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.

These were two new California Health Facilities Financing Authority (CHFFA) programs that we expected to see started early in 2017.

Fortunately our advocacy efforts in the legislature were rewarded, as both programs were reinstated in the new 2017-18 state budget.  We expect to soon get details on the schedule for the adoption of guidelines and regulations for these new programs. Draft guidelines and regulations had been developed and scheduled for adoption at the January meeting so they should be ready for action soon.

The program for facilities for people coming out of state prisons likely will take a bit longer.

We were also pleased to see funding for the development and implementation of the EPSDT performance outcome system, which includes funds for counties to support the cost for their providers in implementing the new system. We expect details on this any day, and startup in January 2018.

The budget also included $4 .5 million for community college mental health programs. These are students who historically have generally been uninsured, but now mostly have some type of insurance through Medicaid expansion or other provisions of the Affordable Care Act.

We are also pleased to see that the Mental Health Services Oversight and Accountability Commission (MHSOAC) has funds to begin our long-sought school mental health partnership pilot programs. It doesn’t include the significant new money we had hoped to see, but it looks like a promising start that we can build on with other funds.

How I see the situation in Washington

As we have known since the November elections, the fate of the Affordable Care Act and Medicaid would rest in the hands of Republican senators from states which expanded Medicaid and have Republican governors advocating in support of continuing federal support for healthcare.

They are each in a difficult political position.  While the overall support for repealing Obamacare or cutting federal Medicaid support is very low, there is still much support among Republican voters.  Those senators who fear a Republican primary challenger more than a Democrat when they are next up for reelection are likely to think it is in their best political interest to not come out against the Senate proposal.

On the other hand they are likely to recognize the significant damage it would do to their state.  If it never comes up for a vote, they can have it both ways – they don’t have a vote on the record that could be used against them, and their state keeps its funding.

Naturally we are hoping that will be the result, but we can’t underestimate the political pressure that Republican leadership will bring to bear on them and the potentially creative new versions that might emerge in the next few weeks.

AB 1250 could destroy our current mental health system – somehow it must be stopped

All private mental health provider organizations have joined counties in opposing this labor-sponsored measure, which makes it virtually impossible for counties to continue to contract out for mental health services – and probably substance use disorder services.

It includes new standards that counties would have to meet before they could contract out for any services that are currently or customarily provided directly by counties.  While most mental health services and nearly all substance use disorder services are contracted out to private providers, the fact that some services are provided directly by counties means that this proposed law appears to apply to all behavioral health services as well as related health human services and homeless programs.

All other mental health advocacy groups, including family and consumer groups, should be equally concerned about this proposal.  It would mean that virtually all private mental health nonprofit provider organizations would be put out of business. Consumers and families served by these organizations would have to be diverted to newly created providers directly operated by County programs.

Numerous studies over the years have shown that most of the time the private providers offer better services at a better overall cost with better overall outcomes.

We were not aware of this bill when it was in the Assembly until it was too late to do anything about it. In spite of vigorous opposition it still was approved by the Senate Governance and Finance Committee.

It now goes to the Senate Appropriations Committee. That committee will consider the bill in late August. A financial analysis will show that is likely to create hundreds of millions of dollars in new state-mandated County costs that the state would be required to reimburse counties for.

Ordinarily such a bill would have no chance of getting out of that committee. But labor representatives have made this a top priority. They make the argument that these new rules are similar to what the state has to live with. However there is no parallel in state government for behavioral health services. These are programs which are primarily contracted out to private providers, but also have significant amounts of services directly provided by counties.

For CCCBHA, this is our top priority oppose legislation for the remainder of the legislative session. We hope all other mental health and substance use disorder supporters will share this urgent priority.

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