Some 2,800 people with HIV remain homeless or unstably housed in New York Communities outside of New York City, based on estimates from the NYS Office of Temporary and Disability Assistance (OTDA), because the existing HIV Emergency Shelter Allowance public assistance program, in place since the 1980's, is not available in any locality outside NYC. Why? Because no other local social service district has the resources to shoulder the standard 71% of this public assistance cost.

There is an easy fix to this inequity—make it possible for any county to offer this lifesaving HIV housing support by providing New York State reimbursement of 100% of these public assistance costs in counties outside of NYC.

This is not a mandate on local districts, but rather a solution to make it fiscally possible for counties to voluntarily provide this program of lifesaving housing assistance to their public assistance eligible residents with HIV experiencing homelessness or housing insecurity. The county executives of the five most heavily impacted Upstate counties—Albany, Erie, Monroe, Onondaga and Westchester—have written to Governor Hochul they are eager to implement this program. OTDA has estimated the additional NYS public assistance spending for this policy change at a level that can easily be handled within the current public assistance budget appropriation.

In fact, this NYS investment in HIV housing would be both lifesaving and cost-effective. . Ample evidence shows that safe, stable housing is HIV healthcare—essential to benefit from highly effective HIV treatment that maintains health and stops ongoing transmission of the virus. Indeed, a NYS AIDS Institute study found unstable housing the strongest predictor of disparities in viral load suppression—the goal of HIV treatment. Receipt of housing assistance has been found to significantly reduce in-patient stays, ER visits and costly new HIV infections—generating Medicaid savings that more than offset the public costs of housing. Health economists estimate that the $3.7M anticipated NYS cost of expanded HIV housing assistance in FY27 funding will generate over $6M in Medicaid savings.

Our HIV, AIDS and LGBTQ+ communities are under attack in Washington. NYS HIV health disparities also remain stark with 78% of new HIV infections in 2024 among the Black and Latino communities which also experience high rates of homelessness and housing instability. It is critical for NYS to step up with cost-effective housing investments to promote health equity through safe, stable housing for New Yorkers with HIV, no matter where in the State they live.