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42 Alameda Countywide Homeless and Special Needs Housing Plan to Care Collaborative received a $900,000 grant to address avoidable or unnecessary emergency room utilization at Alameda County Medical Center's Highland Hospital Campus in Oakland during a three-year period.8 In March 2004, Alameda County voters approved Measure A, which adds a half-cent sales tax to maintain emergency and trauma medical services throughout the county and to provide primary, preventative and mental health services to indigent, low-income, and uninsured children, families and seniors. The Board of Supervisors is allocating a portion of the funds (up to twenty-five percent) throughout the county to hospitals, clinics, and community-based organizations to pay for medical, mental health, substance abuse services and uncompensated emergency care. Context for HIV/AIDS Housing and Services Alameda County's HIVlAIDS Housina and Service System Todav The HIV/AIDS services system has an ongoing planning function in the form of the Collaborative Community Planning Council (CCPC). The HIV/AIDS housing system last formulated a comprehensive HIV/AIDS housing plan in 1996 with the Alameda County Multi-Year HIV/AIDS Housing Plan, and completed an update to that plan in 1998. As a part of the successful implementation of that plan, Alameda County developed two new programs, Project Independence and the AIDS Housing Information Project, and received a "Best Practice" award from HUD. Alameda County's current HIV/AIDS housing and service system is supported primarily by two federal programs: HUD's Housing Opportunities for Persons with AIDS (HOPW A) program and the Ryan White CARE Act, a program of the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). Alameda County is a part of the Oakland metropolitan area, which has received a HOPW A grant annually since 1992. HOPW A funds are awarded to the largest city in a metropolitan area to administer for the region; in this case, funds go to the City of Oakland, and the City of Oakland has contracted with Alameda County's Housing and Community Development Department (HCD) to administer funds in Alameda County. HCD has used these HOPW A funds for the development of emergency, transitional, and permanent housing, as well as related support services, following the recommendations and strategies of the HIV/AIDS Housing Plan. In 2004, Alameda County received $1.8 million in HOPW A funding. Project sponsors annually apply to Alameda County HCD for HOPW A funds through a competitive RFP process. Alameda County has an additional HOPW A grant that supports Project Independence, which provides partial rent subsidies, support service coordination, and accessibility improvements to people living with HIV/AIDS who are at risk ofhomelessness. Development Agency, City of Oakland Human Services Department and Oakland Police Department, Alameda County Sheriff's Office, and Alameda County Behavioral Health Care Services. 8 Ibid. In 2002-2003, the most common diagnoses for this population were alcohol.related mental illness, cellulitis related to injection drug use, pain, chronic illnesses (such as diabetes, epilepsy, asthma), and injuries. Two-thirds of these patients received treatment in the Emergency Department (ED) for a psychiatric or drug/alcohol-related illness. Over a three-year period, 84 percent had been admitted for inpatient care, 33 percent had used the psychiatric emergency department, and 20 percent had been admitted for inpatient psychiatric services.