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Update on Mental Health Policy Issues. June 2007 Presentation by Rusty Selix Executive Director California Council of Community Mental Health Agencies (CCCMHA). Congress – Mental Health Parity. Chance to pass Mental Health Parity Impacts large employers exempt from state laws - PowerPoint PPT Presentation
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Update on Mental Health Policy Issues
June 2007 Presentation by Rusty SelixExecutive DirectorCalifornia Council of Community Mental Health Agencies (CCCMHA)
www.cccmha.org
Congress – Mental Health Parity
Chance to pass Mental Health Parity Impacts large employers exempt from state
laws Full Mental Health Parity Substance Abuse Parity Senate Bill Pre-empts State Laws No adverse impacts in California House bill is more certain but unacceptable to
interests needed to get 60 votes in Senate
www.cccmha.org
CMS/Rehab Option Restrictive Medicaid Philosophy Rehabilitation Option Definitions Telephone advice to states Rehab limited to improvement to a former
state of being Can’t be maintenance Can’t be a skill you never had Proposed Regs expected soon Home and Community Based Services
Option – Iowa example gives hope!
www.cccmha.org
Home and Community Based Services Option -HCBS Authorized in deficit reduction act (DRA) Available January 1, 2007 No guidance regs yet Iowa just approved Broader benefits for defined pop - SMI/SED States can cap # eligible Not a waiver – need not be cost neutral Permanent state plan amendment DMH-CMHDA Interested
www.cccmha.org
Services to Veterans?
Iraq war returnees with PTSD overwhelming VA capacity
Funding and authority to refer to other providers
CMHCs doing this in other states Contract or fee for service CCCMHA north and south committees
www.cccmha.org
California Healthcare Reform
Six million uninsured Schwarzenegger, Kuehl, Perata, Nunez All have legal and political problems Pressure to do something Mental Health benefits protected Guaranteed right to coverage –pre-
existing condition limit overcome
www.cccmha.org
Prison Overcrowding
170,000 in system – double capacity # and % of California prisoners with
serious mental illnesses growing faster 80% Recidivism Rate 1998 – 16,000 – 11% 2003 – 25,000 – 16% 2006 – 34,000 – 20%
www.cccmha.org
Prison MH Reform – SB 851
Prop 63 will eventually serve everyone in harm’s way
Provide AB 34 Recovery Services Homeless Outreach to Prevent Crime MH Courts - Diversion to reduce incarceration In Prison Rehabilitation, AB 2034 for parolees phased in State pays for parolees – counties fearful
www.cccmha.org
Co-Occurring Disorders?
Alcohol and drug with mental illness Expectation not an exception Fully cover in public and private plans? Bill A/D under EPSDT? Train professionals to be able to do both Require integrated services Co-locate with Primary Care? Report to MHSOAC in July
www.cccmha.org
2007- 08 Budget
Estimated permanent $5 Billion Deficit Prop 63 Revenues Exceed Projections $55 million AB 2034 - Restored? SSI/SSP COLAs? AB 3632 fully funded – not discussed EPSDT back payments over 3 years EPSDT $$ up - Realignment $$ up?
www.cccmha.org
AB 3632- What is funded?
$69 million formula via Dept of Education for 06-07
Add’l Funds to fully pay claims for 06-07 Add’l Funds to pay most 07-08 claims Total won’t be known until several months
into 07-08 and not due until 08-09 No new Funds for 00-01, 01-02, and 02-03
claims to be repaid over 15 years
www.cccmha.org
EPSDT Audits Extrapolation limited to error rate over 5% Retroactive to 04 and 05 audits 75% of audits – no extrapolation New appeals to address clerical errors and
other adjustments – not yet settled Cases kept open Each audit only one service function
Extrapolation to 90% confidence- Final guidance manual nearly done
www.cccmha.org
Proposition 63 Revenues Up!!!
Revenue by Year
Prop 63 estimates in 2003
Current State Projections
Excess above estimates
Available Funds
05-06 $680 m $1.1 B $420 m $680
06-07 $690 m $1.6 B $910 m $690
07-08 $730 m $1.8 B $1.070 B $1.15 B
www.cccmha.org
Future Resources to spend
Three year plans 09-10 to 11-12 Estimated average - $2.4 Billion More than double original projections Assumes 10% annual revenue growth Conservative compared to current trends Original Projection was 7% annual growth Cuts in other funding and programs Supplantation??
www.cccmha.org
Realignment – Adult CSS/otherNON MHSA FOR ADULT COMMUNITY CARE VS. EXPENSES FOR 5150 AND OTHER
MANDATORY NON MHSA COSTS
$0
$500,000,000
$1,000,000,000
$1,500,000,000
$2,000,000,000
$2,500,000,000
2006
- 20
07
2008
- 20
09
2010
- 20
11
2012
- 20
13
2014
- 20
15
2016
- 20
17
2018
- 20
19
2020
- 20
21
2022
- 20
23
2024
- 20
25
YEARS
DOLLARS
Non MHSA for Adult Community Care
Expenses for 5150 and Other Mandatory nonMHSA Costs
www.cccmha.org
Supplantation Issues
MHSA says only for increases - no cuts No exceptions DMH emergency regs - “required” $$ Exempts overmatch + realignment transfers Permanent regs pending Office of Administrative Law review Legal challenges MHSOAC says it could withhold $$
www.cccmha.org
Adult CSS RevenuesMHSA AND REALIGNMENT FUNDS CHART 2006 - 2025
$0
$1,000,000,000
$2,000,000,000
$3,000,000,000
$4,000,000,000
$5,000,000,000
$6,000,000,000
2006
- 20
07
2008
- 20
09
2010
- 20
11
2012
- 20
13
2014
- 20
15
2016
- 20
17
2018
- 20
19
2020
- 20
21
2022
- 20
23
2024
- 20
25
YEARS
DO
LL
AR
S
MHSA Funds Available for Adult CSS
MHSA Funds Incoming Share for Adult CSS
Realignment and Other non MHSA Revenues (excluding funds earmarked for EPSDT or AB3632)
Expenses for 5150 and Other Mandatory nonMHSA Costs
Non MHSA for Adult Community Care
Regular Estimate CSS Adult Need
Highest CSS Adult Need
www.cccmha.org
Adult CSS $$ - MHSA vs RealignmentADULT COMMUNITY CARE
$0
$500,000,000
$1,000,000,000
$1,500,000,000
$2,000,000,000
$2,500,000,000
$3,000,000,000
$3,500,000,000
$4,000,000,000
$4,500,000,000
20
06
- 2
00
7
20
07
- 2
00
8
20
08
- 2
00
9
20
09
- 2
01
0
20
10
- 2
01
1
20
11
- 2
01
2
20
12
- 2
01
3
20
13
- 2
01
4
20
14
- 2
01
5
20
15
- 2
01
6
20
16
- 2
01
7
20
17
- 2
01
8
20
18
- 2
01
9
20
19
- 2
02
0
20
20
- 2
02
1
20
21
- 2
02
2
20
22
- 2
02
3
20
23
- 2
02
4
20
24
- 2
02
5YEARS
DO
LL
AR
S
Non MHSA for Adult Community Care
MHSA Funds Available for Adult CSS
www.cccmha.org
Prop 63/Mental Health Services Act (MHSA)
Community Services and Supports
Capital Facilities and Technology
Education and Training
County Planning
Prevention and Early Intervention
State Administration
County Administration
Innovative Programs
Reserves
www.cccmha.org
Full Service Partnerships
Not well understood by some counties 24-7 and include dually diagnosed Housing for those not clean and sober Outcome oriented Independent living and employment Not limited to high need clients Physical health and wellness early death, smoking, diet, exercise
www.cccmha.org
FSP for Kids + EPSDT/3632
Most high need kids get EPSDT/3632 Won’t pay for all needs Respite care and other family support Alcohol and drug? 3632 Crisis care Case rate to supplement EPSDT/3632 Can have risk/reserve factor
www.cccmha.org
Education and Training
Stipends to attract/retain Loan Forgiveness Academic program expansion and
improvement of curriculum Attract high school students Employ consumers and family members Retraining staff Fair share for private providers!
www.cccmha.org
Education and Training
$500 million through 2007-08 Some Funds remain with state Based upon county needs State prepares five year plan Draft state plan due in June Some funds available in 07-08 Additional funding for future years
www.cccmha.org
Capital Facilities and Technology $500 million through 2007-08 Formula distribution –not yet announced Very flexible eligibility Must relate to providing eligible services Technology likely to be web based open
system that can be used in all counties and by all providers
Additional funding through plans for future Fair share for private providers!!
www.cccmha.org
Innovative Services
5% of what a county receives for CSS + PEI County proposals must be approved by
Oversight and Accountability Commission Commission Developing Guidelines Funds expected in 2008 Ideas may be developed locally or at state Can’t be something already widely done
www.cccmha.org
Prevention and Early Intervention
PEI State first draft guidelines/regs out soon OAC – jump start Higher Ed/Schools Respond to Virginia Tech Broad competitive grants to institutions Develop strategic plan? Stigma and Discrimination Statewide media campaign informed by
political consultant Suicide Prevention Committee and set aside
www.cccmha.org
Prevention and Early Intervention - concepts Take steps to get help as soon as possible
after someone exhibits symptoms that could be or become a severe mental illness or a serious emotional disturbance
Make sure it happens before someone has hit rock bottom or been hospitalized
Requires education and outreach to those in a position to recognize that someone near needs help
www.cccmha.org
Changing Attitudes through Early Intervention Identify and treat schizophrenia in first few
months – “Early Psychosis” began in Australia
Back to work or school within a year Save $$ and shift to private insurance Educate 15-25 year olds, their families and
primary care about symptoms and value of treatment and how to access it
Outreach/education $1 per capita per year Expanding to Bipolar and Depression
www.cccmha.org
Help for schools and kids
Teachers know who SED/at risk kids are
Need referral system/on campus help Early treatment costs hundreds vs
thousands Increases attendance and graduation Reduce teacher burnout Reduce out of home placements
www.cccmha.org
Prevention and Early Intervention Minimum 20% of funds – starting in 2008 $200 per year for 2 years $400-600m after Formula distribution State must develop new program State process through summer County planning in fall/winter County plans must be approved by Oversight
and Accountability Commission
www.cccmha.org
This is totally new
What are the most likely programs? Who will be the providers? What other funds will be leveraged? What will each program cost? How many people can be served? What results are we looking for? How will we measure what is achieved?
www.cccmha.org
Planning process
(1) State establishes program and planning requirements – statewide stigma reduction and suicide prevention $$ and plans
(2) Develop County Plans with expanded stakeholder participation
Within each community each setting and age group may require a different set of strategies
Not all expected to be included at first(3) Review and approval by Commission
www.cccmha.org
CCCMHA Priorities?
Early Childhood? Early Psychosis? School Based Programs? Suicide Prevention? Outreach to elderly/primary care? Outreach to Latino/Asian communities? Other??
www.cccmha.org
www.dmh.ca.gov/mhsa
Situation constantly changing Unprecedented level of stakeholder
participation All materials posted on DMH website Sign up to get notice of new materials www.cimh.org – county specific info
www.cccmha.org
Remember how special this is
Transformation of a large public mental health system won’t happen overnight
Take the time to get it right Don’t delay the things we know should
be done Appreciate the broad and diverse
participation Be assertive and patient
