Central Texas hiv/aids planning Area



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The frequent reference to financial and transportation barriers as the primary issues impacting accessing many of the service categories discussed with participants is particularly troubling. It is unclear whether clients were referring to financial and transportation barriers as keeping them from accessing services like dental care without Ryan White assistance, or whether financial barriers and transportation barriers were present even when receiving services through the Ryan White system. Future needs assessments will be designed to draw a distinction between these two cases, in order to develop a better understanding of true barriers to care.



Two other recurring barriers were participants not knowing the service was available, and information about the service was not available in the client’s language. This has guided the development of the service system improvement goal of increasing client self-advocacy by making clients aware, at intake and reassessment, of available services and resources in their area.
Historically, participants have reported a high unmet need for Health Insurance assistance, which was also reflected in the 2009 needs assessment. However, more recently a few rural providers have reported difficulties in expending their full Health Insurance Assistance allocation, though no clients were denied services and funds were eventually expended before the end of the contract year. While lagging utilization may be attributable in part to clients being unaware that the service is available, this may also reflect economic and employment changes in the country since the 2009 needs assessment. As clients, and the general population experience increasing difficulty finding secure, full-time employment that includes benefits, the need for assistance with maintaining health insurance through an employer decreases. This trend does not account for the continuing need for assistance with health insurance payments in all HSDAS, and the particularly high need for health insurance assistance in the Austin HSDA, which is so great that a waiver to restrict eligible services was submitted for the 2011-2012 and 2012-2013 grant years, despite significant reallocations and the addition of supplemental funding. Current levels of utilization indicate that this waiver will be necessary for the foreseeable future in order to ensure continued client access to any form of health insurance assistance in the Austin HSDA.
Needs Assessment: Prevention Needs
There has traditionally been a division between HIV care services and prevention activities, extending largely from varying funding sources and a focus on prevention among high risk individuals who are HIV negative, but DSHS’ recent development of the Texas HIV Plan as a comprehensive coordinated response encompassing aspects of both treatment and prevention is an encouraging step for bridging this divide. In the past, the Health Education / Risk Reduction category was funded in the CTHASA to educate PLWHA about transmission risk reduction strategies. As the costs of medical and other core services have continued to rise, lower priority, non-core service categories like Health Education / Risk Reduction have been defunded out of necessity to continue providing quality medical treatment and support services for PLWHA in Central Texas. DSHS’ increasing inclusion of both HIV care services and prevention is promising for the eventual restoration of prevention-related HIV services activities in the CTHASA.
At the administrative agency level, BVCOG is currently providing support and guidance to one provider who is working to pilot a program that incorporates prevention staff working at the agency in the regular risk assessment activities performed by case managers. These prevention staff members have the training and experience necessary to quickly build rapport with clients and have candid conversations with clients about risk behaviors. As this pilot program progresses, BVCOG may utilize successful portions of this strategy to foster better working relationships between HIV service agencies and prevention bodies. However, changes in the funding environment have resulted in the Bryan-College Station and San Angelo HSDAs no longer being State funded for prevention services. This will require BVCOG and the subcontracted agencies in these HSDAs to for innovative and pragmatic opportunities to increase coordination of prevention activities.

The needs assessment survey tool does not include questions about sexual practices, partners, serostatus disclosure, or intravenous drug equipment sharing, potential transmission to others, or about practices that may exacerbate participants’ own infection. These topics are difficult for many clients to discuss candidly with their medical providers and case managers, much less via telephone contact with a researcher. For this reason, there are no findings available for presentation on these particular issues. Future needs assessments will inquire about prevention through less threatening avenues, such as asking clients what they feel most PLWHA would like to know about preventing transmission to partners. However, when asked about the need for outreach programs, 20% of needs assessment survey respondents reported needing this service at 58% of all respondents reported that this service was available. Common responses as to what types of outreach are needed in the CTHASA included more education programs, testing resources, HIV awareness programs and increased condom access.



Summary of Current Care Resources
The needs of clients go beyond the services that BVCOG directly funds. To help meet these needs and maximize limited funding, BVCOG solicits updated resource lists from subcontracted agencies on an annual basis to assess the current care and treatment resources for PLWHA in each HSDA. The following resource inventory is a compilation of information taken from these lists, along with resources funded through Ryan White and State Services. The resources below cover the ten service categories that participants in the 2009 comprehensive needs assessment reported as the most used and needed. Though ranking high among the most important and most needed services to clients in the 2009 needs assessment, Emergency Financial Assistance is omitted below due to the problematic nature of identifying exactly what clients need under this service category. However, this need may often be met through faith-based communities in the HSDAs, a source that is considerably more flexible than BVCOG. It is important to note that many of these resources do not specifically serve PLWHA, meaning that clients utilizing these resources often must compete with other populations in need.
Summary of Current Care Resources: Austin HSDA



  • Ambulatory / Outpatient Medical Care: The David Powell Community Health Center in Austin is the main source of primary medical care for PLWHA in the Austin HSDA. The clinic is part of the Austin/Travis County Community Health Centers, a group of federally qualified health centers, with 17 total sites. The David Powell Community Health Center is designed solely for PLWHA, and is accessible by public or private transportation. A clinic at Community Action Inc. of Hays, Caldwell, and Blanco Counties is available for PLWHA residing in the rural areas around Travis County, and who are uninsured and not eligible for any other insurance program. This clinic is also accessible by public and private transportation. Specialty care providers, including infectious disease physicians and OB/GYNs, are available to PLWHA in Austin at many hospitals and community clinics.

  • AIDS Pharmaceutical Assistance: The David Powell Community Health Center has an on-site pharmacy and is able to fill many prescriptions, serving the bulk of the clients. The pharmacy also has the benefit of 340B status, allowing medications to be purchased at significantly lower costs, the savings of which are passed on to clients. The Community Action clinic also has a pharmacy, but is limited in the prescriptions it can fill and is geared towards clients of a family planning program. Clients may also choose a pharmacy to fill their prescriptions, if the BVCOG contracted provider makes payment arrangements in advance. Such arrangements exist throughout Austin, San Marcos, and the surrounding areas. Community Action is also negotiating arrangements with a local mail order pharmacy and the Wal-Mart Specialty Pharmacy to have ART/HAART and other medications shipped to clients at no additional cost. Initial client feedback indicates that this is a highly favorable option for clients to obtain their medications.

  • Oral Health: The Jack Sansing Dental Clinic at AIDS Services Austin (ASA) is the primary dental provider for PLWHA in the Austin HSDA. ASA coordinates care with the David Powell Community Health Center, Community Action Inc. and a number of other local AIDS service organizations to serve all clients in the HSDA.

  • Case Management: Though not currently funded for Medical Case Management through BVCOG, David Powell Community Health Center offers this service to clients. Non-Medical Case Management is provided by two BVCOG-contracted agencies in the Austin HSDA. AIDS Services Austin receives Ryan White Part A and MAI to provide case management services primarily to residents of the five county Austin TGA. Community Action (which has offices in Elgin, Georgetown, and San Marcos) and Wright House Wellness Center (located in Austin) share case management of clients in ten counties of the Austin HSDA. Any clients that receive Section 8 housing assistance from the Department of Housing and Urban Development (HUD) must have a housing case manager, provided by HUD.

  • Substance Abuse Treatment and Mental Health: The Austin/Travis County Mental Health/Mental Retardation (MHMR) Community AIDS Resources and Education (CARE) program provides mental health and substance abuse treatment, specifically targeting out-of-care and difficult to reach populations. They have a location on the east side of the city in a high prevalence area, in addition to a program for people recently released from incarceration. Waterloo Counseling Center in Austin specializes in Gay, Lesbian, Bi-sexual, and Transgendered issues, and provides both mental health counseling and psychosocial support group services to residents of the Austin HSDA.

  • Food Bank: The Austin resource guidebook published by the Austin Area Comprehensive HIV Planning Council lists over 50 food bank resources in the ten county Austin HSDA. Some require a referral from another agency, while others allow clients to access the food bank on their own. Community Action provides vouchers to grocery stores through its Food Bank allocation so clients may purchase food on their own. ASA operates a food bank specifically for PLWHA residing in the Austin HSDA, but the client must have a case manager at one of the AIDS service organizations in the HSDA, be HIV positive and symptomatic, and provide medical information from their provider to be eligible for assistance.

  • Housing: The Housing Opportunities for Persons with AIDS (HOPWA) grant program from HUD provides short term, emergency housing assistance, and long term rental assistance. A person seeking assistance from HOPWA must first apply for Section 8 Housing Assistance through HUD. HOPWA funds may be used if the applicant is ineligible, wait listed, or unable to begin Section 8 assistance for any other reason. For those clients who are able to get on the wait list for Section 8 assistance, the wait time can be as long as four years. Project Transitions provides transitional housing (as well as hospice) for PLWHA in the Austin area. The Austin HSDA has a variety of other housing arrangements including homeless shelters and community centers /community housing. The Austin Area Comprehensive HIV Planning Council resource guidebook identifies 25 organizations that provide services and referrals related to housing. Habitat for Humanity may also be another source of housing assistance.

  • Transportation: Bus passes, gas vouchers, taxi vouchers and rides from case managers are available to PLWHA in Austin. The public transit system in Austin includes Capitol Metro buses that run throughout the city, as well as MetroAccess, which provided transportation for individuals with disabilities preventing them from riding on the Capitol Metro lines. For those residents outside of the city, gas vouchers, taxi vouchers, and rides from case managers are available for medical and support service related appointments. The Capital Area Rural Transportation System (CARTS) provides transportation to and from Austin for individuals living in the rural counties of the HSDA. Clients enrolled in Medicaid are eligible to use Medicaid transportation.

  • Health Insurance: There is not an insurance pool available specifically for PLWHA. There are some government programs that PLWHA may qualify for, including Medicaid, Medicare, and County Indigent Health Care programs. Case managers assist clients in determining eligibility and applying for these programs at entry into services, or as needed. Privately purchased individual policies for PLWHA are not common, however, some PLWHA do have individually purchased or employer sponsored private insurance or COBRA. Assistance with premiums, co-payments, and co-insurance are available through contracted providers


Summary of Current Care Resources: Bryan – College Station HSDA:


  • Outpatient /Ambulatory Medical Care: The Brazos Valley Community Action Agency (BVCAA) is a federally qualified health center (FQHC) with eight sites available to provide primary care to all low-income residents of the Brazos Valley, including PLWHA. For specialty care needs relating to HIV, most PLWHA in the HSDA receive treatment from an infectious disease specialist in his private practice. This provider currently has a MOU with the contracted provider (Project Unity) to provide services at a negotiated rate. Clients are also able to choose their own physician, as long as payment arrangements can be made between the physician and contracted provider, Project Unity. TAMU Physicians/Family Medicine Clinic is a residency program in the Bryan area that sees patients for primary care on a sliding fee scale. The Health for All clinic sees patients who do not qualify for private insurance or Medicare/Medicaid.

  • AIDS Pharmaceutical Assistance: The BVCAA clinic has a pharmacy available to fill prescriptions for patients of the clinic. Clients of the contracted provider who are not patients at the BVCAA clinic may also choose another local pharmacy to have prescriptions filled, as long as payment arrangements between the pharmacy and contracted provider are made in advance. The contracted agency has many such arrangements in place on a continuing basis.

  • Oral Health: Dental services are available at the BVCAA FQHC dental clinic, but are limited in capacity. The subcontractor currently has an MOU in place with a local dentist to provide basic dental services at a negotiated rate. Clients requiring more advanced and costly procedures are referred to the Bering Dental Clinic in Houston, which provides care at a reduced or free rate.

  • Case Management: Medical Case Management and Non-Medical Case Management services are provided by one agency located in Bryan, Texas. For those receiving Section 8 housing assistance, housing case management is offered by HUD.

  • Substance Abuse Treatment: The Brazos Valley Council on Alcohol and Substance Abuse (BVCASA) is the primary source of both inpatient and outpatient substance abuse treatment. Inpatient substance abuse treatment for residents of the Bryan – College Station HSDA is available at the Freeman Center in Waco. Scott & White hospital also has an outpatient substance abuse treatment program in the Bryan/College Station HSDA that is available for those with third party/private insurance.

  • Mental Health: The Brazos Valley MHMR is able to see people with severe psychosis or other extreme cases only, due to a lack of capacity. The contracted case management agency has an MOU with a counselor to lead support groups and provide individual counseling on a fee for service basis.

  • Food Bank: The Brazos Valley Food Bank sells food only to agencies in the Brazos Valley; PLWHA are not able to access it directly. The contracted provider receives food from the Brazos Food Bank and makes it available to clients.

  • Housing: The Housing Opportunities for Persons with AIDS (HOPWA) grant program provides short term, emergency housing assistance, and long term rental assistance. A person seeking assistance from HOPWA must first apply for Section 8 Housing Assistance through HUD. HOPWA funds may be used if the applicant is ineligible, wait listed, or unable to begin Section 8 assistance for any other reason. BVCAA and the Community Housing Development Organization partner to provide affordable housing for low-income and special needs households. Phoebe’s Home is provides emergency housing/temporary shelter for women and their children. Twin City Mission has programs to assist residents in obtaining stable housing and also functions as a homeless shelter. The Brazos Valley Affordable Housing Corporation can assist people with purchasing their own home, geared towards those with low incomes, and poor or no credit history.

  • Transportation: The Brazos Transit System operates a bus system within the Bryan – College Station area, as well as the Medicaid bus. The Retired Senior Volunteer Program and the BVCAA Elder Aid Program provides transportation assistance to older residents. The BVCOG-funded case management agency can also provide assistance to clients for medical and support service appointments when other resources are unavailable. Assistance from the provider includes bus passes, taxi vouchers, and gas vouchers, as well as rides to appointments using an agency vehicle.

  • Health Insurance: There is not an insurance pool available specifically for PLWHA. There are some government programs that PLWHA may qualify for, including Medicaid, Medicare, and County Indigent Health Care programs. Case managers assist clients in determining eligibility and applying for these programs at entry into services, or as needed. Privately purchased individual policies for PLWHA are not common, however, some PLWHA do have individually purchased or employer sponsored private insurance or COBRA. Assistance with premiums, co-payments, and co-insurance is available through the BVCOG-funded provider.


Summary of Current Care Resources: Concho Plateau HSDA:



  • Outpatient /Ambulatory Medical Care: The contracted provider, Shannon Supportive Health Services, is part of a medical center in San Angelo that provides primary medical care for PLWHA in the HSDA.

  • AIDS Pharmaceutical Assistance: Clients may select a pharmacy at which to fill their prescriptions if payment arrangements are made in advance between the pharmacy and the contracted provider.

  • Oral Health: The BVCOG-funded agency has a contract in place with a local dentist to provide care to most of the clients in the area.

  • Case Management: The contracted provider is the primary source of Medical and Non-Medical Case Management for PLWHA in the HSDA. Healthcare Continuum is an agency that offers case management to people with disabilities. Those receiving Section 8 housing assistance receive housing case management from HUD.

  • Substance Abuse Treatment: The Alcohol and Drug Abuse Council of Concho Valley has a variety of resources available for substance abuse treatment. Additional resources include Rivercrest Hospital for in- and out-patient substance abuse treatment, Sara’s House and the West Texas Recovery Center also offer treatment services, and William’s House is a sober living facility for those in recovery.

  • Mental Health: The MHMR authority in the San Angelo area is only able to see severe cases due to a lack of capacity. Samaritan Pastoral Counseling offers counseling services. Shannon Behavioral Health Services, part of the local hospital, offers a range of mental health services as well. The contracted case management agency has also established fee for service arrangements with local mental health counselors.

  • Food Bank: The contracted provider assists clients by purchasing food from the Concho Valley Regional Food Bank and delivering the food to clients. The Concho Valley regional food bank is accessible by anyone in the area, as is Project Dignidad, another local food bank. Meals for the Elderly is a food assistance program geared towards those over 65.

  • Housing: The Housing Opportunities for Persons with AIDS (HOPWA) grant provides short term, emergency housing assistance, and long term rental assistance. A person seeking assistance from HOPWA must first apply for Section 8 Housing Assistance through HUD. HOPWA funds may be used if the applicant is ineligible, wait listed, or unable to begin Section 8 assistance for any other reason. Other community resources include William’s House, a sober living facility that combines housing assistance and substance abuse recovery, and Christmas in April, which offers emergency housing assistance and home rebuilding services.

  • Transportation: The Concho Valley Council of Governments operates the regional transportation system and offers reduced rate bus passes to local agencies (TRANSA Urban for city use and Thunderbird Rural for individuals outside San Angelo city limits). Medicaid transportation is available to those with Medicaid, and the contracted provider offers bus passes, gas vouchers and taxi vouchers for medical and supportive services appointments when other sources are unavailable.

  • Health Insurance: There is not an insurance pool available specifically for PLWHA. There are some government programs that PLWHA may qualify for, including Medicaid, Medicare, and County Indigent Health Care programs. Case managers assist clients in determining eligibility and applying for these programs at entry into services, or as needed. Privately purchased individual policies for PLWHA are not common, however, some PLWHA do have individually purchased or employer sponsored private insurance or COBRA. Assistance with premiums, co-payments, and co-insurance are available through the contracted provider.


Summary of Current Care Resources: Temple – Killeen HSDA:


  • Outpatient /Ambulatory Medical Care: Temple, Texas is home to Scott & White Memorial Hospital (S&W). The hospital provides a large amount of primary and specialty medical care free of charge to PLWHA in the Temple – Killeen HSDA. To qualify for free or reduced cost care, the patient must meet with the hospital’s social worker to determine eligibility. The Scott & White Infectious Disease department provides HIV care to PLWHA. A Veterans Affairs hospital is also located in Temple for clients who are veterans or active duty military. . The Temple Community Free Clinic and the Greater Killeen Free Clinic also provide primary medical care. Metroplex hospital is another source of ambulatory care.

  • AIDS Pharmaceutical Assistance: The S&W Pharmacy can assist patients with accessing low to no cost medications, depending on income. The contracted provider, Central Texas Support Services, also makes payment arrangements with pharmacies throughout the HSDA for clients to fill prescriptions. Oral Health: Scott & White Dental Clinic provides much of the dental care for PLWHA in the HSDA, though the contracted provider is also exploring partnerships with other dental providers in the area.

  • Case Management: The contracted agency provides Non-Medical Case Management, Scott and White provides Medical Case Management through their Infectious Disease department, and those who receive Section 8 housing assistance also receive housing case management from HUD.

  • Substance Abuse Treatment: The Central Texas Alcoholic Rehabilitation Center is available for alcohol abuse treatment. The contracted agency has agreements with substance abuse treatment facilities Christian Farms, Meadows House, and Word of Life to take client referrals.

  • Mental Health: Central Counties Center for MHMR, Scott & White Mental Health Clinic, and Counselors of Texas all provide low or no-cost mental health services to PLWHA in the Temple-Killeen area. Referrals to these care resources have been so successful that additional funding for the provider to arrange private counseling for clients is not necessary.

  • Food Bank: The Temple, Killeen, Cameron and Bell County HELP (Health, Education, Leadership and Progress) Centers refer individuals to area food banks for assistance. There are several community-based organizations and charities in the area that operate food pantries and provide clothing and emergency financial assistance. The contracted provider also uses BVCOG funding to purchase nutritional supplements for clients.

  • Housing: The Housing Opportunities for Persons with AIDS (HOPWA) grant program provides short term, emergency housing assistance, and long term rental assistance. A person seeking assistance from HOPWA must first apply for Section 8 Housing Assistance through HUD. HOPWA funds may be used if the applicant is ineligible, wait listed, or unable to begin Section 8 assistance for any other reason. Families in Crisis provides emergency housing assistance. Martha’s Kitchen and Cove House both provide food and shelter for individuals who are homeless.

  • Transportation: The contracted provider assists with clients’ transportation needs through gas vouchers, taxi vouchers, and bus passes. If other means of transportation are not available or the client is not able to use public transportation due to medical reasons, the case manager may drive a client. Medicaid transportation is available to those with Medicaid,

  • Health Insurance: There is not an insurance pool available specifically for PLWHA. There are some government programs that PLWHA may qualify for, including Medicaid, Medicare, and County Indigent Health Care programs. Case managers assist clients in determining eligibility and applying for these programs at entry into services, or as needed. Privately purchased individual policies for PLWHA are not common however, some PLWHA do have individually purchased or employer sponsored private insurance or COBRA. Assistance with premiums, co-payments, and co-insurance are available through the contracted provider.


Summary of Current Care Resources: Waco HSDA

In addition to the contracted provider in Waco there is a charitable organization, the McLennan County AIDS/HIV Resources and Education Services (McCARES), which can assist PLWHA with emergency needs. If the contracted provider is unable to fulfill a need due to funding issues or other programmatic reasons, McCARES is generally able to assist.




  • Outpatient /Ambulatory Medical Care: The Family Practice Center in Waco is a federally qualified health center (FQHC) that sees patients on a sliding fee scale; due to capacity issues, they limit eligibility to residents of McLennan County. Primary care is also available through the Hillcrest and Providence health care systems in Waco and the Falls County Hospital and Clinic in Falls County. Those with HIV/AIDS outside of McLennan County are able to use Scott & White in Temple for HIV care. The Waco / McLennan County Public Health District (WMCPHD) can provide vaccination services through its immunization clinic.

  • AIDS Pharmaceutical Assistance: FQHC pharmacies are able to fill prescriptions for clients of the clinic. The provider also has existing payment relationships with several pharmacies used regularly by clients.

  • Oral Health: The WMCPHD dental unit is consulted first for clients. For residents that live outside McLennan County or have an existing relationship with an oral health care provider, payment arrangements can be made between the contracted provider and a dentist.

  • Case Management: The contracted provider, WMCPHD HIV/AIDS Services, is funded for Medical and Non-medical Case Management. Those receiving Section 8 housing assistance receive housing case management from HUD.

  • Substance Abuse Treatment: The Freeman Center is the primary source of in- and out-patient substance abuse treatment.

  • Mental Health: Due to a lack of capacity, the MHMR agency in Waco is only able to see clients with extreme need, such as debilitating psychosis or other similar problems. The Providence DePaul Center provides mental health services for at a reduced fee or for free for indigent individuals referred by MHMR.

  • Food Bank: CARITAS is a large community food bank that serves residents of the City of Waco. The Red Door is a food pantry that specifically serves PLWHA. Meals and Wheels delivers food to seniors and people with disabilities living in the HSDA. The contracted provider also receives a Food Bank allocation to purchase nutritional supplements to distribute to clients with a documented need.

  • Housing: The Housing Opportunities for Persons with AIDS (HOPWA) grant program provides short term, emergency housing assistance, and long term rental assistance. A person seeking assistance from HOPWA must first apply for Section 8 Housing Assistance through HUD. HOPWA funds may be used if the applicant is ineligible, wait listed, or unable to begin Section 8 assistance for any other reason. Falls County Samaritan Aid provides emergency housing assistance for residents of Falls County. The provider has also established relationships with several apartment complexes that determine client rent payments using a sliding fee scale based on income.

  • Transportation: County transportation systems, primarily busses, are available. Falls County Samaritan Aid will assist Falls county residents with transportation to medical appointments. The provider can also assist clients by distributing bus passes, gas, or taxi vouchers to use for medical appointments and supportive services when other resources are not available. Meals and Wheels also provides transportation to seniors and people with disabilities living in the HSDA.

  • Health Insurance: There is not an insurance pool available specifically for PLWHA. There are some government programs that PLWHA may qualify for, including Medicaid, Medicare, and County Indigent Health Care programs. Case managers assist clients in determining eligibility and applying for these programs at entry into services, or as needed. Privately purchased individual policies for PLWHA are not common however, some PLWHA do have individually purchased or employer sponsored private insurance or COBRA. Assistance with premiums, co-payments, and co-insurance is available through the contracted provider.

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