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Analysis finds Ryan White legal services funds distributed disproportionately, not by need

Comptroller William C. Thompson, Jr. today criticized a new Department of Health & Mental Hygiene (DOHMH) contract because it fails to provide services to individuals with HIV and AIDS based on geographic need.

Thompson charged that portions of the $471 million contract with Medical Health and Research Associates (MHRA) do not provide services under the Ryan White CARE Act where the need is greatest.

Specifically, Thompson noted that the subcontracts awarded by MHRA for legal services, supportive counseling and family stabilization services, treatment adherence support and outstationed medical care teams shortchanged the boroughs of Brooklyn, Queens and the Bronx in favor of Manhattan and Staten Island.

“I am concerned that the contract, as administered, provides services in a manner financially and geographically disproportionate to the number of individuals across the City who have been affected,” Thompson wrote in a letter to DOHMH Commissioner Thomas Frieden.

Thompson found that the number of zip code areas being serviced under the MHRA subcontract for legal services decreased, and that sites in Brooklyn were drastically cut by 67 percent, versus a 25 percent cut in Manhattan and 10 percent cut in the Bronx.

Surprisingly, Staten Island, which has the lowest number of New Yorkers with HIV and AIDS (1.8 percent), will get a 50 percent increase in the number of zip codes served under the contract.  

“The subcontracts were, in fact, awarded in an inequitable fashion. Brooklyn and Queens, for example, did not receive subcontracts for legal services in a capacity aligned with the number of individuals with AIDS/HIV in the borough,” Thompson said.

Number of zip code areas with legal services sites

As a result, MHRA’s contract will have only three Brooklyn sites providing legal services to clients and all would have been clustered in downtown Brooklyn – failing to assist those living in the rest of the borough. On the other hand, Manhattan will have 12 sites and the Bronx, 9.

“This raises a serious concern about the process followed when awarding the subcontracts,” Thompson said. “This represents a highly inadequate distribution of services, and does not consider the pressing need that many individuals have for services in their neighborhood.”

In another area, supportive counseling and family stabilization services, the Bronx and Queens received no funding at all. An equitable distribution, according to Thompson, would have resulted in the Bronx receiving $515,208 and Queens receiving $319,051. Thompson faulted MHRA’s justifications for the realignment of services, charging that MHRA did not ensure an “adequate geographic distribution of services.”

MHRA “does not address the relevant issues regarding site selection or the failure to expend financial resources equitably across the five boroughs.” For instance, he noted, Staten Island received a subcontract that amounted to approximately 70 percent of the Brooklyn-based contract, when it only has 1.8 percent of Citywide HIV and AIDS cases.

According to the DOHMH, there were 94,495 persons living with HIV and AIDS in New York City as of December 2004 (the most recently available statistics). Of that number, 29, 493 (31.2 percent) live in Manhattan, 23,345 (24.7 percent) live in Brooklyn, 20,628 (21.8 percent) live in the Bronx, 12,778 (13.5 percent) live in Queens and 1,706 (1.8 percent) live on Staten Island.

Thompson further criticized MHRA for reasoning that clients living outside of Manhattan can be seen at the Manhattan locations.

“People diagnosed with AIDS or HIV should not have to travel great distances to receive services. Clearly, if services were made more readily available closer to the clients’ home, a larger number of individuals could be accommodated. The City should ensure that there is coverage throughout all boroughs to meet this need,” Thompson said.

In order to maintain these vital services, Thompson registered the contract, but called on DOHMH to immediately scrutinize the awarding of subcontracts to ensure a much more equitable distribution of services. 

“I encourage DOHMH to recognize the urgency in addressing these issues so that people can receive critical services that they often desperately need,” he said.

You can view the Comptroller’s letter at his web site: www.comptroller.nyc.gov.