All posts by rustyselix

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.

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 they were envisioned and a lot has changed from what we knew in 2003 when it was written.
Continue reading Mental Health Services Act: Then and Now

Biggest Highlights for This Year Are the Things That Didn’t Happen

“Repeal and Replace” And AB 1250. Those Threats Remain For 2018

2017 has been a year of positive stock market gains in a healthy California economy. The national economy is also doing well. Normally, in good economic times, our focus is on the opportunities created by unanticipated tax revenues from which we hope to get a portion dedicated to help improve behavioral health care services and facilities.

State Budget and Legislative Successes Mental Health Service Act

(MHSA) revenues are estimated to be up by $200 million which should provide growth in county programs. We had success in the earmarking of the growth in state administrative fund MHSA dollars, which are 5% of the total. Most went to a youth crisis care system which should see grant opportunities for counties and providers released from the California Health Facilities Financing Authority in the next few months. We also supported the Community College Mental Health Pilot Program, recognizing this is a key population for Prevention and Early Intervention with a large percentage being Medi-Cal recipients at many campuses, and others now obtaining insurance through the affordable care act or their parents- neither of which used to be possible. Continue reading Biggest Highlights for This Year Are the Things That Didn’t Happen

Growing Washington bipartisanship on many issues gives hope for healthcare future, but everything is still at risk.

Last week the US Senate began hearings on a bipartisan effort to provide greater short-term or moderate term stability to the health benefit exchanges which depend upon federal subsidies to provide affordable health insurance to individuals who do not qualify for Medicaid or employer insurance.

These exchanges also depend upon the mandate that everyone must pay at least part of their health insurance if they have above Medicaid incomes, which is the single part of the Affordable Care Act that Republicans have most strongly campaigned to eliminate. Continue reading Growing Washington bipartisanship on many issues gives hope for healthcare future, but everything is still at risk.

What Happens Next in Washington DC?

Right now it is hard to think about anything beyond the president’s unbelievably offensive statements made on Tuesday in response to the Charlottesville protests and Neo-Nazi terrorist attack that killed one woman and injured many. The statements were broadly condemned by both Republican and Democrat congressional leaders. But what impact will this have on policy? Continue reading What Happens Next in Washington DC?

The State budget has more good news than bad, but federal uncertainty is still the elephant in the room

In discussing this year’s state budget most of our attention has gone to the re-realignment of in-home support services back to counties in a form that will divert $36 million of realignment funds that otherwise would have gone to mental health – and increasing amounts in future years the could total as much as $200 million annually after six years – unless there are changes made to this legislation. Viewed in total dollars at risk over the long term this action alone makes it a bad budget year for mental health and substance use disorders.  But in terms of advocacy and support we got just about everything else we were seeking, so we have to view the budget overall in a positive way similar to the press release that the County Behavioral Health Directors Association recently sent out.

At the start of 2017, CCCBHA’s highest priority was to secure funding for the children’s crisis care system. This had been approved in the 2016-17 state budget. But in presenting his 2017-18 budget Governor Brown eliminated $17 million in funding for that program, as well as $67.5 million for mental health and substance use disorder services and facilities for people discharged from state prisons. Continue reading The State budget has more good news than bad, but federal uncertainty is still the elephant in the room

AB 1250; Prop 63 and 64; School Mental Health

AB 1250 (Jones- Sawyer): Extreme limits on County contracting.  This is the biggest threat ever to member agencies. Strong opposition seems to be making an impact, but the outcome is uncertain.

By now all members should be familiar with this SEIU and ASFCME sponsored bill which would make it virtually impossible for counties to continue to contract out for the types of services our members provide. Continue reading AB 1250; Prop 63 and 64; School Mental Health

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