Mental
Health Association in New York State, Inc. |
Friday Fax from Albany
CALLING ALL ADULT HOME RESIDENTSThe New York State Coalition for Adult Home Reform (NYSCAHR) is organizing the 2nd Annual Adult Home Resident Speak Out and Day of Action in Albany on Monday, February 28, 2005. Please join as we fight for dignity, respect and choice for every person living in adult homes. Residents
will be speaking out about the need for:
Come join us in the fight for adult home reform! Let's stand together as residents from all around the state! If you are an adult home resident or a service provider working with residents and you want to join us or want more information, please contact Tanya Kessler or Noor Alam at the Coalition of Institutionalized Aged and Disabled: (212) 481-7572.
In the News: The
Mentally Ill as 'Frequent Fliers'.
Editorial Pressed by rising costs, the states are scrambling for ways to keep millions of people who are released from jails and prisons each year from coming back. An obvious first step would be to abolish senselessly punitive laws that make it difficult for felons to reconstruct their lives, like those in all 50 states that bar ex-convicts from occupations that have nothing at all to do with their crimes. Another prudent step would be to create high-quality programs that provide newly released people with counseling and job placement. Perhaps most crucially, those who qualify need assistance in getting back their federal disability and Medicaid benefits; inmates typically lose such benefits when they find themselves locked up for 30 days or more. The loss of benefits is especially devastating for the mentally ill, who make up one-sixth of the prison population and who are particularly susceptible to recidivism. Most of them get psychiatric drugs and treatment for the first time in jail. They often improve quickly, but deteriorate just as fast when they are released without being re-enrolled in federal disability programs or Medicaid, which would give them access to medication and psychiatric care. Homeless, delusional and out of control, they are inevitably rearrested for behaviors related to their illnesses. Many of them come back to jail so regularly that corrections workers call them "frequent fliers." Impoverished people who suffer from mental illnesses and other serious disabilities are entitled to Supplemental Security Income assistance, handled through the Social Security Administration. In many states, people who are declared eligible for Social Security-based benefits are automatically enrolled in Medicaid, which in turn provides mentally ill people with care and drugs. Federal law requires that people be suspended from S.S.I. benefits when they land in jail for even a short time. The federal government diligently enforces the suspension rules - and even pays a small bounty to the prisons and jails in exchange for notice that a beneficiary has been incarcerated. But the institutions are offered no incentives to report that inmates are about to be released and need to have their benefits restored. Moreover, the rules governing the program are so vague and complicated that most prison officials don't understand them. A similar situation has developed with Medicaid, which bars states from receiving federal matching funds for treatment given to inmates except in acute cases requiring hospitalization. The federal government envisioned an arrangement under which Medicaid benefits would be suspended during incarceration and resumed upon release. But the states have resorted to terminating inmate eligibility outright and allowing inmates, including the mentally ill, to leave custody without access to care. The states, which are already being shortchanged by the federal government on Medicaid, got another scare recently when the Bush administrated suggested that it might shift even more of the burden. Pressed for money, the states have clearly opted to save dollars by taking inmates off Medicaid rolls and leaving them off for as long as possible. But mentally ill inmates who are dumped onto the streets without access to care drive up incarceration costs by going back to jail again and again. The smarter approach would be to ensure that eligible inmates had disability and Medicaid benefits in hand before they left jail. Setting up the new administrative process might not be easy, but it would more than pay for itself down the line
Time might be up for psych center. By Dianna Cahn Middletown – This might be the year that Middletown Psychiatric Center finally closes. For four years, Gov. George Pataki has included the demise of the psychiatric hospital as part of his proposed budget, saying it would save the state $7 million a year. For three years, it failed to get past lawmakers from the district. But this year, Sen. John Bonacic, R-C-Mount Hope, and the Orange County Mental Health Association suggested that the closure was inevitable. "It's going to be hard to justify keeping the psych center open," Bonacic said. "But I will fight to preserve services to the community." Nadia Allen, Mental Health Association executive director, said her agency was also relenting because the trend was away from hospitals. She called for creating a commission that would incorporate hospital staff, lawmakers and mental health officials to design a comprehensive plan for replacing the services. "It's imminent," Allen said. "So, as long as we have no alternative, let's come up with the best solution we can find." The proposed budget says the 100-year-old facility now has just 115 beds. The staff and patients could be transferred to the Rockland Psychiatric Center, it says, and the savings "reinvested in expanded state-operated community services in the Middletown area." Sen. Tom Morahan, R-New City, and Assemblywoman Aileen Gunther, D-Forestburgh, said they'll fight the closing, as did Middletown Mayor Joe DeStefano. "We'll do the same thing we've done every year," DeStefano said. "Rally around the unions and put political pressure on the legislators. This is a regional center that services Orange County and part of Sullivan. It is needed and should be kept."
Pataki's
Plan Looks to Spread Medicaid Cuts Without a Major Overhaul. By Michael
Cooper and Al Baker ALBANY, Jan. 19 - The big idea guiding Gov. George E. Pataki's plan this week to rein in Medicaid spending was his desire to steer the state's poor away from costly long-term care in hospitals and nursing homes and into home health care. Over the long term, his administration says, such a move could save huge amounts of money. So his budget calls for squeezing hospitals and nursing homes by cutting the reimbursement rates they receive, raising their taxes and creating a commission to recommend closing underused hospitals. At the same time, it calls for spending more on home health aides and other programs to help the elderly stay in their homes longer. But the governor's plan to cut $1.1 billion in Medicaid spending is not the radical revision of the state's biggest and fastest-growing spending category that some legislators had hoped for and many health care providers had feared. While some governors around the nation are retooling their Medicaid programs by cutting their rolls by hundreds of thousands, imposing severe spending caps and drastically reducing benefits, Mr. Pataki's plan consists of a series of more pragmatic measures that his aides say would spread the pain and trim the $44.5 billion program without nearing the bone. While Mr. Pataki is proposing a preferred drug program that would limit the kinds of prescription drugs the program covers, along the lines of most private health insurance plans, he is not planning to have the state buy its drugs in bulk, for example. Even if these cuts go through, New York will still have the most expensive Medicaid program in the nation. And even if they are adopted after what will probably be the main legislative battle this year, they are only cuts in planned growth: New York will still spend more on Medicaid next year than this year. Some of the governor's cost-cutting proposals would sharply reduce the benefits for poor and working-class New Yorkers. The state's insurance program for the working poor, Family Health Plus, would no longer pay for mental health services for adults, and its eligibility rules would be tightened. The 340,000 people in the program would be required to pay $250 for each hospital visit. Adults on Medicaid would no longer be able to visit dentists outside dental clinics, and they would lose their podiatry, clinical psychology and private nurse benefits. Co-payments for drugs would rise. But the broad outlines of the state's Medicaid program would remain intact, and the tentative nature of some of the governor's proposals may be a recognition of the difficulty Mr. Pataki faces in getting his plan through a skeptical Legislature that has deep political investments in the Medicaid status quo, one that has thwarted his proposed cuts to the program in the past. The governor himself said that he recognized the need to keep the health care industry, which is one of the state's biggest employers, strong in New York. Already, health care lobbies are gearing up for an effort to beat back the proposed cuts. Edmund J. McMahon, a fiscal analyst with the Manhattan Institute, a conservative policy group, noted that Mr. Pataki's proposal still calls for overall Medicaid spending in New York - which is divided among the federal, state and local governments - to jump next year to $44.8 billion from $44.5 billion, a $353 million increase. "What Pataki did not do here is push the envelope," Mr. McMahon said. "He's making incremental changes in the existing model. The question is: If you were going to start all over, is this the type of Medicaid program you would really want to have?" Still, health care advocates are already lining up against the proposals, which they say would have an impact of roughly $3 billion on the health care industry once the loss of matching federal and local Medicaid spending was factored in. The biggest lobbyist in the state in recent years - a partnership of the hospital and health care workers' union and the Greater New York Hospital Association - said in a statement that the cuts would have a "catastrophic effect on the quality of health care." Kenneth E. Raske, the head of the hospital association, said in the statement that "the magnitude of these proposed cuts is unbearable, and if these cutbacks actually took place, the care of all hospital and nursing home patients would suffer." Dennis Rivera, the president of 1199/S.E.I.U., the politically potent health care workers' union, made an argument that has carried the day in Albany before. "Polls have shown time and time again that the overwhelming majority of New Yorkers are strongly opposed to cutting funding for health care workers," he said in a statement. The last time the governor proposed large cuts to Medicaid, in 2003, the Republicans in the State Senate joined the Democrats in the Assembly to pass their own budget, over Mr. Pataki's vetoes, to restore the spending. This year Mr. Pataki is trying to enlist the help of county officials, who have been complaining loudly of the strain of paying their share of rising Medicaid costs, which have forced them to raise local property taxes. The governor's budget calls for capping local Medicaid spending at the current levels, and allowing for a 3 to 3.5 percent increase each year for inflation. He made it clear in his budget presentation that there can be no local cap without significant cost reductions. But while some county officials were pleased by the proposed cap, they were noncommittal on the cuts, which could prove unpopular locally. The New York Association of Counties said it was "cautiously pleased" by the governor's budget. New York City officials noted that any savings it realized would be partly offset by the loss of revenue to the public hospitals that it operates. One of the more politically sensitive aspects of the plan is Governor Pataki's decision to name a commission to identify hospitals to close. "We cannot afford to invest more in underutilized facilities," the governor said in his budget address, and if he avoided words like "close" and "downsize," he spoke several times at a budget news conference of the need to "right-size" the state's health care system. And he made a proposal that could end Medicaid's emergence as a middle-class entitlement, calling for the closing of a loophole that allows elderly people to give their assets to their relatives to qualify for Medicaid to pay for nursing home care. New York's Medicaid program spends $7.1 billion on nursing homes, which the Pataki administration notes is more than the combined spending of the next two highest states, California and Pennsylvania. But hospital closings and a proposal that could impoverish middle-class families are not hugely popular in the Legislature. Senator Kemp Hannon, a Republican from Long Island who is the chairman of the Health Committee, said: "They are trying to make less hospitals stronger. I think it is up to the Legislature to review that kind of conclusion and see whether or not that is a viable course to take."
Until
next time, we remain, |