CTHPCA Members present: Parker Willson - Chair, Sissy Riffin, Cynthia Juniper

BVCOG staff present: Christopher Hamilton, Crystal Crowell

DSHS staff present: Brenda Howell, Laura Moch

The meeting was called to order at 9:10 a.m.

Brenda Howell checked with Michelle Porter regarding the health insurance category and confirmed that ambulatory copays are funded from the health insurance category. Ms. Howell will talk to Frances Hodges to get a ruling from HRSA. A question was raised that if an Austin agency came to the Planning Council with a reallocation request to move money from ambulatory to health insurance to correct this, would that agency be at risk of having the money given to another agency? Ms. Howell stated that it will have to go back to the table, but the agency could make a compelling argument that it's still going to ambulatory care for clients.

The committee continued allocating funds for the remaining HSDAs:

WACO HSDA - $375,411

Ambulatory/Outpatient Medical Care (AOMC)
*2005-06 funding: $7,114 in RW, $23,514 in SS

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$35,859.90	1	$31,317	$30,628	$8,488	$20,139

Discussion:
- Provider Survey: under #5 the agency addresses AOMC and expects to spend less next year because of the Scott & White HIV clinic, but will spend more in transportation to get clients to the clinic
- The committee reviewed past years' expenditures
- It was suggested that if this category remains level, it should be adequate based on the data
- The committee had consensus to stay level for AOMC from 05-06 allocations
- Mr. Hamilton stated that the Council does not have to split the funding between Ryan White (RW) and State Services (SS) and it could be allocated to one or the other. Ms. Howell stated that it's better to split categories that can't be spent down easily at the end of the year. For example, funding for food and drugs can be easily spent down, but AOMC can't.
- It was suggested that the committee should consider the different funding years when taking money out of a funding source and putting it all in another, so the providers are not without that money for several months.

Decision and Justification:
- The committee decided to leave AOMC just like it was in 2005-06 in both RW and SS.
- Justification for not meeting the threshold: the provider survey shows that it's sufficient and the Scott & White Clinic will result in lower costs.

Drug Reimbursement
*2005-06 funding: $85,245 in RW, $562 in SS

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$102,921.58	4	$89,883	$85,807	$85,802	$20

Discussion:
- Provider Survey: the agency states they are using more programs than before to assist clients
- The agency spent 96% last year in RW. With 1 month left in SS they are at 3%, and there's 10% left in RW currently.
- A point was brought up that Waco's costs went down because of more frivolous spending in the past and because of not getting people on the Texas HIV Medication Program (THMP) more quickly.
- The data show that the provider does not need as much as last year
- A suggestion was made to take the $562 out of SS and drop RW funding to $80,000.
- The committee discussed splitting the funds so the provider would not be without drug funding for the time between fiscal years.

Decision and Justification:
- The committee decided to fund $80,000 in drugs total ($51,631 out of RW and $28,369 out of SS)
- Justification for not meeting the threshold: because the data, especially patterns in expenditures and the fact that the provider is utilizing other sources, show that additional funding is not necessary to meet the needs of the clients.

Oral Health
*2005-06 funding: $9,000 funded entirely out of RW

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$12,397.58	2	$10,827	$9,000	$8,437	$9,532

Discussion:
- Provider Survey: there is no alternate funding for oral health and no waiting list identified.
- Expenditures are at 17% now; final was 95% in 04-05.
- This category was under spent in both 03-04 and 04-05, as well as the current year.
- The committee decided that the data do not support increasing the oral health category much, but that they could increase it slightly because of the increase in expenditures from 03-04 to 04-05.
- Expenditures increased 12% from 03-04 to 04-05, so another 12% increase would be $10,640.

Decision and Justification:
- The committee reached consensus that $10,640 will be the allocation for this category in RW.
- Justification for not meeting the threshold: the allocation was increased slightly because of patterns in expenditures; however, the data show that additional funding is not necessary to meet the needs of the clients.

Mental Health
*2005-06 funding: not funded out of RW or SS

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$41,222.22	23	$0	$0	N/A	N/A

Discussion:
- Provider Survey: MHMR is adequate to take care of the needs of clients
- A question was raised about whether or not family practice has a mental health component. Participants were unsure.
- Representatives from this HSDA stated that other efforts have been made in the Waco area to get clients together for a support group, but they were not interested - there doesn't seem to be a high need.

Decision and Justification:
- The committee decided not to fund this service.
- Justification for not meeting the threshold: none of the data, including the needs assessment, indicate a need from the clients for this service; the small need is taken care of by other resources

Substance Abuse
*2005-06 funding: not funded out of RW or SS

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$2,542.04	13/14	$0	$0	N/A	N/A

Discussion:
- Provider Survey: The Freeman Center meets the needs of all clients according to the provider
- data indicate there is not a need to fund this category
- no utilization in previous history; no indication of need

Decision and Justification:
- The committee decided not to fund this service.
- Justification for not meeting the threshold: none of the data indicate a need from the clients for this service; the small need is taken care of by other resources

Case Management
*2005-06 funding: $117,946 in RW, $53,848 in SS

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$194,468.12	3	$169,832	$171,794	$103,367	$48,636

Discussion:
- 04-05 final was spent at 100%; right now in RW the provider is slightly overspent. The provider spent 100% in 03-04 and current SS is 88% with 1 month remaining
- The committee discussed a 3% increase, which would be $176,948

Decision and Justification:
- The committee reached consensus to fund this category at $176,948
- Justification for not meeting the threshold: this category consists of salaries; it's a marginal cost and the committee provided a 3% increase

Health Insurance
*2005-06 funding: $12,257 funded entirely from RW

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
N/A	16	$14,600	$12,257	$7,395.95	$14,359

Discussion:
- Provider Survey: use has exceeded expectations; the provider is spending more than allocated - the provider was paying for 2 clients with cobra that are about to reach their maximum; expenditures should stabilize after that
- The committee discussed level funding health insurance - it seems from the data that the provider could make it on that amount next year

Decision and Justification:
- The committee reached consensus to fund this category at $12,257 out of RW
- Justification for funding this category over core services: this funding will be used to pay health insurance costs for clients to access medical care at a greatly reduced cost; the core services were met with the allocation given.

Transportation
*2005-06 funding: $4,800 funded entirely from RW

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
N/A	7	$4,000	$4,800	$5,273.75	$4,000

Discussion:
- Provider survey: more funding is needed in transportation for clients to seek services at the Scott & White HIV clinic.

Decision and Justification:
- The committee reached consensus to fund this category at $4,800 out of RW
- Justification for funding this category over core services: this is an access service and without this category, clients would not be able to access needed medical services; the core services were met with the allocations given; not as much funding was needed in ambulatory because of decrease cost from the Scott & White clinic, but more is needed in transportation to access that clinic.

Food Bank/Nutritional Supplements
*2005-06 funding: $50,000 funded entirely from RW

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
N/A	6	$52,033	$50,000	$60,457.30	$51,965

Discussion:
- The need seems to be continually increasing.
- There is very little in the area regarding other sources of funding for food and nutritional supplements.
- The majority of the utilization from Emergency Financial Assistance was food - the committee decided to not fund EFA and increase the food bank category to make up for the difference.

Decision and Justification:
- The committee reached consensus to fund this category at $56,737 - $28,369 in RW and $28,368 in SS due to the difference in grant years.
- Justification for funding this category over core services: the core services were met with the allocations given and utilization and past expenditures indicate a high need for funding in this category.

Emergency Financial Assistance
*2005-06 funding: $6,000 in RW, $2,327 in SS

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
N/A	12	$256	$8,327	N/A	$0

Discussion:
- The majority of the utilization from Emergency Financial Assistance was food - the committee decided to not fund EFA and increase the food bank category to make up for the difference.

Decision and Justification:
- The committee reached consensus to not fund this category.

Plan for 5% decrease
- A 5% decrease for the Waco HSDA would be $18,770.55
- The entire decrease would come out of the food bank category
- If the core services need more funding, then the funding will first come out of the food bank category, then transportation, then health insurance

---

CONCHO PLATEAU HSDA - $217,852

Ambulatory/Outpatient Medical Care (AOMC)
*2005-06 funding: $25,531 completely funded out of RW

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$43,445.37	1	$37,521	$25,531	$33,055	$2,595

Discussion:
- Provider Survey: the provider has an EACPS grant (early access) from DSHS that pays for a lot of AOMC expenses; provider states that they do not foresee an increase or decrease in any core services; the provider enrolled 4 new clients with no insurance
- With 8 mo remaining, the provider is 67% spent; with 1 month left in SS, they are 100% spent.
- 1st quarter expenditures are high because of 4 new clients
- A proposal was made by a member to increase AOMC to cover some additional clients
- In 04-05, the provider spent around $33,000; In 05-06, they are at 67% with 8 months left
- The utilization data show that labs were done for 50 clients

Decision and Justification:
- The committee decided to allocate $40,000 to the AOMC category in RW
- Justification for not meeting the threshold: the allocation was significantly increased to cover new clients and the rise in utilization and expenditures; the remaining amount of the threshold is covered by other resources through a grant ending in 2007.

Drug Reimbursement
*2005-06 funding: $35,500 completely funded out of RW

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$41,119.16	3	$35,512	$35,500	$15,718	$14,343

Discussion:
- Provider Survey: EACPS grant also covers drugs
- In 04-05, the agency spent close to $30,000 with 1 month remaining in State Services

Decision and Justification:
- The committee decided to leave this category at level funding
- Justification for not meeting the threshold: because the data, especially patterns in expenditures and the fact that the provider is utilizing other sources, show that additional funding is not necessary to meet the needs of the clients.

Oral Health
*2005-06 funding: $2,663 completely funded out of SS

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$3,077.68	5	$2,658	$2,663	$2,383	N/A

Discussion:
- Provider Survey: the provider has a waiting list with 9 clients. A question was raised about whether that is because of funding or because the clinic is backed up - what is their definition of a waiting list?
- The Provider survey says it's because of differences in funding streams

Decision and Justification:
- The committee decided to fund oral health at $3,100 to cover the threshold and increased need.

Mental Health
*2005-06 funding: $2,500 completely funded out of SS

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$614.84	18	$531	$2,500	$428	$0

Discussion:
- RW 04-05 allocation was $531, but increased for 05-06 SS to $2,500. Increase appears to be based on historical utilization and expenditures.

Decision and Justification:
- The committee decided to leave this category at level funding - there was some confusion with past numbers, 03-04 had close to $8,000 in expenditures, then 04-05 dropped to $531.

Substance Abuse
*2005-06 funding: not funded out of either RW or SS

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$9,934.74	22/23	$0	$0	N/A	N/A

Discussion:
- It has never been funded by RW or SS - no demonstrated need.
- Another provider receives TCADA funding to cover this need.

Decision and Justification:
- The committee decided to not fund this category
- Justification for not meeting the threshold: no demonstrated need; other resources available.

Case Management
*2005-06 funding: $81,900 completely funded out of RW

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
$94,837.37	2	$81,905	$81,900	$53,600	$14,514

Discussion:
- The committee will provide a 3% cost of living increase.

Decision and Justification:
- The committee decided to fund this category at $84,357 out of RW, then after discussing the Related Housing Services category, decided to move an additional $12,748 into SS for case management and not fund housing related services.

Related Housing Services
*2005-06 funding: $15,000 completely funded out of RW

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
N/A	4	$15,771	$15,000	$9,868	$2,850

Discussion:
- There was some discussion regarding what this category actually pays for- some believe it is for a case manager to find housing services. The AA checked on that for the committee and found that it does actually pay for case managers' salaries.

Decision and Justification:
- The committee decided not to fund this category and put the money into case management.

Buddy Companion Services

Discussion/Decision and Justification:

- The committee decided not to refund this category. They decided that they really need to fund Transportation, Health Insurance, and Food Bank and there is not enough money to fund all support services.

Health Education/Risk Reduction

Discussion/Decision and Justification:

- The committee decided not to refund this category. They decided that they really need to fund Transportation, Health Insurance, and Food Bank and there is not enough money to fund all support services.

Transportation
*2005-06 funding: $5,573 funded completely out of RW

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
N/A	9	$5,287	$5,573	$2,865	$1,193

Discussion/Decision and Justification:
- The committee decided to allocate $3,647 to transportation in RW and $3,000 in SS
- Justification for funding this category over core services: this is an access service and is needed for clients to access medical services

Health Insurance
*2005-06 funding: $22,555 funded completely out of SS

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
N/A	11	$13,292	$22,555	$7,142	$4,117

Discussion/Decision and Justification:
- The committee decided to allocate $23,000 in health insurance in RW
- Justification for funding this category over core services: this funding will be used to pay health insurance costs for clients to access medical care at a greatly reduced cost; the core services were met with the allocation given.

Food Bank/Nutritional Supplements
*2005-06 funding: $10,489 funded completely out of SS

Threshold	Priority	04-05 Allocation	05-06 Allocation	04-05 Final RW Expenditure	04-05 SS Expenditure (1 mo. remaining)
N/A	4	$11,785	$10,489	$5,114	$4,490

Discussion/Decision and Justification:
- The committee decided to allocate $10,000 in food bank in SS
- Justification for funding this category over core services: funding was allocated to this category based on past utilization and expenditures demonstrating a need for this service.

Plan for 5% decrease
- A 5% decrease for the Concho Plateau HSDA would be $10,892.60
- The committee decided to take 70% out of food bank, 20% out of transportation, 10% out of health insurance.

---

AUSTIN HSDA
The committee revisited the Austin HSDA allocations - the total didn't add up because the committee was looking at the allocation minus administrative costs instead of the full allocation. The committee decided to make the following adjustments:
- increase case management by $1,470
- add a justification to the mental health category that local funds (a donor account) can cover the difference
- $171,147 is the new total for case management in RW

Public Hearings will take place in October and November and the Planning Council will vote at the December meeting. Input received from community members and subcontractors will be taken into account before the final vote of the Council.

Since Marla Madison was present for the first day of allocations and is needed for a quorum of votes, she will be informed of the allocation decisions from today and will be asked to vote.

The meeting was adjourned at 12:55 p.m.