Fulton County overhauls process after poor handling of HIV grant

The scope of the problem was clear: Among metropolitan areas, Atlanta ranked fifth in the nation in the rate of new HIV diagnoses.

But last year, Fulton County officials found themselves in the embarrassing position of having to return millions of dollars of grant money intended to pay for HIV testing and prevention programs. The reason? They hadn't spent the funds, from the Centers for Disease Control and Prevention, in a timely fashion.

Hoping to prevent that from ever happening again, the county overhauled the way it handles grants. While there are still improvements to be made, early indications are the changes have been a success, with more oversight and tracking of how money is being spent, officials say.

"It did damage to our credibility with the community and with the CDC," County Manager Dick Anderson said, referring to the bungled grant. "I think we're feeling good about our grant administration now. … All arrows are pointing in the right direction."

The fixes mean the county can move faster to spend the money it has on hand. At the same time, Fulton is using its changed process as an opportunity to seek more grants and, toward that end, is tracking applications and rejections for the first time.

The $28 million grant from the CDC required the county to spend money by certain deadlines. When the county’s internal tie-ups slowed the process and delayed the grant’s implementation, Fulton forfeited nearly $9 million by missing those deadlines. The county was able to recoup about $3.4 million.

The HIV grant wasn’t the only one mishandled. Fulton also failed to properly monitor more than $5 million in grant money for housing, employment and other services.

Since then, the county has taken several steps to increase communication among those who handle grants and with the community partners it relies on, for example, those who provide HIV testing. So far, it appears to be working.

In 2014, the county spent 74 percent of the HIV grant money, and less in previous years. But after returning part of the money last year, then implementing the changes, the county spent 92 percent of the funds available that year. Using grant money, the county conducted 61,000 HIV tests and distributed more than 2.5 million condoms in an effort to prevent HIV transmission, said David Sarnow, Fulton’s deputy health director. His goal is to spend 98 percent of the money this year and conduct 100,000 tests.

It is typical that 100 percent of a grant is not spent, due to the difficulties involved in having everything ready to go the day a grant is given, Sarnow said.

After Fulton County's issues came to light, Sarnow said, the CDC paid closer attention to Fulton's spending to ensure improvements were being made, calling every two weeks and adding steps to confirm the county was succeeding in its changes.

But as Fulton demonstrated its overhaul was working, Sarnow said, the county regained some trust.

“Personally, I’m really pleased with what the program has done,” he said.

Jeff Graham, the executive director of Georgia Equality, is a member of the task force that oversees the grant. He said the improvements have been “miraculous” for a program that was in crisis just last year.

“I’ve never seen something move this quickly with this many changes,” he said. “The turnaround is amazing.”

After the issues with the HIV grant, Fulton put its chief financial officer, Sharon Whitmore, in charge of administering grants, a job that was done department-by-department in the past. When grants are awarded, meetings are held to discuss requirements and deadlines, increasing accountability, grants management officer Angela Ash said.

Even before an application is made, Whitmore said, Ash participates in planning, so she is aware of what a grant might require.

Whitmore said the county is following up about grants it did not receive, something it had not done in the past. County departments now have strategic plans for what they hope to get from grants.

“I think we’re finally off to the right start,” she said. “We’re really making progress in the right direction in a lot of different ways.”

The county has also sped up the application process by allowing Anderson to sign off on requests. Previously, the board of commissioners had to approve grant applications, which meant many potential grants went unapplied for as county meetings didn’t align with application deadlines.

The changes, Whitmore said, have been “a long time in the making.”

The county averages between $80 and $90 million in grants annually, Whitmore said, but is becoming more aggressive in its grant-seeking, too.

“Even increasing it by 5 percent each year, that would be an accomplishment,” she said. “Would we like to see it double? Sure. Whatever resources we’re getting, we have a plan to spend it, and that’s what was most significant.”