IN THE LOOP

Gov. Brown is expected to approve a state budget before the end of the month that includes additional investments for prevention of HIV and other sexually transmitted diseases (STDs), including a one-time $5 million allocation for comprehensive HIV prevention services and a one-time $2 million allocation for STD prevention efforts. This funding is critical to increase the number of people aware of their HIV status, improve access to PrEP, and reduce the incidence of HIV and other STDs.

APLA Health, in collaboration with other members of the California HIV Alliance, advocated aggressively for these investments. While California is making progress in the fight against HIV, the state is falling behind other parts of the country that have seen significant reductions in new HIV infections. New York saw HIV infections fall by roughly 22 percent (from 3,702 to 2,881) from 2012 to 2016. Meanwhile the number of new HIV cases in California declined by less than 3 percent (from 5,208 to 5,061) during the same time period. In addition, there were more than 300,000 reported STD cases in California in 2017—an increase of almost 45 percent since 2013.

The state budget also includes several changes that will improve access to treatment for hepatitis C. The state budget removes all liver fibrosis restrictions in Medi-Cal and includes more than $100 million annually for three years to expand hepatitis C treatment to all inmates in state prison. APLA Health urges elected officials to build on these efforts and develop a more comprehensive, well-resourced plan to effectively address the interrelated epidemics of HIV, hepatitis C, and STDs.

Regrettably the budget does not include additional funding to provide healthcare to low-income, undocumented adults. Although the legislature had moved forward proposals to expand Medi-Cal to cover undocumented seniors over age 65 and young adults ages 19-26, the funding to implement these proposals was ultimately not included in the final budget deal. Instead, the budget includes $5 million to establish a task force to develop a plan that includes options for achieving universal coverage. APLA Health is committed to working with our partners across the state to cover all Californians, regardless of age, disability, income or immigration status.

Good news for people on Supplemental Security Income (SSI). For the first time since 1974, SSI beneficiaries in California will be eligible for assistance from CalFresh, the program that used to be called food stamps. That’s because the new state budget includes a proposal to end something called the SSI “cash out” provision, starting next year.

SSI “cash out” is an obscure program that allowed states to include a food allowance in the SSI program. In California, that allowance came to $10 a month for single individuals, $20 for couples. While SSI recipients got the supplement, they were barred from applying for the federal food stamp program. California is the last state in the country to include the food supplement in the SSI program.

Under the new proposal, single individuals on SSI will be able to collect close to $80 per month in CalFresh benefits, and some families that include SSI beneficiaries will also see an increase in their CalFresh benefits. The measure goes into effect as early as June 1, 2019, and no later than August 1, 2019. CalFresh benefits are used at the grocery store in place of money using Electronic Benefit Transfer cards (EBTs).

Some current CalFresh families could lose some or all of their current benefit under this budget measure. That’s because once the cash-out program ends, SSI beneficiary income will be included in total family income and CalFresh benefits vary depending on household size and total income.

The California Legislature has included provisions in the measure to potentially hold these families harmless—meaning no decrease in benefits—for current CalFresh applicants, and a transitional nutritional supplement for families who lose all their CalFresh benefits. But the Legislature must appropriate the funds for these programs each year.

SSI benefits in California are around $910 per month for single individuals and $1,532 for couples, but amounts may vary. And just in case the new proposal sounds too good to be true, be aware that the state will deduct the $10 or $20 food supplement from SSI checks once the measure is in place.

Last week, the Los Angeles Homeless Services Authority (LAHSA) released preliminary results from the 2018 Greater Los Angeles Homeless Count. Overall, homelessness in the county decreased for the first time in four years—from 55,048 to 53,195 individuals (3%), and by 5% in the city, with significant decreases in the number of homeless veterans (18%) and chronically homeless (16%). The highest rates of homelessness remain in the ‘Metro’ region of Los Angeles and in South Los Angeles, and rates are highest among Blacks. Despite the overall decrease in homelessness, the number of individuals who experienced homelessness for the first time over the past year increased by almost 1,300 individuals, from 8,044 in 2017 to 9,322 in 2018. Most individuals cited a loss of employment or inability to afford their housing as the primary reason for falling into homelessness. And while preliminary estimates suggest the number of homeless individuals living with HIV has decreased by 36% in the county, the actual number is likely much smaller due to underreporting.

At the release event, Supervisors Mark Ridley-Thomas and Janice Hahn, as well as LAHSA staff stressed that one of the biggest challenges moving forward is increasing the stock of affordable housing. According to the California Housing Partnership Corporation, Los Angeles has a shortage of 565,255 affordable units for low income renters, and NIMBYism (“Not In My Backyard”) from Los Angeles residents has been cited as one of the most detrimental factors in the county’s efforts to increase housing stock. Yet the county’s Measure H-funded Homeless Initiative has successfully housed more than 16,000 individuals in the past year and is now in its second year, and the Board of Supervisors has passed several motions to invest millions of dollars for both homeless services and the construction of more affordable housing units.

Access to stable housing is one of the most important interventions for people living with HIV to improve their health outcomes and is also an effective way to prevent new infections. APLA Health continues to advocate for people living with and at risk of HIV, asking county and city officials to take steps to prioritize people living with HIV into affordable housing, both to combat the homeless crisis and to take steps towards ending the HIV epidemic. You can find out more about the homeless count and check out the data here.

If you are in need of housing assistance, or are at-risk of or experiencing homelessness, please reach out to APLA Health for more information and to schedule an appointment with one of our housing specialists. Call 213-201-1637 or send an email to bbrown@apla.org.