The California Budget and Mental Health Updated: 02/14/11

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1 The California Budget and Mental Health Updated: 02/14/11 It is the governor s job to propose a budget in January and the legislature s job, its most important job, is to review, counter-propose, and finally send a completed budget to the governor for his signature by June 15th. This year is just a bit different because Governor Jerry Brown has asked the legislature to do all of its budget work, including any trailer bills needed to implement the budget, by March 1st but not to send the final budget to him until the June deadline. As time goes on and we keep you posted, you will see part of his thinking. For, this means that we must review the budget and educate legislators about its effects right away. So, in summary form, here the pieces of the budget that will affect our members. Proposition 63 (MHSA) The proposal takes MHSA monies that have not been contractually obligated at state or county level and uses nearly $900 million to fund other programs. They are AB3632 (the program to provide mental health services necessary for some children to profit from their K-12 education), EPSDT (Early and Periodic Screening, Diagnosis, and Treatment for Medi-Cal eligible children and youth), and Medi-Cal managed care. What this really means to the mental health community is not easily determined. The proposed budget is a multi-year document and this raid on the MHSA fund is only for Perhaps that is the best deal we can get. is working in coalition with other mental health care organizations to develop a full picture of the proposal and to respond with a united front. Whatever we say as part of the coalition, NAMI California will emphasize the importance of preserving and continuing the Mental Health Services Act as the voters intended in November, Realignment The proposal realigns programs so they are either county programs or state programs without duplicate levels of administration. Several programs are being realigned to the counties from the state. These programs would be funded by extension of the 1% sales tax and 0.5% vehicle license fee, if voters choose to vote for extension on the June ballot. If passed, this has the potential of being a greater funding source for community mental health programs than was the funding attached to the 1991 Realignment. Again, is working with the coalition to explore the potential benefits and risks of this budget move but we will tell legislators that safety net community mental health services must be available.

2 Medi-Cal The governor s budget proposed a series of Medi-Cal changes that, combined with the proposed SSI/SSP reduction, would put too many individuals at risk. They include: Please note that these cuts and limits apply to payments made by the state and do not apply to services included in the counties managed mental health care plans. Since many people living with mental illnesses need treatment for physical injuries and illnesses, this is still of major concern to NAMI. Also note that has not taken positions on all proposals NP means No and that positions may change if the positions evolve or more information becomes known. $1.7 billion in spending reductions: Proposition 10 Direct $1.0 billion in Proposition 10 reserves to fund Medi-Cal services for children ages 0-5 Provider Reduce Provider payments by 10% payments Includes providers exempt from previous budget reductions, such as long term care facilities Assumes favorable Supreme Court ruling on other 10% provider cuts Cost sharing Implement mandatory co-pays 5/1/11 $5 for physician, clinic, dental, pharmacy services (dental) $50 for emergency room services 10/1/11 $100/day for inpatient hospital stays ($200 maximum limit) (all else)* Benefit limits Annual dollar cap on benefits for adults: 9/1/11 o $1,510 for hearing aids (visits) o $1,604 for durable medical equipment 10/1/11 o $1,659 for incontinence supplies (all else)* o $6,435 for urological supplies o $391 for wound care Limit prescriptions to 6/month (with limited exceptions) Limit doctor/clinic visits to 10/year (with limited exceptions) Benefit Eliminate adult day health care elimination Eliminate over the counter cough/cold medicines Eliminate nutritional supplements Hospital fee Extend hospital fee program through 6/30/11 Upon enactment or 90 days thereafter* Savings NAMI CA $1.0 B NP 7/1/11 Requires voter approval 6/1/11* $719 M NP $557 M Oppose $217 M NP on first five Oppose Oppose 6/1/11* $195 M NP $160 M NP * These programs require federal approval This information was provided in part by CalOptima in the FY Proposed State Budget Summary of Health and Human Services Proposals

3 SSI/SSP (Supplemental Security Income/State Supplemental Payment) The SSI payments that eligible individuals receive in California include a State Supplemental Payment that helps make up for our state s higher cost of living. The State Supplement (SSP) has been reduced more than once in the last several years and couples have already been reduced to the lowest SSP allowed by the federal government. The proposed cut would reduce an individual s SSP by $15 to the minimum allowed by the federal government. Individuals living independently would receive $830 a month. That reduction combined with the Medi-Cal co-pays described above would make it even more difficult to survive on SSI. Healthy Families Healthy Families is California s State sponsored low-cost insurance for children, teens and pregnant mothers for families whose incomes place them in the 250% of poverty or less but do not meet Medi-Cal financial criteria. Families pay premiums of 2% of their income to participate in this program known in other states as SCHIP. The budget proposes increases in premiums for families with incomes at or above 150% of poverty. In addition, there would be some increases in co-payments, especially for emergency room visits and hospitalizations. Budget changes will affect 565,000 children for this program that provides one more way that children and youth can receive early mental health services. $40 million in spending reductions: Savings Benefits Eliminate vision benefit 6/1/11* $11 M NP Cost-Sharing Increase premiums for 150% FPL and above 6/1/11* $22 M NP o $14 increase for 151% - 200% FPL (from $16 to $30) and $42 increase to family maximum (from $48 to $90) o Increase for % FPL (from $24 to $42) and $54 increase to family maximum (from $72 to $126) Increase mandatory co-pays o $50 for emergency room services o $100/day for inpatients hospital stays ($200 max) 10/1/11* $6 M MCO tax Extend AB 1422 Managed Care Organization tax permanently 7/1/11* $97 M NP * These proposals require federal approval This information was provided in part by CalOptima in the FY Proposed State Budget Summary of Health and Human Services Proposals NAMI CA

4 CalWORKs The CalWORKs program provides temporary financial assistance and employment focused services to families with minor children who have income and property below state maximum limits for their family size. Mental health services are included in those services provided to qualifying recipients. The budget proposes reducing the monthly grant amount by $90 a month and reducing eligibility from 60 months to 48 months. CalWORKs and other health and human services program cuts Savings MSSP Eliminate MSSP Program NA* $20 M NP IHSS Reduce services hours by 8.4% 7/1/11 $486 M NP Eliminate domestic and relat3ed services for recipients who live with their provider or who have shared living arrangements Eliminate services for recipients without physician certification Eliminate state funding for IHSS advisory committee Department Extend 4.25% regional center and provider payment reduction Upon $750 M NP of Dev. Increase accountability and transparency Enactment Services Implement statewide service standards Continue Proposition 10 funding Increase federal funding Department of Mental Health Redirect Proposition 63 reserves to fund federally mandated community services (EPSDT, mental health managed care, mandated mental health services for special education) NAMI CA 6/1/11 $862 M See Separate Statement CalWORKs Reduce time limit for receiving benefits from 60 months to 48 months (with limited exceptions) 6/1/11 (grants)* Reduce CalWORKs grant amounts by 13% to federal minimum 7/1/11 (from $694 to $604) (all else)* Extend reductions of county block grant funding (single allocation) *These proposals require federal approval This table was provided by CalOptima in the FY Proposed State Budget Summary of Health and Human Services Proposals $1.5 B NP The tables do not include the SSI/SSP reduction which Opposes. The tables also do not reveal whether there are net savings. For instance, they do not include the cost of hospitalization caused by limiting Medi-Cal outpatient services. No documents related to the Governor s budget proposal have provided that information so it is left to individuals and families with experience in that area to surmise whether a net savings does indeed exist.

5 Important s in the Legislative Cycle Information provided by: Judy Wolen Legislative Analyst Bettie Reinhardt, MPH Coordinator, Advocacy Network (NAMI CAN!) Board of Directors Government Affairs and Public Policy Committee CalOptima Public Healthcare Agency, Orange County