Return to HASA Hell?
If case management ratios change, don’t expect HASA to return your calls
With HIV/AIDS Services Administration (HASA) Scattered Site II transitional housing programs in danger of losing city funding, some housing providers have proposed a radical solution: Lift the statutorily mandated and court ordered-HASA case management ratios, lay off HASA workers, and redirect the savings to the endangered Scattered Site II housing programs. The only problem? Cutting case managers would be devastating to poor people living with AIDS in New York City. It would also be illegal.
Under Local Law 49, a 1997 law sponsored by then- City Council member Tom Duane, and pursuant to the 2001 court order in the landmark federal lawsuit Henrietta D v. Giuliani, the city is required to provide poor New Yorkers living with AIDS “intensive case management with an average ratio which shall not exceed one caseworker or supervisor to twenty-five family cases, and with an overall average ratio for all cases which shall not exceed one caseworker or supervisor to thirty-four cases.”
HASA case managers serve as a bridge between HASA clients and other government entities. Although clients often grumble about their case managers, managers serve a crucial role, approving apartments and making sure clients receive their critical subsistence benefits. HASA case managers’ jobs are vastly different from Scattered Site II case managers, who help poor people with AIDS navigate medical and mental heath care, substance use treatment, and general life problems. The latter simply cannot provide clients with government benefits.
Case management ratios at HASA are crucial for maintaining quality services for poor people living with AIDS. During Giuliani’s reign of terror, he attempted to starve the Division of AIDS Services (now HASA) by cutting back drastically on case workers. The case managers were so overwhelmed with their client caseloads that people were not getting benefits. Families with children didn’t see them added to their budgets, and homeless clients lost apartments. Some clients were starving for lack of Food Stamps, while others were cut off from their life-sustaining medications for lack of Medicaid.
“The case management ratios became so woeful you couldn’t reach a human body at HASA,” said Housing Works Senior Staff Attorney Armen H. Merjian, who, with co-counsel, pursued the lawsuit Henrietta D v. Giuliani on the grounds that the mayor was violating the Americans with Disabilities Act. Housing Works and other advocates staged protests where they dumped phones at HASA headquarters to demonstrate the point that calls to HASA went unanswered.
High-caseload perils
In addition to permanently requiring the case load ratios, the order in Henrietta D mandated three years of federal court monitoring of HASA. The reports showed that when case load ratios increased—even to 40 to 1—there was a direct correlation to higher numbers of clients who were unable to receive timely subsistence benefits.
“The reports showed that the HASA sites with the highest case load ratios were the most dysfunctional,” Merjian said. As a result of the legal advocacy in Henrietta D., by the end of the monitoring period in December 2004, HASA had come close to observing the law.
HASA for All, a bill that has been introduced by City Council member Annabel Palma, would expand HASA benefits to all people with HIV before they get sick. This law would expand the need for more HASA case workers, not less.
“Unlike the three-year monitoring period, the caseload mandate is of course permanent, and rightfully so, since it is the very ‘ramp’ that the ADA requires,” Merjian said, adding, “Accordingly, it is in fact illegal for the City or HASA to change those ratios under federal law.”
A better solution
Rather than bring back the bad old days of HASA, we need to fight for the Mayor to use money from the Federal Medicaid Assistance Percentage (FMAP) to save Scattered Site II housing. Under the proposed cuts to Scattered Site II housing, the City and State will each save $1.3 million in 2009 and $4 million in the years afterward, as contracts run their course. The relatively small amount of money it would take to save Scattered Site II can instead come from the $2 billion New York City will receive as its share of the FMAP stimulus money.
“In tough fiscal times, more people will need city- and state-funded health care and prevention services,” said Kristin Goodwin, Housing Works director of New York Policy and Organizing. “Housing and supportive housing are health cuts, and the city needs to be encouraged to use some of this money to fund health-related initiatives and save essential programs.”
Like all of HASA, Scattered Site II is a joint city/state funded venture, and is meant to be a transition from congregate housing to independent living in a regular apartments. Fourteen of the city’s contracts with Scattered Site II providers will end in June 2009 and the remaining four will end in February 2010.
Former Scattered Site II residents will be assessed and either placed in supportive housing or transferred to independent housing, and then, with consent, be linked to a COBRA case manager—a far more cost-effective placement, or just receive help from a HASA case manager. Nearly 5,000 formerly homeless people with AIDS live in some form of HASA-contracted supportive housing. HASA has 40,000 clients.
photo credit: http://www.flickr.com/photos/mpsfender182/2681841205/
Posted on February 27, 2009 at 2:20 am
Share
Donate Today
Join our healing community by becoming a member today
