Category Archives: Medicaid and Medi-Cal

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

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

Shedding Light on County Behavioral Health Finances

I was fortunate to have two outstanding summer interns from the University of California: Monica Venegas and Deepika Dilip. They produced this report which is now as complete as it is going to get, so it is time to share what they found and provide some explanation.

Since this is not a formal report, but intended only to provide a meaningful snapshot of what information was available, I asked them only to develop information on the 20 largest counties (by population). While this excludes 38 counties it does cover about 95% of the state’s population and behavioral health funding.

Continue reading Shedding Light on County Behavioral Health Finances

Behavioral Health Revenues Rise – November Ballot Measures of Interest

County behavioral health revenues continue to rise. Many counties are budgeting for significant spending increases for 2016-17

My summer interns were asked to contact the state’s twenty largest counties (by population) to ascertain behavioral health revenue and spending information for 2014-15, 2015-16 and 2016-17.  They started by looking online and then contacted county officials to obtain more information.  They reported more success in obtaining this information than had previously been experienced by most mental health stakeholder organizations, which had expressed frustration in the lack of readily available information online.  The key to their success seems to have been contacting county budget offices instead of behavioral health departments. Continue reading Behavioral Health Revenues Rise – November Ballot Measures of Interest

Governor Signs Funding for Certified Community Behavioral Health Centers

April 11 – Governor signs AB 847 (Mullin) – Funding for Certified Community Behavioral Health Centers

  • 30% increase in federal matching funds for outpatient behavioral health
  • Improved and streamlined way to receive federal funds
  • Counties must elect to participate and be certified by state
  • State must be selected as a participating state; odds are good that this will happen
  • Lots of work between now and October 31 Deadline for submittal of the state plan

AB 847 appropriates $1 million to enable DHCS to develop a California proposal to participate in the federal Certified Community Behavioral Health Centers (CCBHC) program.

California is one of 24 states receiving a planning grant in October 2015 to develop a proposal to submit in October of 2016. Under current federal law, eight states will be selected to begin a two year demonstration program. These programs will show that increased federal investment in outpatient behavioral health will pay for itself in reduced physical health and behavioral health inpatient and other costs.

Continue reading Governor Signs Funding for Certified Community Behavioral Health Centers

California Well Positioned for Excellence Act (CCBHC) Certification, Management and PPS

December 20, 2015

On Monday, December 7th, I participated in the National Council for Behavioral Health’s second all day training for state associations to support state planning to develop proposal under the Excellence in Mental Health Act Certified Community Behavioral Health Centers program which will significantly increase funding and significantly reduce documentation requirements for outpatient behavioral healthcare. See my paper documenting that the value of this is about $1 Billion statewide in the first year and growing.

A centerpiece of that training was the review of a new and expanded “Integrated CCBHC Certification Criteria Feasibility and Readiness Tool (I-CCFRT)”.
In studying that tool and discussions with other state association representatives I learned that the structure of county mental health in California (not yet the case for substance use disorders- but should eventually be with the implementation of the Organized Delivery System) is well aligned with the requirements for CCBHC certification, management and establishment of a prospective payment system.

Continue reading California Well Positioned for Excellence Act (CCBHC) Certification, Management and PPS