Pelosi Expresses Concern to HHS Secretary Over Cuts in San Francisco AIDS Funding

Pelosi Expresses Concern to HHS Secretary Over Cuts in San Francisco AIDS Funding

Tuesday, May 22, 2007

Contact: Brendan Daly/Nadeam Elshami, 202-226-7616

Washington, D.C.â€"Speaker Nancy Pelosi sent a letter today to Health and Human Services Secretary Michael Leavitt on the nearly $9 million cut in San Francisco’s Ryan White Treatment Modernization Act Title I award:

Below is the text of the letter:

May 22, 2007

The Honorable Michael O. Leavitt

Secretary

Department of Health and Human Services

Hubert H. Humphrey Building

200 Independence Avenue, S.W.

Washington, D.C. 20201

Dear Secretary Leavitt:

I am writing to express strong concerns regarding the nearly $9 million cut in San Francisco’s Ryan White Treatment Modernization Act Title I award, which was announced today. The drastic nature of this cut will have a devastating impact on services that keep people living with HIV/AIDS in the Bay Area healthy. Moreover, it does not reflect either the bipartisan agreements that were reached during last year’s reauthorization or the final legislative language.

The San Francisco EMA's (Eligible Metropolitan Area) total combined formula and supplemental award dropped from $27.4 million in 2006 to $18.8 million in 2007. This cut of approximately $8.6 million represents about one third of the previous year’s award for the EMA, which includes Marin and San Mateo Counties. The severity of this cut is partially due to HRSA’s failure to appropriately recalculate the 2006 baseline in order to reflect language in the reauthorization that increased the formula portion of Title I funds from one-half to two-thirds of total funds. Language was included in the reauthorization directing HRSA (Health Resources & Services Administration) to make this adjustment when applying the â€Å"hold harmless” provision:

(i) For fiscal year 2007, an amount equal to 95 percent of the amount of the grant that would have been made pursuant to paragraph (3) and this paragraph for fiscal year 2006 (as such paragraphs were in effect for such fiscal year) if paragraph (2) (as so in effect) had been applied by substituting `66 2/3 percent' for `50 percent'.

Congress was clear in its intent that the baseline should be adjusted to allow an â€Å"apples-to-apples” comparison between the 2006 and 2007 awards. However, rather than adjusting the final 2006 award, HRSA readjusted the baseline before applying the â€Å"hold harmless” provision that was in effect in 2006, which rendered that important protection almost meaningless. Undoing the â€Å"hold harmless” protection that was in place for 2006 was clearly not part of the bipartisan reauthorization agreement, and this action had a significant impact on the 2007 formula award. Since last year, the EMA’s AIDS population has not changed significantly relative to other Title I EMA’s. Therefore, the EMA should have received approximately the same proportion of Title I formula funding that it received last year (which would amount to $19,449,437) minus the 5 percent â€Å"hold harmless” reduction ($972,472) for 2007. This translates to an award of $18,476,965, which is $3,804,412 more than the EMA’s actual 2007 award.

HRSA was also directed to take this severe cut to the EMA’s formula award into account when determining the supplemental award:

The Secretary shall provide funds under this subsection to an eligible area to address the decline or disruption of all EMA-provided services related to the decline in the amounts received pursuant to subsection (a) consistent with the grant award for the eligible area for fiscal year 2006.

However, the EMA’s supplemental award was also drastically cut. After receiving 5.1 percent of total supplemental funds ($11,985,334) in 2006, the EMA received only 2.8 percent of those funds in 2007 ($4,134,300). If the EMA had received the same proportion of supplemental funds in 2007 that it did in 2006, then the supplemental award would have been $7.5 million â€" nearly $3.4 million more than the actual award. The reauthorization language makes it clear that EMA’s absorbing significant cuts to their formula awards should receive larger supplemental awards, but San Francisco’s supplemental award was cut nearly in half. Instead of offsetting the severe formula cut, the supplemental award exacerbates that reduction.

The high level of severe need in San Francisco is well documented. Since the beginning of the epidemic, San Francisco has been one of the hardest hit cities in the country. San Francisco continues to have the third largest number of people living with HIV/AIDS and one of the nation’s highest prevalence rates. In addition, the population of San Franciscans living with HIV/AIDS is increasingly impoverished, homeless and struggling with co-morbidities such as addiction or mental illness.

This dramatic decrease in funding for HIV/AIDS programs will have harsh repercussions on San Francisco’s system of care, threatening access to primary medical care and life-saving medications for hundreds. Although the City and County of San Francisco will do everything possible to mitigate the impact of this cut, the reduction is so severe that disruptions in access to needed medical care and support services are inevitable. The statutory language cited in this letter was included in the reauthorization specifically to prevent such disruptions in any EMA. However, that language was not followed in determining San Francisco’s award and the resulting cuts are unacceptable.

Please respond as soon as possible with an explanation of HRSA’s response to the statutory provisions referenced in this letter. HRSA provides critical health services to some of the neediest populations in our country, and I strongly support the agency’s mission, but it is imperative that all federal agencies honor Congressional intent when implementing programs.

Thank you for considering these concerns. I look forward to working together to address the issues raised in this letter.

Sincerely,

Nancy Pelosi

Speaker of the House