, let me paint it to you this way.

What's happening? Let me let me tell everybody what's happening in Florida. What Florida did was they they reinvisioned is the term that's being tossed around their ADAP. They used to cover folks up to 400%. It looked very eerily similar like ours. Uh it was so eerily similar that their ADAP director was also named Jimmy. That's how eerily similar they were to us. Um their state government decided to drop that FPL level for ADAPP enrollment down to 130% or less. anyone between 130.1 and 400 was now on their own basically to obtain their medications and their uh medical care their Ryan White part A's and part B's which they have several Miami Orlando several part A's they maintain their outpatient amulatoratory up to 400 and all their services as did the rest of the state but their ADA app will only get medications for US citizens below 130% FPL No, they do not have expanded Medicaid. So for these, they had roughly 32,000 clients. It basically cut off half of them. So for the remaining 16,000, they now have to go through Gilead, V, Jansen, whoever was making their medications to get their medications through patient assistance programs or what's called compassionate use programs. So in the big giant scheme of things, it's a huge project. Correct. It's a huge project. So where it's while initially you hear 16,000 people have lost access to medication, they now have to just get it through the manufacturers. The million-doll question here is if that 16,000 people do not become virally suppressed compromised in the next 6 8 12 months, it's going to look like a success because those folks care was never interrupted and they're still virally suppressed. So that's the model Randle's referring to that could then

spread to other states, more than likely Republican states first and then other states that basically look at ADAPs as a budgetary concern. So that's kind of where the Florida model is. And it gets worse. Um they actually removed big tar from their ADAP formulary and are restricting access to disco. I did HIV care there for two and a half years. I have a lot of friends there. Um and it's it's not good. It's It's really bad.

Correct. Correct. Catherine's correct. But that the thing with removing the Tarvy is Vivve apparently is not opposed to this because they can jump over to one of the Vivve products. So, it's basically a human game of chess is what they're playing. And we're all waiting for the 6, 8, 12 month uh trial period to see what happens with that 16,000 people's viral load suppression rates. And of those 16,000 people, about 60% of them are currently on big tar. Correct.

I mean, that's par for the country. It's 80 plus% of your HIV regimens across the country. So basically, they're playing with people's lives like a test run. Basically. Basically. Yeah. Basically.

And now that's the thing. If these 16,000 people remain virally suppressed, it's going to look like it worked because the states no longer having to invest or go after $120 million and these folks are still getting their care through Ryan White and they're getting their meds through Gilead Viv, etc. And they're going to say, "What's the problem?" So other Republican states, I guarantee you, are going to jump right on board of that saying, "Well, we're not going to chase this money either." So they'll start restricting their adaps and then from there you all know we have an election coming up in November. Everybody just falls in suit like a very well played chessboard. I learned a long time ago in college money talks BS walks. And that's where we're at with this.

Mr. Michael. Yeah. I have one question following up on Erica's question about Medicaid Medicaid and the potential of people maybe losing it or falling off the roles. Mhm. I had one question. Does that happen when they automatically like when the when it's adopted the new standards or whatever it is or does that happen on their enrollment? And will we see a real big increase in those people that have lost that Medicaid service or does it happen slowly?

I don't know how they'll do it. I'm sure there's some discussion about that as well. Um, it's a great question, Michael. Um, I will say with SNAP benefits, it was one fell swoop. So they basically looked at all the people that they felt uh you know fell into the bucket of people that shouldn't get the benefits anymore based on the new guidelines. They sent them all a letter and they all lost their benefits. So that it happened that way with SNAP. I don't know how it'll be with with Medicaid. It's very scary.

Yeah. Yeah. Um, I also wanted to follow up on Michael's comment about the federal marketplace because I I think he's, you know, that's a good concern as well. Um, Jimmy can speak to this better. I mean, I he can share. I know that the the premiums went up a lot. I mean it I feel like we're so fortunate that we do have a program uh via ADAP to help those individuals, but this is kind of a Jimmy question. Is there a point at which you know you guys couldn't do that anymore like or you'd have to max out how many people or limit or I mean do you have any sense of what could happen there because that then also is a population like Michael was saying like do we need to be worried about them also because you know they don't have employer coverage they're over income for Medicaid and now we wouldn't have FFM support for them so they'd kind of fall into that no insurance bucket also.

Yeah, the uh easy answer is as of this moment in time, I can't tell you what's going to happen with marketplace moving forward. Um what has made the premiums jump up was what was called the enhanced premium tax credit which was added when we were in the COVID uh pandemic. That's what sunset and that's what got taken away that made the premiums go uh up. Basically what's happening now would have happened in 2020 had COVID not happened. We would have faced increased premiums then because the EPA EPC would have been would have never been applied. So that's kind of where we're at now. I don't know what the future holds. We are taking some steps internally to try to better shore up our funding um with some changes coming down the road. I'm not in a position to discuss those in detail yet, but um we're looking to shore up some funding there. And then as far as premiums going up next year, the kind of canned answer is because this year saw a fewer people enrolled, the risk pool is smaller, thus next year's enrollment premiums will be shared amongst even less people. So it's kind of like your car insurance, your home insurance when unfortunately you're on State Farm and they've had a ton of claims or you're with Geico and they've had a ton of tornado claims or hurricane claims. everyone's insurance goes up because of the they have to absorb you all are in a risk pool together because you're all in State Farm and you have to absorb other folks's misfortune. So that's kind of the riskreward game that's played with insurance, which we all know we need it and it's just something hopefully we're able with the steps we're about to take, we're able to better shore up our funding uh here in three to six months with with another option that we're going to execute. And Jimmy, I'm not asking you to commit to anything and I know you can't share

things, but like hopefully for this year, we're we're okay, but yeah, who knows what next year brings.

Yeah, I mean that on average in Maricopa County, we used to have premiums for for Maroba County folks around 200ish. This this year we're seeing those up near 400. It was a dramatic dramatic jump. But again, because that other 200 would have been the EPTC, that's sunset. That's where basically we're seeing what would have happened seven years a six years ago. Eva, I've got a feeling that your next meeting in two months is going to be very robust.

I feel that. I know, right? Do we have any more discussion though? I just hope it's okay that I ask questions and I'm absolutely probably not on the committee, but Okay. Thank you. Michael is correct that you ask as many questions as you want. I love being asked questions. So, thank you. Questions are made up of people of all walks and experiences and they bring their expertise to this platform. So, it's super super important. Um, if you have a question, you ask it.

And questions is how folks learn. That's why two and three and four year olds are like, "What is this? What is that? What is this? Who is this?" That's how we all begin to learn. Someone else has the question you have, even if you feel like it's a bad question.

All right, so we're gonna continue on. Yes. Um, off topic, but since Deborah is here, when's our next meeting? Okay. Um, I'm gonna need a little more context. I'm on a lot of meetings. I know. The one that we were supposed to be having, I thought this month. Oh, for um, integrated plan. Integrated plan. Okay. Um, we are working on that schedule right now. Sorry. With site visits, I got totally uh, sidetracked from everything else. That's okay. That's okay.

But yes, I will send something out hopefully later today that tomorrow, Thursday, Friday. That's all good. Okay. I was like, "Oh, there's a lot of meetings." That that could be Oh, I know, right? Okay. We have meetings to plan meetings.

Any last comments, questions, concerns before we move on? If you guys have any questions um to get over to the doctor, go ahead and please send them towel by the end of the week or by tomorrow if you guys can. Um we're going to move on to I believe agenda 8. Is that where we're at? Okay. Um with Shanti Coleman and if you guys can pop up the part a menu of services and she'll take it over from there.

Perfect. Thank you, Eva. Um, thank you, Gwen. So, a couple things regarding the menu of services. Our office, we're not recommending any changes to the current FPL's by service category. Um, by service category, two reasons. We don't know what our final award will be. Congress has yet to pass the budget that will impact that award. Second, we anticipate higher cost in some service categories as Medicaid changes take effect. So, Department of Health and Human Services did release the 2026 poverty guidelines earlier this month, and 400 FPL now equates to 63 um or 63,840 a year for a single individual. Um, and my asked well with this recommendation, we're asking that we if you agree with the recommendation to not change the menu of services and keep them keep it as is. Um, can we have a motion to approve the menu of services? I will make that motion to keep the menu of services as they currently are, but keeping in mind that what we do sometimes is very fluid and we have to change with the times. But for now, if we could keep it as is, please. We have a motion from Miranda to keep the service menu as is. Do we have a second?

Eric, I'm confused. I see you in the room, but I also see you in the lobby. Do you have two devices going?

You're on mute. Yeah, I just want to make sure that we're not being compromised. Okay. Does anybody have a second for my motion or Eric, if you're trying to talk, you're on mute. Hey, Randall. I do see Eric in the session twice too as well. Eric, he's a

Eric, did you join from a phone as well or is it just um through your laptop? I think he dropped off. Okay. Is that what's going on? I was trying to troubleshoot the audio from my end and I was having some issues with that. Um, we are still looking for a second to accept the menu of services. Um, hopefully we can get Eric back on. Um, I can second if we don't have someone else to do it. I just felt like since I'm a service provider, it was

should come from someone else. But if it's okay for me to second it, I will. When it's a conglomerate of categories that don't pertain to you, then yeah, it's okay. Okay. Some are used, but yeah. Thank you, Erica. Thank you. We have a second by Erica. Uh, do we have any discussion? And we will have a vote. Yes. Yes. We'll do a roll call vote. Yeah. Um, yes. I'll pause for any questions or comments. Hearing none, I'll start with Eva. Four. Randle Furrow four. Erica Tamp.

Cat Barbara. And then I don't know if Eric is still on the call. I see one of the boxes. Um I don't know if he is able to unmute though. Um Eric, are you with us? If not, the motion would still carry. Um, I do want to give him a chance to vote, but either way, the motion carries. I think he might just still be having audio issues. Okay. Oh, yeah. Motion carries. Thank you. We're going to move on to agenda item nine. Well, actually, Shanty, were you Were you all done? I'm so sorry.

Oh, no. That I was done. Yeah, you're right. Um, I'm done. Uh, is it nine me still, though? Nine is the review of the annual quality improvement plans. That will yeah be Gina. Okay. And then back to you. We're going to move on to agenda item nine, review of annual quality improvement plan with Gina.

Good afternoon everyone. Um, for those who don't know me, my name is Gina Alan Williams and I am the interim quality manager here for the Ryan White Part A program while Karina is currently on military leave and I'll be going over the 2024 2026 clinical quality management plan update. Next slide. The clinical quality management plan was originally approved in December of 2024. The version was revised on March 4th of 2025, which does not change the overall structure or the goals of the plan. Instead, it documents implementation progresses, clarifies processes, and strengthens our readiness for HERSA monitoring and site visits. So the three areas that we've improved is our new periodic performance reviews methodology, quality improvement activities documentation, and we've recently added a CQM monitoring tool. Next slide. So for our year 2 quality improvement activities, this slide summarizes the quality improvement activities that are currently in progress and shows how we are building on the work from last year. From an oversight perspective, we are continuing the annual review of the clinical quality management plan and using an updated organizational assessment during site visits. We're also developing a formal technical assistance and data request process to strengthen responsiveness tracking and documentation for Careware and data governance. We're finalizing the Careware units policy and continuing the review of contracts and active service units to ensure consistency, accuracy, and compliance across subreients. In terms of quality improvement, we're continuing to streamline Careware onboarding and working with subreients

to complete case management continuity plans following the system redesign implemented last year. Our data modernization efforts in year two focus on sustaining and expanding the predictive analytics work completed last year, including continuity planning and enhanced analytical reporting to better support planning and monitoring. Finally, for people living with HIV involvement, we're developing a client welcome email campaign with the engagement tracking with engagement tracking, which will be first a test phase with clients, planning focus groups, surface category feedback surveys, and working with CHIPS on the needs assessment, and using disparity data to inform the design of new programs and improvement efforts. These efforts are currently on hold being short staffed with two of our QM team members on extended military leave. Next slide. To continue with the last slide, this highlights one of our significant updates between the December 2024 CQM plan and the March 2025 CQM plan revisions. In December 2024, performance measurements and reviews were described, but the plan did not clearly define a formal consistent review cycle while data was being collected and reviewed. The process for how often reviews occurred and how these reviews informed quality improvement activities was not explicitly documented. The March 2025 revision adds a new standalone periodic performance reviews methodology section. This section clearly defines quarterly and annual cycles and explains how performance data is reviewed on a routine basis. It also explicitly documents how these data reviews are

used to select, prioritize, and adjust quality improvement activities. By adding this methodology, the plan now formally documents an evaluation process, demonstrates active use of performance data, and shows direct connection between data review and quality improvement decision-making. This update was added to clearly show that performance data is not only collected, but reviewed regularly and used intentionally to guide improvement activities, which aligns with HERSA monitoring expectations. Next slide please. So lastly, our CQM monitoring tool is a quarterly tracking document used to monitor provider clinical quality management progress throughout the grant year. It's updated after key key activities such as PDSA pre presentations which stands for plan study due act plan do study act excuse me site visits COA reviews as COA reviews include a review of each provider's CQM plan during our HERSA site visits there were no CQM findings confirming that overall our quality approach is compliant with program requirements. Persa did recommend strengthening how we demonstrate ongoing monitor pro monitoring of provider quality activities and considering whether PDSA and quality improvement activities could be better aligned with provider capacity. In response to this, this tool was developed to document continuous monitoring across the year rather than relying on isolated reviews. This the intent is to support account accountability, guide technical assistance and strengthen system level quality improvement across the Ryan White service program. Ryan White service system. Next slide.

These updates strengthen our alignment with HERSA monitoring expectations by clearly by clearly documenting how data is used, how leadership provides oversight, how quality improvements activities are implemented and evaluated. The March 2025 revision does not change the foundation of the plan. It strengthens accountability, transparency, and monitoring readiness. We will soon be working on our QM plan for the 2026 through 2028 grant years. However, this is currently on hold until Karina returns in May. Do we have any questions? And that finalizes my presentation. Thank you.

Thank you. Um if anyone has any questions, I'm more than happy to assist and answer. Okay, seeing and hearing none, um, Eva, the floor is yours. Thank you. Absolutely. Thank you again. We're going to move on to agenda line item 10, review of quality assurance site visits back to Shanti.

Awesome. Thank you, Eva. Uh, my last update for the day, I promise. Uh, for grant 25 or 2025, we conducted provider site visits a little different than in previous years. Instead of the Ryan White program completing full chart audits, providers were asked to conduct self audits of their client charts using the tools we provided. Because we completed a thorough review of policies and fiscal components during last year's site visit, this year was intentionally focused on quality improvement. The goal was to give providers insight into what we look for during site visits and allow them to assess their own processes. As this was a quality improvement year, no findings were issued. providers reported that the tools helped them identify opportunities to streamline processes um address training needs for staff and make um internal improvements. We also collected feedback from providers on the tools and the audit questions. We're currently updating those tools based on their feedback and some items may be forwarded to star committee for considerations or questions on certain standards. Next year, we will return um to our standard site visit review process while considering incorporating pro provider self audits again every few years as part of our ongoing quality improvement efforts. That is my update on site physicist. Is there any questions? hearing. And seeing none, I'm going to turn it over to Eva.

Thank you. We're going to move on to agenda line item 11. This is the review and resolve any parking lot items. At this time, we don't have any parking lot items to resolve. Um, we're going to

I'm going to I'm going to actually um because I've been looking at the data while we were doing this. So, I do want to just give you guys a quick update. It actually looks very similar. The Medicaid and no insurance when you split it out, they look very similar to what I presented to you. very similar trends. Um the big difference is that almost all no insurance clients with no insurance or underinsured clients indicate that they need medical care and ADAP versus Medicaid. That's not the case. Um it's a much lower percentage. And then it looks like clients with no insurance or underinsured clients had less trouble receiving the services they need. So those are really the only big differences from what I presented to you guys. So it seems like the two groups are fairly similar except for just a handful um of exceptions there. So again, ADAP and medical care and then um clients with no insurance or underinsured clients are getting the services that they say they need at a higher rate than the Medicaid clients. Um so if you guys still want me to go into a lot of detail and break it down in a presentation for you, I can. But I think the conclusions are going to be largely the same. Um, so I just wanted to offer that to you guys before we finish up this meeting.

Thank you, Reagan. Appreciate that. Thank you, Gen. We have a question.

Thank I do actually just want to ask if you guys are okay with that explanation I just gave or if you want me to put together a full presentation for you for the next meeting. I think I would like to have it in a written form to see not that you have to like present it all again but um I think think we want to have that data anyway for our next meeting. So, if we could have it in in with the three columns, I would appreciate that. Thank you. Okay. Um, Glenn, would it be possible to just like send that over as an email instead of presenting it?

Yeah, I can definitely do that. Um, yeah, just send it out to the chips committee whenever that's available or whenever you Yeah. want to send that out. Thank you. I

Yeah, I had one question uh also on the data that you said that is almost the same with medic uh Medicaid and underinsured or un uninsured. Are do do you have the number breakdown as well like the number of surveys answered on each one of those categories so we could see how many were Medicaid, how many of those surveys were the underinsured. Mhm. Yeah. I will I'll tell you right now 95 of the respondents indicated they had Medicaid and 63 indicated that they um had no insurance or were underinsured. So they're fairly small populations, but um that's still like around 20% of the total respondents.

Thank you.

Thank you for that, Michael. Do we have any other questions? Last minute comments for Reagan. Thank you for doing that so quickly. We really appreciate it. Thank you. Um we're going to move on now to line item 12. Um Gwen, if you could pull up the PCAP. It's January. Yes. Okay. Um uh we reviewed resolved uh the parking lot items. uh in integrated plan progress and updates were reviewed. Um planning for the needs assessment uh reviewing part A menus of services we reviewed the annual quality improvement plan quality insurance site visit results and we are going over the PCAT. Did we miss anything? Um, I don't think we missed anything unless Deborah, did you have any other updates regarding the integrated plan you wanted to share? I know that you had mentioned that you'll be sending out um the invite for the next um workg group meeting. Not to put you on the spot, but if you had any um other updates you wanted to share if maybe Deborah had stepped away. Um I know that her her one update was that there will be um an invite sent out for the next workg groupoup meeting. Um if I hear more information from Deborah regarding the integrated plan I will definitely be sharing that with the council though and then I don't know I think yeah we covered everything else.

Perfect. Thank you. Uh next we're going to go into our line item 13 determine of agenda items for the next meeting. This is the time we review any items that came out of today's discussion to ensure they are at and needed in next meetings agenda. Are there any items that we need to add to the agenda that are not on the PCAT for the next one?

So definitely planning for needs assessments. Um it's not on the PCAT for March, but I will be for sure adding that to our agenda for March. Um, do we need to redo any of the reviewing for the integrative plan again then or no? Um, I will ask Deborah if there are any updates for um her. Oh, Deborah, you have your hand raised. Yeah, thank you. Um, I was going to ask if we could do an update on the integrated plan. We do have to um we have to submit in June. So, I would love to get the planning looking at it a couple of times before we have to do concurrence. Yeah,

for sure. I'll add that to the agenda, too. Thank you. Any others? We're going to move on to agenda item 14, current event summaries. This is the time for planning council members to share a brief summary of current events. Members of the planning council cannot propose, discuss, deliberate, or take legal action on any matter of voice during this time. Do we have any that anyone would like to talk about? Just a reminder of the ones that were mentioned at the beginning of the meeting with the events that are coming up in March. Any others? You guys, we're moving on to agenda. Um, agenda. Agenda item 15, the call to the public. This is the time for the public to comment. Members of the planning council cannot propose, discuss, deliberate, or take legal action on any matter voice during this time. Do we have any community or public community members that want to speak or calls? Sorry, I'm looking at two different screens. I apologize. All right, we are going to adjourn today's meeting at 1:29. The next meeting will be March 31st at 12:00. Um, we hope that you guys will join us. We have a lot to discuss and continue to discuss in our next few meetings throughout the year. So, thank you for all of the conversation, all the questions today. Um, and all of the feedback from everyone was really, really greatly appreciated.

Thank you, Ava. Thank you, everybody. Thank you. Just everybody just a quick sorry jumping in but the 31st is Cesar Chavez day. So I don't know um I know I won't be a I'll be off. I don't know if other providers are off. Um and STAR will run run into the same issue. So yeah, thank you Erica. Let me touch base with Jeremy and Randall and we can reach out to folks and yeah plan or maybe reschedule things. But yeah, thank you for letting us know. Okay, thanks. Yeah, thank you. Thank you everyone. Thank you.