Ryan White Planning Council - Regular Meeting

I'll share. There we go. Thank you. All right. Um, I would like to welcome everyone to the planning council special meeting. Um we're going to do some funding um some in-ear funding adjustments today. Um today is Thursday, June 5th. Um and we're meeting from 12 to hopefully no later than 2. Um but we will start off um again um item number one is determination of quorum and that is according to Gwen 16 of 23. So we can move forward uh with uh line item number two which is our welcome introduction and declaration of any conflict of interest that you might have.

Thank you Randall. So for everyone who is a voting member of the planning council or if you are scheduled to speak on today's agenda um when I call your name please list any conflicts of interest that you have and we'll go ahead and start with Randall Furrow. Uh Randall Furrow, Planning Council Chair, no conflict of interest. John Gomez. John Gomez, board of supervisors. No conflicts. Eric Een. Een, no conflict. Shane Sangster. Changster. President, no conflicts. Alan Barnes. Alan Barnes. No conflicts.

Erica Tamp. Erica Tamp conflicts with case management referral for healthcare and support services medical transportation HIPSA and housing. Bradley Reese. Bradley Reese. No conflicts. Brian Hagenbart. Brian Hagenart. No conflicts. Celeste Maya. Celeste Maya. No conflicts. Emily Hauling.

Emily Hauling. Prisma Community Care. Uh conflicts of interest are medical case management, non-medical case management, um substance substance use, um mental health, nutrition, and food bank meals. Eva Galindo, Eva Galindo, present. No conflicts. Jason Bel Cruz. Uh Jason Bel Cruz, present. Um, uh, conflicts include primary medical, substance use, mental health, HIPSA, and referral for healthcare and support services. Jimmy Borders,

Jimmy Borders, ADHS, alternate for Patricia Sandival, conflict with ADEP, Eduardo Morera. Good afternoon, team. ADHS. Eduardo Morera, ADHDs, HIV prevention manager, no complex. Esmeralda Barentos. Hello. Esmeralda, present. Conflicts with medical case management and primary medical care. Benjamin Pearson.

Oh, I think you're muted, Benjamin. Oh, there you go. Benjamin Pearson. Um, medical case management and psychosocial. Jeremy Hiveron. Jeremy Havarna, Maropa County. Shante Coleman. Shante Coleman, Maricopa County. Carmen Batista. Carmen Batista, Maricopa County. I'm division administrator of health outreach partnership and empowerment. So we have the Ryan White teams mental health substance use and community health planning and needs assessment. All right. Thank you so much everyone. I will hand it back to you Randall and I'll go ahead and share the agenda too.

Thank you. Um and before we uh proceed um Taylor Kirkman unfortunately was not called on. So if you want to go ahead and do that. Yes. Thank you so much. Sorry about that. Taylor Kirkman. No problem. Present uh conflicts with primary medical HIPSA substance use mental health and referral for healthcare and support services. Thank you Taylor. Okay. Um any other planning council members that we did not catch? I didn't lock. You locked yourself in.

No. Okay. So, uh, next on our agenda is item number three, which is a review and acceptance of the agenda. Uh, the agenda has been posted. It has been sent to you and it's now on the screen. Um, it's just for your quick review. Uh, we cannot change any items on the agenda. However, if we need to move the order of any of the items, um I do have the discretion to do that. Okay. Uh line item number four is our chair update. Um today is Thursday, June 5th, and there's a couple of days that we need to recognize real quick. Uh first, it is National Audacity to Hope Day. It is the International Day of Innocent Children, victims of aggression. It is National Cheese Day. It is National Hug Your Cat Day. And no laughter, but National Old Maids Day. Oh, and then I have one more. Um, today is HIV long-term survivors Awareness Day. Um, so again, let's just recognize all of our long-term survivors that have with us that are uh with us. Um, I want to thank everybody that participated last Thursday in our allocations workg group. Um, amazing group of people that came. We had a lot of participation. Um, a lot of hard decisions were made, but it was very um, amazing and really touched my heart the decisions, not the decisions because we weren't able to vote on anything, but uh, the recommendations that were

carrying forward today to present to um, the rest of the planning council. Um, I also want to thank everyone uh that is here today um to formalize um the emergent in-ear funding adjustments that we're going to be making today. Um couple of logistic items. Um our meetings are recorded both audio and visual. Um, so if you have any problem um with your voice or likeness u being captured, we would ask that um you leave the meeting um when you're prepared. Um and just a reminder, I don't think that we have anyone that fits into this category. Um but just a reminder that our non-planning council members can only speak during the call to the public section which is at the end of the meeting. Um we usually limit your comments to 2 minutes. Um and it's not in the format of open discussion. Um it's for you to make comments only. Um any comments that are made we take back to our executive committee um to see if there's any action that needs to be taken on any of the comments that are made. So we will move forward to line item number five and that's the Ryan White HIV AIDS part A recipient update. and Jeremy,

real quick. Actually, um, we just let Duvia Lozano into the meeting. Just going to let Duvia declare her conflicts real quick before we move on.

Thank you. This is Duvia Lozano. Can everybody hear me? Yes. Perfect. Uh, Duvo Loausano, conflict of interest with mental health, substance abuse, medical case management, non-medical case management, psychosocial, and eh. Thank you. Thank you, Duvia. And Gwen, just real quick, does that take me up to 17 or 18? And that will be 17, Randall. That'll be 17 with Duvia. Yes.

Okay. And Jeremy, am I speaking first or are you speaking first? I've already forgot. No, I'll do my recipient update. So, good afternoon everyone. Uh Randall asked me to do uh some level kind of setting during our during my recipient update in terms of uh kind of giving you all the same rundown that I've uh provided the last couple of meetings regarding funding. Um and then walk through the final uh expenditures for last grant year so you have that information. um and then uh talk a little bit about uh what our current funding looks like this year. Um I'll have some stuff to share on the screen in a moment, but uh to uh um update you quickly, we have um we finalized all of the grant year 24 expenditures uh uh two weeks ago and we'll be presenting those at the planning council uh the June meeting later this month um for full review and ratification and I'll be previewing those for you in just a moment. Uh we have uh uh final carryover amounts from last grant year into this year uh in the amounts of 335,161 for part A and 42,535 uh or yeah $42,535 for uh minority AIDS initiative uh funding carryover. So that's a total of 377 uh,696. Um, and as a reminder, last year uh we only carried over about 11,000. Um, so that is a an increase in uh carryover for this year that we'll have available. Um, we've also received our second partial notice of award from uh HERSA uh HIV AIDS bureau um for our part

A grant. This brings our total funding so far for this year to $5,84 which is about 46% of last year's full award. They have HERSA has informed us that final awards are delayed and they don't currently have a timeline for when those will be released. Um there is potential to get a third partial for part A. Um but again, nothing like that has been set in stone or communicated in writing. That's just been some of the things we've been hearing. Um uh and but for today and for the work we're doing, we are operating under the assumption of level funding for part A this year. So if that changes, we would have to come back to the council and make uh and potentially make adjustments. Um but uh we are operating under a continuing resolution for this federal fiscal year which uh level funded part A the level the levelable fund of the part A program. Um so that's why we're anticipating to uh get level funding or we're that's why we're operating under that assumption also and we communicated this uh a few weeks ago to the planning council. We have received an update from uh our partners at the state at ADHS regarding uh part B rebate funding for this grant year and due to reduced funding at the state level our award is 150,000 which is a significant decrease from previous years and for context last year we build in the most we ever had which was um just over 1.8 million in direct services including for dental and co-ay and deductible assistance. Um, so that's part of that's the the main reason why we're meeting today and why Randall asked for an allocations work group um is because of that reduction in funding that was used um all for direct services

to supplement the part A services. Also just want you to be aware um we are monitoring the potential impacts to uh Medicaid and Medicaid expansion um if changes to Medicaid are officially enacted federally um which seems uh uh likely. Uh this would have real impacts on our outpatient amulatoratory health services or primary medical care costs as clients would be transitioned onto part A um from access. And uh that's not a problem for us to solve today, but it's something that we will uh we will want to be coming back to soon. And the allocations workg group as they continue will um be looking at and evaluating what the impact of that could be. Any questions before I jump into sharing uh grant your 24 expenditures?

Jeremy, could we just um call in Patricia Sandaval real quick? She joined the meeting. Yes, everyone. Sorry. Uh, Patricia Sandaval, u Arizona, uh, conflicts with, uh, ADAP. And Patricia, is it all right if I ask? I think Jimmy Borders is here. Um, who is going to be your voting member today? Will that be yourself or Jimmy? Uh, either one of us. You You pick. That would be me. Yeah, that will be you. Okay.

All right. I'm going to share um the final expenditures for last year. So, this is uh where we landed on services. Let me know thumbs up or something when you can see the screen. Okay. Um, I just want to uh really quickly let you know that for HIPSKA, we have it split here into co-pay and deduct uh assistance and and dental insurance program. This funding here includes the part B uh uh rebate funding. Um we combined it because uh uh it's just easier to present it to you that way. Also, um, for quick clarification, majority of the funding for dental insurance program was build to the part B rebate funds. Um, so we um got really close to 3.5 million for primary medical care or outpatient inventory health services costs. Um, and everything else kind of trended. Uh normally we do have I want to call out food uh food bank or food vouchers here that is higher than we had originally allocated. But if you recall at the end of last year end of last grant year the um we increased food vouchers for January and February because we knew we were going to have some carryover and wanted to use um some of that funding and we had that part B uh funding available. Also, I just want to point out too on dental insurance program, I know, sorry I'm skipping around a little bit. I missed my note on that. Um, on the dental insurance program, this cost reflects that midyear reduction to uh an annual cap of uh $1,500 uh dollar per client to use for

dental. Um the projection for this year uh at the current two uh $2,500 cap would be well over $2 million. Um so that is uh um that's something to to keep in mind as we're looking forward. Uh housing is in a little bit of a darker gray because uh mid year last year we the planning council uh defunded that under part A. that was a specific position for um assisting clients searching for housing who had vouchers and uh we were able to work with HOPA to absorb those activities uh into HOPA case managers once uh that position became vacated. So that helped a little in cost savings for for us. So just wanted you to be aware of those things. Do we have any questions? I'll be presenting a more full picture of this in June before you all vote on it. This is just to help level set for today. Okay, I'm going to switch over to the uh funding. So just kind of walk walk you through that as you for grant 2024 our par a grant including MAI was um 10.8 almost $10.89 million uh we had that $11,000 in carryover from the previous year and we build uh in this period um just over $1.6 6 million to uh part B rebate funding for a total amount of funding of just over 12.5 million. Um there is a for admin QM so our our staffing and internal costs to to run the program and our PC and our planning

council the actual spends for that uh last year was 1.3 million um wi which left us a total of 11 um 11,196,9 to use for services and that is what we did. We use that for services minus that through this amount here which is the carryover amount that we're bringing into this year. Does that make sense? The funding for last year I see a couple thumbs ups and some nods. This year with that red with the increased carryover and the reduction in available part B rebate funding to our program. Um again we left uh level funding for part A. Um that would uh have a total available funding of 11,4 uh $16,79. We have uh found some areas to reduce and are continuing to look at some uh reductions of costs uh internally. Um but we've got it down to 1.2. 2 million. So 1 1,245,000 um for admin QMPC um budget, which would leave us at 10,171,000 as the the um what we're the amount we're trying to stay within or budget um for allocations for service categories. You'll notice that the shortfall because of the increased carryover, the reductions uh that we've already looked at for the admin and QM and PC stuff, the actual shortfall that we're trying

to make up is just over 1 million. So, it's not a complete uh uh $1.6 million reduction from uh that would have been indicated from the that email we shared with you all about going from 1.8 8 million uh in repeat prebate funds down to 150,000. So we are able to make up some room with the carryover there. Any questions on the funding? This right here that I just made into yellow, that's the magic number that we're trying to get to with allocations. I'm not hearing any questions, Randall. So, I will go ahead um I will go ahead and turn it back over to you for the next agenda item.

Great. All right. Um, thank you. And I'm going to, um, it's a little bit lengthy, so I wrote some notes and got a little bit of input and I'll proceed with that. Um, I just want to make sure that before we dive into the specifics of the allocation workg group proposal, um, I want to give you some of the context around how we got here. Um we started off with um Jeremy and his team presented the work group with three distinct funding scenarios to help us weigh options in a datainformed valuedriven way. First scenario was based purely on the planning council's guiding principles. The second applied straight cuts from the bottom up based on the council's service category rankings. Um, and the third was developed by the recipient team drawing on data needs, subreient input over the past nine months, internal discussions that the program had, and then conversations with me as the chair. Uh these scenarios were not intended for public presentation today but served as critical background to help guide our thinking and to shape our discussion. They gave us a clear view of the tradeoffs involved and the values we wanted to preserve in our final decision making. The conversations that followed required a lot of hard work and even more

difficult decisions. Um, but I just want to say that the final proposal represents total consensus from the workg group. Um, again, we did not vote or make any final decisions at that work group, but we did have total consensus. Um it was something that we we spent a lot of time two and a half hours I think talking through together thoroughly and respectfully um until we reached a shared agreement. The work group brought together a strong mix of subject matter experts and community voices with lived experience, including our clients. That combination helped to ensure our proposal is both responsive to community needs and grounded in operational realities. Throughout this process, the work group worked hard to ensure the least amount of impact possible on our client services with a shared goal of preserving as many services as possible while staying within our anticipated budget. What we'll walk through today reflects that careful balance rooted in both data and compassion. I also want to explain how this process fits into our broader priority setting and resource allocation or PSR work. Last year's PSR gave us our original plan for grant 2025. What we're doing today is a response to the current funding environment as an in-ear adjustment. The next PSR cycle, which will begin soon,

um will focus on planning for the next grant year, 2026, which begins on March 1st of next year. Finally, a quick note that all of our discussions and this proposal assume level funding for part A. if the final notice of award is higher or lower or if there are changes to Medicaid that are implemented, we may need to revisit these allocations later in the year. Um, with that all being said, I would like to turn the floor back over to Mr. Jeremy, who's going to share um share the proposed allocations on screen for us to review and discuss.

Randall, I'm going to share them. Am I talking through them or are you? I'm talking through them. Okay. We're going to give you a little break today. There you go. Until it starts getting real heavy. Let me know when you can see my screen. Okay. Can everybody see that? Okay. And again, basically what we're looking at is the final column uh which is highlighted in is that called mustard. Sure.

Yeah. Let's call it mustard. And while you're looking at that, I just have some talking talking talking points um to kind of guide you into what we're looking at. Okay. The target amount for service allocations for this year is uh 10,171,000. That's the number that we had to work within. And here's how we got there. Several service categories like medical care or OAS, referral for health care, medical case management, non-medical case management, mental health and substance use are funded very close to level compared to actual spending in grant year 2024. These reflect steady cost trends over the past several months and were prioritized for stability. In the ta in the table um any funding that you see uh that is shown in uh that teal color um indicates a reduction in funding for that category. One clarification, however, is on dental. While the number may look like an increase, it re it's really maintaining the current benefit structure. Uh we did lower the annual benefit to $1,500 last year and then when we got the additional funding from part B, we raised it back up at the beginning of the year to $2,500.

This proposed funding level assumes that we're going to lower it again to $1,500 and that would go into effect on July 1st of this year. So next month to stay within budget. The other reductions are proposed to be implemented by August 1st. The recipient team will work closely with the subreients to adjust service delivery and levels so that the programs remain with within their allocated amounts. Um there are actually two services that are shown in red. These indicate services that would be funded through July 31st of this year only and then beginning August 1st of this year, these services would no longer be funded under the Part A program. Some of these reductions like transportation and co-pay and deductible assistance are strategically delayed um to give the part a program and the subreients time for them to do thoughtful planning and implementation. Uh some were developed with the understanding that there are other funding opportunities for that specific services. These decisions weren't just math exercises. They were guided again by very thoughtful discussion, a lot of data questions and of course and most importantly the needs of our clients. Importantly, this proposal is built under the assumption of level funding from HERSA, which again we will not know

until we get that final grant award. So at this time I would like to ask if any members of the work group that were with us last Thursday if you have any additional information that you would like to share at this time. Um and again um once we go into our discussion with the full planning council today uh we would also appreciate your input. So any work group members, do you have anything that you want to share based on our meeting? Randall, we had two new people join. Um, so James Michael Brown and Anthony Holshire. So I just wanted to give them a chance to declare their conflicts. So we'll just start with Michael Brown.

No conflicts. Thank you. Michael Brown, no problem. That was Michael Brown and then Anthony Holshire. Thank you, Anthony.

Um, great to have both of you gentlemen um with us today. Um we just finished um um a large portion of what we're covering today, but again if you have questions um we'll do our best to answer them um while working through what we're doing. So um back to our workg group members. I believe I see Erica's hand raised. Hi Erica. Hello. I just wanted to uh clarify that the food bank vouchers uh the 2024 expenditures at 289 um that we were in our work group talked about. Generally, it really runs at 192. That looks in it was bigger because there had been additional spending. So, just when we compare, it's not really going from 289 to 150. It's more so going from 192 to 150 because that 289 was really just an aberration of uh some extra funding.

Great call. So, um and again, um I believe Jeremy just put a little um help in there for us. So, um again, just confirm what you're saying. That's a $42,000 reduction in service, which softens it quite a bit. So, um Erica, did you have anything else? Um while you still have the floor, I do not. Thank you. Um any of our other workg group members,

Randall, there's a question in the chat from Patricia. you um asking should medical case management be teal as well since it looks to be reduced. Can can I answer that one? Yes, please.

So, uh case man, we looked at trends over the last uh several months of the grant year and into this year for allocations for medical, non-medical, and uh the referral for healthcare, which includes CE, but there's also additional staffing in there that's not CE related. Um, and we looked at those trends based on things we'd already done. Uh, uh, vacancy holds that we placed, uh, asked the agencies not to fill current vacancies while we were waiting on funding. Um, and because there had been shifts in staffing to align with the uh, updated standards last year, it took several months going into the year to get those fully shifted. So, funding was a was uh, slightly different. So, we're looking now at what the current trends are. So we don't we believe that is uh close to being uh a a good uh projection for this year without actually being a reduction in the service.

Great. Thank you Jeremy. Of course. Thank you for asking that. I meant to say that when we were going through it and I forgot that one. Okay. And again, any of our other workg group members, did you have any uh comments or information that you'd like to share at this time? Hearing none, um we'll go ahead and um open it up to questions from the planning council. Um again, um Eva, I saw you pop up. Hi, how are you? I'm good. How are you? I'm doing well, thank you. Thank you.

Um, just a quick question. I know that you guys said that these are kind of like the trends and everything. So, um, for voting purposes, is that safe to say that these numbers are suggested because it's going to have the least effect on clients? Yes.

Thank you. least impact um on clients and then um where we're talking about um defunding those services. Um those are services that um we've been informed that there's some um other funding opportunities or streams that might be able to um be taken into account. if I'm able to. Um, so it looks like that early intervention services funding will end in August then.

Um, based on this proposal that is correct. Okay. Thank you. Sorry, I just wanted to clarify. Eric's got his hand up. Okay, great. Early intervention service. Can you hear me? Uh, yes.

For early intervention service, don't you think that's kind of bad to to cut that? I think that's not really helping our clients if they need like early the services. I'm confused.

Um, do we have anyone that would be able to help out with that question um about what other funding or what other opportunities are out there? It's not like the service the service will go away from our menu, but we hopefully um we talked about other Can I get somebody to help me with that a little bit about who the other resources are or what kind of information can we share? I'll just jump in and say that uh early intervention services is a um for part A has very clear guidelines on things like we can't supplant but we can supplement uh um the other funding for that. Um I know there's been some uh reductions in uh prevention um efforts too, but the work group talked about um how uh case managers h have also worked uh and and continue to work to help connect people quickly. Um there is also uh we have over the last several years um in conjunction with the planning council we've moved uh much of our EIS uh funding over to EHE because it allows for a little bit more flexibility um in terms of of of that. So this is specifically talking about part A um and yeah so I hope that helps a little bit. First of all, um, Eric, that's a great question. Did that help you?

Yes, it did. Thank you so much. So, I'm hearing there's other funding sources for early intervention services elsewhere that will continue providing some of those services, just not through part A. Correct, Emily?

Um, I was not in the work group. However, um we at Prisma um used to have EIS funding and um once we didn't receive that funding anymore, we kind of pivoted. Our uh prep navigators are now just clinical program navigators and do early intervention services just not funded under Ryan White. So, we do the navigation pieces um when someone tests positive. That's very helpful. Thank you, Emily. Um I think and if I'm calling people out of order, let me know. Alan Barnes,

Brandle, thanks. I was just going to ask for a couple of examples of early intervention services. I heard Emily just say some of them. is are are there any other examples of the services as far as what the service actually entails? Correct. Okay. Um Emily, would you mind fielding that and tell us what EIS is? What does it do?

So, um it really is that linkage to care. So, it's you get like a warm handoff. This is how we did it. So when we were funded and what we do now is when someone tests positive um we inform uh one of the navigators. So there's a warm handoff between the tester and the navigator. Um and the navigator kind of helps guide the newly diagnosed person um through the process of applying for uh Ryan White services. um getting linked to CE, getting linked to um a medical um appointment and uh case management and really just any other uh services that this person would need. That's like really quick overview.

They also get six months of follow well from our EIS they get six months of like case management and followup as well. That was helpful. Thank you. Thank you. That was my main concern because when you're newly diagnosed and especially the young kid, the young adults, they're going to be confused. So, it's that was one of my main concerns. Thank you. Thank you. Um Taylor has her hand up. Randall

Taylor, I'm sorry. Yeah, I just wanted to add to what Emily said. Um, Valley Wise has EIS funding through our Part C grant as well, and we have four or more staff members who do that exact same work. So, if somebody happens to filter through Valley Wise testing um or is referred to Valleywise, they'll get those same EIS services as well. Thank you, Taylor. Um, Reagan, what does that mean? That little symbol. I think that was a typo, Randall.

Oh, at first I thought, was that something falling over a cliff or Okay, like a child, I was like dwelling on that. Um, any other Oh, Erica, I caught you. So, it' be Erica first and then Patricia and then anybody else that I can't see.

Well, my question is kind of for Patricia I think would have the answer. Um, if is it correct that anyone funded for testing, which I think a lot of that comes through the state um that kind of the concept of connecting them to services is paramount for their role after testing. Is that correct?

Are you talking exclusively just HIV testing or exclusively with like EIS or both? I guess I'm just talking about for groups out there who get funded to do HIV testing isn't one of the expectations is that they link them to services whether it's called EIS or whatever it may be called linking them to you know for Maroba County and Panel County central eligibility. Oh I see what you mean. Yeah. management and everything, you know, and then that from there follows everything else. Like that's an expectation whether or not it's called EIS.

Yes. So, um they're correct. part of HIV testing and if it turns out to be positive is linking that to care and having the warm handoff and that's really where um an early intervention specialist comes in or a navigator comes in and it's all under there because that person can connect them to eligibility services our services um and then also um other resources they may need um and then connect them to if they qualify for medical case management um so it's also as well as and I'll just this is what I was going to say too as EIS is also can be utilized for persons coming um from out of state um who have not been uh have who have not been in care um for a very long time and they're wanting to get back into the care. And we also have our um which is helpful and they work t uh work in work uh together with our day-to-day care program um to make sure the person is virally suppressed and has access to um the doctor and and all of those things. So um early uh the EIS is in um goes for newly diagnosed and persons um who have not been in care um for for for a long time.

So just to clarify my question was there was no EIS does someone who is funded to do testing just testing is it expected that they link them to services? Yes. I'm sorry. Good afternoon team. I can take this one. Yes.

Um, so yes, if you have questions about the actual testing process and the the standards of care, it is listed on the ADHS website. Um, one of the key activities for HIV testers, whether they're directly funded or indirectly funded, who for those that access just the bulk HIV test kits throughout the community, the expectation is that they will facilitate um any kind of linkage to care process with within either their own their own agency or through collaboration with partner agencies. That's great information, Eduardo. And then Patricia, did you also have an additional question or comment?

Sorry. Yeah, that was it. Yeah, I was just saying yeah, that was the whole thing. I just wanted to make sure that it's not exclusively to uh newly positives, but we also do and facilitate with HIV testing. It is the expectation they are as well. Grant again, Patricia, thank you for that information. I know I'm learning a lot today. Uh, Duvia, did you have a question or comment?

Sorry, I just wanted to clarify like some organizations have that like EIS component built in as a best practice. um like for example when uh we do testing at CPLC we do do the whole linkage process without um any like additional EIS funding. So I just wanted to add that piece because I know um every clinic is different and everybody works differently. Um so I just wanted to explain like how it's done at some clinics. I know everybody has a different process, but um whether you are funded for EIS or not, um best practice indicates that we um link our patients to care um and to HIV services or prevention services just depending on what the client needs are.

And then how long do you keep with that person? like three months, six months or as

need for for us Randall uh we have a a linkage to care um process where we do uh we make sure once the patient is linked to uh the CE office and they have completed their intake uh once they've seen their medical provider and they have been prescribed their medication and then they're linked to a case management agency. So say they must qu they must meet all of those um uh different things in order for us to completely um consider them linked to care. So if somebody tests positive at our clinic, they have to be linked to central eligibility, complete their intake there. They have to have gone to their doctor visit. They have to have their first prescription of HIV treatment and they have to be linked to their case management agency. So we stay with them until all of those components are and then we consider that connected to care.

Great. Thank you again. Phenomenal information. And then um Jimmy, I hope you don't mind when I read what you're um putting in the chat, but um Jimmy Borders also said, "Please note there is still rapid start um LTC up and running across MC now. Also, linkage to care. LTC is linkage to care. Thank you, Patricia. and MC is Maricopa County. Okay, thank you. So, um, again, more great information. Other questions or comments? Um, not a fail, Jimmy. That was a success. Great information. Um, I think what you're beginning to see hopefully is um the work group and our combination of um our subreients uh subject matter experts and our um clients and their lived experience really got this could look a lot different and this is while it's hard um it's to me it's also doing the least amount of damage. So, um, any other questions or comments

hearing? None. Um just a straw vote is based on your questions and what you're seeing and what you're contemplating, is this something that you're comfortable with that um we can approve and um our recipient uh Jeremy and his office uh can start working on or not. Eric, yes.

Looking at the medical nutrition, why is it I mean, I know I looked at it, but shouldn't that be like a priority medical nutrition? Um it everything is a priority and again medical nutrition um is not being eliminated. It's just um and again a lot of these we we tell the recipient you know how much to spend and how many clients we want served. I think basically what you would see is um most likely fewer uh food vouchers would go out, but that our clients would be triaged and the most neediest, the ones most in need um would again most likely continue to receive their food voucher. Is that kind of what you're asking? And if so, is it helpful or

No, it helps. Thank you. You're very welcome, Eric. You're asking some great questions today. You get one of those gold stars. I see my community. I'm sorry. I'm just concerned because I see people in my community. So I sometime wonder what are their struggles and make things better for them. Do you hear me?

That's why you're um Yes. You're kind of cutting in and out and sounds dist I'm catching what you're saying and and that's and that's why you're on the planning council, sir. is to help us make these decisions um where based on our funding we're able to um give the best services that we can um to each of our clients. So yeah, our funding hurt.

Yeah, you um you hit the nail on the head. you hit the nail on the head. We're um basically a million dollars short on our budget between now and February 28th. So, I think you would have to agree that to balance that million dollars out, um those people in the work group have done a really really good job. So, For context, in one of the in some of the other scenarios, there were four to five potential services that would have been eliminated that the work group looked at. So, this was their kind of compromise to look at to ensure that the most services were uh uh still in place um even if they're at a slightly reduced levels um but they were still available for those who who really needed it. Thank you Jeremy. I really agree.

Patricia

want to say yes. Thank you. Uh Eric, please keep the questions coming because you are correct. This is very hard decisions. These are very serious issues. Above all, we have to serve the community. it's for our clients and um just we all I think we all recognize that in our positions we have the privilege and the opportunity to make these decisions but we also don't want to we don't want to lose anything. So that is why this is why I love having planning councils as well because it's definitely we can only do so much as part A and B. You know, we can only do so much and that's why it's great to have these questions and keep like I just always encourage everyone, please keep the questions coming. Please keep your opinions coming because that's what the planning council is all about and this is a very serious issue. So um we don't take this lightly. So I just, you know, thank you again to everyone. I know this is not easy at all. it hasn't been easy for us um over at part B in the state. So um I just I just wanted to say that. So thank you.

Yeah. And you guys over there, you're you're dealing with your own challenges and um this is uh we're not in a individual silo anymore. It's like just across the board. Um painful. It's the best word I have for it. So, um, as Jimmy said, um, budget cuts over there, they're having layoffs. If you lay people off, then you don't necessarily have the staff to administer services. So, um, Michael Brown, calling on you, sir.

Yeah. Hi. Hi. Thank you, Randall. I I joined late. I'm so sorry you guys. I joined late. Um, was the federal poverty level is it going to remain the same at 400%. Uh, for our programs? Yes.

Yes. And then another question was the the food the medical nutrition that or that went down. Maybe I'm looking at the wrong thing. The food bank, the vouchers, that's the $50 price food card. Are we going to keep that at the same poverty level or should maybe that be reduced to for the most needy ones? Um that's a Jeremy you're smiling.

Um so that is I think Randall actually said it all already about uh the like the recipient. So our office and the subreients will work uh to find out solutions to meet these allocations. Um so that is Michael a an option that may be on the table. There might be some other uh things we look at as well. Um but uh we're still in since these have not been finalized and this was a the proposal here that we're showing was uh discussed last week. So just a week ago those I don't think we have any answers to how exactly all that stuff will be implemented but uh we'll be working with the subreients on that.

Awesome. Thank you guys.

But great question. I know that they um again I don't want to get involved in contractual issues because um we as planning council members are really um not supposed to talk about those but um they have run data where you know what if we just lowered everything from 400% to 300% and what they found is it would not it would have such a minimal impact um that it would kind of defeat the purpose of doing that. So, it just would not get the desired results. However, within this line item, um the recipient's office again will work on um working with the subreient on what it's actually going to look like. If that makes any sense.

Is that okay? Yeah. Perfect. Thank you. Thank you, sir. Uh Mr. Barnes. Yes, thank you, Randall. Um, thank you.

Mine is more of a comment. So, looking at the budget, the cuts, but the goal of everybody, all of us, and all these people working together, it's still the U equals you to correct. It's to get everyone so that they are they're tested, they know their status, they will take get medications and and get to the point where they're untransmittable. So the goal is the same, but what someone wrote in the chat, it's doing more with less money. It's and that's I could take that in a cheerful way. That's, you know, hats off to you guys, but the goal hasn't changed. There's just less money to achieve it. Would that be fair to say?

Absolutely. So, um, Reagan gave us, um, once her cat got off the keyboard. Um, this sounds more like my friend Reagan. Uh, regarding, uh, FPL and food bank clients, 80 86% of our food bank clients are under 200% poverty level already. 95% are under 300%. So, Reagan, thank you for providing us with that information. Did I just do something weird with the screen?

No, I see you. Sorry. No, I hit I hit a button and it changed my whole view. So, I thought it changed yours. You all can still see the um I think we can't see it. Did that go away? Okay. Yes. Do you want me to pull it back up, please? Okay, wait.

And again, these are funding adjustments that are going to get us from now until February 28th. later on this summer when we come together for PSR. Keep thinking all of these thoughts because it's basically the same thing that we're going to be doing at PSR for 2026 next year.

Um again, it's what makes it more challenging is we don't have our final grant award. So, we don't know if we're level getting level funding less, more um there's other variables that are coming at us left and right on a daily basis. Um, and again, just looking at it, I'm I'm very proud at this point in time um that we still have the quality of menu of services and the quality of providers that we have in this community. Um, I spend a lot of time talking to other jurisdictions. Um, and common theme is we're shutting down providers. Um we're losing services to the point where basically um our clients in our jurisdiction all they have and it's not all it's the two most important things but they have their medication and and um they have their doctors but they don't really have any support services. So, um, again, that's why I'm always amazed with this community that you guys come together and put these quality discussions together and make hard decisions like this. So,

anybody else?

I'm glad we still have the mental health services that are I'm sorry, Eric. Say that one more time. Oh, I'm happy to see that we still have the mental health services because from what I've seen in my community, we need it. We need it in a lot of communities. So, Randall, I have a question, please. Allan, please.

Our clients asked their citizenship status before receiving I see Jeremy shaking his head. Okay. Before they receive services. No, it is specifically in the Ryan White guidance, by the way. Oh, it is. Okay. All right. Thank you. Thank you, Alan. And thank you, Patricia, and thank you, Jeremy. Was a big no. Any other questions or comments?

Brandon, I just wanted to add real quick. Um the question that Eric had uh or the comment related to mental health um in the work group last week for those of you that were not present for that meeting uh we decided not to touch mental health or substance abuse services because we are seeing a really uh big increase in the use of those services uh from our rhy clients. So, you know, if we could salvage that, you know, category because of the influx of people coming into those services, we decided if we don't have to touch those service categories with any decreases, we will leave it as it is um so that we can make sure that everybody gets those services.

Awesome. Great. Thank you. Um Michael has his hand raised. Yeah. Thank you, Randall. uh on the mental health services, do we know what the viral suppression rate is for that? And are they getting linked as soon as they are testing positive if there's like u if they say they're they're struggling with mental illness?

Hopefully you can hear me.

We can hear you, Michael. I'll jump in. So uh yes if people are indicating that during like their intake with eligibility or at other areas they are getting referred over to uh mental health services. We aligned the mental health service standard that uh the planning council did uh um and continue to align it with the uh standard that access house for referrals including uh the timelines for emergent referrals which I I'll have to pull it up but I believe it's uh if they're an urgent request it's within 3 days that they have to be seen um not just referred and contacted but they have to be seen um for by a therapist. Um, and that's the same as that's the access standard. Um, I think mental health is probably going to be looked at in the next uh we the next four or five standards. We did it I think last in 2013. So, it's relatively updated to access um the access standards as well. And Reagan just popped in the chat, viral suppression for mental health clients is currently 94%. Which means their linkage rate is higher than that. And Reagan, do you have substance use substance use clients viral suppression rate?

Uh yes, that is 98%. 98%. It is a smaller population, but uh um yeah, it's grow. Thank you. That's awesome. Thank you.

Of course. Okay, I am If there aren't any more questions or comments, I'm going to do like a five Mississippi. And if anyone is so inclined, we would welcome a motion to accept the grant year 2025 allocations work group proposal.

This is Jasonville Cruz. So moved. Hi Jason, it's good to see you, sir. Uh we have a floor a motion on the floor, excuse me, from uh Jason Bell Cruz. And do we have a second? E second.

Right. Um motion is seconded by Eric Een. Um, any last moment comment hearing? None. Gwen, um, we'll give you a few seconds to put it together, but Oh, you've already did it while I was talking. And I have to remember I cannot vote unless there's a tie. And also just a quick reminder um if only voting members of the council um can vote in this poll. So if you haven't been approved yet by the board um just go ahead and close down the poll.

Okay. I'll give a few more moments for people to vote. And again I think um Patricia said that she would be voting for um I already I already closed my poll. Randall, that's all Patricia. I know, right? You're right, Randall. You're right. Already voted.

Anyone is having trouble with the poll or it's not um showing up, just go ahead and send me a private chat and I can record your vote that way. Um but it looks like we have everyone um voted, so motion carries.

Fantastic. Um, thank you everyone. Um, the recipient's office is going to get started on everything um, based on your vote today. Um, and they are going to keep us posted of things as they happen. uh we have our regular planning council meeting uh scheduled for this month and then I think we have also an allocations work group uh that would be limited uh again because under Arizona open meeting law the work group cannot be a quorum of the planning council members. So um basically same ground rules on the allocations work group it would be um uh 10 people would be able to participate in that. So, um, next, one of the things I don't know if everybody remembers, but back when we had our site visit, one of the things that um, the site visit committee um, requested and recommended of us that we um, start using or utilizing directives more um where the planning council um comes up with directives and they're from the planning council to the part A recipient named Jeremy um based on um work that we're requesting be done. They're given a certain amount of time to tell us well yes we can we can make that happen.

um this is the time and everything like that. So, uh Gwen, if you don't mind, go ahead and pull up our planning council directive to Maricopa County Part A program recipient um from the Maricopa County HIV Health Services Planning Council, US. Um it's going to be dated tomorrow. Can everybody see that? You can kind of read through it on your own, but um the subject line is next steps for grant 2025 service adjustments and transitions. Um why does this matter? As part of the process, the planning council carefully reviewed services and how they're currently being used and the funding available for the upcoming year. These decisions are not made lightly. The council remains committed to meeting client needs while ensuring funds are used responsibly and in alignment with priorities. The council acknowledges that changes in service delivery can have um real impacts on both clients and providers and expects that these shifts be made with care, coordination, and clear communication. Um what is the planning council directing the recipient to do at this time? one, stay within the grant year 2025 allocations, which is what we did today with that um million dollar um in-ear adjustment. Um two, implement service reductions. The following service categories are being reduced. The recipient must coordinate with subreients to implement these changes by the dates listed below.

And again, you've got your uh service categories and what's happening there. Uh three is to transition select services out of part A funding. And again, that's to collaborate with the impacted subreients to responsibly phase out the following services under part A during grant year 2025. Um, and again, you can see our two service categories there. Um, these transitions should be conducted collaboratively and respectfully with appropriate client notice and linkage to alternative resources when available.

Say what? This is telling Gwen to go to the next page.

Oh, I was like I thought you were like saying something like wrong wrong wrong. um collaboratively, respectfully. The planning council expects the recipient to support subreients during this press during this process and ensure an orderly transition for our clients. Uh number four, communicate uh changes to our stakeholders. The recipient must provide consistent and timely communication to all stakeholders and this includes sharing at a minimum monthly updates during planning council and committee meetings. Um if something is urgent, they will contact us earlier. Um use the Ryan White community newsletter and direct mailings to inform clients of service changes. Um, and I think this has been discussed before, for the people that don't get email, there's provisions made for them to get that information in another format. Is that correct, Jeremy?

Yes. For non-e people. Yes.

Yes. Okay. Um, and then providing subreients with clear guidance and tools such as talking points or written materials to support our client communications. Um, again, maintain regular communication with our providers to ensure smooth implementation and alignment across agencies and then ongoing reporting. Council requests regular progress updates to be shared during planning council and committee meetings at identified checkpoints or as needed. The recipient should inform the council promptly if any barriers to implementation arise. Um, we would like to have every or get everyone a few minutes to read that without me talking over the top of it, which I'm sure makes it harder to read.

Erica has her hand up too, Randall. Oh, Erica, which question? Which comment? If you can scroll back up to the um amounts that are being decreased. I think there's an error there in medical transportation. I think it should be reduced by 26,617. Whoa, typo. Thank you for catching that. No worries. I was just like, woo, that's a whole crack category. Um, I did not do the math on all. That's awesome. Thank you. The rest of it is correct.

Okay. They call you eagleeye Erica, right? No, but I I'll take that. They better. All right. So, if everybody um gets a chance to read that again, what we're looking for um is a motion um so that we can again get this um surprise surprise presented to the part A recipient.

This is Erica. I move to move forward with this directive. Erica's made a motion to approve today's directive. Do we have a second? I second Erica. Tuvia. Thank you. Thank you.

Um seconded the motion. Any last minute question, comment? Hearing none. Gwen always has a poll or is typing to make a poll. And again, that's our directive to the recipient. And I will Jimmy and I are going to X out. Oops. Whoops.

Motion carries.

Um Allan, are you waving? Sorry, I had a question. So, these directives that um from the site visit, are there do we have to do one every month? Is there a certain time limit we just have to do? But then that's that part's up to us. Yeah. Showing showing as needed when we're making requests of the I think the idea was they just wanted to see that you were using that option. All right. It's a little bit more official when you're not just voting on something, but you're actually asking the recipient to do something specific like this is more along that lines. Okay. Thank you. Mhm.

See, and again, because a lot of jurisdictions, they don't have the working relationship that we have in this jurisdiction. So, that's how they communicate is through directives, but we're going to do it because it leaves a nice paper trail. Correct. Um, agenda. Can you pull that up for me? I know it's easy stuff, but I'm so used to visualizing everything that this is a new world for me. Oh, it is really easy. Current events summary line item number seven. This is the time for our uh 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 voiced during this time. Um, again, it's not a discussion. It's just a statement or giving us content. So, any current event summary from our planning council members?

Randall, this is John Gomez. I'd like to mention something. Yes, Mr. Gomez. Yeah. I just want to announce to the team that uh we are already gearing up for our fifth annual Latino Pride Festival which will be October 4th at Historic Heritage Square and we're advertising it already online on um on our various social media Latino Pride Alliances social media platform. Come on. Come on. Thank you. That's it. Um, thank you, John. Um, anyone else? Current events summary of planning council members.

Uh, it's June. It's Pride month. I'll say that. Tagging off of that since it's Pride month. Um, Pride Nights Saturday. I believe it's 7 o'clock, 6 or 7 o'clock. Um, for any soccer fans, Phoenix Rising is having, I think, their second or third annual night.

Oh, that's fun. Anyone else? Okay, moving on. Call to the public. Um, this is the time for our public to comment. Members of the planning council cannot propose, discuss, deliberate, or take any legal action on any matter voiced during this time. Um any of our public members or non-planning council members um have any comments that they would like to share with us? Um again um kudos to the workg group. You guys were nothing short of incredible. So, I'm giving you a round of applause. Um, and for everybody today, um, appreciate all of your hard work and being understanding of the process. It's not easy, but um we I think as I told somebody else, we have the right people and team in place um to handle anything that they throw at us, so we're ready. Um Carmen, thank says, "Thank you to everyone for your thoughtful approach." And um big uh round of applause to Carmen also um who is uh that silent powerhouse in the background. So we appreciate all of your help and your input. So

um hopefully I'm not missing anybody because I'm going to give you some time back for your day. Go out. It's beautiful. Um, enjoy something good for yourself today. So, um, and Eric says, "Thank you everyone." So, let's adjourn the meeting at 1:30. Um, again, we'll see you at the regular planning council um meeting, which I have no idea when it's at to be quite candid. It's the Can I say something real quick?

Yes. The Diamondbacks are looking for uh leaders in our community. 40 under 40. Um so applications are open right now. You guys want to nominate somebody um a really great leader in the community under 40. I don't qualify for that. So please don't nominate me, but I know we have some great people in our community that are really great leaders. Um that should be recognized. Duvia, how about we just like misinform them and you and I get submitted and you're 39 and I'm 30 and I'm 39.

Okay, sounds great. Yeah, but if you guys know anybody out there, um it's a really great recognition. Um and the application is really easy to fill out. Say, do leaders die after they're 40 or something? I I'm not I know it's a different category. But Patricia has a question. Thank you for saving me, Patricia. Oh, no worries. I just Dia, you don't look over 40. So, I know, right? Yeah. As long as they don't ask for like a form of ID proving your your date of birth. You never ask a lady how old they are.

That's right. That is right. Um, I just wanted to uh mention uh sorry I forgot to mention this earlier. Gwendelyn um did email out a learning session from ADHS that Ricardo is presenting. So I just wanted to remind everyone about that. There's a lot of clarif um going to be a lot of clarifying information um that I think that would be really helpful just for the community and just for everybody. So I just wanted to plug that as well. Yeah, it went out yesterday morning. Yesterday morning to all of you and uh the the session is tomorrow uh from 12:00 to 12:30. If you didn't get it, reach out to Gwen and she can forward it to you.

Well, Patricia, I assume with it being a half hour that it's we're going to be presented information. It's not really going to be time for questions or comments, anything like that. Yeah. Um, information is power. So, thank you. That's right. Knowledge is power. Randall. Randall, I've rubbed off on Ricardo. He's learning how to talk faster. So, there might be time for questions. My My East Coast is rubbing off on cross our fingers. East coast.

Doo is just a thumb. So all right everybody um it is such a pleasure to know all of you and to be a part of this process with you and work with you all. So uh thank you for allowing me that um opportunity in my life. So thank you. Bye. Thank you Angelo. Thank you everyone. Thank you Eric. Thank you everyone. Bye. Thank you. Thank you.