ayor Bloomberg dropped an unexpected bombshell into his otherwise well-received AIDS policy speech last week. While ticking off a list of nonspecific reform ideas, he expressed interest in amending Local Law 49, a statute that requires the city to provide intensive services for New Yorkers with HIV and AIDS.
Passed in 1997, Local Law 49 was the result of efforts to box the Giuliani administration's social services reforms out of AIDS policy. It requires the city to maintain an office that oversees HIV/AIDS services. That agency, currently called the HIV/AIDS Services Administration, must provide comprehensive case management to anyone with HIV or AIDS who qualifies for Medicaid, and must maintain a set of minimum standards, including having at least one case manager for every 34 cases.
The mayor says this law is now outdated. "Simply put," he intoned, "that model is insufficient." His central concern, he said, is the city's inability to outsource case management to community providers. By obligating the city to provide all services itself, he said, the law "shortchanges" community groups and stifles innovation.
The Human Resources Administration, which oversees HASA, declined to offer more details, saying only that it's "studying a number of potential changes."
AIDS service providers, which fought fervently to win Local Law 49, generally responded to the mayor's proposal with a wait-and-see attitude. Of the mayor's speech overall, the New York AIDS Coalition called it "truly refreshing," noting the mayor's strong support for needle exchange, among other things.
But their reserve isn't entirely surprising. Peter Rieder, chief of staff for City Council Health Committee Chair Christine Quinn, notes that many groups are already doing a lot of the work the law is supposed to force HASA to do, but until now have never had a chance to get city dollars to pay for it. "There are definitely huge, huge problems with HASA in terms of its ability to live up to its mandate," Rieder says. So many groups may be asking themselves: Why not get public funds to do what we already have to do anyway?
New York AIDS Housing Network's Jennifer Flynn has an answer: it's opening Pandora's box. Once the city starts tinkering with case management, how do you make sure that Local Law 49's mandates stay in place, she asks. And will the city, facing budget troubles, shirk funding once the service is a shared responsibility? Not to mention, as Housing Works points out, the city still faces a number of pending lawsuits charging that it has failed to meet its obligations under the existing law.
"We're all beaten down so much," says Flynn, "that we're like, 'That sounds like a good idea, give the money to the community.' But the better idea is the mayor should be saying, 'How can we fix our city agency?'"
The proposal is part of a larger HASA reform plan that Commissioner Verna Eggleston promised during City Council testimony last November. Eggleston has invited a number of community groups to a meeting at Gracie Mansion this Thursday to hash out the agency's future.