HOUSING
Apparently the rally held by the NYS Campaign for Mental Health
Housing last week, at which nearly 1800 people descended on Albany
calling for additional investments in housing for people with
psychiatric disabilities, was successful. This effort, in conjunction
with many other factors, helped make the case for Governor Spitzer
to include additional housing for people with psychiatric disabilities
in his budget proposal. Governor Spitzer’s budget includes
$6 million this year ($12.1 annualized) to create 1000 new supported
housing beds. In addition, he also identifies $200 million to
be dedicated to the capital costs of creating 1000 new congregate
care beds, likely to be Single Room Occupancy (SRO) beds. This
is the largest investment in mental health housing in recent memory
and mental health advocates are very excited about the possibilities
this will provide for people with psychiatric disabilities.
In
addition, with $12.9 million in the OMH budget, Governor Spitzer
has continued the state’s commitment to the NY/NY III agreement
of a few years ago to meet the housing needs of homeless individuals,
including those with psychiatric disabilities.
$12.6
million in new funding to provide funding for the first year of
a three-year initiative to enhance staffing and respond to inflationary
pressures in Community Residences and Family-based Treatment programs.
$6.3
million in new funding to handle increased rent and utility costs
in the third year of a three-year increase in stipends for Supported
Housing.
Also,
OMH provides additional funding to provide supplemental funding
for increased property, construction, rehabilitation and facility
rehabilitation costs promised for beds currently ‘in the
pipeline’ that were promised in previous years.
While
we know that the budget includes initiatives to improve the lives
of adult home residents, we do not have much information yet.
As we get a better idea of the Governor’s proposals in this
area, we will share this information.
In
documents that support the release of the Governor’s budget,
they state, “The lack of decent, safe, affordable, and integrated
housing is one of the most significant barriers to full participation
in community life for people with mental illness. OMH will need
to continue developing integrated and affordable housing opportunities
and accompanying support services for individuals with mental
illness committed to in previous budget cycles, and initiate new
priority housing opportunities as State finances allow.”
We
couldn’t agree more.
COMMUNITY
SERVICES
As part of last year’s NYS budget, a 3-year 2.5% Cost of
Living Adjustment (COLA) was provided to community-based programs
throughout the human services sector. This year’s executive
budget proposal continues that commitment, providing the second
year of that COLA ($30 million). Therefore, if it is approved
by the Legislature, direct care staff in mental health programs
will receive another 2.5% COLA this year, hopefully helping to
address the continued problems with recruiting and retaining qualified
staff.
Specifically,
language accompanying the budget states that, “Funding and
management strategies for voluntary-operated community based service
systems needs to balance expansion efforts with ongoing infrastructure
needs and address staff recruitment and retention issues and other
inflationary pressures. Accordingly, OMH will need to continue
working with community-based providers to ensure that all available
funding is used in the most efficient and effective manner to
meet the needs of consumers and their families, and that stable
funding sources are pursued to ensure adequate support for agency
operating expenses.”
CHILDREN'S
SERVICES
Governor
Spitzer’s budget proposal includes an increase in the number
of Home and Community Based Waivers slots, a program that has
proven extremely successful at meeting the needs of children with
psychiatric disabilities. This year’s recommendation is
to expand the program by 180 new slots to 1620 at a cost of $1.2
million this year ($4.7 million annualized).
OMH
also identifies $.5 million to provide continuity of care to young
adults transitioning to the adult service system. We believe this
funding is geared toward kids placed out of state transition back
into the state, however we will have additional information on
this in the coming weeks, especially as this is a priority issue
for MHANYS.
In
addition, this year’s budget proposal builds upon the historic
commitment included in last year’s budget, Achieving the
Promise for New York’s Children and Families. This initiative
includes a program called Child and Family Clinic Plus intended
to provide screening and early detection of mental health needs
in children. This year’s budget includes a continuation
of the components of the Achieving the Promise initiative, including
Child and Family Clinic Plus, tele-psychiatry and early detection.
In
addition, as part of the Department of Health component of the
budget, eligibility for Child Health Plus will expand from 250
percent to 400 percent of the Federal Poverty Level, allowing
an additional 400,000 children presently without any health insurance
to join the program.
See
also, Research.
PRISON
MENTAL HEALTH SERVICES
In
the Department of Correctional Services portion of the budget,
supporting documentation states, “In concert with the Office
of Mental Health, the Department will proceed with targeted investments
to expand and enhance services to prisoners with mental illness,
featuring the development of a specialized residential mental
health program – as an alternative to a Special Housing
Unit placement – specifically for those with persistent
mental illness.”
While
we hope that this will include funding for capital construction
of facilities specifically dedicated for prisoners with psychiatric
disabilities, MHANYS and other members of the Mental Health Alternatives
to Solitary Confinement (MHASC) campaign are very please to see
OMH identify an additional $2 million for an expansion of prison
mental health services ($9 million annualized).
FACILITY
CLOSURES
Though
there are no proposed facility closures in the budget. There is
language indicating that this is something the administration
will be reviewing in the future. To quote from the budget narrative,
“Despite significant reductions in inpatient capacity, which
allowed for reinvestment of resources into the community, the
current institutional service system now being operated by OMH
needs to be right-sized, in order to be more cost effective and
better meet regional needs.”
MHANYS
looks forward to playing an active role in discussions about better
utilizing the resources available in the mental health system
to the benefit of all New Yorkers with psychiatric disabilities.
MEDICAID
Governor
Spitzer’s budget proposal with regard to Medicaid makes
sweeping changes to the current Medicaid system in an effort to
save nearly $1 billion in Medicaid costs. Initiatives include
stepping up efforts to reduce Medicaid fraud and strengthening
quality oversight of community providers in collaboration with
the Office of the Medicaid Inspector General. There will also
be a simplification of the process by which individuals apply
for and maintain coverage through Medicaid and Family Health Plus
intended to bring more than 900,000 uninsured adults and children
into these programs and keep them in. Public outreach campaigns
will also be stepped up for these programs. In addition, trend
factors in reimbursement rates for hospitals, nursing homes, Child
Health Plus, Family Health Plus and managed care plans will be
frozen “as part of a strategy for a more rational reimbursement
system that more appropriately aligns payment to health care providers
with services rendered.”
A
series of demonstration projects will be undertaken to better
manage the care of nursing home patients, persons with co-occurring
disorders, such as mental illness and substance abuse, and other
medically complicated cases and high cost users. These projects
are intended to avoid the need for costly hospitalizations and
institutional care while improving quality of care.
See
also, Medications.
MEDICATIONS
Also
in the area of Medicaid, the Governor’s budget calls for
changes to the Preferred Drug Program, enacted in 2005. Specifically,
anti-depressants will no longer be exempted from the Preferred
Drug Program under the Governor’s proposal – atypical
anti-psychotics will remain exempt along with HIV/AIDS and anti-rejection
medications. In addition, the Governor’s proposal calls
for using cost as a criterion in the drug review process under
the Preferred Drug Program. Also, there is mention of amending
the time frames for public notice for the Preferred Drug Program
- details are yet to come. Physicians will retain the ability
to have the final determination as to which medication a patient
is prescribed. MHANYS has traditionally opposed efforts to roll
back any of the safeguards, like those mentioned above, that were
included in the original Preferred Drug Program agreement in 2005.
We believe that these actions, while intended to simply save money,
would likely reduce access to medications that help people with
psychiatric needs remain healthy and stable, instead causing them
to rely on more intensive and expensive forms of care when access
is denied.
Citing
the fact that 75% of the Medicaid program’s resources are
spent on 20% of the enrollees – primarily elderly and disabled
individuals - the budget proposal also calls for improving the
care coordination for medically complicated and high cost individuals.
For people with psychiatric disabilities, this will likely include
building on the existing Psychiatric & Clinical Knowledge
Enhancement System (PSYCKES) program currently run by OMH, which
has proven quite successful at providing better coordinated care
and reducing costs ($4.3 million).
Lastly,
while it is not a continuation of the Medicaid wrap-around benefit
provided to all dual eligible individuals throughout much of last
year, a wrap-around benefit will continue for dual eligible individuals
needing mental health (likely anti-depressants and atypical anti-psychotics),
HIV/AIDS and organ transplant drugs to ensure access to those
unable to get their medications through their Medicare Part D
plan.
SEXUAL
OFFENDERS
Governor Spitzer’s budget proposal also calls for an additional
$19.2 million ($46 million annualized) to continue the efforts
begun under the Pataki Administration to house sexual offenders
in the state’s inpatient mental health system. This funding
will go to hire 335 full time employees this year, totaling 782
when the funding is fully annualized.
MHANYS
and other mental health advocates have joined with experts in
sexual offender management to, instead, call for the establishment
of a comprehensive approach to sexual offender management that
includes education, prevention, treatment, monitoring and supervision
– all of the aspects that comprise an effective sexual offense
reduction strategy.
GERIATRIC
MENTAL HEALTH ACT
Funding for the Geriatric Mental Health Act, enacted into law
in 2005, continues at $2 million – no additional funds were
added.
SUICIDE
PREVENTION
Funding
for Suicide Prevention programs, including support for the ongoing
State Suicide Prevention Plan, continues at $1.5 million –
no additional funds were added.
RESEARCH
An additional $1.5 million was proposed to improve the capacity
of OMH research facilities at Nathan Kline Institute and Psychiatric
Institute to enhance children’s mental health treatment
and support services.
TIMOTHY'S
LAW
"The
Executive Budget also includes a $100 million General Fund appropriation
for the Department to finance provisions of "Timothy's Law"
which was enacted in late 2006. Under this statute's provisions,
on or after January 1, 2007, the State is required to fully reimburse
employers with 50 or fewer employees for the costs associated
with providing broad-based mental health insurance coverage."
ADDITIONAL
ITEMS
$.4
million in new funding to replace Federal funding to continue
Project Caring, to bridge corrections and community-based services
for women with mental illness.
$.6
million in new funding to add supported employment slots for people
with psychiatric disabilities.
$.9
million in new funding to cover costs above the Medicaid funding
for Comprehensive Psychiatric Emergency Programs (CPEP).
$1.2
million ($1.9 annualized) in new funding to support trend factor
increases for Residential Treatment Facilities.
$.3
million in new funding for school mental health services.
Continued
funding to maintain current bed levels within OMH facilities for
adults (4030), children (526) and forensic programs (695).
Continued
funding of $326.6 million to support state facility building preservation,
design and construction, health and safety, accreditation, energy
conservation and environmental protection.
