. >> good morning, everyone, welcome to the it san francisco board of supervisors budged and finance subcommittee meeting for wednesday , april 1, 2015. my name is mark farrell, i will be chairing this meeting,

joined by supervisor katytang, joined by supervisor mar and supervisor scott weiner. madam clerk. >> yes, mr. chair, please silence all cell phones and electronic devices, completed speaker cards and copies of all documents to be included as part of the file actions today will be appear on the april 7 board of supervisors agenda unless otherwise stated. >> colleagues, we were going to go in order today. we have a hearing as item no. 1, all though there was, apparently i just realized there was one item held over from last week because that was completely cleared up, so we're going to take one quick one out of order, item no. 4. >> item no. 4, ordinance appropriating approximately 11.5 million for the renovation, repair or construction of parks and open

spaces and recreation and parks department for fiscal year 2014-2015. >> donna is here to speak on this item. >> supervisors, good morning, a very brief presentation on a fairly routine item, supplemental appropriation of the 2012 parks bond. of the roughly 160 million given to us by voters we have now, we did a first sale of about 53.2 million after the election. today we have spent approximately 14 1/2 million dollars and due to various policy changes about how other city-wide projects should proceed we find us in the space where some projects have cash that won't need it and other projects need that cash. so here we are to request a reappropriation of 52 million of projects that don't need the fublds to projects that will need the fupbtds to go into

construction this summer. in general the biggest sources of appropriation of the balboa park pool which is going forward. this in any way does not impact voter approved funding, it's really just a cash flow measure and reallocating that to (inaudible) which is ready to go into construction and needs 9.9 million for us to reencumber the the contract. so this reappropriation allow us to stay on the schedule. just in terms of program milestones, we have concept plan approvals for most of the phase i projects, gilman, glen canyon why, west mountain sunset and we started planning well in advance for willy wu a failing play grounds task force to make recommendations about which projects we should

prioritize with the 15 1/2 million dollars from the failing playgrounds fund. this chart shows basically the summer and fall ahead and the major projects that we expect to go into construction. we're actually in construction right now on joe dmrapblg owe and expect to be going into construction on gilman park and soulgt like as well as west sunset and then glen park recreation center. with these projects dwoiing into construction we expect to have fully expended our first sale and be ready to approach the board with a second sale this fall, which will allow us to begin and complete design on the second phase of projects. with that, i'm happy to take any questions. >> colleagues, any questions on item 4? seeing none, we will open this up to public comment. anybody wish to comment on item 4? seeing none, public comment is closed. we don't have a budget

analyst's report? do we? sorry about that. >> mr. chairman, supervisor tang, supervisor weiner, i did testify on this item last week and recommend you vote this forward. >> supervisor tang >> no, i had no questions from the last time around, just restating this does not change any of the project budgets for the project so i am happy to recommend this ordinance with a positive recommendation for the full board. >> we have a recommendation from supervisor tang and can take that without objection. >> hearing to discuss the expect edify napx needs recrated by the increase of people living with hiv/aids who will lose their private disability insurance as they become eligible for social security benefits and requesting the budget and legislative analyst to report. >> thank you, madam clerk. colleagues, this item was sponsored by supervisor wiener

so i will turn it over to him to run the hear ?oog ?oo thank you very much mr. chairman and colleagues, thank you for hearing this item today. today this hearing will focus on the increasing challenge that many people in our city is facing with regards to long-term survivors of hiv/aids who have been on private disability insurance policies and whose private disability insurance will terminate when they turn usually 65 and then transition on to social security, resulting frequently in a significant drop in income and resulting housing instability and housing instability. this issue was identified by the lgbt aging task force which, colleagues, as you know issued a report last year after we formed the task force in

order to explore the challenges and opportunities around our growing lgbt senior population. the task force identified this as a looming problem for our community and the purpose of this hearing is to learn more about it and to really begin a process to determine how best to address it. in the 1980's and early 1990's, in particular, before there was any effective treatment for hiv, many people particularly gay men with hiv who were employed and who became sick during the height of the crisis became disabled and left the work force, frequently accessing their private disability benefits. for many of these people they did not necessarily think that they were going to make it, given the lack of effective

treatment and they remained on private disability policies. , out of the work force for many years. starting the mid-1990's we began to see more and more effective treatments, not to cure hiv but to allow people to stabilize their health and to live long and healthy lives. and so we are now seeing a growing population of long-term hiv survivors who are approaching or in their senior years. this is a good thing that we're seeing a growing population of hiv positive people living into their senior years, we want that to happen, we want people to live long, healthy, happy lives, but it does create this issue and it is a discrete issue of a discrete population of largely gay men who went on on to private disability in the

1980's and 1990's that did not re-enter the work force and are now approaching age 65, an age they didn't necessarily think they were ever going to reach, but here they are and about to experience a significant drop in income. we know that in san francisco housing is incredibly challenging right now and for people who are experiencing or who are going to experience this drop in income, even if they are in stable housing, it may cause them 20 lose their housing because they can no longer afford to pay their rent and right now the last thing we want is for people to lose their housing and potentially become homeless. we want to make sure that people are stable in their housing. this issue having been raised and flagged, i decided that we needed to try to analyze it and quantify it so we know the

scope of the problem that we're facing. so i requested that our budget and legislative analyst study the issue and produce a quantification of where we are and what the problem is and what time frame, when it's going to emerge and how long it will last. so working with various experts in the community, the bla did perform an analysis and produced a very thorough and well-done report. this analysis provides us with information on which we can make policy decisions about how best to proceed. so, colleagues, today we're going to hear from the budget and legislative analyst to present the report and i think they distributed copies as well. we'll then hear from a few folks in the community who are doing work in this area and then hear public comment. with that, colleagues, mr. chairman if i may i'd like to

call up the budget and legislative analyst to present and i want to note we have representatives from the department of public health and human services here if any questions arise with respect to those departments. >> good morning, chair farrell, supervisor tang, supervisor weiner, supervisor, we were requested to estimate the number of people in san francisco living with hiv and aids who have private disability insurance and will be transitioning to social security. hampton smith from our office will be giving the presentation of our report. >> good morning, supervisors, hampton smith from the budget and legislative analyst's ofrs and i will be, we approached

the 15 largest companies by market share and asked for information dektly from them. since we didn't hear back and in a few instances company representatives simply declined to supply that estimation. we also approached state and federal agencies including the california department of insurance, the california department of state disability insurance and the centers for disease control, the social security administration, the regional office here in san francisco and washington, dc we asked for the information from disability advocates, academic researchers,

especially cornell employment disability and kaiser, ucsf and several ryan white service providers. this kind of information is generally not a part of hiv surveillance so none of the people that we spoke with had the specific information that we were looking for. the number of people with hiv living into middle age apblgd approaching retirement and social security eligibility has increased as hiv has become a chronic managable illness since the mid-90's when antiretro viral therapy was introduced. this is a nationwide phenomenon and in san francisco the number of people living with hiv 50 and older has increased to 55 percent of the total. in 200fuer, 4300 people, or about a third of the total number of people living with hiv, were 50 or older. by 20148,800 out of

a total of nearly 16,000 people living with hiv were 50 or older. >> that is a really important point, not just for this issue but in general in terms of our approach to hiv, that the percentage of people 50 and older living with hiv has basically doubled in the last decade and the face of this epidemic is shifting over time. we see it in terms of general demographics but also in terms of age, so i think it's real important as we think about how we approach the epidemic to understand that it is shifting. >> i'm going to get to some of those shifts in just a moment. another way to look at the aging of pop of people with hiv is to compare hiv surveillance age groups below 50 and above 50. the proportion of people in each group below 50

decreased between 2004 and 2013, while the proportion in each of the age groups 50 years old and older has grown in the same period with the largest growth in the 65 or older age group, which has grown by 282 percent since 2004. and there are differences in the demographic profile of older and younger people with hiv. african american and native american proportion of people living with hiv are about the same above and below 50, but there's been a substantial increase in the latino and asian pacific islander proportions below 50, latinos are 12 percent of people with hiv who are older than 50, but 21 percent of people younger than 50. asian pacific islanders are 3 percent of people older than 50 and 7 percent of people younger than 50, while whites are nearly 70 percent of people over 50, but only 56 percent of people younger than 50.

this change in the racial and ethnic profile has happened as people of color have begun to make up a majority of more recently diagnosed cases. differences in the ethnic and gender composition of the population, 50 and older and below 50, may have implications for the design of outreach and service delivery as the population continues to age and people with private insurance, private disability insurance, who have not used public services in the past turn to ryan white and other city services for the first time when their disability insurance expires. this is another way of looking at the changing racial and ethnic profile of people with hiv, showing the concentration of whites, mostly men, mostly gay men, among older people living with hiv in blue, and the large proportion of people of color among younger people with hiv. again, white men have been the largest proportion in san francisco

since the onset of the epidemic. they reflect an even larger number of people reflecting the large proportion of white men in the early stages of diagnosis. there are also differences in the demographic profile of the general population of people with hiv and people who receive ryan white services. ryan white funded services are generally available to people at or below 400 percent of poverty. it's our understanding that most people who receive ryan white services in san francisco are well under 400 percent of poverty guidelines. white men make up a small percentage of clients in the ryan white program, which serves a greater number of people of color and women than are in the general population of people with hiv. again, these demographic differences might have implications for how

programs are designed and how outreach is conducted for people who have not used public services in the past. as i mentioned, the insurance companies decline to provide information on the number of disability insurance policy holders and health care and other service providers generally don't collect this kind of information. so we've estimated the number of people with insurance, with disability insurance. we began by assuming that people who were diagnosed before antiretro viral therapy became available were more likely to be disabled and unable to work than people diagnosed after effective therapy became available in the mid-90's. they end of 2014 there were 6,668 people in san francisco who had gone diagnosed from the beginning of the epidemic through 95, and we start by assuming that these people are more likely to have

been disabled by hiv and stopped working and we base our estimates on the number of people with private disability insurance on this number. we used two local surveys of people 50 and older in san mateo, marin and san francisco to estimate the number of people in san francisco with private insurance. in 2010 the joint work group on hiv and aging, a project of the ryan white planning council and the mayor of long-term care coordinating council, conducted an online survey of people 50 and older in the three counties. this survey found 18.8 percent of respondents had both social security disability insurance and private insurance and in 2013 researchers at san francisco state conducted an in person survey of people living with hiv at service agencies in

the same three counties and found 6 percent of 160 people surveyed had private insurance. we applied these percentages to the number of people diagnosed through 1995, which gives a range of between 400 and 1254 people. we think the 1200 estimate is probably more accurate because the demographics of the people in the 2010 survey as far as race, ethnicity, gender and age more closely resembles the demographic profile of people with hiv in san francisco. one of the caveats we have to mention is that neither of these surveys saran dumb survey and they both relied on small sample sizes. they are the only two surveys we could find that ask specifically about private disability insurance and we think these numbers give a reasonable order of magnitude

estimate of the number of people with hiv in san francisco. we have made a high and lowest mat of people 50 and older with private insurance reaching retirement age and losing their insurance in the next 15 years. we used the percentage of people with private disability insurance and the age group distributions in the two surveys i just mentioned and we've broken this out in 5 year increments. in the first five years, 110 to 345 people reach retirement age and again in your 6 through 10 and in the last 5 years, 182-564 people reaching retirement age and resumablely losing insurance. we were asked to estimate the service needs of people as they lose insurance at retirement and switch to social security or become completely dependent on social security income.

since most lgbt seniors are renters, housing assistance in the form of rental subsidies allows people to stay in their homes, will probably be the greatest service need. here again we used the two surveys to come up with a high and lowest mat of the cost of new housing subsidies for people reaching retirement at 65 over the next 5 years in this case. these estimates assume renters receive a flat subsidy of $1,551 a month, which is the fair market rent standard for a one-bedroom apartment set by the capa program, the federal housing program for people with aids program. again we use the 2010 survey for high estimate of 2,300 people reaching retirement over the next 5 years and the lowest number of 110 people. capa and ryan

white have decreased as all care act funding has decreased over the last several years, and we are presenting these estimates of 6,019,000 as general fund costs. housing will probably be the most urgent need for people losing insurance but we were also asked to look at other service needs. again we have made two projections for increased service costs for other services in the next year and we base this on ryan white funding in the 2013 ryan white fiscal year. again, a lowest mat of people reaching retirement age in years 1 through 5 of 22 people and a high with 69 people and we've estimated core services and support service costs ranging from 35,000 to $112,000. we've

excluded medical costs from this estimate because people will be eligible for medicare and medical when they reach retirement. so without the cooperation of insurance companies, we can't know the exact number of people with private insurance, but what information is available indicates the size of the population is somewhere between several hundred and approximately 1200 people. we know that few people with private insurance make regular use of services intended for people with hiv with private disability insurance, which will have to -- i'm sorry -- and this will have to be taken into account when designing services for this population. the overall effect of the drop in income that will occur as people lose their insurance is difficult to predict

conclusively because some people have other resources including home ownership, but what evidence is available indicates that for many people the lost income will make it impossible to afford san francisco's median rent and housing assistance is a most likely need that most people have when they reach retirement. i'll be glad to answer any questions. >> thank you very much for the presentation, also for the analysis that you did. i know it was very challenging. this is not an issue that has been really studied before and i think you did i think really good work given the data limitations, so i appreciate the creative thinking. one question i have. if you go to slide 11 where if you look at the high estimate, estimates the housing rental

subsidy needs over the next 5 years starting at 1.3 million, approximately, next year, escalating to about 6 1/2 million five years out, that obviously continued past year 5. and i guess the question is do you have a sense for what is the total time frame of this issue? it's obviously not a permanent issue because from more recent infectiouses people are less likely to be on disability to begin with, so if you could just give us a sense of some of the long-term beyond year 5? >> that would be determined by the number of people 50 or older perhaps who are reaching retirement. we know there are approximately