090.002 HIV Client Services Funding Allocation Formula

Policy Number	090.002
Effective Date	February 18, 2005
Revision Date	December 4, 2024
Subject Matter Expert	Care and Medications Unit Director
Approval Authority	HIV/STD Section Director
Signed by	Samuel Hebbe-Goings (acting)

1.0 Purpose

The Texas Department of State Health Services (DSHS), HIV/STD Section (Section) allocates funds for medical and psychosocial support services for people living with HIV to eligible administrative agencies within HIV service delivery areas (HSDA) throughout Texas using the allocation formula described in this policy. The formula adopted by the Section allocates Ryan White Part B and State Services funds using three variables to determine the percentage of funds that each HSDA receives for direct client service delivery. The variables used in the formula are:

(1) the number of people living with diagnosed HIV currently in the HSDA, (2) the number of people living with HIV receiving Ryan White and State Services-eligible HIV services, and (3) the percent of residents of the HSDA who are eligible for Medicaid.

The allocation formula described herein does not apply to other funds received by the Section.

Texas uses both state and federal funds to provide health and support services to i people living with HIV. The Section allocates funds to administrative agencies within defined HSDAs using a funding formula. Each administrative agency, in turn, competitively distributes the funds following the priority setting and allocation processes for each HSDA and in alignment with the comprehensive HIV services plan for the area.
 

2.0 Authority

Texas Health and Safety Code, §85.015, §§85.031 - 85.038; Ryan White CARE Act, 42 U.S.C. §300ff
 

3.0 Funding Formula

The formula uses three variables to assign funds to each HSDA: (1) the number of people living with diagnosed HIV in the HSDA, (2) the number of people living with HIV receiving Ryan White and State Services-eligible services in the HSDA, and (3) proportion of the population of the HSDA who are eligible for Medicaid (indicator of economic distress). These three variables have different weights in the formula. The Section assigns the number of people living with diagnosed HIV the greatest weight in the formula (50 percent), the number of people living with diagnosed HIV receiving Ryan White and State Services- eligible services at 30% and the proportion of the population in the HSDA that is Medicaid-eligible at 20%.The Section uses the same formula elements to distribute  Ryan White Part B funds and State Services funds, however the count of people living with diagnosed HIV differs  by source of funds. Therefore, section 4.1 describes the operations of the formula for State Services awards and section 4.2 describes the operations of the formula for Ryan White Part B awards.

Please note that all formula elements will use the most recent available year of data.
 

3.1 Funding Formula for Allocating State Services Funds

A. Percentage of people living with diagnosed HIV by their HSDA of current residence

Data source: Enhanced HIV/AIDS Reporting System (eHARS)

Weight in formula: 50 percent

The Section will divide the total number of people living with diagnosed HIV in each HSDA by the total number of people living with diagnosed HIV in Texas to create the percentage used in the formula. The most recent year of data available at the time the formula is run will be used.

B. Percentage of people living with diagnosed HIV receiving HIV services eligible for Ryan White or State Services funding in each HSDA

Data source: TakeChargeTexas (TCT)

Weight in formula: 30 percent

The Section uses information from the most recent year available from TCT for this formula element. The Section staff randomly select three non-consecutive months to sample and record the number of unique PLWH receiving Ryan White and State-Services eligible services across these months for each HSDA. This is the numerator for the percentage. Because clients can receive services in more than one HSDA, the sum of the unduplicated client counts across the HSDA is the denominator for this measure.

C. Percentage of HSDA’s population eligible for Medicaid (indicates economic distress of a community)

Medicaid data source: Texas Health and Human Services Commission

Population data source: U.S. Census

Weight in formula: 20 percent

To obtain the percentage of an HSDA’s population who may be eligible for Medicaid, the Section divides the total number of persons residing within an HSDA who applied for and were eligible for Medicaid by the total population of the HSDA. DSHS staff annually obtain Medicaid eligibility data from the Texas Health and Human Services Commission with a year lag in availability. The section derives both data sets, Medicaid data and population data, from the same year. 

To obtain a standardized score on this measure for each HSDA, the Section divides each HSDA’s percentage of eligible residents by the sum of the percentages for all HSDAs. This calculation makes the sum of all HSDA standardized percentages equal 100 percent.

D.  The Final Proportion of Available State Services Funds

The Section calculates the final proportion of available State Services funds for each HSDA using the weights and formula elements described above: 

(A x .5) + (B x .3) + (C x .2)
 

3.2 Funding Formula Operations for Distributing Ryan White Part B Funds

To decrease the overlap in funding between Part A and B, the Section divides Ryan White Part B funds into two portions: one representing 70 percent of the available Ryan White Part B funds, and the second consisting of the remaining 30 percent of the funds. The Section distributes the 30 percent portion exactly as State Services funds. The Section distributes the remaining 70 percent by using a modified count of people living with HIV as described below, labeled D.

D. Percentage of People living with diagnosed HIV Not Residing in Key Part A Counties

The Section uses data from routine HIV disease surveillance as described above. However, the Section excludes people living with diagnosed HIV in the following counties from the HSDA count: Bexar (excluded from the San Antonio HSDA), Dallas (excluded from the Dallas HSDA), Harris (excluded from the Houston HSDA), Tarrant (excluded from the Fort Worth HSDA) and Travis (excluded from the Austin HSDA). The counts of people living with diagnosed HIV in these counties are also excluded from the state total.  Section staff then calculate the proportion of people living with diagnosed HIV in each HSDA by dividing the count of people with diagnosed HIV in each HSDA by the revised total of all people living with diagnosed HIV. 

As a result, the Section calculates the Ryan White Part B HIV services formula that excludes living cases within EMA lead counties for 70 percent of the funds as follows (letters represent the values for the variables discussed above):

[((A x .5) + (B x .3) + (C x .2)) x .3] + [((D x .5) + (B x .3) + (C x .2)) X .7]
 

4.0 Minimum Funding and Hold Harmless

The Section uses two methods to address fluctuations in funding calculations that result in an extreme loss of funds to an HSDA: minimum funding and hold harmless. Both methods are contingent upon the Section receiving at least level funding for HIV client services.
 

4.1 Minimum Funding

If level funding is available, the minimum combined Ryan White Part B and State Services award a year is $250,000. The Section may change this amount at its sole discretion. 

After the initial application of the funding formula, the Section calculates the amount of funding needed to bring all HSDAs to the minimum funding level and identifies the HSDAs that gain funding compared to current awards. The Section transfers an equal proportion of funds from each HSDA that gains funds to bring the HSDAs to the minimum award amount so long as this transfer does not trigger hold harmless provisions.

After the initial application of the funding formula, the Section will calculate the amount of funding needed to bring all HSDA to the minimum funding level and identifies the HSDAs that will gain funding compared to current awards. The section will transfer an equal proportion of funds from each HSDA gaining funds to bring all HSDAs to the minimum funding amount so long as this transfer does not trigger hold harmless provisions.
 

4.2 Hold Harmless

If level funding is available, the Section ensures each HSDA receives no less than 95 percent of their current allocation. After the initial application of the funding formula and adjustments to awards to assure minimum funding, Section staff compare the results of the formula to the current awards for each HSDA, and identify the amount needed to bring all HSDAs to 95 percent of their current award or to the minimum award, whichever is higher. The Section transfers the amounts needed to bring HSDAs to hold harmless or minimum funding levels in equal proportions from HSDAs that gain funding according to the initial run of the funding formula. HSDAs that the Section projects to lose five percent or less of their previous allocation according to the formula neither contribute to nor benefit from the method of calculating hold harmless funding.
 

5.0 Availability of Funds to the Section

Allocations released in Request for Proposals (RFPs) or renewal applications for HIV services contracts are subject to available funding. The Section’s ability to implement either the "hold harmless" or "minimum funding" method is contingent upon the Section receiving, at minimum, level funding for HIV client service delivery.

If level funding is not available, the Section may consider the other sources of funding available for HIV clients services available in HSDAs. This may include holding Part A areas harmless at a different level than non-Part A HSDAs. It also may include increasing the percentage of federal funds the Section distributes without the influence of the cases within the Part A lead counties. The Section also reserves the right to implement other methods to reduce the impact that decreases in funding may have on HSDAs.
 

6.0 Revision History

Date	Action	Section
12/4/2024	Updated terminology with changes to Section organization, Ryan White CARE Act, and Texas Statutes; current minimum funding; and data sources.	All
9/3/2014	Converted format (Word to HTML)	-
2/25/2005	New policy	All