County AIDS Budget Cut Process Still Simmering
By Karen Nakamura
Cuts made last month in the Marin AIDS services budget are still holding. The 2002-2003 allotment for direct services, (vitamin and acupuncture vouchers), were cut by about $16,000. At the same time, approximately $19,000 was allotted to the Marin Treatment Center business office to buy computer upgrades. The problem was the Marin AIDS Commission (MAC), an umbrella organization of patients, agencies and service providers, was not fully informed of cuts until after the fact. Adding fuel to the fire, the business supervisor at the Marin Treatment Center (MTC), which received the $19,000, was rumored to be one of two who made decisions on the budget cuts. In contrast, the community was outraged that already sparse vouchers for well-received programs were cut.
It became evident we needed to explore the reasoning behind these distributions. Karen Wuopio of the County Department of Health and Human Services (HHS) was asked about her reaction to charges of favoritism. As the County's representative on the Commission, she called attention to the fact that MAC and the County have been dealing with dwindling funds for several years. She also pointed out mistakes in the last month's article. For example, the Ryan White/Care funds are distributed to the San Francisco Eligible Metropolitan Area not the San Francisco AIDS Foundation. This entity consists of San Mateo, San Francisco and Marin counties and had a loss of $2.2 million not $2.5 million in 2002-03.
She then addressed the charge that two commissioners, she and Brian Slattery of MTC, met behind closed doors to determine cuts, in particular, to the Marin Treatment Center's higher grant. "Funding decisions were never made simply by Mr. Slattery and myself. Nor did Mr. Slattery and I approach the Marin Board of Supervisors."
The three person staff of the Marin Department of Health and Human HIV/AIDS Services makes these budget cuts. Ms. Wuopio is the supervisor. She never gave a direct answer to why the $19,000 was rolled back into the Marin Treatment Center account. Inference was the funds were a MTC surplus from 2002. What those funds were used for, ostensibly for computers, was never answered either. Nor was the reason why moving part of those funds to direct medical services was not implemented. Rather, she explained the HHS; HIV/AIDS staff met individually with each agency providing services. They discussed potential surplus of funds, such as with MTC, possible reduction scenarios and the impact of reductions on services.
However, even though these interviews have been used as a tool for years, providers discuss funds only within their specific service areas. MAC members also receive a priority survey but unless they're service providers, they're not interviewed. Ms. Wuopio stated that MAC's task regarding Ryan White CARE funds is to recommend to county staff a prioritization of service categories. In other words, MAC members have no authority to make budgetary decisions. That belongs to the 3 person HIV/AIDS services department.
Chairman of the Marin AIDS Commission, Gregory Giorgi said the computer vs. vitamin debate is a bone of contention in the community. "During Y2K, all the computers within the agencies network were upgraded. That was only two years ago. How can the Marin Treatment Center claim it needs computer upgrades? What bothers me most is these decisions were made behind closed doors and not brought before the Commissioners for discussion before final submission to the Board of Supervisors. I'm the Chair and I wasn't informed. We were given the survey about ten minutes before a MAC meeting concluded. Not given time to research the survey for the best answer, we were instead asked to prioritize immediately."
Giorgi added, "It appears there are allotments to selective service contractors with an inside tract. These contractors seem to deliberately mask allotments by working behind the scenes. It seems any extra funds at the end of the year always rotate around three agencies, the Marin Treatment Center, Hospice and the Marin AIDS Project. They do great work. That's not the point. The point is that at the same time, direct medical care services get cut. Patients find a $5 voucher cut here, a $10 voucher cut there. It's true, we did have a priority survey but that was very general and agency representatives were interviewed about priorities. However, we were never allowed to discuss the final budget submission. Let's say it was poor planning. Everything was very last minute. I wrote a letter to the Board of Supervisors in complain but haven't heard from them."
To solve this problem, Chairman Giorgi suggested during a July 11th Commission's Executive Committee meeting that an ad hoc task force for budget planning be formed, where individuals other than just County officials would be in on final budgetary decisions. He wanted the task force to be composed of commissioners, perhaps a San Francisco representative and someone from the community. Commissioner Chris Garvey, who also works for HHS, wasn't sure the task force could realistically do anything because of CARE regulations concerning advisory boards.
The first meeting of this ad hoc task force was held September 19th and according to task force member and commissioner, Howard Long, it was very positive. "We're starting to look at expenses and surpluses in the various programs to see if and where we can legally switch funds from one program to another. We have to make our recommendations to the greater Commission in October and face a final budget advisory presentation in January."
The solution to the problem may just lie in an old remedy, more transparency from the county and improved input from the Community.
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