‘People’s lives are in danger.’ Delayed payments from state hurting Pierce HIV programs
TACOMA – Two Pierce County organizations that help people with HIV and AIDS contend months of delayed reimbursements from the Washington Department of Health threaten the work they do and the well-being of an extremely vulnerable population.
Ace Robinson, the CEO of the Pierce County AIDS Foundation (PCAF), told the News Tribune last week the Washington State Department of Health has not reimbursed the foundation over $600,000 for contractual services since February. PCAF serves about 3,000 clients in Tacoma and Olympia and typically receives about $200,000 a month from the DOH, he said.
Affordable Housing and Treatment (AHAT) is a nonprofit organization which provides housing and health care assistance to unhoused people living with HIV and AIDS in Washington state. Officials there said recently it also had not received reimbursement for contractual services with the DOH for May or June, which executive director Chace Hunter said has happened in the past.
A spokesperson with the Washington Department of Health said inaccurate and incomplete invoices submitted by PCAF were the cause of invoice delays in April and May. PCAF requested an extension for a June invoice, due Monday, “citing concerns around the complexity of the care contract and new staff hires learning the process,” according to the DOH.
The department temporarily paused processing payments from July 11 through Tuesday “as we transition from one state fiscal year to the next,” said DOH public information officer Mark Johnson in an email Tuesday.
“To this end, our contracts and monitoring staff have worked hard to provide technical assistance and support to PCAF staff to ensure their invoices are submitted complete and without unallowable costs. This has taken a significant amount of time and has created some delays,” Johnson wrote in the email. “I will also add that PCAF has new leadership as well as new financial staff. The Ryan White Program grants are very strict and as such DOH is also monitored for compliance. This means our compliance review for allowable costs and expectations for full and complete back up documentation are rigorous. PCAF has been a contractor for this work for many years; however, with new staff the learning curve has been steep.”
Robinson said DOH recently changed its standards of how to submit invoices and has provided conflicting guidance to staff, which has made it difficult to submit invoices.
“It depends on who you talk to and what day. You’ll get one email saying everything’s great and everything’s in line. And then someone else will say, ‘No, this is an improper allowable expense.’ It’s so challenging,” he said. “We’re increasing the number of people we’re serving because people have been priced out of Seattle and can’t afford to live and work and have their lives there … in my mind, DOH should be doing everything in their power to support us, to expand services.”
Johnson told the News Tribune earlier this week the May AHAT payment was processed and released for payment and should reach the agency in a day or two. Hunter confirmed the payment was received Monday.
“For an organization that nets $4 million in revenue a year, not being paid $600,000 in such a short amount of time is not only unacceptable for business, it’s endangering communities who are impacted by HIV across Washington state,” Robinson said. “It’s not just staff that are primarily impacted – it’s our clientele who aren’t getting services they desperately need when it comes to food security, housing security, case management, peer navigation.”
Robinson said the DOH funds about 70% of his agency’s work, and the additional delays for payment have been difficult.
“I’ve been in the HIV field for 20-something years and only once in my career have I seen such incompetence,” he said. “… People’s lives are in danger. We can talk about the bureaucracy on this side or the other, but at the end of the day, keeping services for communities affected by HIV are not their real priority.”
Johnson said the temporary pause on payment processing from July 11 to Tuesday impacted all the DOH’s contractors. Any other payment delays are a result of other issues, he said.
“To our knowledge, there is one other agency besides PCAF delayed in payments due to late or incomplete invoices. However, the decisions to delay were made by that agency, not DOH,” Johnson wrote in an email to the News Tribune. “Otherwise, the issues identified by PCAF are specific to their agency, not a statewide problem.”
According to the DOH, Pierce County has the second-highest rate of people living with HIV or AIDS in the state. Of those diagnosed with HIV or AIDS, 85% are engaged in care and 77% have achieved viral suppression, where HIV cannot be sexually transmitted. Between 2017-2021 there were 259 new cases reported in Pierce County, about 50 new cases each year, according to the 2022 Washington State HIV Surveillance Report.
Delays threaten staff, clients’ livelihoods
Robinson said he’s worried about the impact PCAF’s financial situation is having on his clients and his staff.
Per PCAF’s contract with DOH, the DOH has agreed to reimburse PCAF monthly for case management, mental health, substance abuse and outreach services, as well as food bank, housing assistance, medical transportation and emergency financial assistance services.
“We haven’t been able to pay their landlords, we haven’t been able to pay their therapists. All have been threatening to stop their services,” Robinson said. “Right now we’re working with our banks to see if we can get a line of credit, take out a second mortgage, we’re trying to do anything to cover this time period before they pay us this money they’ve owed us for six months. … We’re not looking for solutions to end the HIV epidemic – we’re looking for solutions to pay our bills.”
Robinson said the people PCAF provides a safety net to are often “maligned and mistreated” in society.
“We’re speaking specifically about the LGBTQ+ individuals. About Black, Indigenous, people of color. People who use substances. People who are unhoused. All the people who are demonized in the very sense of our political landscape. HIV is one of those modalities that feeds on the mistreatment of those individuals,” he said. “Individuals who are low to middle income, who have very little political voice and little opportunity to advocate for themselves – those are the people who are still dying of HIV today.”
Hunter said all AHAT’s programs are at maximum capacity. AHAT serves 20 people in the Tacoma-Pierce County area and receives about $231,000 annually from the DOH through the federal Housing Opportunities for Persons With AIDS (HOPWA) Program, which is funded by the Department of Housing and Urban Development, he said. AHAT’s contract states that the DOH will issue payment within 30 days of receiving and approving a correct and complete invoice.
“The contract is a reimbursement system where we submit invoices at the end of each month to get reimbursed for that month we provide services,” Hunter said. “For small organizations such as ourselves, we really rely on on-time payment from our funder to continue to keep services going.”
Hunter said delays in reimbursements from the DOH aren’t new but have happened more frequently in the past six months.
In January, Hunter said, AHAT submitted an invoice for December and did not get paid until mid- to late March for services rendered. Hunter said Friday AHAT has not received payment for May and were not notified of the accounting department closure in July until after the closure had already begun.
“We ended up taking out a loan to cover our expenses and operations. And that caused more financial burden on us, because we have to pay interest on the loan,” he said. “If they were to provide us more information or ample time, a month or even a couple of weeks before their closure, this would allow us to prepare better.”
Hunter said AHAT staff submitted their May invoice on June 13, and staff responded to a DOH reviewer’s question about the invoice within 24 hours. Two weeks later, Hunter said the DOH staff asked a question to which they had already responded.
“So it was an oversight on their part that caused us to not receive payment on time,” he said.
Hunter said AHAT’s June invoice was recently submitted, but because of the DOH’s office closure, AHAT wouldn’t get reimbursed until August at the earliest.
On Friday, AHAT’s electricity was shut down until the utility bill was paid with a credit card, Hunter said. For now, clients are still receiving rental assistance services but “this is our first payroll that we have yet to pay our staff,” he said.
“It’s caused us to pick and choose and prioritize our clients first and then our staff,” Hunter said. “Luckily, our staff understands that, but it’s also caused interruption to their own livelihoods.”