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.
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 (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
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
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
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 (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
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?
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