Bay Area Reporter - December 14, 2006
Matthew S. Bajko, m.bajko@ebar.com

The proposal calls for a "cumulative lifetime cap" of 24 months that a person can receive short-term and emergency housing assistance under the CARE Act. The new restriction would take effect March 1, 2007.

If the policy change is approved, nearly 500 San Francisco residents' housing subsidies could be eliminated by March 2009. AIDS advocates acknowledge such a situation would be dire, especially in a city like San Francisco where housing is expensive and in short supply.

But they also said they are hopeful a solution can be found to ensure recipients of the subsidies do not end up homeless.

"People should not fear losing their housing immediately. Beyond that, clients should certainly take note of this situation. There is no denying it is a serious situation," said Dana Van Gorder, director of state and local affairs at the San Francisco AIDS Foundation. "This has produced a lot of anxiety for our clients in subsidized units. We encourage people to be not too alarmed yet."

AIDS Housing Alliance founder Brian Basinger called the housing assistance cap proposal "ridiculous." He said he is confident lobbying efforts will lessen the chances of people becoming homeless due to implementation of the cap.

"Of course it is hard to imagine the government coming in and on March 2 sending everyone a letter saying, 'You are off your subsidy. Get out.' But we don't have any guarantees right now," said Basinger. "I am sure, I am absolutely positive, that we will be able to garner the support from our officials so we are not going to be kicking people with AIDS on the street."

The funding cap is the result of a longstanding feud between federal health administrators and San Francisco officials over the $3.5 million spent locally each year on the CARE Act housing subsidies. Many of the 491 people receiving the funds have been doing so for a decade or more.

The debate boils down to whether housing expenses should be paid for with CARE Act dollars. Proponents of the funding cap point out that the purpose of the Ryan White CARE Act is to ensure that people with HIV and AIDS have access to medical care.

AIDS advocates argue that housing is not only an integral part to keeping people living with HIV and AIDS healthy but reduces the costs of care for that person. They also said that capping subsidies fails to take into account how people's housing needs have changed over the 25 years of the AIDS epidemic. Initially, there was no cap placed on the housing subsidy, partly because no one imagined people receiving the subsidies would be alive seven to 10 years later.

"Their argument is that when this program was created we were not living as long. Now we get to live, on average, 24 years. Before, we died much more quickly," said Basinger. "No one considered longevity when they created the program, so I think right now, it is a matter of semantics. Regardless of what kind of time frame you put on it, it has nothing to do with the reality of the need."

An audit several years ago by the inspector general of the Health Resources and Services Administration criticized such extended usage of the subsidies and encouraged HRSA to place a limit on the amount of time someone could receive the funding.

HRSA's HIV/AIDS Bureau responded by publishing the proposed rule change in the Federal Register on December 6. The agency is taking comments on its proposal through February 5.

Van Gorder said the foundation is working on its response to the new rule. He said if it is to be implemented, the foundation wants to see the cap not be retroactive.

But he said with the Democrats set to take over control of Congress next year, there is renewed hope that the cap will not be put into place.

"We are hopeful, now that we have a Democratically-controlled Congress, that we may be able to deal with this at the legislative level and prevent it from happening or get HRSA to significantly change the policy they have proposed," said Van Gorder. "Failing all of that, we have to start a conversation with the mayor and Board of Supervisors. The city will have to identify its own dollars so people affected by this policy change don't find themselves without housing."

The city's Comprehensive HIV/AIDS Housing Work Group has already begun to look at how the city can address the problem, said Basinger, a member of the group. He also said that if the federal government does restrict use of the CARE Act subsidy, then it must increase funding to the Housing Opportunities for People With AIDS program.

"If they are going to take housing out of the CARE Act then the companion piece on the federal level has got to be to increase HOPWA to the point where it takes care of the need," said Basinger. "Our argument is there are no exits from AIDS and they are not increasing HOPWA appropriately."

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