Mental Health Association in New York State, Inc.
(Publication Archives)

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.

FOCUS GROUPS TO GATHER INFORMATION ON OUT-OF-STATE PLACEMENTS: Families Together in New York State (FTNYS) is planning to hold two focus group meetings to gather information on the experience of parents whose children have been placed in out of state residential facilities. Specifically, FTNYS is looking for people to confidentially share their ‘real world’ experiences in getting help for their child(ren), which will then be used to craft recommendations related to out-of-state placement. Please contact Laurie Rivera at FTNYS at 1-888-326-8644 to register for attendance at either of the following forums.

SAVE THE DATE – MAY 3rd, SPECIAL SCREENING OF MAANGAMIZI

Join the Mental Health Association in New York State (MHANYS) at the Spectrum 8 Theatres on 290 Delaware Ave. in Albany at 7:00 p.m. on May 3 for the Capital District premiere of Maangamizi. Producer/Director Ron Mulvihill will speak about the film at the reception to follow.

Proceeds from this special screening go to support MHANYS. For more information about this event, or to purchase tickets, call (518) 434-0439 ext. 20. Tickets are $35 for regular admission (includes $25 charitable contribution to MHANYS), $10 students/seniors, and free for mental health consumers.

For full details about the event, including a brief synopsis of the film, see the Maamgamizi flyer.

SAMARITANS SUICIDE PREVENTION CENTER'S
7th Annual HOPE Candlelight Vigil

Thursday, May 19, 2005, 6:00-9:00 P.M.

When you are sorrowful look again in your heart,
and you shall see that in truth you are weeping
for that which has been your delight. ~Kahlil Gibran

On May 19th, Samaritans Suicide Prevention Center will hold its 7th annual candlelight vigil on the steps of the NYS Capitol in Albany.

This event not only memorializes the lives that have been tragically lost to suicide (through the faces on the NYS 1998 - 2005 LifeKeeper Memory Quilts), but will also work to save future lives through sharing, courage, and the commitment to the prevention of suicide. In addition, the Vigil serves to recognize those individuals dedicated to the prevention of suicide through the Annual LifeKeeper Memory Award. This year’s LifeKeeper Awards will be presented to NYS Office of Mental Health Commissioner Sharon Carpinello and Associate Director of Clinical Operations for the Albany County Department of Mental Health, Bill Dickson.

For more information, go to http://www.timesunion.com/communities/samaritans/, e-mail sams@fcscapitalregion.org, or call (518) 689-0080.

IN THE NEWS:

At 11th Hour, Albany Moves to Redo Budget. By Al Baker and Michael Cooper
The New York Times, April 13, 2005

ALBANY, April 12 - Twelve days after they passed New York's first on-time budget in 21 years, state lawmakers and Gov. George E. Pataki changed important provisions of the plan on Tuesday night after secret negotiations among the state's leaders.

The revised budget was an unexpected coda to what many thought was a year of remarkable progress in the capital when lawmakers used public, bipartisan negotiations to pass a budget by the March 31 deadline, in daylight, with much fanfare.

Tuesday's deal was a reversion to form: it was struck after private deliberations, and lawmakers had to wait into the night for bills to be printed so they could vote. Even as they prepared for the votes, the state's leaders were hazy about how much money the revised plan called for spending this year.

The agreement ended a standoff spawned by passage of the on-time budget. Mr. Pataki said he would use new powers granted him by the courts to refuse to make changes that the Legislature sought, and he threatened dozens of vetoes by the end of Tuesday if a consensus was not reached. By evening, after the leaders met in private, the sides said they had worked out the differences.

Governor Pataki, who had objected frequently that the Legislature was planning to spend too much in the budget it passed in March, ended up accepting most of their new spending. But he praised the deal, which his aides said would add up to a $106.6 billion spending plan, effusively on Tuesday night, saying it was "not only an on-time budget, but a good budget."

As a result, the Legislature prepared to pass a number of programs that their disputes with the governor had forced them to leave out of their original budget, including $150 million to protect the environment, $150 million for construction projects at private colleges and $1.1 billion in federal surplus aid for the Temporary Assistance to Needy Families program to help the poor get job training and child care.

Much of the new spending would be covered by federal money, but there was also an agreement to extend a sales tax on clothing that had been set to expire, a plan to increase taxes on nursing homes, and provisions to cut costs that the Pataki administration estimated would save $300 million. Sheldon Silver, a Democrat and the speaker of the State Assembly, said the budget was largely the work of the lawmakers, who agreed on many of the provisions in public conference committees. And Joseph L. Bruno, a Republican and the Senate's majority leader, praised the fact that the state budget was done in record time.

Still, after an early budget season that lawmakers had hoped would signify a startling turnabout from the culture of dysfunction in Albany, the return to a process of a handful of powerful officials quietly making deals was disappointing to government watchdog groups. Some lamented the fact that the two bills outlining the deal were written during secret negotiations and sent to the Legislature by the governor in what is known as a "message of necessity," allowing lawmakers to bypass a constitutional requirement to let three days pass after the printing of a bill before voting on it.

"I guess I would say they had a virtual budget on March 31," said Diana Fortuna, the president of the Citizens Budget Commission, a watchdog group. "It's such a step up for them to get almost all their work done on time that I don't know that I would chide them too much over this. But it is unfortunate that they reverted to doing this under so-called emergency conditions, without giving the public time to have a look-see at the legislation."

However, as the hours ticked down to a midnight deadline for the governor to wield his veto pen, lawmakers said their actions were necessary to keep Mr. Pataki from keeping programs for the environment and the needy out of the budget and from cutting several allocations they added to his budget plan. Rank and file lawmakers said the process, though practical, was not preferred.

"You know, there's a little bit of nostalgia going on here," said Senator Michael A. L. Balboni, a Republican from Long Island. "This was in the dark of night, it was 'three men in a room,' and it was not part of the legislative conference committee process, but it is the final details of the budget. Everybody caved a little to get this."

Mr. Silver, while rejoicing in the final product, blamed the governor for the last-minute rush to votes. "I'm apologizing to you and to the public for having to do this at night," Mr. Silver told reporters at a news conference shortly before 8 p.m. "Because I don't think it's right, but we have no choice, and we didn't dictate that."

Mr. Bruno said that pushing to finish the budget late at night was "inappropriate," and added, "if we had a choice, we wouldn't be doing it."

Even with the last-minute deal, Governor Pataki said he would make three vetoes. He said that he would veto two changes that the Legislature made to his proposals for lawyers and prosecutors handling death penalty cases, and that he would strike down their plan to change the way the state spends money collected from utility ratepayers on environmental programs. But he held up a stack of vetoes he said he would have made if the agreement had not been reached.

Lawmakers said they got almost everything they wanted. "In the end, we had to take yes for an answer," said Assemblyman Richard L. Brodsky, a Westchester Democrat who often criticizes the governor.

Although the governor had assailed lawmakers for restoring nearly $700 million of the $1.1 billion in cuts he wanted to make to Medicaid, little of the Legislature's work was changed in the deal struck on Tuesday.

Lawmakers agreed to add an increase of one percentage point to a tax on nursing homes the governor wanted. They also agreed to some changes in the health insurance program for 340,000 poor New Yorkers, known as Family Health Plus, requiring co-payments for dental care and tailoring the plan for eyeglasses to the one provided to state employees. They agreed to defer a plan to spend $80 million on upstate nursing homes in a deal that was tailored to please 1199/S.E.I.U., the powerful health care workers union. And they agreed on how to create a commission to work on closing hospitals, something the governor wanted to ensure a $1.5 billion federal waiver.

On economic development, they revamped a plan to overhaul one of the state's biggest economic development program, the Empire Zones, which gives tax breaks to attract businesses and create jobs.

Pataki and the Legislature Win Partial Victories in the Budget Fight Over Medicaid. By Al Baker
The New York Times, April 14, 2005

ALBANY, April 13 -The revised budget that the State Legislature passed just before midnight on Tuesday includes about half of the $1.1 billion in cuts to Medicaid expenses that Gov. George E. Pataki sought in his budget proposal in January.

It sets up a preferred-drug list that aides to Mr. Pataki said would save New York $60 million this year and up to $200 million next year by using the state's buying power in the open market to urge companies to offer lower prices for generic drugs. It increases a tax on nursing homes, with an eye toward forcing them to cut costs of their own. And it aligns benefits in Family Health Plus, the program that provides health coverage for the working poor, to resemble those given to state workers.

But in one area after another, the Medicaid budget was a plan full of significant compromises on health policy and was bereft of the kind of huge immediate cost savings that independent budget analysts, and Mr. Pataki himself, have repeatedly said are necessary to reduce the burden of Medicaid, a colossal, $45 billion health care program for the poor whose costs are continuing to grow by leaps and bounds.

And because Albany acted with lighting speed and with little public review in passing its final budget bills, people in and out of government on Wednesday were still analyzing the details of the Medicaid changes and their complicated fiscal implications.

"From a global view, I would say that most of what they did was political compromises that protect benefits and tinkers a bit with the system," Michael Kink, the legislative counsel for Housing Works, an advocacy and service organization for people with AIDS, said of the changes state officials made to the Medicaid program, some of which he favored and some of which he opposed. "And for many of the things, I don't know if the fiscal savings are serious."

Indeed, the $545.7 million in cost savings to Medicaid that Mr. Pataki and the two top legislative leaders say they agreed to enact for the current fiscal year, which began on April 1, represents a mere fraction of a program that swallows more than 40 percent of the state's budget.

Reining in Medicaid has proven politically hard to do in a state where health care unions and hospitals have enormous political clout. Even with the savings achieved this year, Medicaid costs are still expected to rise about $1.8 billon, according to Edmund J. McMahon, the director of the Empire Center for New York State Policy of the Manhattan Institute.

"I get the sense that the additional Medicaid changes may not have been as minimal as the bottom-line numbers make them appear, but by the same token, they don't deserve to be called historic or sweeping," Mr. McMahon said. "From a broad perspective, in the big picture, you know, they have done incremental shavings around the edges."

Early on, the governor said this was the year to cut the rate of growth in Medicaid, not just for the state but for local governments whose budgets have been so strained by its rising costs that they have had to increase property taxes and cut core services. The issue became the focal point in the annual budget wars.

But as the dust settled a day after the budget was passed, those in the legislative and executive branches each declared victory. For lawmakers, who said cuts alone did not amount to an overhaul of the program, Mr. Pataki's original goal of cutting $1.1 billion from Medicaid had been reduced by half. But half, his aides said, was precisely what Mr. Pataki wanted all along, and that was without counting $840 million in additional cost-containment measures for other health care programs in the budget that both sides agreed to.

Still, lawmakers rejected Mr. Pataki's proposal to examine more closely the assets of those seeking to put relatives in nursing homes under Medicaid. That practice has become something of a middle-class entitlement in New York.

On the other hand, the Assembly wanted to cap localities' Medicaid costs at 2005 levels, something many local officials preferred, but Mr. Pataki's plan to cap the rate of growth at 3 percent, by 2008, was passed instead.

Michael Marr, a Pataki administration spokesman, said Medicaid savings enacted Tuesday would cover the cost of the cap to the state next year: $121 million. How the state would pay for increasing costs of the cap in future years, however, remained murky.

Still, the governor's aides said he had realized the beginnings of his vision to create a stronger, more efficient health care system in New York. They said he had established a "footprint" for change that would get bigger with time and had satisfied the terms of a deal for the Bush administration to provide an additional $1.5 billion in Medicaid funds to the state over the next three years.

In the end, Senator Dean G. Skelos, a Republican from Long Island, threw one more idea for saving Medicaid money on the table that Mr. Pataki's senior advisers said they were weighing seriously: rooting out fraud.

"There is no disputing there are billions of dollars in fraud in the system that don't affect services or providers and will generate huge savings," said John McArdle, a spokesman for Joseph L. Bruno, the Senate majority leader.

No quick cure for what ails. By James M. Odato
Albany Times Union, April 10, 2005

The new state budget averted a Medicaid crisis -- for now -- but the poor and elderly still depend on a program local officials say taxpayers can't afford

ALBANY -- What New York pays for Medicaid would cover the entire budgets of more than 44 states.

A program that began 40 years ago as a way to provide health care for the poorest New Yorkers has grown into a system that takes in an average 1 million claims a day from the elderly, the disabled and the poor. At $45 billion for this fiscal year, the state's tab is the highest in the nation.

And yet, Gov. George Pataki's Health Care Reform Commission reported what it called "another harsh reality" last fall: "We spend far more on health care than other states, without achieving dramatically better health outcomes."

In the run-up to this year's legislative session, no single issue drew as much worried attention from state officials as Medicaid. But with a new state budget now in place, the major reform that seemed to be on the horizon has been whittled to some lesser changes.

New York still will spend 2.3 times the national average per person on Medicaid this year. That money comes from a range of sources, but they all come down, ultimately, to one: taxpayers.

"If we could simply get Medicaid spending down to twice the national average, taxpayers would save $5.3 billion," says Robert Ward, research director of the Business Council of New York State's Public Policy Institute. The council is fighting for changes, arguing that rising taxes to pay for the program hurt New York's competitiveness.

But for the 4 million New Yorkers who depend upon the program -- disabled people and the poor, as well as many elderly and AIDS patients -- what Pataki and business lobbyists call "reform" is a cut to their lifeline.

"The measure of any society is how it cares for its least members," says Bishop Howard Hubbard, who was among hundreds who came to the Capitol this year to fight Pataki's proposals to cut health care spending, much of it in Medicaid.

The federal government covers half the tab. The state's $15 billion share comes from the income tax, sales tax and taxes on hospitals. Counties and New York City pay roughly $7 billion, relying largely on sales and property taxes.

Medicaid, the governor insists, is out of control. The program is growing fast, usually outpacing the growth of revenue to support it. Citing the state's per capita Medicaid spending -- $2,300 -- Pataki says the coverage, rates and reimbursement under the public insurance program are more generous than those offered elsewhere without proportionate results.

But while he complains of the growing financial burden, Pataki can blame himself for some of the predicament.

New York makes it easier to become a Medicaid patient than most states. The program keeps growing, partly because of a related state program, Family Health Plus, created for low income people who earn too much to qualify under normal Medicaid guidelines. That has added 450,000 people to the Medicaid rolls since 2000.

Pataki, who early on appeared in televised ads promoting Family Health Plus, now seeks to trim the program's coverage, which is better than the HMO plans that enroll most New Yorkers.

Advocates for people who depend on Family Health Plus, though, say the governor and Senate Republicans want to cut too deeply.

For instance, they fear chronically sick people will be pushed into HMO plans that aren't able to handle their diseases. They also worry that services will be taken away, potentially forcing patients to seek more costly emergency room treatments.

"Medicaid plays a very important role in the lives of some very vulnerable people, and while we understand that there needs to be some reform ... it needs to be some very meaningful reform and shouldn't penalize the people who rely on the program," says Doug Berman, a member of Medicaid Matters, an advocacy group of organizations that run health care services for poor people.

The coalition issued recommendations to improve Medicaid and cut costs last year. Ideas include demanding more help from Washington and using the state's buying power to negotiate lower prescription drug prices.

A key reason Medicaid costs are so high compared with other states is New York's unusual mix of patients. Thirty percent of the state's Medicaid patients are elderly or disabled, but they account for about 75 percent of Medicaid spending.

Acute-care bills cost Medicaid about $18.2 billion; long-term care, $15.7 billion. The second biggest Medicaid spender, California, which has roughly

15 million more residents than New York, spends less: $17.8 billion and $7.9 billion in those two categories.

New York has 80,000 to 100,000 people who are infected with HIV, the virus associated with AIDS. This group by itself drives $3 billion in Medicaid costs, most of that because of expensive prescriptions.

Medicaid is big here for many reasons besides the populations of poor and sick people. The Pataki administration has perfected a lesson the state learned long ago: It shifts every possible health expense -- including mental health care -- into Medicaid to maximize federal matching funds.

Along with that, the governor made sure billions of dollars more were made available to hospitals to help recruit and retain workers. Indeed, the powerful hospital workers' union and the hospital lobby are factors in the system's rising costs, Ward says.

"Excess capacity in our hospitals is driving up the costs of health care with no tangible improvement to patients," says Erie County Executive Joel A. Giambra, who has cut $90 million in services and laid off dozens of workers largely because of high Medicaid and pension costs.

He said he's so mad about perks the new legislative budget gives the hospital union -- such as $80 million for wage enhancements for private nursing homes upstate -- that he's calling for the resignation of the leaders of the Western New York legislative delegation.

Pataki has pulled off some financial relief. He got the federal government to provide a waiver to the state, allowing New York to save $2 billion and local governments $1 billion when the administration worked out managed care reforms in 1998.

Three weeks ago, Pataki announced a federal commitment for another $1.5 billion in extra help over three years, if he can cut the system's cost further.

Lawmakers, however, say reforms can't come at the expense of care.

Among the possible strategies, Pataki might end up closing hospitals.

"If New York is ever going to get serious about controlling Medicaid costs, we need to go where the money is. ... That means hospitals," said Ward.

Most agree there are too many, but defenders point out that some hospitals that seem underused may actually be the only institutions serving their communities.

Many hospitals and nursing homes are failing in part because they provide unprofitable services. Others have wings of unused beds that the public pays for.

Some hospitals try to improve their financial performance by buying high-end equipment to gain the most generous Medicaid reimbursements, and then compete with institutions already offering the services.

The hospitals serve some of the 3.5 million uninsured people and may or may not be paid adequately for those patients. And many get money for graduate medical school education and may be overpaid for the training offered, according to state reports.

Yet there are ways to squeeze costs from the health care system without closing hospitals. For instance, the state sends $800 million a year to facilities that train medical students, half of whom leave the state after their education. Pataki has sought a return of what he calls overpayments for that training.

A serious overhaul is overdue, says Stephen Berger, the chairman of Pataki's health care commission. Medicaid's skyrocketing growth, he warns, will soar even higher as Baby Boomers age.

The Berger Commission made recommendations that Pataki included in his proposed budget for 2005-06. Pataki proposed to cut $2.5 billion in federal, state and local Medicaid costs and hold growth to $300 million. This time around, he had help to promote that agenda: the Business Council and the New York State Association for Counties signed on. Some local leaders threatened political retaliation if state officials accomplished nothing.

Only a few ideas, however, survived budget negotiations. Amid a storm of protest from health care lobbyists and their allies in the Legislature, lawmakers accepted just $347 million of the $1.1 billion in cuts and taxes Pataki proposed to ease the state's Medicaid burden. They rejected $747 million in cuts, and then added $695 million in spending.

The governor didn't get a host of things he sought, such as rate reductions and cutbacks in coverage, but some Medicaid changes were approved:

A preferred drug list, although the Legislature made sure physicians have the final say. Such a preapproved list would help reduce spiraling costs for brand-name drugs and replace many with generic medications.

The state savings is expected to be $60 million to $70 million in the first year and lead to annual savings topping $200 million, says Sen. Kemp Hannon, his chamber's health committee chairman.

A two-year surcharge on the gross receipts of hospitals. The "sick tax," as Assembly Democrats call it, will grow by 0.35 percentage points -- half of what Pataki called for. The Legislature estimates the tax will bring in $70 million to $100 million this year, but hospitals will be virtually reimbursed by getting two years of extra funding worth $121 million for "work force retention."

"Selective contracting" -- allowing for savings by finding the cheapest, most efficient health care institutions for certain treatments. That should save $11 million. A cap on how much counties' costs can increase annually, starting at 3.5 percent and phasing down to 3 percent.

A freeze on premiums paid insurers for managed long-term care, home care and nursing home care and reduced premiums for Family Health Plus patients, cutting about $80 million.

A commission to plan hospital closings. After some sparring about its make-up, the Legislature agreed to support the plan if the panel has regional representation, but negotiations continue privately.

All parties expect the debate to continue.

Hannon, the Senate Health Committee chairman, noted that several million dollars in contracts are planned to pursue "disease management," to find more effective ways to care for people with chronic illnesses.

Nor is all the debate about cutting Medicaid. Assembly Health Committee Chairman Richard Gottfried defends Medicaid spending, noting that quality care is enhanced for everyone if hospitals are financially strong. And, he said, some of the attack on Medicaid has been misplaced.

"The truth is the cost of health care is growing for private health plans and Medicaid alike," he said. "And Medicaid's costs are growing at a slower rate than private insurance."

While she agrees the call for reform will continue, Medicaid Matters coordinator Laura Caruso said Medicaid is "a program that works, but needs to be tinkered with. Escalating health care costs across the board are going to harm it."

Pataki believes that other investments in the system may create some savings. He and the Legislature envision $1 billion over four years to help hospitals become more efficient. The Legislature and governor agreed to $250 million in the new budget to start projects for high-technology, consolidations and upgrades

"The ball is now rolling on Medicaid reform," said Ward. "The challenge is to roll it faster."

Medicaid Profiles.
Albany Times Union, April 11, 2005

James D.
Age: 66
Residence: Albany

Background: James D. is a living example of the statistic that a mere 30 percent of the state's Medicaid patients account for about 75 percent of the program's spending. An elderly artist whose body has been wrecked by long-term drug use, hepatitis C and HIV, James D. requires a lot of care. He takes Kaletra, a protease inhibitor; nitroglycerin for his heart; Lortab to combat the pain of arthritis in his shoulders, hips and legs; Ambien to help him sleep; and an anti-anxiety medication. He receives mental health counseling and visiting nurse services. He can no longer work and receives $666 a month in Supplemental Security Income from the federal government, of which $194 goes for rent for the subsidized apartment in which he lives alone. The rest covers the cost of food and the minimal co-pays (between 50 cents and $2 per prescription) for his many medications. He spends his days painting, reading up on and speaking about AIDS, and lobbying with Housing Works an advocacy group for homeless people and AIDS sufferers.

In his words: "Without Medicaid, my life would be disastrous because my behaviors would take me places I don't want to be ... It would be impossible for me to pay out-of-pocket for the medication and mental health services that I qualify for.''

William Healey
Age: 59
Residence: Manhattan

Background: Healey owned a mobile advertising company that would wheel advertisements around the World Trade Center. The Sept. 11 attack on the towers killed his cousin and niece, and destroyed his business. It also left Healey with post-traumatic stress disorder. With no insurance, Healey suffered without treatment. He filled out a flurry of applications for help, and got himself on Medicaid. A doctor diagnosed his mental illness, and today Healey said he feels good enough to go back to work.

In his words: "It took me a long time to realize I needed help. I saw so many terrible things. I saw so many people jumping out of the windows. I saw a head roll by me. I ended up on Medicaid and it was a lifesaver. I would not have recovered if I had to pay for my drugs.''

Judy Fowler
Age: 42
Residence: Watervliet

Background: "I've been on Medicaid since 1988 after a nervous breakdown," she says. Her diagnosis: borderline personality disorder and post-traumatic stress disorder from physical abuse as a child. Her pay at Pie In the Sky Bakery, a business run by a publicly funded community organization, is less than $400 per month. With her Social Services Administration disability check of $625, she struggles to pay rent and bills. One of her medications alone cost $100 a month, she says. The insurance also pays for monthly visits to clinicians and a psychiatrist every three months.

In her words: "I'd like to get off it eventually ... There are people out there with mental illness who take advantage of it. They don't want to work; they don't want to do anything ... I want to be responsible. I don't like people paying my bills."

Legislature approves additional mental health funding. By Paul Esmond
Legislative Gazette, April 11, 2005

For most people, buying well-fitting clothes that look right is simple. A person goes to the store, searches the racks and finds pants, shirts and jackets that fit and they purchase them.

Getting suitable clothing for the institutionalized mentally ill is not so simple, said Dotty Harle, who described the ill-fitting donated outfits that she and others living in adult residences in New York State rely on.

“The shirt I’ve got on, I like the color,” Harle, from Rego Park, Queens, said. “But it’s not my size.”

Harle, who spoke at a press conference held by the Coalition of Institutionalized Aged and Disabled, praised the Legislature for increasing the Personal Needs Allowance of Social Security Insurance recipients in adult residence homes.

The Legislature’s agreement, if signed by Gov. George E. Pataki, would raise the PNA to $144 each month next year, and $159 in 2007. This year, the PNA, based on a cost-of-living index, is $130 per person.

“When you try to cover everything you need there is no way you can stretch $120-$130 a month,” Harle said.

The allowance is intended for residents to pay for personal items including, clothes, toiletries, and transit fares.

CIAD members urged Pataki to agree to PNA increase as well as a boost in funding for independent case managers they say are essential to healthy living in the adult residence system.

Life in an adult residence is made easier when a person is assigned to an independent case manager said, Patrick Rapp, of Rockaway Beach in Queens.

Rapp, an adult home resident, said case managers assigned to houses are often too busy or simply indifferent to important needs of residents, particularly those seeking greater independence, even employment.

Often, Rapp said, residential case managers take care of time-consuming administrative duties as well as coordinating kitchen staff.

“Independent case managers take time with us,” he said.

The Legislature approved $5 million for independent case management in this year’s fiscal budget.

Rapp said he thought it would not only be beneficial for residents to see case managers outside of the residential setting, but would save the state money as people gain more independence.

The state should consider funds to purchase more air conditioners for adult home, said Steven Peterson, a Bronx resident and CIAD member said.

Peterson said residents of adult homes often swelter in the heat of summer and must remain still indoors to keep as cool as possible.

“At my house people have been going to the hospital for [heat related] seizures,” he said.
The state could cut some Medicaid spending by putting more air conditioning in residential homes, Peterson said, because heat-related hospitalization would decrease.

During their lobbying last week, CIAD members said they would urge the Legislature to increase housing for the mentally ill, who often end up in adult homes, which, they said restricts their independence.

Gary Levin, a resident of a residence in Rockaway, Queens, praised a bill by Sen. Thomas P. Morahan, chair of the Senate mental health committee that would establish a mental health housing waiting list.

Steven Yaare, who lives in a Brooklyn adult residence, said CIAD was pleased with the legislative agreement, which he said puts people in a better position for more independence.

“We think it’s about time that we see some progress,” Yaare said.

Until next time, we remain,
Working to ensure available and accessible
mental health services for all New Yorkers