January 22, 2008

BUDGET UPDATE

Today, Governor Spitzer introduced his proposed budget for this year. Listed below is the mental health breakdown.

Considering the difficult budget deficit facing New Yorkers, the mental health budget put together by Governor Spitzer and Commissioner Hogan is one that is in many ways unprecedented in its commitment to the mental health community and to many of MHANYS major issues. They have recognized several of MHANYS top priorities including workforce and housing and have made sure that there is a continued down payment on these programs and several others that are significant for individuals with psychiatric disabilities.

The Governor has committed significant resources to the mental health system and it is important to recognize how impressive this is especially in the context of the deficit. He and has staff have clearly demonstrated their commitment to people with psychiatric disabilities in this budget.

Below is a brief budget summary. We will provide a more extensive summary in the days to come. We will also provide copies of our written budget testimony to the Senate Finance Committee and the Assembly Ways and Means Committee, next Tuesday.

Workforce

This has clearly been a major priority of MHANYS as we have made clear throughout the past year with letters, calls, editorial support and op-ed pieces in newspapers (included in the end of this summary is an op-ed piece from MHANYS in yesterday’s Albany Times Union).

The Spitzer administration has agreed to fund the third year of the COLA and most significantly agreed to extend the 2.5 percent COLA to human service workers for an additional three years. This is an investment of almost $400 million over the next several years and a significant recognition by the administration of the needs of the mental health workforce. This is also an important recognition of MHANYS and the priorities of our members as we have taken a strong leadership role in the fighting for workforce issues.

This is groundbreaking in the context of the overall budget and the Governor should be commended for his recognition of the needs of the mental health workforce.

Unfortunately, the health care enhancements that we have been fighting for are not in the Governor’s Budget but the legislature has voiced a strong interest in this area and the Senate mental health chair Thomas Morahan is planning to introduce a bill calling for health care enhancement for mental health workers. We have also spoken with the Assembly about this as well and they feel very strongly about the heath care enhancements. We will certainly provide you with a lot more information about this in the coming weeks.

Housing

Last year, despite only being in office for a few weeks, Governor Spitzer added two thousand units of funding in the budget for more housing. One thousand units of supported housing and one thousand units of capital beds.

This year, the Governor continues this commitment by providing an additional two thousand units of housing in the budget. 1500 units of supported housing and 500 SRO units. This is a continued recognition of the call of advocates for additional housing especially for those individuals in desperate need of housing including adult home residents, homeless individuals, those coming from psych centers and nursing homes and we cannot forget the needs of aging families with adult children with psychiatric disabilities still living at home with their parents.

We are very appreciative of the administrations recognition of housing as a major concern across the board. This funding combined with the Governor’s proposed Housing Opportunity Fund could create thousands of new units of housing in the next several years. This is a very serious commitment by the administration to housing for people with psychiatric disabilities.

In addition there is more flexibility in HFA funding to provide innovative housing projects for OMH, OMRDD and OASAS.

This housing commitment from the Spitzer administration is very impressive and will likely have a very positive impact for years to come.

In addition, there is a licensed housing fix of 8% adjustment for licensed housing programs which has long been a priority of our colleagues at ACL. This is the second year of a three year commitment from the state to insure that licensed housing providers continue to provide quality services.

Employment

In the area of employment, the budget has increased employment funding in PROS programs. Medicaid will not traditionally pay for employment programs which is a serious concern for PROS providers. This funding which is specific state dollars will hopefully spur increased employment opportunities in PROS counties for individuals with psychiatric disabilities.

MHANYS will be working with our colleagues at NYAPRS in the fight for employment dollars for non Medicaid programs.

Children’s Mental Health

Among the list of priorities of our agency through our partnership with Families Together was the call for funding in the budget for family support services in Child and Family Clinic Plus. Though there is not as much funding in the budget as we had hoped, it is an investment in the needs of family support services. We will continue to advocate for additional funding in this area.

In addition, there was an expansion in telepsychiatry in rural areas in regard to child psychiatry. This funding should expand the number of counties with rural telepsychiatry from ten to twenty counties.

Adult Homes

There is a funding set aside for conversion of existing adult homes to more appropriate housing to better accommodate the needs of individuals with psychiatric disabilities. When there is planned closure of an adult home, this funding will hopefully insure that the facility would stay in the mental health system. This could be very significant given the groundbreaking work that has taken place with innovate housing designs at programs such as Pollack Gardens in Suffolk County.

Criminal Justice

In recognition of the anticipated signing of the SHU bill, the Governor has added funding in the budget to create over a dozen more slots to oversee the program in the budget of the Commission on Quality of Care.

Also, we will report back on the likelihood of additional behavioral health units in the state prisons in anticipation of the Governor signing the SHU bill.

Clinic Reform

Throughout the year, Commissioner Hogan has been consistent in his call for reform of clinic funding in New York. The funding in this year’s budget is being used to equalize rates for COPS and non COPS clinics. This volume adjustment will create a consistent rate for all clinic providers.

Also, the Governor has proposed the elimination of Medicaid neutrality for clinics in mental health. The hope for these reforms is that this rate will help in providing a stronger outcome based system of care and clinics will receive a more equitable rate that will allow them to have even greater flexibility in meeting recipient concerns.

In addition, the Governor has proposed the elimination of the Medicaid neutrality cap which could hopefully provide a role in the expansion of services.

Centers of Excellence in Cultural Competence

We are pleased that the administration has continued their commitment to Centers of Excellence in Cultural Competence. They will continue to provide $2 million in funding for this program.

Co-Occurring Disorders

There is an additional one million dollars in the OMH budget and 1.5 million in the OASAS budget to help fund integrated models of care and funding for dual diagnosis coordinators. MHANYS served on the Co-Occurring Task Force and we are very pleased to see that strong commitment from the Spitzer administration

Research

Recognizing the wealth of expertise and knowledge at the Psychiatric Institute and Nathan Kline Institute, the administration announced the creation of the Center for Genomics.

What is not in the budget?

Though the administration deserves a great deal of credit for what was put in the budget, there needs to be additional funding in mental health to enhance the recovery of people with psychiatric disability.

I already mentioned that health care enhancements were not in the budget and that will be one of our major advocacy strategies with the legislature and the administration.

This year, the administration has decided to cut anti-depressants from the mental health carve out for medications in the preferred drug list. Individuals on Medicaid with a psychiatric disability must have access to quality medications that are based on choice, not based on a limited formulary. We will fight strongly to restore this carve out.

There was also no new funding in the budget for Geriatric Mental Health (though we have not had the opportunity to review the OASAS budget which will hopefully include some additional funding). Over the last few years; there has clearly been a growing recognition of the mental health needs of older New Yorkers. There must be continued funding in this area to insure that the needs of older New Yorkers with psychiatric disabilities are being addressed.

The members of the New York State Coalition on Adult Home Reform has called for an increased in funding for independent case mangers who can work with adult home residents and help create individualized recovery treatment plans that can include more independent housing options Unfortunately, there was no additional funding in the budget for that program. Also, there was no new funding for veterans issues in regard to mental health.

There was no new funding in the budget for suicide prevention efforts and veterans issues. We will continue to advocate for those as priorities for community mental health.

Summary

The Governor should be lauded in his very strong commitment to mental health including the top priorities of MHANYS-- workforce and housing. Funding the third year of the COLA and expanding the COLA for three additional years will be a great tool in helping to both recruit and maintain quality staff. We applaud the administration for this commitment.

The Housing commitment of the administration is also significant. Two thousand new units of housing combined with the administration’s commitment to house individuals with disabilities in the Housing Opportunity Fund will have positive effects for many years to come.

Both in housing and in workforce, this is an unprecedented commitment to the mental health community.

We are also pleased that the administration has a strong commitment to funding for prison reform, children’s mental health issues, co-occurring disorders and clinic restructuring.

To continue Governor Spitzer’s commitment to a quality system of care for individuals with psychiatric disabilities, we must include funding for health care enhancements for direct care staff in mental health programs as well as funding to insure that anti-depressants are added back into the formula for the Preferred Drug List, additional funding for geriatric mental health, employment funding for non-Medicaid programs, veterans issues, enhanced independent case managers for adult home residents and suicide prevention.

We also look forward to working with the Executive and the Legislature on amendments to Timothy’s Law, restructuring of parental custody in DSS Law and the Housing Wait List Bill.

Mike Attwell to Retire from Division of Budget at the end of January

In most cases when we put out at a budget update, we usually just focus on budget but this is clearly a related story.

Mike Attwell, the head of the Mental Hygiene Unit in the New York State Division of the Budget is retiring on January 31st. Many of you who do not know Mike would not know the significance of this announcement.

Simply put, Mike is one of the smartest and most decent people I’ve ever worked with both inside and outside government. He has always recognized the priorities of community mental health advocates and has always been an internal advocate for us on so many of these issues. One of the significant reasons for the extension of the COLA is us working closely with Mike on workforce issues and his tireless commitment to make sure that the community system of care remained an administration priority.

He will be greatly missed. We wish him the best of luck in his retirement. We are honoring his work and legacy at our March 12th Legislative Conference.

In the News

In a last minute push, we had been trying to convince the Governor about the significance of funding health care enhancements. We will continue this advocacy throughout the year. It is time to end this inequality for direct care staff.

Attached is the op-ed piece in yesterday’s Albany Times Union.

Mental Health Workers' Incentives Key
Albany Times Union, OP ED January 21, 2008
by Glenn Liebman

A very wise boss once told me that you can develop the greatest system of care in the world, but if you don't have the staff to implement the design, it will fail.

That is how many of us in community-based mental health services feel about work force issues. We need a strong, educated, well-trained and well-compensated work force.

For years, we have been talking about our work force problems -- the poor salaries, the lackof benefits, the difficult work conditions and the high turnover rate -- and almost nothing has been done about them. In the last few years, there have been some positive steps through increases in state-set cost of living adjustments for human services workers. But they do not go far enough.

Both inside and outside of government, New York has some incredibly creative minds that have developed models of mental health care that enhance an individual's recovery. We have developed strong community-based programs. We also have developed a better understanding of the science of mental health that has helped bring about better medications.

Most importantly, we have a strong recipient and family movement that has played a major role in improving recovery rates during the past decade.

The reality, however, is that without a qualified work force, even the best mental health system will have serious implementation issues. Salaries for direct care staff in community-based programs are often less than $20,000 a year, and benefits are frequently minimal.

Qualified individuals are choosing to work at McDonald's and Burger King rather than in the mental health field. No wonder the turnover rate in some programs exceeds 40 percent.

A strong work force also is one of the best predictors of individual recovery. Many people with mental illness say the No. 1 factor in their recovery was their relationship with a staff person, whether it is a peer recovering from mental illness who is paid to work with others, a case manager, a therapy aide or someone else who cares deeply about the individual in recovery.

When that staffer leaves the agency, the relationship ends, often resulting in a major setback for the recipient of mental health services. The recipient may leave community-based services and end up homeless, in emergency rooms or in the criminal justice system. This is much more costly to state taxpayers and certainly a scenario that no compassionate New Yorker would want to see happen.

We need action to help the work force. The action we seek is not unprecedented: We are asking that mental health direct-care workers receive a stipend to help pay for their health insurance costs, just as those who work in the developmentally disabled community now get.

Direct-care staff licensed through the state Office of Mental Retardation and Developmental Disabilities receive a $425 annual stipend that helps pay for medical costs like copayments and deductibles. This successful program has not cost a great deal of money -- about $70 million in Medicaid funds, with the state share of that at $35 million.

But it is the kind of incentive that helps keep caring professionals in the field.

Many community providers run both mental health and developmental disabilities programs. They are able to provide the stipends to staff in the developmental disabilities area, but not to their mental health workers.

Staff in both areas work to provide the best possible care. Why does one work force get the health care enhancement stipend and the other does not?

Direct-care staff in both systems should be better funded, but to have such a discrepancy based not on need, but on greater access to funding streams is not what should drive health care enhancements for direct-care staffs.

It would be a victory for all New Yorkers to see this stipend in the state budget. People with mental illness would win as they continue to recover, providers would win by incentivizing good workers to stay in their programs and the state's taxpayers would win by saving money through keeping people with mental illness out of more costly services.

We urge Gov. Eliot Spitzer to support a $10 million health care enhancement for the mental health work force.

Glenn Liebman is CEO of the Mental Health Association of New York State.

http://www.timesunion.com/AspStories/storyprint.asp?StoryID=656607