healthcare resources of last resort and critical for the hiv patients and as we know, sadly congress has been shrinking this program over the last few years and we are grateful to nancy pelosi, who protected it as long as anyone could do and it has been a challenge because of that shrinkage. and many patient whose relied on the ryan white programs will be eligible for medical or insurance through the coverage california, the exchange for the first time and these patients will be eligible for that. >> and of course, that is fantastic. and for these patients but as we go forward in the implementation and we know that it is going to be a challenge to sort of implement the new forms of coverage under the affordable care act and so i am grateful to the task force and for taking the time to develop,

a report and to issue recommendations so as to insure the continuity of the care and maintenance of the high quality comprehensive services for these patients. and first we will hear from two task force members, and courtney, pearson, and the san francisco aids foundation, and which does amazing work in san francisco and hofmann from the mission neighborhood health center and so, we will turn it over to you. >> great. so thank you, so much supervisor campos and weiner and mar, and we appreciate the opportunity to present on what took about a year, for us to pull together this recommendation document and some other documents from the hiv health reform task force and they had to leave as did other members of the task force and so i am going to represent us and i will try to speak quickly and go through it and answer the questions if there

are any. and so my name is courtney pearson and the san francisco aids foundation, as you pointed out in san francisco, our task force really focused on people living with hiv and primarily who are uninsured because we saw for that population the transition would be the or would have the greatest impacts and so we are focusing on the 24 percent of clients who receive ryan white funded of the hiv positive san franciscans. and again, as you pointed out, the ryan white program, has developed to be quite comprehensive and model of hiv care which was never the intent of the program but because folks with hiv were excluded from purchasing traditional insurance and were not eligible for medical and it has gone up and to provide the really come prohenive services and it is a pair, and therefore, it can be pay for services that are or

can be provided for the public coverage and how the care four represents the tremendous opportunities for the people for hiv and also presents challenges and especially after this provision and the fact that healthcare reform becomes mandatory with people with hiv if they want to continue on the treatments they will have to transition to new forms of coverage. and that can be transitioned to new plans and also, potentially new providers and even pharmacies. there is also opportunity and challenges in the integration of the services and we know that even though these new options will be great they will not be as comprehensive as what was available under ryan white and we have the challenge to figure out how to continue to integrate the services that are still available under ryan white with the new services under healthcare reform without running into issues.

>> and so we have some transition and experience in san francisco and in california, and medical, programs, did move all senior and persons with disabilities including a large number of people with hiv from the service medical and managed care beginning in 2011. and there is also plans under way dually eligible people with medical and medicare. and also, this partial medical under california undertook as part of the 1115 waiver called the programs and passed here in san francisco we did learn that they were not opt mal, and we

think that 60 percent of the folks will be medical eligible and the rest minus obviously the folks who will remain uneligible will be eligible for the qualified health plans through coverage california. and the transition is less mandatory and is strongly encouraged and something that we are working towards. and again, for the less beneficiaries and in the past we will be moving into the medical expansion and some other counties that we see them moving into coverage california as well. and then there is the piece that programs that was a temporary program that is ending so she will also be facing transitions and the mission of the task force that formed nearly a year ago to develop a set of recommendations. and our goal and preparing the

community based hiv providers for the changes that are coming to their funding and also preparing the broader healthcare system to meet the needs of people leaving with hiv and the task force is come price prized of members and the prevention and care planning councils and the san francisco department of health and hiv aids provider network and advocates and other key stake holders. and we had some key deliverables from the start and so we wanted to research the best practices for the integration of the hiv service and looking to other transitions that have already happened and we wanted to create a set of recommendations that you have before you that are geared toward the policy makers, and mostly geared toward sfdph and although some of the recommendations are broader and more system wide. and then also, we were really focused on just developing the practical tools that both the providers and clients could use to help inform themselves about the transitions, and make sure

that they were ready. we took the hiv continuum of care which if you are involved in the hiv world has become the measure of late of how to measure how well a system is caring for the people with hiv. so the number that are infected. and having them, and the adequate treatment, and should mean the undetectable viral load and we mapped them over, the continuum of care to show which or how they were serving the needs of the focus of the continuum and they were to promote the interventions and reduce the barriers to the engagement and insure the appropriate and patient center care and promote the continuity of care and improve the

individual and health out comes and all of the recommendations met one or all of these goals. so i will briefly walk through the recommendations and we have nine. to first insure that the resources are in place to preserve this continuum that i have mentioned and that should include the awareness or the testing and that will be the combination of the potentially dph funds and as well of the primary care and the prevention could be done through the pair of resource and we also recommend reducing barrier to the care and reducing the retention through the coordinated and stream line and we see that the clients are taking advantage of many, many different programs and our recommendations as much as possible to work to traoem line

those eligible time line and that someone is not constantly in an eligible determination process but potentially once or twice a year if possible. >> we also think that it is essential to insurance a number of number of workers and the field we do not have a sufficient number of counselors to meet the needs of the people living with hiv.

>> this is a local and state responsibility. we participate in the straight process as the members of the planning council as well. there's something on the second page it's - this oversees the raining white funding program and we've done the status so they can come in once and provide all the documents on 0

yearly basis. we're required by federal legislation to do 6 months kind of recertifications. so that was we consider that a real win. in a much larger - what's - in terms of a much larger thing there's an initiative that's starting to create a consistently medical record for each patient whatever they are in the city of san francisco. it's an idea on the drawing board with you it could go a long way to not have sf have medical records. so other people i supposed to be

- >> okay. great. so for recommendation 3 which gets at the culturely and linkly bins the planning council initialing put in funding and we supported a number of trainings and then dph a new participating in the chinese community health plan and increases a letter of if not and people are moving forward to get the people are hiv to get the same contingent of area. lots of training happening. a part of this it happening with the state and again, we operator with them.

on a local level we've trite tried to be responsible. we'll continue to offer them and we have thirty plus enrollment its and the job of those people is to enroll people. a lot of the agrees have asked about the benefits consulting. in terms of language capacitate i think that san francisco anyone in terms of a bilingual or beyond a shadow of a doubt linoleum we've had a number of people the amount of spanish can in the cause and russian there's a phenomenal amount of that. i know with with the chinese translation has become an issue. do you have a map of the enrollment sites >> i don't we can get it.

>> 3 would be great. >> so recommendation number 4 excelsior the insurance coverage affordability. we're in favor of that. the chinese community health plan is the cheapest for the patient to be able to participate it's based on age and a gender so far as your financial plan. it's the most affordable for patients it is a state program but increase county workers to do the enrollment and we spent a lot of time insisting they go thereto ranks. the hiv organizations have

useful information about implementation. we respond by training and most particle through the health program those are the first folks we offer training to. and one training we did a mass training. and asking if that's enough? probably not. the challenge is we're laying the tracks as we drive on them. i'm calling courtney so i think we're going to do a catch up. particularly as we unrainfall the difference not so much as the expanded medi-cal but it reminds me of a time many years ago