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About Just out. (Portland, OR) 1983-2013 | View Entire Issue (June 16, 1995)
i u o t i u ( V S M f .0 « « n u i * S í Just out ▼ Juno 16. 1099 ▼ 13 R E G IO N A L H IV /A ID S F U N D IN G The quest for parity ealth officials in Oregon are explor ing ways to make AIDS funding more equitable across the state. The move is prompted in part by the recent infiision of federal dollars to the Port land metropolitan area in the form of Ryan White Comprehensive AIDS Resources Emergency Act Title I supplemental grants. The purpose of Title I is to provide emergency assistance to areas that have been disproportion by Inga ately affected by HIV and AIDS; not surprisingly, the money is directed toward urban areas, which is Region 1, which covers Multnomah, Clackamas, carry heavy AIDS caseloads. While HIV/AIDS Washington, Tillamook, Columbia and Clatsop service providers in the Portland metropolitan counties). area are pleased by the additional funding, some In all, an estimated $2.4 million in Title I funds advocates for people with HIV and AIDS in rural have also been granted to the area covering areas are questioning whether they’re getting Multnomah, Washington, Yamhill and Columbia their fair share of the funding pie. counties, as well as neighboring Clark County in “When the Title I supplemental funds came Washington. through, it seemed appropriate that the rural areas According to state health officials, Region 1 receive a bigger bulk of the Title II funds. Instead, was initially scheduled to receive about a half it seemed like the Portland metro area also made a million dollars in Title II funds, significantly more grab for the Title II funds,” says Billy Russo, than any other region. For example, Russo says, founder of Ruby House, an HIV/AIDS hospice in Region 5— which comprises Douglas, Coos and rural Douglas County. “So they get $2.4 million in Curry counties— was initially slated to receive Title I funds, plus a huge chunk of the Title II about $47,000 in Title II funds. Region 4— which funds. It just doesn’t seem fair to me.” covers Jackson and Josephine counties—was to This past December the Portland metropolitan receive about the area received $986,510 in Ryan White CARE Act same am ount. Title I formula grants, which are awarded noncom- An o t h e r petitively to metropolitan areas reporting 2,000 or $500,000 in more cumulative cases of AIDS. It marked the first Title II funds are time since the act’s passage in 1990 that the area earm arked for was eligible for Title I funds. “statewide ac Up until then, Oregon had only received Ryan tivities,” includ White Title II funds, which are issued to states to ing $290,000 to help them improve the quality and availability of help people with existing health care organizations and support ser AIDS pay for vices for individuals with HIV and AIDS. Title II designated also supports home- and community-based care medications, as services, drug reimbursement, expensive pharma well as $16,000 ceutical treatments and insurance continuation. specifically for In February, federal health officials announced Ruby House. the allocation of an additional $174.7 million in The remaining Title II funds are distributed among supplemental Title I funds to help urban areas with the respective regions. the growing costs of care for uninsured or Dace Brown, a community health nurse for the underinsured people with AIDS. The supplemen Jackson County Public Health Services HIV pro tal grants are awarded competitively based on gram says: “There is a sense that there’s a double evidence of unmet needs of each area’s residents dipping going on. Region 1 gets the Title I funds living with HIV. Nearly all of the $1.5 million in and the Title II funding, while the other regions supplemental funds requested by AIDS funding only receive the Title II funds. The fact is there are advocates in the Portland metro area was granted. a lot of free and low-cost services available to “We knew we would be receiving some supple people in the metropolitan area that just aren’t mental funds, but we didn’t realize it would be this available to people with AIDS living in rural much,” says Robert McAlister, PhD, HIV program regions. It’s more expensive for us to get people manager for the Oregon Health Division. “This is the services they need. There are transportation prompting us to take a look at how we can adjust costs and housing costs. People in the metro area the level of financial support to other areas in order can easily get to the services they need. Our clients for them to be able to meet the needs of people with usually don’t have those options.” HIV and AIDS.” McAlister says, “There is no doubt that there is Larry Hill, OHD’s HIV program client services a constant tension between the urban and rural coordinator, says the state has received an esti areas. People in rural areas say: ‘How can you mated $1.2 million in Title II funds for 1995-96, continue to take so much money while we get so which will be divvied up statewide among eight little?’ And the folks in the metropolitan areas say: designated regions (the Portland metropolitan area ‘Yes, we do take the bulk of the money, but we also H Health officials statewide are striving to achieve equitable distribution offederal support funds for people with AIDS and HIV Sorensen have the majority of cases.’ It makes for a difficult situation.” According to OHD officials, decisions about how to allocate Title II dollars are made using a consensus model. Title II requires the establish ment of HIV care consortia, which are designed to provide assistance and assure the continuity of health care to people with AIDS. Consortia mem bers include representatives from health care, pub lic and nonprofit support service providers, re gional representatives, those involved in commu nity-based organizations, and people with HIV. “All of these people bring their thoughts and proposals to the table and they’re discussed at length. The consortia comes up with [funding] recommendations which are then put before a group of local health officials [known as the Conference of Local Health Officials]. It’s not as though only a few people are making these decisions,” says Hill. “Ev erybody has in put.” Russo has attended these m eetings, as have representatives of other rural regions. “These meetings are almost always held in Portland. It makes it very difficult for the rest of us to get there,” Russo says. “Not only that, but [Region 1 ] attracts the people with the most politi cal savvy. They’re well educated. It can be intimi dating for people from rural areas.” Hill doesn’t buy that argument: “Everybody has a place at the table here. People in rural areas are no less educated or concerned with these is sues.” He adds: “When the Title I supplemental funds came through, Region I decided to turn back the $74,000 increase in Title II funds it was supposed to receive. They wanted the money to go to the other regions. Because they did that, the other regions will likely see increases in their Title II allotments.” Region 5, for instance, could get more than double the amount it was initially set to receive when the Title II funds are reallocated. Jeanne Gould, HIV services planning manager for the Multnomah County Health Department says, “I had asked the consortia to consider a parity model that would ensure equitable distribution of funds a year ago, but the rural areas didn’t want to do that. “All of a sudden when we got the supplemental grants, Billy decided he wanted to switch over to the parity model. He also wanted all the Title II money handed over. By then we were already in the very late stages of planning how the Title 11 funds would be spent. Commitments had been made.” She adds: “What Region 1 did was say we wouldn’t take the $74,000 increase coming our way. We also handed over other unspent funds so other regions could use them." And let’s not forget, says Gould, that Region 1 has the majority of AIDS cases. “Seventy percent of the AIDS cases in Oregon are in Region 1,” she says. Jackson County’s Brown, who has attended the HIV care consortia meetings for the past three years as a Region 4 representative, agrees: “While we need money badly in rural Oregon, the reality is that most of the cases are in [Region 1 ], and if you look at the dollars per AIDS case, [Region 1] has been shorted in the past.” According to OHD, through 1994 Region 1 had 971 people living with AIDS, while Region 5, for example, had 35. Using Hill’s breakdown, that would mean $528 in Title II funds per living AIDS case for Region 1, compared with $1,352 per case for Region 5. “Region 1 has always had far fewer dollars per AIDS case than other regions. In some cases, rural regions were getting $4,000 per AIDS case com pared with $400 per AIDS case in Region 1,” says Gould. Even when the Title I funds are factored in— and after the Title II funds are reallocated to the other regions—Gould says Region I still falls short in dollars per AIDS case when compared to nearly all of the other regions. (The numbers are fluid, but Region 5 is estimated to receive $3,422 per AIDS case, while Region 1 would receive roughly $2,474 per case.) Gould admits, however, that Multnomah County officials have allocated close to $500,000 in general funds for HIV/AIDS services. She says that money has not been factored into the Region 1 estimates because it stays directly in Multnomah County and does not extend to other counties in Region 1. “I think the Multnomah County Board of Com missioners is the only county commission that has allocated substantial general funds for HIV/AIDS services. I’d like to see other counties do the same.” McAlister says, “This is a very tough process. I don’t know at this point whether parity is pos sible. 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