Legislative Advocacy Priorities 2012-13
State and Local Advocacy Priorities
Increase Funding for Mental Health and Substance Abuse Prevention Services
Florida now ranks 50th out of the 50 states plus the District of Columbia in mental health funding. Our nation has seen a $4.6 billion decrease in mental services nationwide 2009-2012 despite an increase in people who need help. This translated in 2010 to an almost $20 million cut locally and another $38 million was shifted to non-recurring funds. In 2011, the state decided to privatize mental health and substance abuse services, which has cost us another 5-9% in overhead for this new entity. And an additional $12 million was lost in the last legislative session for a new computer system that was denied funding.
This is a good time to roll back our funding levels to 2009 levels.
Florida ranks 50th in the nation (including DC) in spending for mental health and substance abuse services and we should not be turning away what could be billions of federal dollars for Medicaid Expansion. The State of Florida must implement all parts of the Affordable Care Act including the consumer protections in the law, the Health Insurance Exchange, and most importantly the Medicaid Expansion to 133% of poverty. Our Governor’s refusal to follow the ACA and expand Medicaid eligibility to 133% of poverty level will affect both people and providers. The federal government is paying 100% of the cost of this expansion through 2017 and at least 90% ever after (versus the 57% it pays on average for the rest of the Medicaid program).
These are the numbers for Florida, according to a recent report prepared for the Kaiser Family Foundation. If there is no Medicaid expansion, then Florida will still spend $269 billion on Medicaid over the next ten years – an average of almost $27 billion per year. If Medicaid is expanded, this will add a total of $71 billion of Medicaid funded services over the next ten years, or an average of $7 billion per year. But the federal government will pay $66 billion of this; the state will pay only $5 billion – or an average of $500 million more per year. Until 2017, the federal government will pay the whole bill.
The State of Florida’s estimates are similar. In January, 2012, Attorney General Bondi told the Supreme Court that expansion would cost Florida $351 million per year in 2020. This would draw down at least $3.2 billion in new annual revenue from the federal government – a return of $9 for every state dollar invested!
Because single adults are among the groups most affected by the expansion, this will draw down service dollars for adults with mental illnesses and other chronic conditions, removing burden from the states and counties—and saving counties, providers, and insurers dollars in uncompensated care.
If the Medicaid expansion is not implemented, 6 million fewer Medicaid recipients will be eligible nationally and 3 million more people will become uninsured. Most of the new enrollment projected to occur under the ACA’s Medicaid expansion would be among adults with chronic conditions including mental illnesses and parents who are not already covered under their state’s eligibility rules. Providers such as nursing homes, which get 60% of their total revenue from Medicaid, community health centers, which get 37%, public hospitals, which get 35%, behavioral health providers, which get 26%, all hospitals, which get 17%, and assisted living facilities will all lose an important revenue stream for comprehensive and integrated care for adults with chronic conditions (like mental illness) which could offset the drastic state cuts they have all suffered in recent years.
Early Identification of Mental Health Concerns in Children as part of EPSDT
One half of all serious mental illnesses begin by the age of 14, which means that children are the major victims of mental illnesses. There is a simple public policy strategy that can have a major impact on this, actually helping us to prevent some mental illnesses and mitigate the effects of nearly all of them.
Mental illness can be prevented if detected early and appropriate treatment is provided to children and their families. However, many children have undetected and untreated emotional and behavioral problems. There is a law that requires mental health screening called the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) legislation. However, the law is not specific enough to enforce the requirement of early and periodic mental health screening. Because mental health screenings are not listed as “medically necessary”, the mental health screening requirement is frequently ignored or overlooked. The words, “medically necessary” should be added to the legislation and language should be added that requires documented and verified mental health screenings using evidence-based screening tools for children starting at age 5 and every five years thereafter until age 18 yrs.
As a matter of public policy, we can make small statutory changes that will have a major effect on our ability to identify young people with behavioral health symptoms and find appropriate early treatment for them. We can make mental health screening a part of wellness exams. To do this, we should change the definition of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) ‘medically necessary’ screening to require, reimburse, and verify regular, evidence-based mental health and substance abuse screenings for children starting at age 5. And we should require private insurers to make coverage for these screenings a part of regular child wellness examinations at least once every five years through age 18. There are many simple screening tools available that take no more than a few minutes to administer and many are reimbursable. We propose to change the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) definition of ‘medically necessary’ early and periodic screening to require regular mental health and substance abuse screenings for children starting at age 5 to include reporting requirements to verify that the screenings are done using evidence-based screening tools.
Baker Act for Children
We need meaningful professional development for teachers, guidance counselors, and other school personnel about how to handle children having a mental health crisis. Better training about what questions are asked of the children could prevent escalation to the point where the mobile crisis team is called and eventual Baker Acting becomes necessary. If a Baker Acting is necessary, kids should not be restrained unless they are violent and they should be taken out from the school using a separate entrance to protect their privacy. A better transition process should be established for the children who are returning to school from hospitalization.
CIT training for Police
All police and sheriffs should receive CIT training.
Increased funding should be allocated to programs that divert individuals to community based services, rather than using our prison system as the largest mental health provider.
Federal Issue that affects us locally:
Parity Law must be enforced
The Paul Wellstone & Pete Domenici Mental Health Parity & Addiction Equity Act (MHPAEA) was signed into law on October 3, 2008. It applies to employer-sponsored health plans with 50 or more employees and Medicaid managed care plans. Interim final regulations implementing the law were published in February 2010 and went into effect for all plans on January 1, 2011.
Under MHPAEA, plans are not mandated to offer addiction & mental health benefits but, if they offer the benefits, they must do so in a non-discriminatory manner. That means:
There are many documented cases of this law not being enforced. We need to put some teeth into this law so that abuses cannot continue.
For more information, please contact the Mental Health Association of Palm Beach County at 561-832-3755 or go online to www.mhapbc.org
The 2012-13 Legislative Session began on January 10th 2012. MHA will work with other advocates to keep you informed about what is happening in Tallahassee. Please contact us if you have information relevant to mental health and substance abuse services by emailing us at firstname.lastname@example.org or calling us a 561-832-3755
Jannuary 12, 2012-- Governor Rick Scott Delivers State-of-the-State Address,
Last year's Legislative Session Wrap Up
For anyone who would like to review the priorities and happenings from the 2011-12 Legislative Session, please CLICK HERE.
2012-13 Legislative Session Updates
February 14, 2012 Time to start contacting your Senators! "Programs that serve mentally ill patients or addicts could see their state funding zeroed out this year under a Senate budget proposal. The proposal would slash overall state spending on adult mental health and substance abuse treatment by about 40 percent, or $87 million." See article here.
Comment on the Essential Health Benefits Bulletin released by the Center for Consumer Information and Insurance Oversight