SUMMARY OF THE FINAL 2005-2006 BUDGET AGREEMENT

(This was originally written for the April 15, 2005 issue of the Friday Fax from Albany)

NOW THERE’S A BUDGET: Over the last two weeks in which the Governor had to make decisions about whether to approve or veto portions of the Legislature’s agreed upon budget, negotiations between the two houses and the Governor took place. And by the time the Governor’s 10 day period had expired on Tuesday, he and Legislature agreed to some changes to the budget the Legislature passed on March 31st, averting what would surely have been a showdown of sorts. This avoided the uncharted waters that have come about as a result of the Court of Appeals’ decision in December, stripping the Legislature of much of its authority when it comes to the budget process.

Aid to Localities – The Legislature’s agreement to restore $4.3 million of last year’s $7.7 million cut in local assistance remained intact as the Governor reviewed this, and many other Legislative changes. In addition, there has been the official approval of the $24 million enhancement of Article 31clinic rates and the $6.5 million increase for supported housing stipends. Though this is all positive news, unfortunately, it still leaves in place the $3.9 million in local assistance cuts for this year. Now that the budget process is over, we will turn our advocacy to the Executive, Division of the Budget and the Office of Mental Health to monitor the $3.9 million cut and the $4.3 million in restorations.

Medicaid and Family Health Plus - MHANYS has worked closely with a coalition of organizations concerned about the impact of changes in Medicaid to consumers called Medicaid Matters. Among the issues we worked with Medicaid Matters on was the effort to maintain or restore benefits under the Family Health Plus program. While we were successful in staving off the elimination of mental health benefits that were proposed by the Governor, the final agreement includes co-payment increases for physician visits to $5, an increase in co-payments for generic drugs to $3, an increase in co-payments for brand-name drugs to $6, and an increase in co-payments for hospital visits to $250. It is interesting to note here that it appears that these co-payment increases will generate very little in terms of savings for the state. However, savings to the state will be realized when these co-payment increases effectually reduce the utilization of services by people on Family Health Plus who can no longer afford to make these co-payments. Also related to decreased utilization, the budget agreement also required that potential enrollees in Family Health Plus cannot have had coverage for 9 months prior to their enrollment in the system. However, this could increase long-term healthcare costs due to the fact that people will be sicker when they eventually get treatment, rather than practicing preventative medicine which costs significantly less.

Hospital Closure Commission - It appears that a Hospital Closure Commission will move forward in an effort to ‘right-size’ the current network of hospitals throughout New York. We are pleased that consumers will be part of this commission, and that the Legislature will have the authority to reject the commission’s finding. However, we have serious concerns about moving forward with hospital closures as concurrent discussions regarding closure of state-operated psychiatric centers may be happening as well. If such PC closures are going to happen in the future, individuals with mental health needs who require inpatient hospitalization will increasingly be relying upon these private hospitals. Discussion about the future of these hospitals must include discussion and input from consumers regarding the future of the mental health system as well.

Preferred Drug Program - While we have not read through all the amendments passed by the Legislature and approved by the Governor this week with a fine toothed comb, we understand that there are no significant changes to the Preferred Drug Program (PDP) agreement reached by the Legislature 2 weeks ago. Therefore, the PDP will take effect 1) with an exemption for all atypical anti-psychotic and anti-depressant medications, 2) an option for other therapeutic classes of mental health medications to be exempted as well, 3) doctors will be given the final say as to whether a patient will be prescribed a ‘non-preferred’ drug or not, and 4) inclusion of consumer representation on the Pharmacy and Therapeutics (P & T) Committee, which will decide which drugs are ‘preferred.’

We still have serious concerns about 1) how individuals taking other mental health medications (i.e. mood stabilizers) will be impacted, 2) how individuals with co-occurring mental health and physical health needs will be effected, 3) how the Clinical Drug Review Program (CDRP) will impact individuals with mental health needs, 4) whether the process doctors must use to get approval to prescribe a non-preferred drug will prove too time consuming for doctors to pursue prior approval, 5) the accessibility of mental health medications that come in different delivery modes (injectibles or patches), and 6) the state’s intention to contract with an organization in Oregon with questionable practices to determine which drugs will be on the Preferred Drug List (PDL).

Adult Homes - Lastly, as part of the final, agreed upon budget, an SSI increase for adult home residents was included as well, which will take place over the next 2 years. This increase will include an increase in the Personal Needs Allowance that residents get to spend as they wish. Many residents who attended the recent ‘Speak Out’ in Albany spoke of how they would use this money to buy things like clothes that actually fit them. The agreement also includes additional resources for case management as well. We are appreciative of the Governor and the Legislature for identifying the need and providing resources for adult home residents. We will continue to advocate for additional resources for resident oriented programs that will promote independence, including activities of daily living skill training, education programs and vocational programs.