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.

While we did not learn about the bill in time to advocate against it in the Assembly, we have been vigorous in opposition before the Senate Governance and Finance Committee which is scheduled to vote on the bill on July 12.

We have not yet seen any substantial amendments to the bill but have heard numerous statements about proposals to reduce the impact on contracting with nonprofit agencies.

Members in the districts of Senators serving on the committee need to continue the pressure on them until a final vote is taken.

The first phone number is the Senator’s Capitol office; the second is the Senator’s Fax number.

Jim Beall
(916) 651-4015      (916) 651-4915            Capitol Room 5066

Ed Hernandez O.D.
(916) 651-4022      (916) 651-4922            Capitol Room 2080

Robert Hertzberg
(916) 651-4018      (916) 651-4918            Capitol Room 4038

Ricardo Lara
(916) 651-4033      (916) 651-4933            Capitol Room 5050

Mike McGuire,  Chair
(916) 651-4002      (916) 651-4902            Capitol Room 5064

John Moorlach
(916) 651-4037      (916) 651-4937            Capitol Room 2048

Janet Nguyen,  Vice Chair
(916) 651-4034      (916) 651-4934            Capitol Room 3048

Should amendments be offered we will of course present them to the membership before deciding whether they are adequate.

Federal health care reform still uncertain – Support for behavioral health strong

You all know as much as I do about whether the Senate is going to pass some version of health care reform that significantly reduces federal support for Medi-Cal.  We know that the House version and the new Senate version do not have the votes they need to pass. But we don’t know is whether they will admit defeat and work with Democrats to stabilize health insurance markets – and whether some new version is about to be released there would still include major cuts.

The conversations taking place are encouraging for behavioral health.  The opioid crisis continues to be a major factor.  An offer to set aside funds for medication-assisted treatment shows that the Republican leadership recognizes its importance. Republican Senators from Medicaid expansion states are saying that is not enough and that you must cover all of the Medicaid benefits.

The California Chronic Care Coalition (organizations representing a cross-section of individuals with chronic diseases) which I participate in, has been holding town halls throughout the state and reporting that coverage for mental illness both in Medicaid and with regard to pre-existing conditions is one of the top subjects the people raise.

Newspaper stories have also documented that Medicaid represents over 50% of funding for mental health.

Our efforts are making a difference and we need to keep them up.  While we don’t have any Republican senators in California, our 14 House members are going to have to vote on a bill again should something pass the Senate.  The impact on behavioral health could be a factor in what they decide to do.

School mental health pilot projects advancing through oversight and accountability commission funding

On June 30, a committee of the Mental Health Services Oversight and Accountability Commission (MHSOAC) met in Riverside.  They voted to approve a staff report to start a pilot project in 15 elementary schools.  Eligible schools will be those that already are implementing Tier 1 positive behavior intervention and supports.  This is also known as “school climate and culture” which provides support to all students intended to reduce the number of students who need individualized services.

Schools will also have to demonstrate a partnership with providers that can bring insurance reimbursements. For schools with a large Medi-Cal population that will mean a provider with the County EPSDT contract.  Schools representing more affluent areas will need providers that are part of the network of commercial health plans.

Those partnerships are necessary for the Tier 2, (at risk students) and Tier 3 (intensive services) to make the programs financially viable and sustainable.

The MHSOAC already has funds in the budget for this program, which will offer about $25,000 per year for each school.

The Commission is expected to approve these recommendations at its July 27 meeting.  Detailed terms and conditions will be developed soon thereafter with an RFP and funds being awarded a few months after that.

This will be a major topic of discussion at the Children’s System of Care Committee meetings.

Proposition 64 – workforce funding: Lessons learned from Prop 63

Recreational marijuana legalization funding from Proposition 64 will become available in 2018, although state plans to allocate those funds may not be finalized in time for distribution of funds for the 2018 – 19 State Budget.

In all of the discussions about how to expend those funds, setting aside an amount for workforce seems to be a subject of broad consensus – at least within the behavioral health community.

At the same time, to set aside a funding for workforce education and training in Proposition 63 is ending.

I was asked to join the Prop 64 Workforce Subcommittee to share lessons learned from Prop 63.  I told them that it was a good idea to have money set aside for workforce but we’ve probably made a mistake in terminating the guaranteed funding for that after 10 years, as it now will be up to counties to allocate money for this purpose.

We also failed to specify how that money should be spent.  We listed many categories of eligible expenses but did not require specific allocations for any particular activity.

There is concern that too much money went to counties for their own employees and not enough contract providers since two thirds of services are contracted out. Also it appears as though a lot of the money went for training of existing County staff instead of focusing on expanding workforce capacity.

Proposition 63 then and now – ideas to consider

I’m always asked questions about the original thinking in various parts of Prop 63 and how well various parts of it are being implemented in relationship to what we had hoped or expected.

That led me to draft a document highlighting what I thought were the current issues. Eventually I would like to send this to the full mental health community. For now I would consider it a draft that we should be discussing at our committee meetings next week.

Legislature goes into recess on July 20 and returns August 21

In light of this legislative schedule we are suggesting that all of our committee calls for this month be consolidated into a single call on Friday, July 21 at 12 o’clock noon.


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