Texas AIDS Network participated in the Austin meeting. The central issue was, of course, lack of funding. The discussion focused, not on whether to cut the program, but how it would be cut.
Funding pressures come primarily from the steady decline in Ryan White CARE Act funding for the Title II Base allocation and from the lack of increase in state funding. A cap on administrative costs and the state's decision to take a bigger cut for indirect costs completes the grim picture.
One other possible source of pressure on funding for services is the reauthorization of the Ryan White CARE Act. Some scenarios being discussed will allow Texas to maintain stability. At least one will force a $2.5 million cut in the Title II Base.
Even without the "worst case scenario," the program must make cuts in the next fiscal year. Stakeholders were asked to suggest ways to cut the program without cutting direct client services. There were the four key questions:
- What could be done to simplify local administration and reduce costs?
- What could be done to simplify local planning and reduce costs?
- What changes to services and/or planning boundaries are needed to simplify activities and reduce costs?
- Should we be considering other changes to administrative structure overall?
While the discussion groups provided many useful suggestions, the Network's concern was (and is) that the Department of State Health Services (and its past iteration as the Texas Department of Health) has made no requests for services funding (or prevention for that matter) for several years. Indeed, even when information about those funding needs was requested, the program has stonewalled the Network, despite the fact that "How much do you need for services?" is a pretty simple question.
While several productive suggestions came out of the Austin discussions and more will surely arise in the other meetings, the Network is concerned that too many more cuts will simply destroy the infrastructure that supports HIV treatment as well as prevention.
So what to do? First, we strongly encourage all stakeholders to participate in the meetings and/or provide their comments through the online form. Second, we are urging the Department to be more open about the budget process and more forthcoming about actual needs for funding.
Failing that, we go to the third option and the reminder that this blog is a source of news and information. To paraphrase that old joke, "Yesterday I couldn't spell 'journalist,' and today I are one." All sources are confidential. Operators are standing by. And the big question is:
What level of state GR is needed to maintain HIV services at their current level?