HIV/AIDS Program Mistake, Change Spark Pushback

More than 20 representatives from nonprofits that help people living with HIV/AIDS sent a letter to the mayor criticizing the city for changing how it handles a federal grant program — and warning the Elicker administration against ​“dismantling” a system of care they say works just fine.

The Health Department has responded by correcting an error regarding who is eligible to apply for these funds, and by arguing that centralizing oversight with city government is necessary to bring this program into compliance with federal requirements.

That’s the latest with the Ryan White HIV/AIDS Program Part A, a tranche of federal funds that the city’s Health Department applies for every couple years, and then distributes through grants to nonprofits scattered throughout New Haven and Fairfield counties.

The program allows local government recipients to distribute those funds to support a mix of ​“core medical services” — like hospice, home health care, mental health services, and AIDS pharmaceutical assistance — and ​“support services” — like child care, housing, and medical transport — for people living with HIV/AIDS. The city’s most recent fiscal year allocation covers the period March 1, 2025 through Feb. 29, 2028, and totals just over $5.4 million.

Last Wednesday, APNH Executive Director Chris Cole and Yale School of Medicine HIV/AIDS Care Program Director Merceditas Villanueva led the way in penning a press release and a letter to Mayor Justin Elicker, decrying what they feared would be a harmful shakeup to how the Health Department handles Ryan White Part A funds. 

The letter was signed by a total of 21 people who work for regional HIV/AIDS healthcare nonprofits, including representatives from Yale New Haven Health, Anchor Health, Leeway, Family Centers, and Staywell Health Center.

The group focused their concerns on two potential local grant-program changes.

The first and most prominent concern involved who is eligible to apply for these funds. The Health Department has attributed confusion over this issue to an administrative mistake that it has subsequently corrected. 

The second concern involved the city’s decision to scrap the existing ​“regional lead” structure by which the city allows grant recipients to subcontract with ​“peer” nonprofits. The Health Department has clarified that it is moving ahead with this change, in response to a 2022 set of federal recommendations about how New Haven can improve its oversight of this program. (See more on that below.)

Who Exactly Can Apply?

According to nonprofit groups’ press release, a Dec. 2 request for proposals (RFP) posted by the Health Department to the city’s procurement portal indicated that only federally qualified health centers (FQHCs) and community health centers (CHCs) could apply.

Cole told the Independent that that would immediately box out 19 of the 22 organizations that currently receive Ryan White Part A funds through New Haven city government, including APNH, the state’s oldest community-based services organization for people living with HIV/AIDS.

“This decision will seriously impact the health of our clients who depend on our networks for critical health issues,” the group’s letter to the mayor reads. ​“These clients who are among the most vulnerable among us … Without Ryan White services, many would not be able to access life-saving treatment that affects their health and that of the larger community.”

“The well-established relationships between clients and providers will be disrupted, leaving the most vulnerable patients with fewer choices of where, and from whom, they receive care,” Joseph Canarie, the chief medical officer at Anchor Health, is quoted as saying in that same press release.

The Health Department wound up pulling that RFP on Dec. 5. In an informational Zoom session with relevant nonprofits on Dec. 11, and in a set of comments provided to the Independent for this story, city Health Director Maritza Bond made clear that this was a mistake — and that Ryan White Part A funds are not restricted to just FQHCs and CHCs.

“The initial RFP was withdrawn due to an oversight that suggested only FQHC and CHCs should apply – this was an oversight that we have corrected and that was also clarified in the information session with service providers that we had last week,” Bond said. ​“The revised RFP, which notes all non-profit service providers can apply individually or with subcontractors, is now live on the City’s procurement website.”

Indeed, the new RFP, posted on Dec. 12, describes eligible applicants as including but not limited to ​“community-based organizations, hospitals, Federally Qualified Health Centers (FQHCs), Community Health Centers (CHCs), and other non-profit entities located within the two-county Eligible Metropolitan Area (EMA), particularly in cities or neighborhoods with the highest rates of HIV.”

John Hamilton, who leads the Bridgeport-based Liberation Programs, praised Bond for retracting the ​“erroneous” RFP. He said that the health director ​“clarified the confusion out of the gate” with last week’s info session.

Hamilton’s nonprofit works with individuals from Greenwich to Bridgeport who are living with HIV/AIDS and struggling with substance use disorder. His organization currently receives Ryan White Part A funds through New Haven, and was one of the 21 signatories to the Dec. 11 letter to the mayor protesting the potential restriction of funds to just FQHCs and CHCs.

But on Monday, he stressed that this is no longer a concern of his.

Cole and Villanueva remain skeptical.

Cole said he believes that the Health Department’s intention under Bond’s leadership is still to direct these Ryan White Part A funds towards FQHCs and CHCs. That move would effectively cut funding for community-based organizations like his that have been building trust with clients for decades.

Cole told the Independent that Ryan White Part A funding currently makes up $700,000 out of APNH’s $3 million budget. He said he has put on notice six full-time staffers and three contracted staffers, as he cannot guarantee that funding for their jobs will be in place come March 1. 

“We will lose our behavioral health program, the bulk of which is funded by Part A,” he said. ​“We will completely lose our care and cuisine home meals delivery program, which have been in effect for 38 years. We will have our case management staff reduced by half. That’s a significant impact on our organization.”

He also said that the only reason the Health Department held its Dec. 11 info session was because he and his nonprofit leader colleagues spoke out with such force about their concerns with changes to the Ryan White Part A program.

(Update: City spokesperson Lenny Speiller said on Tuesday that this isn’t true. He noted that the group’s press release was circulated the morning of Dec. 11, the same day of the info session. He also said that, prior to the info session, the Health Department had communicated to service providers about the error in the RFP. He added that ​“a vast majority” of the 140 people who attended the info session ​“expressed positive feedback on the proposed changes to the program” and thanked the health director for her transparency.)

Villanueva added in a separate email comment that it is ​“unclear’ whether or not the Health Department plans to direct these funds to FQHCs and CHCs, even though the new RFP expanded eligibility.

Asked if that is indeed the Health Department’s intention, Bond replied that her agency encourages all nonprofits that meet the federal Health Resources and Services Administration’s (HRSA) requirements to apply for this funding. ​“Serving people living with HIV/AIDS with the highest quality care is our number one priority and we will select entities that best demonstrate this standard whether they are a FQHC, a CHC or another direct service organization,” she said.

So Long, Regional Leads

While the Health Department has walked back as a mistake the initial indication that this funding will be made available to a much smaller group of organizations, Bond’s agency has confirmed it plans to scrap a different part of how New Haven has historically administered Ryan White Part A funds.

That is, the Health Department plans to get rid of the current ​“regional lead” structure. That setup saw the city designate one nonprofit grant recipient in each of the five geographical areas covered by this program — Greater New Haven, Greater Waterbury, Greater Bridgeport, Norwalk and Stamford, and Greater Danbury — as a main point of contact allowed to subcontract with other relevant nonprofits.

Cole told the Independent that this regional lead structure has been in place for over 14 years. ​“This decision effectively dismantles an established, well-coordinated and effective system of care and service delivery that has been serving people living with HIV in New Haven and Fairfield Counties for decades,” he’s quoted as saying in the Dec. 11 press release.

Cole and Villanueva defended that setup in followup interviews with the Independent by arguing that, essentially, it isn’t broken, so no need to fix it.

As Villanueva put it: ​“The Lead model had many strengths and dismantling a system that existed for 15 years with excellent public health outcomes without a stated transition plan and without stakeholder input is concerning.”

Bond explained this proposed change by pointing to a March 2022 virtual site visit by HRSA that found holes in how the city monitors subcontracts of Ryan White Part A grants.

“In this upcoming grant funding cycle, we have proposed changes to improve how the program is administered in order to comply with federal guidelines, ensure greater transparency and fiscal accountability, and direct as much funding as possible directly to client services,” Bond said.

“This updated approach no longer uses five regional leads that subcontract with direct service organizations. Instead, the New Haven Health Department will be the lead entity to ensure proper monitoring and compliance of the recipients who are awarded grant funds.”

Hamilton, of Liberation Programs, and Suzanne Lagarde, who leads one of the city’s two FQHCs, Fair Haven Community Health Care, both praised the city for this change to the Ryan White Part A funding structure.

Hamilton described the Health Department’s move to get rid of the regional ​“lead” structure as simplifying the application process for organizations like his. Up until now, his nonprofit has had to apply for New Haven Ryan White Part A funds through the Greater Bridgeport Adolescent Pregnancy (GPAP) program, the designated regional lead in the area. Now, he can apply directly to the city itself.

Lagarde, whose organization does not currently receive Ryan White Part A funds, praised the city for doing its ​“due diligence” in response to HRSA recommendations based on the 2022 site visit. ​“I believe their response makes sense to me. I have faith the city will do right by patients” through this change to how the program is administered. 

She added that Fair Haven Community Health Care currently receives Ryan White Part C funds, and works with a relatively small patient population of around 200 people living with HIV/AIDS. She said her organization is reviewing the city’s RFP and is still deciding whether or not to apply for Part A funds this cycle.

Asked for comment on how he feels about how the Health Department has handled communicating changes to the Ryan White Part A program, APNH’s Cole replied, ​“I’m feeling blindsided, frustrated, uncertain, and lacking confidence in why and how this decision was made. Communicating months ago would have gone a long way in [building] trust and confidence” between the city’s Health Department and regional nonprofits like his that know, work well with, and are trusted by New Haveners living with HIV/AIDS.

Bond defended her department’s work as trying to bring this program into better line with federal guidelines, and in prioritizing outcomes for people most in need.

“We value the long history and quality of care that these organizations have provided to low-income people living with HIV/AIDS,” Bond said. ​“It is because of their coordinated care that 92% of clients in our metro area are virally suppressed. At the same time, the Health Department must ensure that the program is meeting federally mandated requirements and there is proper oversight of these funds. We believe this updated approach will ensure these fiduciary and programmatic responsibilities are both met so that people living with HIV/AIDS in our city and region receive the highest quality care.”