Governor’s Proposed 2015-16 Budget: Mental Health Highlights
by Kiran Savage-Sangwan
Last Friday, January 9th, Governor Brown released his 2015-16 state budget proposal. NAMI California has identified the following areas, among others, as having potential impacts on consumers and families. We will continue to follow the budget through the legislative process and provide updates and advocacy opportunities to members.
- Mental Health Services Act Revenues. The budget estimates annual revenues of $1.8 billion for 2014-15 and $1.775 billion for 2015-16. The 2013-14 estimates and 2014-15 estimates are $100 million and $200 million above the estimates for those years stated in the Governor’s January 2014 budget.
- Medi-Cal Growth. The budget proposes total expenditures of $95.4 billion ($18.6 billion General Fund) for 2015-16. With enrollment projected at 12.2 million eligibles, about 32 percent of Californians will be in Medi-Cal. The Medi-Cal expansion, as provided by the Affordable Care Act, will result in an additional 3.3 million people enrolled in Medi-Cal.
- AB 3632 Payments. The budget proposes $533 million of the $800 million currently owed to counties for pre-2004 mandates be paid in the 2015-16 year presuming that the May 2015 revenue estimates continue to show funds exceeding the May 2014 estimates. AB 3632 mental health services for students are a significant share of these payments.
- Coordinated Care Initiative. Under this pilot project, dual eligibles (Medi-Cal and Medicare) receive medical, behavioral health and long-term supports. This pilot was intended to operate in eight counties; however, Alameda will now not be participating. Due to various implementation issues, including a large opt-out of participation rate of 69 percent, less federal shared savings, and delays in implementation, the program may not continue in the future due to poor cost-benefit. If factors don’t improve by January 2016, the CCI may cease operating effective January, 2017.
- Drug Medi-Cal Program. California has submitted a federal Waiver for the Drug Medi-Cal Program, which focuses on the delivery of substance use disorder services, which will be finalized in 2015. A key component of this Waiver is to expand Residential Treatment Services. In addition to the federal Waiver submitted for restructuring this program, the Department of Health Care Services is in the process of trying to complete recertification of hundreds of facilities that provide drug treatment. DHCS contends they will complete this recertification process by November 2015.
- 2011 County Realignment. The Behavioral Health Account within realignment is to receive growth funds of $146 million in 2014-15 and $141 million in 2015-16. A priority for these growth funds will be for children’s specialty mental health and Drug Medi-Cal Program services.
- Department of Social Services-Continuum of Care Reform. The budget proposes $9.6 million for DSS to begin implementing the Continuum of Care Reform, which includes preventative, wraparound and mental health services for foster youth.
- Supplemental Security Income/State Supplementary Payment (SSI/SSP). Total expenditures of $2.8 billion are budgeted which reflects a revised maximum grant level for January 2015 set at $881/month for individuals and $1483/month for couples, and a caseload of 1.3 million recipients.
- Department of State Hospitals and Department of Social Services: Department of State Hospitals and Department of Social Services will increase the number of beds available to admit clients who need to be restored to competency in order to stand trial. The San Bernardino County Restoration of Competency Program and Porterville Secure Treatment Program are likely to be expanded.
- Proposition 47 Funds. Proposition 47 funds will be placed in a new fund to be used for mental health and substance use disorder treatment services, among other programs. These funds will be available beginning in the 2016-17 fiscal year.
NAMI California Endorses Proposition 47–The Safe Neighborhoods and Schools Act
Click on the image below to open the letter
California State Assembly Passes NAMI California Authored Resolution Establishing July as Bebe Moore Campbell Minority Mental Health Month – Raising Awareness of Communities of Color
On July 3rd, the California State Assembly passed the NAMI California sponsored resolution recognizing July as Bebe Moore Campbell Minority Mental Health Month. Following the 2008 proclamation from the United States House of Representatives, National Minority Mental Health Awareness Month was created to raise awareness about severe mental illness in diverse communities of color, while highlighting avenues for wellness and recovery.
The legislation, ACR 163, authored by California State Assemblymember Sebastian Ridley-Thomas, recognizes July as Bebe Moore Campbell National Minority Mental Health Awareness Month in State of California. Assemblymember Sebastian Ridley-Thomas is the Chair of the newly established Assembly Select Committee on Mental and Behavioral Health.
Rising in support of the resolution on the Assembly floor were distinguished Assembly members V. Manuel Perez, Majority Leader; Dr. Richard Pan, Chair of the Assembly Health Committee; Steven Bradford, Chair of the Select Committee on the Status Boys and Men of Color; Bonnie Lowenthal, Commissioner on the Mental Health Oversight and Accountability Commission; Mariko Yamada, Chair of the Assembly Select Committee on State Hospitals; and Rob Bonta, speaking on behalf of the Asian Pacific Islander Legislative Caucus.
Watch the video of the floor discussion here:
About Bebe Moore Campbell
In addition to being an accomplished author, Ms. Campbell was a founding member of NAMI Urban LA and an advocate for the mentally ill. In 2003 she received NAMI’s Outstanding Media Award for Literature for the book, “Sometimes My Mommy Gets Angry”, written especially for children, about a young girl who learns how to cope with her mother’s bipolar illness. In 2005, her novel “72-Hour Hold” focused on an adult daughter and a family’s experience with the onset of mental illness.
“Stigma is one of the main reasons why people with mental health problems don’t seek treatment or take their medication,” Campbell said. “People of color, particularly African Americans, feel the stigma more keenly.”
About the Resolution
You can access and read the entire resolution HERE.
NAMI California Legislation Overview
As the statewide organization, NAMI California takes an active role in California’s legislative process. Each year, we select a package of legislation that we will support, as well as identify legislation that may negatively impact individuals with mental illness, which we will oppose or seek to amend. We make our decisions about legislation based on our guiding policy document, the NAMI California Public Policy Platform.
NAMI engages local NAMI affiliates who want to impact legislation through our Capitol Coalition. The Coalition is made up of local affiliate members and leaders who receive NAMI Smarts for Advocacy training, attend legislative and policy briefings, and provide testimony before the State Legislature and the Mental Health Services Oversight and Accountability Commission (MHSOAC). The goal of the Capitol Coalition is to empower consumers and family members to effectively influence the legislature and the MHSOAC.
NAMI California does not currently sponsor legislation. Please see our 2014 Bill List for more information on particular pieces of legislation we are following.
The Helping Families in Mental Health Crisis
Act of 2013
NAMI California has received a number of questions regarding our position on the “Helping Families in Mental Health Crisis Act of 2013”, introduced by Congressman Tim Murphy. NAMI California’s Board of Directors has not yet taken a position on this legislation, but will be considering it at their next meeting. At present, we are following the position of NAMI’s national office, who is working closely on this legislation with the author and other members of Congress. Please read the message below describing NAMI’s interests and concerns relating to this legislation. We hope to come to a position on this bill soon after our internal vetting and analysis.
NAMI’s Statement on The Helping Families in Mental Health Crisis Act of 2013
We have received numerous inquiries about legislation introduced late last week by Congressman Tim Murphy (R. Pennsylvania) entitled the “Helping Families in Mental Health Crisis Act of 2013.” This memorandum is being shared with you to provide an overview of the entire bill and to clarify NAMI’s position on it.
The “Helping Families in Mental Health Crisis Act” has generated controversy and a significant response from certain groups in the mental health field. These groups have largely focused on provisions in the bill that they view as negative and have not discussed the many positive aspects of the bill.
NAMI and a number of other organizations have avoided public criticism of the bill and have written letters supporting specific provisions and expressing the desire to work with Congressman Murphy to improve the bill into one that can be supported by the entire field.
What is NAMI’s Position on the Bill?
As detailed below, there are many positive provisions in the bill. Enactment of the positive provisions would represent a significant legislative accomplishment on mental health. Because of his personal background as a psychologist, Congressman Murphy is a key ally on mental illness among Republicans in the House of Representatives. NAMI therefore believes that the wisest strategy moving forward is to support the many positive provisions in the bill and to work with Congressman Murphy and others to improve or remove the more controversial provisions. Opportunities like this to advance meaningful legislation on serious mental illness in Congress do not occur frequently.
NAMI also recognizes that with most legislation it is very difficult to get language that everyone stands 100 percent behind. We look forward to working through the political process to advance the best possible bill.
Why is Congressman Murphy so concerned about serious mental illness?
Congressman Murphy is a psychologist with a background in providing community mental health services to people living with serious mental illness. He is very concerned about the gaps in mental health care and the fact that many individuals living with serious mental illness fall through the cracks and experience multiple hospitalizations, homelessness, criminal justice involvement, and other tragic circumstances. He is also aware that families frequently play an essential caregiving and support role but also frequently encounter legal, policy and environmental barriers in serving this role.
Congressman Murphy is Chair of the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee. With Congresswoman Diana DeGette (D. Colorado), the ranking Democratic member of the Subcommittee, he conducted three hearings on the federal role in mental health services in the aftermath of the tragedy at Sandy Hook Elementary School in Newtown, CT. NAMI Executive Director Mike Fitzpatrick testified at one of these hearings and NAMI members were involved in all three of the hearings. Congressman Murphy has also heard from many people about the tragic consequences of a failed mental health system.
Overview of the “Helping Families in Mental Health Crisis Act.”
The bill contains many provisions intended to improve the lives of people living with mental illness, some of which reflect priorities that NAMI has worked on for years. These include:
· Improving community mental health services and integrated mental health and primary care treatment through enactment of the Excellence in Mental Health Act;
· Expanding Medicaid reimbursement of inpatient psychiatric treatment;
· Reauthorizing the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA), an important federal program providing resources to states, communities and tribal governments for jail diversion, law enforcement and first responder training, and other services to prevent unnecessary criminal justice involvement of youth and adults living with serious mental illness;
· Improving the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA) to permit access to vital information for family caregivers;
· Reauthorizing the Garrett Lee Smith Suicide Prevention Act, an important federal program providing resources for suicide prevention and postvention;
· Improving access to psychiatric medication in Medicaid and Medicare;
· Enhancing federal coordination of mental health services through the creation of a federal interagency Council on Serious Mental Illness
· Increasing resources for research at NIMH on early identification of serious mental illness in youth;
· Authorizing a federal campaign to combat the stigma associated with mental illness;
· Reauthorizing federal programs focused on mental health services for children and youth and
· Expanding Health Information Technology (HIT) resources for providers of mental health services.
Certain provisions in the bill are more controversial, including:
· Transferring authority for administering the mental health and substance use Block Grants from SAMHSA to a new Assistant Secretary for Mental Health and Substance Use Disorders established through this bill;
· Reducing or eliminating funding for certain other SAMHSA programs;
· Eliminating the authority of state Protection and Advocacy programs to engage in lobbying and class action lawsuits;
· Requiring some states to expand civil commitment criteria as a condition of receiving federal block grant dollars;
· Requiring some states to enact Assisted Outpatient Treatment (AOT) laws in states that don’t have them (this would apply to only 5 states, since the majority of states have such laws but rarely use them).
Process and Timetable
The Policy Committee of the NAMI Board of Directors will meet soon after the New Year to discuss the bill and provide further guidance to staff. Staff will continue their efforts on Capitol Hill to represent NAMI’s perspectives based on existing policy and guidance from the Board.
The bill is very comprehensive, with 11 broad sections, separated into multiple sub-sections. It is likely that some of the provisions will be referred to other Committees in the House of Representatives for consideration. While discussions about the bill will likely commence in January when the House re-convenes, it is unlikely that serious consideration of the bill will occur until Spring, 2014 or even later in the year.
Thank you for your interest and for taking the time to read this memorandum. Please contact Andrew Sperling (Andrew@nami.org, 703-524-7600) or Ron Honberg (RonH@nami.org, 703-516-7972) with any questions or comments.