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July 2004 NACBHDD Newsletter

The Newsletter of the National Association of County Behavioral Health and Developmental Disability Directors

In this Issue...

Ninth Annual Conference: Developing New Leaders for the Future

Ritz Carlton, Phoenix, Arizona, July 15-17
Don’t Miss This Opportunity!

NACBHD’s New Leaders for the Future Conference promises to provide participants with knowledge, skills and tools that can be readily used in their communities. Highlights and opportunities are described below:

Register online now!

NACBHD Attends the Annual Conference of the National Association of State Drug and Alcohol Directors (NASADAD) & the National Prevention Network (NPN)

For the first time in the association’s history, NACBHD attended the Annual Conference of NASADAD and NPN. NACBHD attended this meeting to publicly express our willingness to partner with the state and federal governments in the provision, planning and oversight of addiction services. NACBHD also attended this meeting as a way to provide staff with a better understand the treatment and prevention sectors. A better understanding will result improved effectiveness efforts to advocate for counties in both treatment and prevention. NACBHD made its attendance known and eagerness to partner to all participants during an open microphone session.

Several themes that were highlighted by NASADAD, NPN and SAMHSA during this conference included:

If you would like more information about the conference or about NASADAD/NPN policy and advocacy positions, please contact Melissa Staats at mstaats@nacbhd.org or (202) 661-8816.

NACBHD Provided Testimony to SAMHSA National Advisory Council

On June 30 2004, NACBHD provided both written and verbal testimony to SAMHSA’s National Advisory Council. The National Advisory Council and its subcommittees were established to advise the “Director of the Administration or Center for which the advisory council is established concerning matters relating to the activities carried out by and through the Administration or Center and the policies respecting such activities." NACBHD’s testimony can be found at www.nacbhd.org/members/legislative/070504.cfm.

NACBHD and NACo Send Joint Letter to New CMS Director Regarding Medicare Modernization Act and Dual Eligibles

NACBHD and NACo recently sent a joint letter to the new CMS Administrator, Mark McClellan, regarding concerns about the new Part D benefit of the Medicare Modernization Act and its impact on access to medications for dual eligibles. The letter outlines recommended protections to guard against this loss of access. To view the letter, see the NACBHD website at www.nacbhd.org/members/legislative/061504.cfm

Transformation

NACBHD to Participate in Conference on Transformational Leadership

Melissa Staats, NACBHD’s Executive Director, will participate in the Conference on Transformational Leadership, this August 8 and 9. The Center for Mental Health Services (CMHS), as part of its Action Agenda to implement key components of the goals and recommendations of the Presidents Commission on Mental Health (see April, June, and current newsletters), is convening “a select group of experts who can advise us about aggressive, yet realistic strategies to effectively address the need for strong leadership” (from the invitation from Kathryn Power, M.Ed., Director, CMHS). The purpose of the meeting is to “define a process that CMHS can implement that will create and sustain a strong leadership and knowledge base in the mental health field.” Invitees include SAMHSA officials, officials from NASMHPD, NMHA, NAMI, the National Empowerment Center, NCCBH, and the National Alliance of Multi-Ethnic Behavioral Health Associations. Look for a report on the meeting in the September newsletter.

Update on the Campaign for Mental Health Reform: Intense Effort Focusing on State and Local Transformation Continues

NACBHD spoke with Bill Emmet, project director at the National Association of State Mental Health Program Directors (NASMHPD), and project director for the Campaign, about recent Campaign activities.

The New Freedom Commission Report: A Multicultural Perspective Forum

An Interview with NACBHD Member Marvin Southard

On June 2, the Los Angeles County Department of Mental Health, the Latino Behavioral Health Institute, the California Mental Health Directors Association, the California Institute of Mental Health, and the National Alliance for the Mentally Ill held the “New Freedom Commission Report: A Multicultural Perspective Forum.” The one-day event is part of California’s overall effort to implement the Report’s recommendations and included leaders from communities of color and Commissioner Steve Mayberg (also Director of the California Department of Mental Health) to discuss the report and possible recommendations and policy implementation strategies from a multicultural viewpoint.

Marvin Southard, Director of the Los Angeles County Department of Mental Health, and NACBHD member, reports that while the event was a one-day forum, it brought out some important issues and “spawned” other events.

Clients and families as the center and starting point of the discussion
The forum focused on the mobilization and inclusion of clients and their families as a starting point for discussion. Southard says the most important thing that came out of the forum for him is how different the dialogue can be if clients and families have the central place in the discussion. Representatives from NAMI and local client groups, Mayberg, and experts on multicultural services were present. Latinos, African Americans, American Indians, Asian Pacific Islanders, and older adults were represented because they are all underserved groups in the area. Break out groups discussed access, training of professionals, and reduction of stigma. Training issues involve finding ways for people with cultural backgrounds to enter the mental health field and supplement undergraduate education with additional higher education.

Events following from the forum
State forums will be held throughout the summer to advance the issue of multiculturalism, which Southard says is “a topic that needs to be addressed in every aspect of providing quality mental health care.” And, in Los Angeles specifically, there will be a multi-year initiative focusing on access for minorities to mental health care, particularly Latinos, who are the most underserved population in Los Angeles. The reasons for this are complex, notes Southard, but are most likely related to immigration issues and reluctance to seek care, the shortages of professionals with language and cultural skills, and the shortage of community organizations in some areas to serve mental health needs. Similar issues arise in the American Indian and Asian Pacific Islander populations.

For more information on the forum
An interim report on the forum is due by the end of June on the California Institute of Mental Health website at www.cimh.org; the final report will be available at the same address.

An opportunity to make a practical difference
“Let’s take advantage of this opportunity to put something in place that makes a difference,” says Southard of the Final Report of the President’s Commission on Mental Health. California’s effort to implement the report’s recommendations focuses on the report as a practical document; and Southard views it as a means for practical implementation of things that states and counties can do. He is also involved in another effort related to the implementation of the Report’s recommendations – the better integration of mental health and substance abuse. Look for an interview with Southard on this effort in the August newsletter.

Developments in the California Budget Crisis: An Interview with NACBHD Member Patricia Ryan

NACBHD reported on the California state budget and Medicaid crisis in the April and February newsletters. The finalization of the budget and Medicaid restructuring are close but still underway. NACBHD spoke with Patricia Ryan, NACBHD member and Executive Director of the California Mental Health Directors Association, about recent developments and issues of interest to county behavioral health directors.

So far, the legislature has rejected proposed cuts for mental health, but the Governor could still line item veto in this area. The current situation for counties is bad, regardless of the 04-05 budget proposals. When NACBHD spoke with Ryan, the budget was at the “big five level” of discussion, which includes the leadership of the Senate and Assembly and the Governor. The Chair of the Senate Budget Committee, Darrel Steinberg, is a strong advocate for county behavioral health. But, according to Ryan, there is a feeling of “calm before the storm,” or a feeling of “systematically dismantling” a good system of care. Ryan reviewed the following issues in the budget crisis that impact local public mental health in California:

  1. Timeline
    The FY 04-05 budget was scheduled to be adopted by the legislature by June 15 and signed by the Governor by July 1, and was behind schedule when this newsletter went to publication. The Medicaid Reform Proposal is due in August and the California Performance Review (see below for discussion of both) will be completed sometime after the budget. Neither Medicaid Reform nor the results of the California Performance Review will be part of the FY 04-05 budget; they will effect the FY 05-06 budget.

  2. Realignment Funding
    In 1991, the legislature, through realignment, transferred financial responsibility for most of the state’s mental health and public health programs, and some of the social service programs, from the state to local governments, and provided counties with a dedicated revenue source to pay for the changes. Two tax increases – the statewide sales tax rate increase of a half-cent and the vehicle license fee – were dedicated to funding the realigned programs. The first claim on the Sales Tax Growth Account (from the two tax increases) goes to caseload-driven social services. Because of the caseload growth in Child Welfare Services and Foster Care and the significant and unanticipated cost increases in the In Home Services Support Program, growth distributions to the Mental Health Subaccount and Health Subaccount have been substantially reduced. (For mental health, the realignment was transferred to the prerealignment areas of general community mental health funding, state hospital civil commitment funding, and IMD funding.)

  3. Counties in California Manage the Medicaid Program (Medi-Cal) for the Seriously Mentally Ill
    Medi-Cal is the second largest revenue source for county mental health programs. Understanding the changes in California’s Mental Health Medi-Cal program since realignment and the interaction of Medi-Cal revenues with realignment are critical to analyzing the current structure and status of public mental health in California. There are several complex realignment/Medi-Cal issues, including: 1) Counties have not received COLA’s for Medi-Cal since 2000 and the allocation was reduced by 5% in FY 03-04; 2) Counties must use an increasing proportion of realignment funds for the federal Medicaid match, resulting in fewer funds for the “targeted” indigent clients; 3) Recent failure of the state to reimburse counties for the cost of providing state mandated services to Special Education Pupils (see below) has put a strain on county realignment and other mental health resources.

  4. Mental Health Services to Special Education Pupils, AB 3632
    Under the federal IDEA law, all children with disabilities are entitled to a free, appropriate public education. This includes mental health treatment. In 1984, the California legislature transferred responsibility for providing mental health services to special education children from school districts to county mental health departments (AB 3632). This has been handled through a mandated reimbursement from the state to counties; however, three years ago the state issued a moratorium on the reimbursement mandate, effectively saying, “We owe you, but we can’t pay you.” This has amounted to about $120 million per year, with this year as the third year with no funding for the federal entitlement. Some counties have no general funds to pay for this program, which leaves them no choice but to use scarce realignment funds meant to serve their “target” low-income and uninsured populations of seriously emotionally disturbed children and seriously mentally ill adults. One small county announced it cannot provide services without funding; and a large county filed suit against the state for non-payment of a state mandate. The lack of funding is causing some service reductions and denials, a violation of state and federal law. Without this county partnership, the California Department of Education may no longer be able to assure the federal government that “related services” (including mental health services) are being provided to all eligible students, jeopardizing the $900 million in federal IDEA funds.

  5. Possible Elimination of the Children’s System of Care
    The Children’s System of Care is an interagency program led by county mental health departments to ensure that high-risk youth with serious emotional disturbances achieve optimal outcomes without duplication of effort and resources. $20 million of funding is involved for 2004-2005; the program’s budget had already been reduced from $35.6 million to $20 million for FY 02-03. Elimination of the program would likely cause children to end up in juvenile justice system. As Ryan says, this used to be the “glue to give kids what they need to stay out of trouble.”

  6. California Performance Review
    The Governor has appointed a bipartisan group of current and former state employees to examine restructuring of the state government, including the relationship between state and local government and related funding. While the results of the performance review will not be incorporated in this year’s budget, a major reorganization of the way the state government works is expected. Ryan says that it makes sense for dedicated funding to go to local services and she predicts that the group will look at more of this. Rumors about outcomes of the performance review include the consolidation of some state agencies and the elimination of others; and that the group is looking at how to eliminate barriers to doing what makes sense and what will allow counties to do what works. While there is no one representing local mental health per se on the review group, a former interim director of the California Mental Health Director’s Association and a former official with the state department of mental health are part of the group; and Ryan says they understand the system and its flaws.

  7. Mental Health Services Act
    The Mental Health Services Act, an initiative to serve California’s most severely mentally ill by imposing a one percent tax on net income above $1 million, has made it onto the November ballot. The initiative would bring more money into counties to treat broader groups than currently mandated, and could have a “significant, maybe even tremendous impact,” reported Cathy Geary, NACBHD member and Chair of the Medi-Cal Committee of the California Mental Health Directors Association in the February newsletter. If passed, the initiative could raise $600 million to $1 billion a year, depending on the economy. Ryan reports that grass roots efforts to get the initiative on the ballot paid off, with more than the 500,000 signatures needed to qualify for the ballot collected; and people involved in serving the mentally ill are very enthusiastic about the initiative. While initiatives are a controversial method of creating public policy, the legislature is viewed as so dysfunctional that something had to be done to help mental health. For more information, see www.campaignformentalhealth.org.

Look for more on the budget situation in California and its impact on behavioral health, as well as a report on Medicaid restructuring in the state, in the August or September newsletter.

September is National Alcohol and Drug Addiction Recovery Month

September 2004 is the 15th annual National Alcohol and Drug Addiction Recovery Month. SAMHSA, along with HHS, and in partnership with national planning partner organizations, has created a user-friendly planning toolkit to help prepare for events and activities related to Recovery Month. Information about media outreach, targeted outreach, and resources can be accessed and toolkits can be downloaded at www.recoverymonth.gov. Hard copies can be ordered for free at 1-800-662-HELP.

Wernert Award Winner Announced

The Technical Assistance Collaborative, Inc. (TAC), in collaboration with NACBHD, will present the fifth annual Thomas M. Wernert Award for Innovation in Community Behavioral Healthcare on July 16 at the NACBHD Annual Conference in Phoenix. The $10,000 award goes to the Consumers as Providers Program (CAP), the University of Kansas Office of Mental Health Training & Research, Supported Education in Lawrence, Kansas.

CAP is a supported education endeavor that creates greater community involvement and quality of life for consumers. Training includes classes and internship activities in a supported academic environment for individuals with severe and persistent mental illness. Participants acquire skills for marketability as mental health providers, self-confidence, and meaningful employment and future academic opportunities. For more information, see the TAC website at www.tacinc.org.

New Reports from the Kaiser Commission on Medicaid and the Uninsured

The Kaiser Commission on Medicaid and the Uninsured (KCMU) issued two new reports of interest to county behavioral health directors in June. The U.S. Supreme Court’s Olmstead Decision: Five Years Later and The Impact of Recent Changes in Health Care Coverage for Low-Income People: A First Look at the Research Following Changes in Oregon’s Medicaid Program, as well as other reports of interest, can be accessed at www.kff.org/about/kcmu.

NAMI To Launch National Walk Program

NAMIWALKS D.C. for the Mind of America, part of a nationwide pilot program sponsored by the National Alliance for the Mentally Ill, is scheduled for October 2004, to increase public awareness about mental illness and to raise money for NAMI’s support, education, advocacy, and research programs. The first of its kind to be held in the nation’s capitol, the walk will be one of fifty walks held across the country in 2004-2005. See www.nami.org for more information.


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