County 1991 Realignment Mental Health Growth Restoration ($84 million GF):
The Governor proposes to increase General Fund support for the In-Home Supportive Services (IHSS) program by $241.7 million and discontinue the redirection of counties’ 1991 Realignment Mental Health Growth and county indigent health revenues. As a result, counties could receive an estimated $84 million in 1991 Realignment Mental Health Growth funding in FY 2019-20. According to the Governor’s Budget summary, “This action reflects a recognition that the state and federal government have taken actions that increase IHSS costs beyond available 1991 Realignment revenues for this program.”
In 2017, Governor Brown and counties negotiated a new county Maintenance-of-Effort (MOE) and annual inflation factor for IHSS program costs. Part of this arrangement included a temporary redirection of all 1991 Realignment growth funds from county indigent health and mental health services to fund a portion of county IHSS costs in FYs 2017-18 and 2018-19.
Public Mental Health Workforce Investment ($50 million GF):
The Governor’s budget provides $50 million in one-time General Funds to the Office of Statewide Health Planning and Development (OSHPD) to “help address the increasing need for public mental health practitioners” and “increase training opportunities for workforce programs.” The Governor’s budget summary indicates that universities, health clinics, and philanthropic organizations contributing to the investment will increase the effectiveness of the funding and meaningfully benefit the entire public mental health system.
Medi-Cal Trauma Screenings for Children and Adults ($30 million Prop. 56): Acknowledging trauma-informed care as a model of care intended to promote healing and reduce risk for re-traumatization, the Governor’s Budget proposes to utilize Proposition 56 revenues to establish and implement the use of a standardized screening for trauma among child and adult Medi-Cal beneficiaries. Department of Health Care Services (DHCS) assume that trauma screening costs will be $60 million in FY 201920, which includes $30 million from Prop. 56 funds and $30 million in federal Medicaid match. Proposition 56 of 2016 increased the tobacco tax by $2.00 to provide resources to support physician training, prevention and treatment of dental diseases, Medi-Cal, tobacco-use prevention, research into cancer, heart and lung diseases, and other tobacco-related diseases, and school programs focusing on tobacco-use prevention and reduction.
DHCS estimates the cost to create a new trauma screening tool to be minimal, and assumes: all children and adults under age 65 will be initially screened within 3 years, one third of both the child and adult population will receive an initial screening in each year for 3 years; providers will be able to bill for children to receive periodic rescreening up to once a year and no less often than every 3 years; and 20% of those initially screened would require a complex assessment.
Early Psychosis Research and Treatment ($25 million GF):
The Governor’s budget provides $25 million in one-time General Fund grants using innovative approaches for detecting and intervening with young people who have had, or are at high risk of experiencing, psychosis. Additional details will be forthcoming from the Administration on the eligible entities that may apply, as well as the state agency that will presumably administer the grants.
Mental Health Resources for University of California (UC) Students ($5.3 million GF): The Governor’s Budget $5.3 million ongoing General Fund to improve mental health programs and support efforts to meet recommended staffing ratios. The Budget describes that each UC campus currently has a division of Counseling and Psychological Services staffed with psychologists and psychiatrists to assist students. Additionally, the Governor’s Budget provides $15 million to address student hunger and housing needs.
Whole Person Care – Supportive Housing, People with Mental Illness ($100 million GF): The Governor’s Budget provides $100 million General Fund for Whole Person Care Pilot (WPC) Programs, which is expected to be used to provide additional supportive housing for people with mental illness. These existing pilot programs focus on coordinating health, behavioral health, and social services. The $100 million will be available for expenditure until June 30, 2025.
Under the Medi-Cal 2020 Waiver, the Centers for Medicare and Medicaid Services (CMS) approved funding for WPC Pilot programs for a five-year period beginning January 1, 2016. The WPC Pilots allow local entities to integrate services for their high-risk, high-utilizing beneficiaries to promote an integrated health system designed to maximize health care value and is sustainable over the long-term. DHCS has approved a total of 25 local Whole Person Care Pilot programs (23 individual counties, one consortium of two counties, and one city).
No Place Like Home” Gap Financing: Voters approved the No Place Like Home $2 billion bond program (to be repaid with Mental health Services Act revenues) in the November 2018 election. These bonds will help provide supportive multifamily housing for individuals experiencing mental illness who are either homeless or at risk of homelessness. The Administration will “accelerate No Place Like Home program awards and, combined with the additional tax credits and state investments included in the Budget (see the Housing and Local Government chapter), provide needed gap financing for developers to increase the production of affordable housing units.” Additional details describing this proposal are anticipated to be provided by the Administration.
Augmented Law Enforcement Training on Mental Health Crisis ($35 million GF):
The Governor’s Budget provides $35 million General Fund for the Peace Officer Standards and Training (POST), which creates and provides mandated local law enforcement training, for augmented training on use of force, de-escalation, and engaging with individuals experiencing a mental health crisis.
Medi-Cal Expansion to Young Adults, Regardless of Immigration Status ($194 million):
The Governor proposes to provide full-scope Medi-Cal benefits to three populations of young adults ages 19 to 25, regardless of immigration status: undocumented full scope children turning 19, current restricted scope adults, and adults that are currently eligible, but have not enrolled into MediCal. The Department of Health Care Services estimates the implementation to be no sooner than July 1, 2019 and assumes this will expand benefits to approximately 138,000 individuals.
County Repayment of Federal Audit Disallowances in Medi-Cal Specialty Mental Health Services ($180 million): Under Federal Audit A-09-15-02040, the Office of the Inspector General (OIG) conducted an audit and determined DHCS claimed Federal Medicaid reimbursement for Specialty Mental Health Services (SMHS) unallowable under the Federal and State requirements for SMHS. The audit covers payments made during the period of federal fiscal year 2014. DHCS repaid $180.7 million to the federal Centers for Medicare and Medicaid Services (CMS) in December 2018. However, the Administration contends that since the responsibility for SMHS was realigned to counties as a part of 2011 Realignment, these disallowances must be repaid by the counties on a quarterly basis, over a period of four years, beginning in the last quarter of FY 2018-19.