Good afternoon Chair Dromm and Members of the Finance Committee. I am Lisa David, President & CEO at Public Health Solutions (“PHS”). Thank you for the opportunity to testify before the Committee.
Our city and our nation are in the midst of a health crisis. As the largest public health non-profit serving New York City, PHS was quick to organize and address the challenges presented by COVID-19, focusing on strategies that would mitigate the disease’s impact on health equity. We provide services directly to low-income families, support community-based organizations through our long-standing public-private partnerships and bridge the gap between health care and human services. Our work addresses crucial public health issues, including food and nutrition, health insurance access, maternal and child health, reproductive health, tobacco control, and HIV/AIDS prevention. Our roots in NYC are deep, stretching back to the mid-1950s. Since the early 1990s, in response to the HIV epidemic, PHS has provided procurement, contracting, monitoring, fiscal management, payment and reporting on behalf of the NYC Department of Health and Mental Hygiene (DOHMH). This work has grown over time, and today, nearly $200 million annually to over 250 unique organizations – from grassroots non-profits to hospitals and universities across the metropolitan area.
As the COVID-19 pandemic continues to evolve, we have centered our work and planning around the health, safety, and well-being of our staff, clients, and fellow New Yorkers. We have taken every precaution necessary to avoid the community spread of COVID-19 across PHS staff and clients, while allowing our core operations and services to continue functioning as well as possible. PHS has rapidly transitioned to remote work, enabling our staff to work from home while still fulfilling our mission and meeting our funders’ obligations — whether that means rapidly executing emergency grants that ensure that DOHMH can nimbly and effectively respond to COVID-19, or facilitating health insurance enrollment for the newly unemployed, we have continued to facilitate the crucial and essential services needed by the most vulnerable at this time.
Because PHS provides services for low-income families across the five boroughs, we know firsthand the impact of COVID-19 on the lives of New Yorkers, and the rapidly increasing need for the services we provide. The number of people who have visited our website in order to find services has more than quadrupled, from 2,025 in March to 8,518 in April. We recently conducted a survey of 1,000 low-income NYC residents, which found financial difficulties to be particularly dire among communities of color: 82% of Black respondents, 92% of Hispanics, and 95% of Asians surveyed were worried about running out of money in the next month. Low income respondents across ethnicities are concerned about getting enough food (76%), paying rent or mortgage (66%), paying for medical costs (63%), and paying off debt (69%). More than half of Hispanic respondents reported being laid off since the outbreak began. Respondents who had a confirmed or presumed COVID-19 case in their household were more likely than those without a diagnosis to have used or applied for public health benefit programs in the last month. Widening health disparities in NYC during COVID-19 require that we rapidly respond through emergency efforts at the same time as we bolster and improve the social safety net to foster resilience during the economic fall-out. Our testimony will highlight PHS’ role in these efforts, and how the city council has supported and can continue to support the communities we serve.
I. COVID-19 Rapid Response Efforts
Challenges in City contracting are well-documented and known to this Committee. Data released over the past two years by NYC Comptroller Scott Stringer sheds light on just how late, unpredictable, and costly funding under NYC contracts can be. To respond efficiently to COVID-19, New York City needs to be able to contract with and pay its healthcare institutions and human services organizations quickly and flexibly to keep New Yorkers healthy, safe, and thriving. PHS ensures that critical institutions receive the contracts and funds they need to do life-saving work for our city — we execute contracts within 90 days compared to the average of 1 year for city agencies, and pay within 30 days of complete documentation.
During COVID-19 crisis, PHS is working closely with our government partners to ensure that the City’s non-profit health and human service grantees of New York City experienced no interruption to their contracts or payments during the crisis. PHS manages over $25 Million in CDC emergency response funding as fiscal agent for DOHMH, enabling the rapid purchase of critical COVID-19 supplies and services. We have expedited contracting and payment for the NYC Department of Homeless Services, so they could quickly deploy a Nurse Triage line, and clinical personnel to support homeless clients in the shelter system.
We’ve leveraged PHS’ organizational strength and assets to support efforts across the City. PHS helped the NYC Mayor’s Office of Contracting Services (MOCS) to vet the deluge of potential suppliers of Personal Protective Equipment (PPE). We are helping to identify and distribute emergency relief to low-income immigrant New Yorkers and their families through the NYC COVID-19 Immigrant Emergency Relief Program, in partnership with the Mayor’s Office of Immigrant Affairs, NYIC, and Catholic Charities. PHS is using its downtown Manhattan headquarters and citywide sites to receive and distribute goods to over low-income families and 60 non-profit partners alike, including from 76,000 face masks, 25,000 face shields, 100 isolation gowns, cribs, strollers, baby food, and cash cards.
In March, PHS joined with leaders from across the City and the country’s healthcare and technology communities, to help serve the most vulnerable through the NYC COVID-19 Rapid Response Coalition (www.nyccovid19.org). Bringing together leaders in social services, hospital and clinical services, logistics and supply chain, technology, managed care, law, and other professions, this group deployed critical rapid response capabilities needed to support vulnerable populations. PHS serves as the fiscal sponsor for the coalition, which has achieved the following:
- Delivery of 172,000 meals to more than 50 high-need buildings across 4 boroughs
- Procurement of 8 metric tons of Personal Protective Equipment (PPE) including gowns, masks, face shields, hand sanitizer, and distribution of donated PPE to more than 50 non-profit service providers
- Development and roll out of and SMS outreach chatbot, which has outreached to more than 40,000 people and connected more than 2,000 of the most vulnerable to needed clinical or social services, including home delivered meals, telehealth, and home delivered prescription service
II. Bolstering and Improving the Safety Net
As PHS has rapidly transformed our services – embracing remote work, digital signatures, and case management through televisits, phone calls, and limited, careful management of our in-person services for the City’s most vulnerable – PHS has experienced unplanned expenditures and revenue losses, in the face of a rising demand for services that will be difficult to meet.
i. Sexual and Reproductive Health
For more than 50 years, Title X has been the only federal funding source dedicated solely to sexual and reproductive health services. PHS was New York’s non-governmental Title X grantee for 37 years, directly receiving $4.6 million annually to support SRH services in NYC. PHS administered Title X funding through grants to health centers, supporting a network of 13 service sites (including PHS’ two SRH centers) that serve 40,000 New Yorkers each year. These sites include community health centers in high-need neighborhoods serving vulnerable populations, like immigrants, teens, the homeless, LGBT persons, and the uninsured. Because of the harmful 2019 Trump Administration gag rule, PHS made the difficult decision to withdraw from the Title X program. We are thankful for the leadership and support of the Women’s Caucus of the City Council, as well as the strong support of the Council Members that rallied to our side to ensure the State temporarily filled the Title X funding gap.
We are closely monitoring the 2020-2021 fiscal cycle for the State, as funding for PHS’ health clinics were included in the Executive Budget. While we are hopeful that the state will soon execute this new grant, we have already experienced impacts to our program’s cash flow due to contracting delays. If this expected State funding is cut, it will greatly impact our financial viability of our centers and our ability to provide critical sexual and reproductive health services in Brooklyn.
In addition to your advocacy, the City Council’s Contraceptive Access Fund, part of the Young Women’s Initiative, and supported by Article 6 Matching Funds, has been crucial for PHS and our partners to provide women, men, and adolescents with affordable sexual and reproductive healthcare, regardless of their insurance status. PHS’ clinics, located in Fort Greene and Brownsville, provide more than 4,000 patients per year with free, walk-in pregnancy testing, gynecological exams, prenatal care, preconception care, birth control (including IUDs and implants), emergency contraceptives, men’s sexual healthcare, teens’ sexual healthcare, STI testing and treatment, HIV testing and counseling, mental health services, and health education. We also connect with over 5,000 teenagers annually in public schools to provide sexual and reproductive health education and support.
We hope the Council recognizes the importance of ensuring access to sexual and reproductive healthcare as the COVID-19 crisis evolves and NYC recovers, as these services are crucial in preventing patients from turning to the acute healthcare system for basic preventive healthcare reasons. Since the start of this outbreak, we have implemented new protocols to ensure patients can receive critical prenatal care, health screening, diagnosis and treatment in a safe environment. We have quickly implemented Telehealth capabilities for our patients, wherever possible. Ensuring Medicaid reimbursement for Telehealth visits be comparable to reimbursement for onsite care will be essential to continued access to care and reducing risk of transmission going forward.
ii. WIC, SNAP, other benefits
As indicated in our recent survey of low-income New Yorkers, access to health insurance and food benefits is more important today than ever before. PHS is one of the largest providers of WIC, SNAP, and Health Insurance Enrollment in NYC, providing these services to more than 80,000 households each year. Extensive research has found WIC and SNAP to be cost-effective investments that improve the nutrition and health of low-income families. Women who participate in WIC give birth to healthier babies, children participating in WIC have lower risk of obesity, and children whose mothers participated in WIC while pregnant show improved cognitive development. SNAP reduces poverty by 14-16% and is considered one of the nation’s most effective anti-poverty programs for low-income families with children.
Since the end of March, we have seen increasing numbers of new SNAP applications as well as new enrollments in New York’s essential plan, which indicates large numbers of people seeking benefits for the first time, following loss of employment. To ensure clients are not forced to choose between receiving benefits and exposure to COVID-19, we have reduced in-person encounters to the bare minimum allowable under current Federal and State regulations. We have created new streamlined access to our services by phone and have been issuing benefits remotely wherever possible. In a recent survey we conducted with more than 1,000 WIC participants, we found higher rates of satisfaction with telephone encounters and remote issuance of benefits than with in-person encounters, so we are advocating to preserve those practices that make accessing benefits more convenient for families.
The City Council’s Access Health Initiative supports PHS to ensure comprehensive health insurance and benefits access. We use these funds, including Article 6 matching funds, to break down the traditional siloes between benefits programs. The funding supports the time and effort of our health and benefits navigators to do more comprehensive assessment of needs to follow-up to ensure optimal health and benefits use. We launched this initiative after learning that an alarming number of people enrolled in health insurance returned to renew it the following year without having been assigned or used a primary care provider. The initiative also ensures access to legal and immigration resources for clients worried about how their benefits decisions might affect them in the wake of the Public Charge Rule. We hope the council will recognize the importance of coordinated access to benefits as the COVID-19 epidemic evolves and NYC adapts and recovers.
Public Health Solutions has been on the front lines ensuring quality, accessible health and human services for the New Yorkers who need it most. We are proud of our work and we are grateful for the support of this Council in the past and we look forward to working with you in the future.