1. Ryan White Client Demographic Summary and Quality Management Report Lisa Krull Program and Quality Manager 1

2. Ryan White Client Demographic Summary 2 2012 Ryan White Client Gender N = 4,394

3. Ryan White Client Demographic Summary 3 2012 Ryan White Client Age N = 4,394

4. Ryan White Client Demographic Summary 4 2012 Ryan White Client Race N = 4,394

5. Ryan White Client Demographic Summary 5 2012 Ryan White Client Ethnicity N = 4,394

6. 6 Ryan White Client Demographic Summary 2012 Ryan White Client Annual Income N = 4,394

7. 7 Ryan White Client Demographic Summary 2012 Ryan White Client Housing Status N = 4,394

8. 8 Ryan White Client Demographic Summary 2012 Ryan White Client Insurance Status N = 4,394

9. Ryan White Client Demographic Summary Client Insurance Status – at or below 100% FPL N = 3,356 (clients with at or below 100% FPL)

10. Ryan White Client Demographic Summary 10 2012 Ryan White Client HIV Status N = 4,394

11. 11 2012 Ryan White Unduplicated Clients: Core Services N = 4,394

12. 12 2012 Ryan White Unduplicated Clients: Support Services N = 4,394

13. 13 Ryan White Core Services Number Unduplicated Clients Served 2011 - 2012

14. 14 Ryan White Support Services Number Unduplicated Clients Served 2011 - 2012 *Outreach clients NOT unduplicated

15. 15 2012 Performance Measure Data: Medical Providers

16. 2012 In + Care Campaign Measures9/30/1211/30/121/31/13Part A National Benchmark Measure 1: Gap Measure % of patients who did not have a medical visit in last 6 months 35%11%12%14% Measure 2: Visit Frequency % of patients with at least 1 visit in each 6 month period of the 24 month measurement period 26%70%71%67% Measure 3: New Patients % of newly enrolled patients who had a visit in each 4 month period of the measurement year 48%63%60%70% Measure 4: Viral Load Suppression % of patients with a viral load <200 at last VL test in the measurement year 60%64% 72%

17. Survey of Consumers* Consumer Input Meeting 5-30-13 Service CategoryReduce or EliminateKeep or Increase Substance Abuse Treatment 10/22 (45%)NA Psychosocial Support10/22 (45%)7/10 (32%) EFA Utility Assistance7/10 (32%)5/22 (23%) Non Medical Case Management 5/22 (23%)NA Outreach5/22 (23%)NA Food22/22 (100%)NA N=22

18. FY 2012 Cost Utilization Data Service CategoryExpenditures# ClientsCost/Client# Services # Services/ Client Outpatient $2,389,7781,663$1,437 8,585 OP visits 5.2 Local Pharmacy$61,833204$303518 prescriptions2.5 Oral Health $608,732643$947 1,445 visits 2.2 Mental Health $92,286274$337 1,164 visits 4.7 Medical Nutrition Therapy $100,6851,180$85 1,948 encounters, 606 cases supplements 1.7 Medical Case Management $883,5963,477$254 32,431 encounters 9.3 Early Intervention Services $405,3982,136$190 8,218 encounters 3.8 Substance Abuse Treatment $25,14941$613 423 encounters 10 Case Management (Non-medical) $196,8641,084$182 3,736 encounters 3.4 EFA $66,659146$457 189 payments 1.3 Food Bank $277,2741,339$207 5,773 bags/1,815 vouchers 5.7 Housing $23,7306$3,955 55 rent/deposit payments 9.2 Medical Transportation $62,8561,424$44 9,432 bus passes, 3,044 gas cards, 265 cab trips, 108 client transport 9.0 Psychosocial Support $97,092320$303 644 individual/244 group encounters 2.8 Referral for Health Care/Support $48,480252$192 298 referrals for care, 578 referrals for testing 3.5 Outreach $38,3983,838$10 5,164 website visits, 15,656 page views 1.3

19. Non-Ryan White and Other Funding Sources Martha Montgomery Data Analyst Ryan White Part A Program PSRA Data Presentation June 26, 201319

20. Other Funding Sources for PLWHA in the Memphis TGA Ryan White Funding Part B, Part C, and Part D Medicaid Centers for Disease Control and Prevention Veterans Administration Food and Nutrition Services Services for Women, Infants, and Children (WIC) Food Stamp Programs Substance Abuse Prevention and Treatment Housing and Financial Assistance Housing Opportunities for People with AIDS (HOPWA) Community Sources for Emergency Financial/Rent Assistance Mid-South AIDS Fund 20PSRA Data Presentation June 26, 2013

21. Overview of Ryan White Part B Part B funding is distributed to states for specific programs States may provide services directly, contract with agencies, or work through subcontracts with Part B HIV Care Consortia TN funds five regional Consortia (Southwest, West, Middle, East, Southeast) with Lead Agencies who contract with agencies to provide services State Programs offered in Tennessee – Outpatient medical services – Medical case management – AIDS Drug Assistance Program (ADAP) Insurance Assistance Program (IAP) HIV Drug Assistance Program (HDAP) 21PSRA Data Presentation June 26, 2013

22. Tennessee ADAP (TGA) 22 PSRA Data Presentation June 26, 2013 Source: State of Tennessee Department of Health. In the past two years, the number of ADAP clients in TN has increased by 16%; total expenditures have decreased by 20%.

23. 23 Overview of Part B Funding in Tennessee in TGA Service FY 2011 (4/1/10 – 3/31/11)FY 2012 (4/1/11 – 3/31/12) Number ServedExpenditure Average Cost Per Person Number ServedExpenditure Average Cost Per Person Number ServedExpenditure Average Cost Per Person ADAP 1681$12,458,618$7,4111938$10,017,213$5,1691948$9,961,657$5,114 OMS NA 44$12,483$28429$13,566$468 MCM 706$188,350$267180$50,004$278204$61,712$303 TOTAL 2,38712,646,9687,6782,17810,079,7005,7082,18110,036,9355,884 PSRA Data Presentation June 26, 2013 Source: State of Tennessee Department of Health.

24. Mississippi & Arkansas ADAP (TGA) 24 PSRA Data Presentation June 26, 2013 In the past two years, the number of ADAP clients in MS has increased while the number in AR has remained relatively stable; MS expenditures increased 13% and AR expenditures increased 33%.

25. Part C Requirements 25 Part C funds comprehensive primary health care in outpatient settings for PLWHA No more than 10% of the budget can be allocated to administrative costs At least 75% of the balance remaining after subtracting administrative costs, must be used for core medical services PSRA Data Presentation June 26, 2013

26. Overview of Ryan White Part C Part C provides grants to service providers to support EIS and ambulatory care for PLWHA Part C funds go to – East Arkansas Family Health Center Outpatient/Ambulatory Medical Care, Dental, Medical Case Management, Medical Transportation, Mental Health, Nutritional Counseling & Supplements, and HIV Testing – Adult Special Care Clinic at the Regional Medical Center Outpatient/Ambulatory Medical Care, Mental Health 26PSRA Data Presentation June 26, 2013

27. 27 Note: Part C fiscal year is January 1 to December 31. PSRA Data Presentation June 26, 2013 Ryan White Part C Funding in TGA In the last year, the total Part C budget in the Memphis TGA has increased by 14%. The total number of clients served has decreased by 9%.

28. Overview of Ryan White Part D Part D funding is for women, infants, children, youth and their families Part D funds are provided through networks in regional areas Community HIV Network serves – Tennessee: Shelby, Fayette, and Tipton counties – Mississippi: DeSoto county – Arkansas: Crittenden county Any eligible consumer can receive services in those counties, even if they are from another county 28PSRA Data Presentation June 26, 2013

29. Part D Programs Previous year (8/1/11–7/31/12) – $353,153 to MAYAH – $777,888 to Memphis HIV Family Care Program Current year (8/1/12–7/31/13) – All MAYAH funding was cut – Memphis HIV FCP was cut to $500,000 A 6-7% cut is anticipated for the next grant year 29PSRA Data Presentation June 26, 2013 Part D funding in the Memphis TGA has been cut by 60% in the last two years.

30. Part D Programs Changes to services in the 2012 – 2013 grant year – All Part D youth initiatives were pooled with standard Part D funding, resulting in the loss of $353,133 for the MAYAH program – Medical case management and social work services provided by ASCC and St. Jude were cut Medical Case Management is no longer a core medical service – All Hope House services (psychosocial support and social work) were cut Funded services for 2012 – 2013 – Le Bonheur Infectious Disease Clinic provides social work and advocacy by Le Bonheur FCP staff – Adult Special Care Center provides outpatient/ambulatory medical – St. Jude provides outpatient/ambulatory medical – UTMG provides social work and advocacy by Le Bonheur FCP staff and obstetrical care – Oral health care is provided by two dental practic es 30PSRA Data Presentation June 26, 2013

31. Part D Programs 31PSRA Data Presentation June 26, 2013 HIV Family Care Program8/1/11-4/30/123/1/12-2/28/13 Medical case management (women)1041138 Outpatient (pregnant women/infants)156168 Psychosocial support services (women/families)635 Non-medical case management (women/families)6322 Youth served by MAYAH8/1/11-4/30/123/1/12-2/28/13 Medical case management (youth)2010 Outpatient (youth)2480 Psychosocial support services (youth)570 Mental health (youth)210 In the next year, the majority of Part D funds will likely be used for medical services; MCM and support services will not be funded.

32. Tennessee Medicaid (TennCare) PSRA Data Presentation June 26, 201332 Source: Bureau of TennCare. Data include only PLWHA; totals are based on the county where the recipient lived. In the last year, Tennessee’s Medicaid expenditures in the Memphis TGA have decreased by 6%. The total number of clients served has decreased by 25%.

33. Mississippi Medicaid 33 Source: Mississippi Division of Medicaid. Note: Data includes only PLWHA. Medicaid coverage in Mississippi requires that a person have proof of income eligibility and be determined disabled. Most PLWHA do not qualify for Medicaid until they are in advanced stages of illness and meet the disability requirements. PSRA Data Presentation June 26, 2013 In the last year, Mississippi’s Medicaid expenditures in the Memphis TGA have increased by 58%. The total number of clients served has increased by 9%.

34. Arkansas Medicaid 34 Source: Arkansas Department of Health. Data includes only PLWHA. Fiscal Year 12-13 is June 1, 2012 – May 31, 2013. Medicaid services in Crittenden county include Medical Care, Private Duty Nurse, Medical Services, Outpatient Services, Surgery, and Home Health PSRA Data Presentation June 26, 2013 In the last year, Arkansas’ Medicaid expenditures in the Memphis TGA have increased by 44%. The total number of clients served has increased by 39%.

35. Centers for Disease Control and Prevention (CDC) Provides funds to states for HIV Prevention and testing programs States distribute the funds to local programs via the state Department of Health or via Consortia 35PSRA Data Presentation June 26, 2013

36. Tennessee Department of Health Projects (CDC) Funding 15 HIV testing sites, 5 prevention/outreach programs in TGA in 2012 36PSRA Data Presentation June 26, 2013 In the last two years, TN CDC funding in the Memphis TGA has been relatively stable. Both the numbers of HIV tests conducted and clients served with outreach/prevention has increased by more than 50%.

37. Mississippi Department of Health Projects (CDC) Funding Testing sites in DeSoto, Marshall, Tate and Tunica DeSoto County Health Department Marshall County Health Department Tate County Health Department Tunica County Health Department Aaron E. Henry Health Services Center 37 Source: State of Mississippi Department of Health. CY 2011CY 2012 Number of HIV Prevention Activities and Outreach Programs/Agencies 7 6 CDC Cooperative Agreement for Prevention $2,023,284 $1,090,150 CDC Expanded Testing Initiative $821,152 $320,577 Table 9: HIV Prevention and Testing in MS in TGA PSRA Data Presentation June 26, 2013 Over the past two years, MS CDC funding in the Memphis TGA has decreased by more than 50%.

38. Arkansas Department of Health Projects (CDC) Funding Crittenden County is not covered in the scope of work for any funded grantees – However, the grantees are not limited to serving only clients that reside in their scope of work Testing events occur in Crittenden County 38 Source: State of Arkansas Department of Health CY 2011CY 2012 Number of Community Based organizations for HIV prevention 6 7 CDC Funding for Community Based organizations $329,409 > $300,000 Table 10: HIV Prevention and Testing in AR in TGA PSRA Data Presentation June 26, 2013 Over the past two years, AR CDC funding in the Memphis TGA has been relatively stable.

39. U.S. Dept. of Veteran Affairs VA claims to be the largest provider of HIV care in the U.S. – 21 Veterans Integrated Service Networks (VISNs), consisting of over 1,100 medical centers, community-based outpatient clinics, and other providers – TN is in VISN 9, MS and AR are in VISN 16 – Nationwide, the number of Veterans living with HIV has been stable (about 1 / 250); information specific to the Memphis TGA is limited 39PSRA Data Presentation June 26, 2013 200920102011 Arkansas245 253 258 Mississippi438 372 425 Tennessee636 646 681 Number HIV Infected Veterans in Care Note: The number of Veterans in Veterans Health Administration (VHA) care who filled a VHA outpatient prescription for a HIV antiviral medication (ARV) during the calendar year, and/or who ever had Clinical AIDS based on an AIDS-defining opportunistic infection prior to or during the calendar year. There is limited data available specific to the Memphis TGA. Source: HIV Infected Veterans in VHA Care by State. http://www.publichealth.va.gov/quality/reports/hiv-in-care-by-state-2009.asp http://www.publichealth.va.gov/quality/reports/hiv-in-care-by-state-2010.asp http://www.publichealth.va.gov/quality/reports/hiv-in-care-by-state-2011.asp

40. U.S. Dept. of Veteran Affairs HIV Testing Rates in the VA – Historically low due to restrictions As of 2009, <10% of Veterans in VA care had ever tested for HIV Over 50% of HIV patients at the VA had AIDS at time of diagnosis August 2009: Policy changes allowed for widespread testing in the VA July 2010: VA was designated as one of the lead Federal agencies for the National HIV/AIDS Strategy (NHAS); primary goals include: – Reducing HIV incidence – Increasing access to care and optimizing health outcomes – Reducing HIV-related health disparities 40 Sources: http://www.publichealth.va.gov/quality/reports/index.asp; http://aids.gov/federal-resources/national-hiv-aids-strategy/nhas-operational-plan-va.pdf PSRA Data Presentation June 26, 2013

41. 41PSRA Data Presentation June 26, 2013

42. U.S. Dept. of Veteran Affairs VA HIV providers adhere to HHS guidelines for HIV health care – 98% of Veterans living with HIV had hepatitis C screening; 80% receive hepatitis B screening and vaccination – 93% have routine CD4+ lymphocyte count – 86% who require PCP prophylaxis are on the recommended medications – 80% receive antiviral medications for treatment 42 Sources: Department of Veterans Affairs (2009). The State of Care for Veterans for HIV/AIDS (http://www.hiv.va.gov/provider/state-of-care/index.asp). Department of Veterans Affairs National HIV/AIDS Strategy Operational Plan (http://aids.gov/federal-resources/national-hiv-aids-strategy/nhas-operational-plan-va.pdf). 200920102011 Veterans with an outpatient visit 5,713,2655,888,5996,114,034 Veterans ever tested for HIV 524,267795,1261,221,328 Veterans ever tested for HIV (%) 9.2% 13.5% 20.0% National VA Testing Rates PSRA Data Presentation June 26, 2013 Nationally and in each VISN, the percentage of Veterans ever tested for HIV more than doubled in two years (2009-2011).

43. Services for Women, Infants, and Children (WIC) Administered by the U.S. Department of Agriculture, WIC provides federal grants to states Serves low-income pregnant / postpartum women and infants and children up to age five who are at nutritional risk WIC Special Supplemental Nutrition Program (SNP) – Provides nutritious supplemental foods, nutrition education, breastfeeding support, and health/social services referrals WIC Commodity Supplemental Food Program (CSFP) – Similar to SNP, but CSFP also serves elderly people and provides food rather than food vouchers Eligible people cannot participate in SNP and CSFP at the same time 43PSRA Data Presentation June 26, 2013

44. WIC Services in Memphis TGA 44 Sources: WIC Program Grant Levels by State. http://www.fns.usda.gov/wic/fundingandprogramdata; WIC Program Monthly Data - Participation. http://www.fns.usda.gov/pd/wicmain.htm PSRA Data Presentation June 26, 2013

45. WIC Services in Memphis TGA 45 Sources: WIC Program Grant Levels by State. http://www.fns.usda.gov/wic/fundingandprogramdata; WIC Program Monthly Data - Participation. http://www.fns.usda.gov/pd/wicmain.htm Note: Federal Fiscal Year (FFY) 2013 is October 1, 2012 through September 30, 2013; number of participants for WIC programs in FFY 2013 is not yet available. PSRA Data Presentation June 26, 2013

46. WIC Services in Memphis TGA 46PSRA Data Presentation June 26, 2013 Approximately $70 million is available for WIC in Arkansas; allocations specific to Crittenden County are not available. In the last two years, WIC funding in the Memphis TGA has increased by 37%.

47. Food Stamp Programs Food Stamp programs are financed 100% by Federal funds and administered in the Memphis TGA by the Departments of Human Services in TN, MS, and AR Client benefits can be redeemed at participating stores, farmers’ markets, direct marketing farmers, homeless meal providers, treatment centers, group homes, and others authorized to accept SNAP (“authorized firms”) To improve access to healthy foods, USDA has developed a strategic plan to increase farmers’ market participation in SNAP – The number of authorized firms increased by >40% in the past five years – The number of farmers’ markets and direct marketing farmers increased 327% in the past five years 47PSRA Data Presentation June 26, 2013 Source: United States Department of Agriculture (USDA) Food and Nutrition Service (FNS)

48. Food Stamp Programs 48PSRA Data Presentation June 26, 2013 Source: United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) In the past decade, food stamp benefits have more than quadrupled nationally from $18,256,200,000 to $74,619,460,000

49. Food Stamp Programs 49PSRA Data Presentation June 26, 2013 In the past decade, the number of clients receiving food stamp benefits has more than doubled nationally from 19 million to 46 million. Source: United States Department of Agriculture (USDA) Food and Nutrition Service (FNS)

50. Food Stamp Programs 50PSRA Data Presentation June 26, 2013 For the Memphis TGA, Shelby County is in Tennessee’s 9 th congressional district; Mississippi’s 1st congressional district includes all of DeSoto, Marshall, Tate Counties and Tunica County is in the 2 nd congressional district; Crittenden County is in Arkansas's 1st congressional district. Source: United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) TN (Shelby)MS (DeSoto, Tate, Tunica)AR (Crittenden) Households Receiving Benefits 46,217 (19.6%)35,263 (13.9%)42,884 (18.7%) Median Income $15,684$13,328$13,191 Percent with Children <18 56.7%60.4%58.0% Overview of Households Receiving Benefits in Memphis TGA (2010) TennesseeMississippiArkansas Monthly Benefit$133.86$122.54$122.59 Average Monthly Benefits by State (per person) Across all three states in the Memphis TGA, 17% of households receive food stamps. On average, annual household income of food stamp recipients is $14,000 and more than half have children under age 18.

51. Substance Abuse Prevention and Treatment 51 Allocations for Shelby, Tipton and Fayette counties PSRA Data Presentation June 26, 2013 Source: Tennessee Department Mental Health, Division of Alcohol and Drug Abuse Services. State Fiscal Year 2011-2012 is July 1, 2011 - June 30, 2012.

52. Substance Abuse Prevention and Treatment 52 Source: Tennessee Department Mental Health, Division of Alcohol and Drug Abuse Services. State Fiscal Year 2011-2012 is July 1, 2011 - June 30, 2012. Allocations for Shelby, Tipton and Fayette counties PSRA Data Presentation June 26, 2013 Allocations for substance abuse prevention and treatment have increased about 44% in the past two years.

53. Housing Opportunities for People with AIDS (HOPWA) The U.S. Dept. of Housing and Urban Development manages the HOPWA program for low-income persons living with HIV/AIDS Serves PLWHA living in Fayette, Shelby and Tipton counties in TN, DeSoto, Marshall, Tate and Tunica counties in MS, and Crittenden county, AR Services include – Tenant-Based Rental Assistance (TBRA) – Short-term Rent, Mortgage & Utility Assistance (STRMU) – Permanent Housing Facility – Short-term Housing Facility – Permanent housing placement (e.g., first month’s rent, utility deposits) – Housing information (e.g., flyers, pamphlets) – Support Services (e.g., case management, life skills management, employment assistance/training) 53PSRA Data Presentation June 26, 2013

54. 54 Source: City of Memphis, Division of Housing and Community Development, Annual Action Plans. PSRA Data Presentation June 26, 2013 Housing Opportunities for People with AIDS (HOPWA) Over four years (FY11-FY14) HOPWA funding in the Memphis TGA decreased 30%.

55. 55 Source: City of Memphis, Division of Housing and Community Development. PSRA Data Presentation June 26, 2013 Housing Opportunities for People with AIDS (HOPWA) The number of households served in FY 2012 is down 12% from FY 2010.

56. 56 Source: City of Memphis, Division of Housing and Community Development. HOPWA Expenditures by Agency Services Provided by HOPWA Agencies 1. Tenant-Based Rental Assistance (TBRA); Short-Term Rent, Mortgage & Utility Assistance (STRMU); Permanent Housing Facility- Operating; Permanent housing placement (first month’s rent, rent/utility deposits); Support Services (case management, Wellness University, etc.) 2. Short-Term Housing Facility; Support Services (mental health, A&D); Housing Information (flyers, pamphlets) 3. Homemaker Services; Support Services (case management) 4. Tenant-Based Rental Assistance (TBRA); Support Services (case management, life skills management, employment assistance/training) 5. Tenant-Based Rental Assistance (TBRA); Support Services (case management, transportation) FY 2010 (7/1/09 - 6/30/10)FY 2011 (7/1/10 - 6/30/11)FY 2012 (7/1/11 - 6/30/12) Number ServedExpenditure Average Cost Per Person Number ServedExpenditure Average Cost Per Person Number ServedExpenditure Average Cost Per Person Friends For Life 470$1,393,765$2,965883$1,391,529$1,576712$828,830$1,164 Peabody House 116$306,992$2,646 55$281,236$5,113 49$229,440 $4,682 Meritan 35$96,059$2,74538$173,136$4,55635$134,095$3,831 Hope House 10$202,012$20,20113$182,870$14,06717$171,643$10,097 Urban Family Ministries 9$159,828$17,7598$148,939$18,6178$180,643$22,580 Family Services of the Mid-South 85$226,709$2,667------ TOTAL 725$2,385,365$3,290997$2,177,710$2,184821$1,544,651$1,881 PSRA Data Presentation June 26, 2013

57. Other Community Sources for Emergency Financial or Rental Assistance Metropolitan Inter-Faith Association (MIFA) – Provides food, rent/mortgage, transportation, and utility assistance to eligible individuals MLG&W Utility Service Payment Assistance Programs – Pay the utility bills of people whose utilities have been or are at risk of being shut off – Includes the Federal Low Income Home Energy Assistance Program (LIHEAP), a non- emergency program that provides utility assistance in the form of a credit once per calendar year – Utility bill payment assistance programs have age, income, disability, need and other eligibility requirements 57PSRA Data Presentation June 26, 2013 Transportation642 clients37,359 trips Food3,210 clients447,976 meals Utility Assistance1,601 households$502,876 on utility bills

58. Mid South AIDS Fund  A Community Partner of AIDS United  Housed at the Methodist Healthcare Foundation  Funding decisions made by the Board of Directors  Awards grants to local programs for education, stigma reduction, prevention and access to care regarding HIV/AIDS  2012 Grantees include: Memphis Center for Reproductive Health (CHOICES); Christ Community Health Services; Church Health Center; St. Paul Baptist Church; Planned Parenthood of the Greater Memphis Region 58PSRA Data Presentation June 26, 2013