Every year, the Philadelphia EMA Ryan White Planning Council (RWPC) hosts three Allocations meetings for each region in the Eligible Metropolitan Area (EMA) to plan its budget for the next year. One meeting is for the New Jersey counties (Salem, Camden, Gloucester, and Burlington), one is for the PA suburban counties (Bucks, Chester, Montgomery, and Delaware), and the third is for Philadelphia County. Each region receives a portion of the total EMA's funding that reflects their share of the HIV/AIDS epidemic, based on the most recent data available.

At the Allocations meetings, each region makes a plan for how they would spend their portion of the funding if the EMA received the same amount of money as last year, if they received a 5% decrease in funding, and if they received a 10% increase in funding. These plans are for the fiscal year that begins on March 1 of the next year. Each region can also make instructions to the grantee (the AIDS Activities Coordinating Office, or AACO) at its meeting.

After these three meetings, the Finance Committee of the Ryan White Planning Council (RWPC) meets to review each region's plan, including any instructions to the grantee. The Finance Committee can choose to recommend, recommend against, or make no recommendation on these plans (although the Finance Committee almost always recommends the regional plans with no changes). The Finance Committee then presents the allocations plans from all three regions to the RWPC, who then votes on the plans and the instructions to the grantee.

The allocations plans for next year were based on the 2009 number of living HIV/AIDS cases in each region. Based on this data, the PA suburban counties represent 14.20% of living HIV/AIDS cases in the EMA, while the New Jersey counties represent 10.55% of cases and Philadelphia represents 75.25%. These shifts provided the starting point for each region's decision-making.

Here's the breakdown for each region.

Philadelphia
Level-funding budget: Philadelphia chose to keep all services funded at the same levels in the case of level funding.

5% decrease budget: Philadelphia chose to spread a 5% decrease proportionally across all service categories (based on their level-funding budget).

10% increase budget: Philadelphia chose to give core service categories a 9% increase (based on their level-funding budget), while giving supportive service categories an additional 1% increase on top of their other 10% increase.

Instructions to the grantee: Philadelphia instructed the grantee to provide utilization data (to the Comprehensive Planning Committee) and expenditure data (to the Finance Committee) for the current and previous fiscal years. Philadelphia also instructed the grantee to clarify whether there were any organizations that provided treatment adherence services, but did not provide medical case management services.

PA Suburban Counties

Level-funding budget: The PA suburban counties chose to keep all services funded at the same levels in the case of level funding.

5% decrease budget: The PA suburban counties chose to spread a 5% decrease proportionally across all service categories (based on their level-funding budget).

10% increase budget: The PA suburban counties chose to spread a proportional increase across all service categories with the exception of transportation and drug reimbursement (based on their level-funding budget), because these categories had been underspent. They instructed the amount of the increase that would otherwise go to transportation and drug reimbursement (approximately $53,746) be placed into other categories as follows:

• 25% into medical case management
• 25% into ambulatory care
• 50% spread across all remaining service categories

Instructions to the grantee: The PA suburban counties instructed the grantee to analyze outreach services in Chester city, with the results reported to the Comprehensive Planning Committee.

New Jersey Counties
Level-funding budget: The New Jersey counties chose to move funding from food bank/home-delivered meals (leaving a $5 placeholder) into state ADAP, as there were no providers currently able to provide food bank/home-delivered meals and the state ADAP program had received cuts.

5% decrease budget: The New Jersey counties chose to spread a 5% decrease proportionally across all service categories (based on their level-funding budget).

10% increase budget: The New Jersey counties chose to spread a 10% increase proportionally across all service categories (based on their level-funding budget).

Instructions to the grantee: The New Jersey counties instructed the grantee to review the efficacy of the medical case management model (to be reported to the Comprehensive Planning Committee), and to possibly expand the model to include triage.