FY 24 Budget Q&A #002: How does the proposed budget reflect the memo Council endorsed last fall regarding protecting reproductive health services in Alexandria?
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Question: How does the proposed budget reflect the memo Council endorsed last fall regarding protecting reproductive health services in Alexandria? Are there any requests in that memo which would incur costs but which are not funded in this budget? (Councilman McPike)
Response:
City Council’s Resolution No. 3087 was adopted on June 28, 2022, and requested the City Manager to: (1) seek participation, as a plaintiff or amicus curiae, in on-going or future reproductive rights litigation, (2) review existing land-use regulations regarding the operating of a clinic providing abortion services and bring forward applicable Zoning Text Amendments to ensure unfettered administrative approval in any commercial or mixed-use zone; and (3) consider budget proposals to ensure the accessibility of reproductive services for residents (Attachment 1).
Since then, the City Attorney has contacted national abortion access advocacy organizations to inquire about potential litigation and indicate potential interest in future amicus brief opportunities. They are monitoring current litigation to see if there are any local government amicus groups forming and will continue to reach out if additional opportunities become available. This effort is not anticipated to have a budget impact for FY 2024. Planning and Zoning will bring the text amendment referenced in the resolution to hearing this spring, which is not anticipated to have a budget impact for FY 2024.
Following the adoption of City Council’s Resolution No. 3087, a November 22, 2022, memo from City Council requested further steps to protect access to reproductive choice and related services in Alexandria (Attachment 2). Information on current programs, efforts, and recent accomplishments for each of the requested steps is highlighted below.
(1)Create a dedicated page on the City’s website that provides accurate and clear information regarding how to access both reproductive health services in the city and financial support. Consult with a search engine optimization firm to ensure, to the greatest degree possible, that this page will appear at the top of search engine queries regarding these issues in the City.
a.Office of Communications and Public Information (OCPI): In response to Council’s November 22, 2022, memo, OCPI is developing a dedicated webpage focused on women’s reproductive health freedom. The objective of the page is to provide a central hub of information for individuals seeking these services. The content of this page will be curated using applicable City resources, supported by other municipal providers, and community partner services and offerings. Based on content appropriateness, the page will be linked to related pages such as the City’s Commission for Women under the Department of Community and Human Services (DCHS) page.
Currently, when searching related terms in Google, Bing, or Yahoo! (top 3 search engines), direct provider information results. Elevating the City’s curated page over direct-service providers is counterproductive to Council’s intent to secure timely community member access to services related to reproductive health freedom. Where appropriate and applicable, OCPI will promote and maximize visibility of a dedicated reproductive health freedom services page. Discussions with community partners and potential stakeholders as to how to responsibly and compassionately promote this page and similar resources with an aligned approach will be had to ensure the intentional and appropriate development of this page. The timeline for completion of this page is April 2023.
b.Alexandria Health Department (AHD): AHD is in the process of developing a hub for sexual and reproductive health information on the City’s website, featuring information and resources on Sexually Transmitted Infections (STI) prevention, reproductive health services, Alexandria data, and support activities. AHD will be including details on how to access contraception on this new sexual and reproductive health website, both from AHD and from other clinics serving people who are uninsured.
(2)Work with the women’s health providers in the City who offer services involving the termination of a pregnancy to ensure that their safety and security needs are as thoroughly addressed as possible, within the limits of existing Federal case law.
a.Alexandria Police Department (APD): APD will reach out and offer Crime Prevention Through Environmental Design (CPTED) Services to any women’s health center that requests our services. APD will meet to address these concerns and share any pertinent intelligence that is gathered though the INTEL Unit to ensure the safety of these providers.
(3)Work with the Alexandria Health Department to ensure access to emergency contraception (EC) at Health Department locations in the City, and to determine what the Teen Wellness Center would require to improve access to long-acting, reversible contraception (LARC).
a.Alexandria Health Department (AHD): Long-acting reversible contraception (LARC) requires skilled medical providers, such as nurse practitioners, to provide counseling, LARC insertion and LARC management. Increasing access within the ACHS Teen Wellness Center site would involve providing existing staff with additional training and supplies at a cost of $3,000 for two clinicians’ registration and associated travel costs plus $1,000 for procedure tools/clinical supplies. However, to increase access at AHD’s main location, as well as to provide for site expansion (such as with the future Minnie Howard TWC location), additional resources (personnel, medication, supplies) would be required.
AHD is actively working with Alexandria Campaign on Adolescent Pregnancy (ACAP) and Alexandria City Public Schools (ACPS) to determine how else to increase information and access to all sexual and reproductive health services for teens. This effort is part of a larger project that AHD will be focusing on in CY 2023 to create a framework for sexual and reproductive wellbeing across the lifecycle. AHD’s current supply of emergency contraception (EC) is funded by the federal Title X program, which has requirements to accept all presenting individuals regardless of jurisdictional residency status and for those individuals to undergo a lengthy patient registration and eligibility processes prior to receiving emergency contraception. A city-funded supply of emergency contraception would eliminate the significant administrative burden and delays for community members and enable an expedited version of walk-in EC services across health department clinics.
(4)Identify funding during the FY 2024 budget process to ensure access to emergency contraception, long-acting, reversible contraception (LARC), and reproductive health services in Alexandria, with a focus on low-income Alexandrians and Alexandrians without access to primary healthcare.
a.Alexandria Health Department (AHD): The FY 2024 Proposed Budget funds an administrative position at the Teen Wellness Center that would improve access to appointments and intake, as well as ensure that clinical staff are focused on providing care rather than completing paperwork. Additionally, the FY 2024 Proposed Budget adds a Health Equity Program Manager position to assist with achieving the vision of health equity through coordinated community engagement and outreach.
AHD identified the follow as areas where additional investments could be made in the future:
i.Expanding access to LARCs and EC would require an increase in clinical provider availability and the coverage of costs for LARC and EC medication and supplies, as well as community engagement, to build equity into programming and communications.
ii.While AHD clinics are open to all Alexandrians, its Sexual and Reproductive Health clinics are funded through the federal Title X program, for which there are variable inventory restrictions. An increase in the availability of medications funded through the City would assist access to no-cost walk-in EC services for City residents. Using current AHD dispensing and visit information as a basis to mirror and the commercial range of $40 to $50, then increasing oral EC medication availability by 100% would have a cost range of $23,200 to $29,000.
iii.An additional health department nurse practitioner ($151,638.93) would be necessary to expeditiously provide the required skilled clinical services for LARC and EC. The additional clinical staff would also ensure continued, stable access to reproductive health services during public health emergencies, when AHD staff diversion to emergency response and clinical service reductions would otherwise be enacted.
iv.Access to medical homes for quality primary health care is vital for long term, sustained health and wellness, including in regard to sexual and reproductive health. While AHD does not provide primary care services, the health department provides referrals to community providers, such as local federally qualified health centers, who have designed capacity to accept uninsured residents.
