The Mental Health Services Act – Then and Now

For a variety of reasons, I am being asked much more than ever about the thinking behind various provisions of the mental health services act when we are writing it in 2003 and how that relates to some of the challenges we now have.

Not surprisingly, most of the challenges we now are seeing involved issues we anticipated when we wrote the Act.  We have posted all of the preliminary drafts of the MHSA on our website in case anyone is curious about how the language evolved from the first draft in May 2003 to the final language in September.

The Act still looks like it correctly identified what was needed to fulfill our goals.  But many parts of it have not been implemented the way it was envisioned and a lot has changed from what we knew in 2003 when it was written. In 2006 I had a different way of viewing how would be implemented and significantly underestimated how challenging it would be for state agencies to regularly update regulations which I thought could be an ongoing process with updates every three years. I also significantly underestimated the delays and challenges in developing outcome data.

In this blog I will speak to some of the issues and some of the solutions.  Mostly what is required is a recognition that we have not revisited the guidelines (which led to regulations), all of which were developed before the applicable parts of the act had been implemented.

Now that we have had many years of implementing each part of the act is time to revisit the guidance (leading eventually to updated regulations) through a series of separate workgroups, that can move us more firmly in the direction that I think we all know is where we need to go.

Continue reading The Mental Health Services Act – Then and Now

AHCA approved by House. What does its passage mean in California?

Last week the House of Representatives passed the American Health Care Act by the narrowest of margins, with all Democrats and 20 Republicans voting no.  It succeeded because of amendments to satisfy the so-called “Freedom Caucus” of very conservative Republicans who objected to the bill in March because it left too much of the Affordable Care Act intact.

The key amendment was to allow states to eliminate pre-existing condition protections replacing that with high risk pools that could be subsidized with federal funds.

The focus on pre-existing conditions got all the news media attention and certainly will adversely affect people with mental illnesses and substance use disorders both of which would be considered pre-existing conditions – even if the only treatment was one or two visits to a therapist, or a single prescription for an antidepressant. Continue reading AHCA approved by House. What does its passage mean in California?

Another Attempt to Weaken the Affordable Care Act

Another Attempt to Weaken the Affordable Care Act?

Grassroots advocacy is making a difference.

As widely reported, there is a new version of Trump care/House Republican efforts to weaken the Affordable Care Act (ACA).  The changes give states additional freedom to eliminate protections for people with pre-existing health conditions. Anyone who has ever received a prescription for an antidepressant or seen a therapist is considered one of those high risk individuals. The new bill also authorizes elimination of 10 essential benefits.  These include behavioral health as well as habilitation and rehabilitation services important to people with behavioral health problems.

All of the Medicaid cuts there were in the original proposal are still there. The changes satisfied the so-called freedom Caucus of extreme conservative Republicans.  On the other hand it has strengthened the opposition of so-called moderate Republicans.  Here is a brief presentation summarizing the status of this effort and other related possible health policy changes. Note especially the charts on pages three and 13.

When the original bill was considered last month all 14 California Republicans were reported to be in support. Now we have heard that Congressman Jeff Denham from the northern San Joaquin Valley is not supporting the bill.  This means that the grassroots efforts of organizations like ours are making a difference. See Sacramento Bee Article.

Unless the bill has been passed by the house before you read this, those of you who provide services in areas represented by Republicans in Congress should redouble your efforts to remind these members of the consequences of cuts in behavioral health services and access to insurance which includes these benefits.

There has never been a time when there’s been so much public attention on how health care systems work. This is the time for all of you to continue to expand your efforts to educate your political leaders and build relationships that will impact policy support beyond this year. These efforts will pay off, even if it doesn’t appear that way in terms of immediate change of position.

Continue reading Another Attempt to Weaken the Affordable Care Act

GOP Health Care Proposal, No Place Like Home, and Vancouver Youth Center

Congressional Budget Office slams Republican healthcare proposal. More people lose health insurance than gained it under Affordable Care Act.

The analysis that came out Monday from the CBO confirms the views of healthcare experts and state officials. Moreover, it only covers impacts through 2026. My analysis suggests that over 20 years most states will find it impossible to continue the Medicaid program as the block grant spending cap gets tighter the gap between Medicaid costs and federal funding grows. If that happens, the number who lose insurance could eventually be double the numbers in this estimate. Continue reading GOP Health Care Proposal, No Place Like Home, and Vancouver Youth Center

Signs of Hope

Signs of Hope – from leading national behavioral health policy advocate Chuck Ingoglia

At CCCBHA’s February membership meeting we were fortunate to have Chuck Ingoglia of the National Council for Behavioral Health as a presenter.  There is probably no one in behavioral health closer to the action in Washington DC and better positioned to make our case.  He had good news to report in that there is growing support for maintaining federal support for behavioral health.  He noted that everyone’s advocacy is making a difference and that the more extreme potential funding cuts are less likely to be enacted. Continue reading Signs of Hope

A Long Strange Trip – and About to Get Stranger

I have been lobbying since 1977, and with CCCBHA since 1986, and in all of those years there has never been one like 2017. One where Sacramento is totally consumed by what will, or will not, happen in Washington DC and what it might mean.

Our agencies are impacted by what it means for Medicaid, and the state and counties will act with that looming shadow.  Immigration policies create threats for many families we serve. For many of us and our staff, we have personal concerns that go beyond any of these specific issues.

These fears and uncertainties are so big that they are now part of every meeting and conversation. What we can do about it must take precedence over everything else. So, all of my blogs this year will start with this subject and my latest thinking. Continue reading A Long Strange Trip – and About to Get Stranger

Proposition 64 Funds Can Close Gaps in Realignment and MHSA Funding and Structure

Proposition 64 (Marijuana Legalization) directs 60% of its funds to “Education, Prevention, Early Intervention and Treatment” for substance use disorders including related services such as mental health for youth and their families.

The measure includes a page or more of detail on how the funds “could” be spent, but from my reading this is the only specific limitation on how it must be spent. Youth is not defined, which leaves that up to the legislature which should define it as primarily ages 12-25 with prevention and early intervention for younger children and the “and their families” including parents.

The estimates on the amount of tax on marijuana sales revenues from this portion of the measure range from $300 million to $800 million – with $500 million as a best guess for the first year (2018-19). We then expect revenues to rise in future years.

This is a very significant level of new funding – nearly as much as the original funding from Proposition 63 of 2004 (The Mental Health Services Act) and more than half as much as the original mental health sub-account of 1991 realignment or behavioral health subaccount of 2011 realignment. Continue reading Proposition 64 Funds Can Close Gaps in Realignment and MHSA Funding and Structure

Election Over . . . Now What?

Wow is this country divided!!! California voters approved four statewide tax extensions or increases and many local property taxes and strengthened the already total Democratic Party control of the legislature while at the same time the majority of states gave Republicans the White House and re-affirmed their control of both houses of Congress.

So what will this mean for community behavioral health care in California?

Continue reading Election Over . . . Now What?

MHSA Now and Then: Need for Comprehensive Needs Analysis and Planning

For the past year I have been participating in a work group regarding Older Adults focusing on the extent to which the Mental Health Services Act (Prop 63/MHSA) has resulted in developing a system of care for that population. Recently I was interviewed, mainly in my capacity as a co-author and principal drafter of that law with questions about our expectations, how it is going, and what needs to happen.

Continue reading MHSA Now and Then: Need for Comprehensive Needs Analysis and Planning

Counties’ Housing Ballot Measures Important to Mental Health

As we look toward the November election, all eyes seem to be on the presidential race, but some are focused on the high profile state initiatives – such as Proposition 64, which legalizes marijuana and provides funding for substance abuse treatment.

Four Bay Area Counties’ Housing Ballot Measures Very Important to Mental Health

However, four bay area housing bond measures may turn out to be the most important issues impacting mental health service funding and housing. They would free up mental health funds that might otherwise have been needed for housing and, even more importantly, act as a catalyst for more similar measures. Any new funding to support people who are homeless will help the Mental Health Services Act (MHSA or Prop 63) in achieving its primary goal of serving everyone with a severe and disabling mental illness – by reducing the pressure to use MHSA funds for housing.

Continue reading Counties’ Housing Ballot Measures Important to Mental Health

Rusty Selix – California Leader in Mental Health Policy Issues and Co-author of Proposition 63