An Evolving Semi-Monthly Update on Community Behavioral Health in New York
February 4 , 2011
Coalition Proposes “Carve Out” Model to Medicaid Redesign Team
The Medicaid Redesign Team (MRT), a group of stakeholders appointed by Governor Cuomo to propose savings in the Medicaid system, will make its recommendation on March 1. As of Tuesday, February 1, they now have their savings targets. The Governor’s Executive Budget calls for a $2.85 billion cut in Medicaid spending in FY 2011-12, and $4.6 billion in FY 2012-13.
While the Governor did not mention any specific details on the ideas being considered by the team, there is strong advocacy by some groups and by some officials to carve in behavioral healthcare services to generic Medicaid Managed Care plans (MCOs), which The Coalition strongly opposes. Little evidence exists nationally or in New York State that MCOs prevent the high use and high cost behavioral health consumers from over using emergency room and inpatient services for their medical or behavioral health needs. To the contrary, there are models around the country and in New York of behavioral health providers and consortia that have shown promising success in providing integrated care and keeping costs in line. The behavioral health providers have value added programs, using evidence based practices, that will help the system of care reach out and engage consumers, coordinate their care, and provide stabilizing housing at all levels of intensity.
The Coalition is working with a group of State advocates to support a “carve out” of the behavioral health benefit and the implementation of a regional behavioral care coordination model that relies on specialty managed care behavioral health organizations (MBHO’s) using “health homes” within behavioral health programs. MBHO’s, with responsibility for providing primary care or for having “high touch” linkages and collaborations with appropriate medical care and housing services will coordinate treatment for people with current high healthcare expenses. For adults and children, savings occur dramatically across homeless and criminal justice services; foster care and juvenile justice. To learn more on our advocacy please read the paper drafted by a group of statewide behavioral health advocates and The Coalition’s very detailed recommendations.
Governor Cuomo Releases Executive Budget with Deep Spending Cuts
On Tuesday, February 1, 2011, Governor Andrew Cuomo released the State’s 2011-12 Executive Budget. The $132.9 billion budget represents a $3.7 billion or 2.7% decrease in year-to-year spending. The Governor proposes to close the State’s $10 billion budget deficits almost entirely through cuts. As such, every State agency will be ordered to take a 10% cut in their operations budget. The 1.1% cut to local assistance that began in middle of FY 2010-11 will be extended into FY 2011-12. This will affect all direct contracts with the State and aid to local governments that can be passed on to providers. The Medicaid budget will be cut by $2.85 billion in FY 2011-12 and $4.6 billion in FY 2012-13. Meeting the Medicaid reduction targets will be the work of the Governor’s appointed Medicaid Redesign Team (MRT), which will recommend a plan on March 1 to save money and improve the delivery of care (for more information on MRT please read previous Briefs article titled “Coalition Proposes ‘Carve Out’ Model to Medicaid Redesign Team).
Overall, the budget for the NYS Office of Mental Health (OMH) will be cut by $3.6 billion (or 2.6%). This includes a $32 million reduction from a freeze on all new community residential programs for one year and a two year elimination of funding to family-based treatment beds. In addition, $27 million in cuts were proposed to non-residential community support programs like children’s Clinic Plus, training and education, and $20 million in savings from keeping residential trend factors level. We still are not clear on exactly where all these cuts will fall and how they will impact consumers and providers on the ground, but expect to have more details shortly. To read more about the broader cuts to housing and homeless programs please view next Briefs article titled “Housing and Homeless Programs Are Cut in State Budget Proposal”).
In the NYS Office of Alcoholism and Substance Abuse Services (OASAS), the budget calls for a total cut of $671 million (or 6.4%). OASAS plans to reduce funding to programs that fail to meet their performance indicators, and delay or cutback on the development of new gambling addiction programs and 3 recovery centers. Again, The Coalition will seek details about on-the-ground impact.
Housing and Homeless Programs Are Cut in State Budget Proposal
Among the cuts in the Governor’s Executive Budget are reductions and eliminations to programs that fund housing and homeless programs. In the NYS Office of Mental Health (OMH), $32 million annually will be cut by freezing all new community residential programs for one year and eliminating funding over the next 2 years to family-based treatment beds. In addition, aid will be reduced to providers funded above the regional per-bed model for supportive housing, and residential pipeline units will be converted to lower-cost alternatives. The cuts to housing services also fall outside of the OMH system.
In the Office of Temporary and Disability Assistance (OTDA), the budget proposes to eliminate all programs funded with TANF funding. This includes $6.3 million for the Supportive Housing for Families and Young Adults (SHFYA) program, as well as the Supplemental Homeless Intervention Program (SHIP). The budget proposes to eliminate $35 million in aid for the Work Advantage Program in New York City. The Advantage program provides people with housing subsidies to leave homeless shelters and find stable jobs. In addition, the Executive Budget proposes a $16 million cut New York City homeless shelters. These cuts will certainly put added pressure on filling City’s own $2.4 billion deficit in next year’s budget. While the City is mandated to cover shelter costs, in other areas, cutbacks can be made. Mayor Bloomberg is expected to release his Preliminary Budget plan later this month. Watch for more details as we get them.
The Coalition Gears Up for Albany Advocacy Days on March 7th & 8th
Now that Governor Cuomo has released the State’s Executive Budget proposal to close the State's $10B budget through spending cuts and reforms, The Coalition is diligently organizing our members to join us in Albany on March 7th and 8th for our annual Albany Advocacy Days. We will meet with elected officials and agency leaders from the Executive and Legislative branches to discuss the upcoming reforms to be considered by the Medicaid Redesign Team, as well as the cuts to housing programs and other community support programs. Last year we were able to cover over 50 meetings in 2 days, and are working to schedule a full agenda for this year too. Stay tuned for more details.
On January 27, 2011, the Wall Street Journal reported that in 2009, for the first time, the NYS Office of Medicaid Inspector General (OMIG) had to return more money to Medicaid providers than the amount it recovered from fraud cases. This was documented in OMIG’s annual report, which listed a negative $66,000 total in fraud recoveries. Although OMIG did actually collect more than $1 million in recoveries from fraud cases, it lost more than this sum when an administrative law judge ordered the state to return recovered funds to a an alcohol-treatment center in Queens. They were accused of fraud in 2005. While OMIG points out that $100 million was recovered through audits that found Medicaid violations, the article reports these were often clerical errors with no determination of fraud.
The Staten Island Advance reported on the work of two Coalition members. Project Hospitality was featured for its domestic violence programs which helps families get the assistance they need, and the Institute for Community Living's coordination of housing for 569 residents from adult homes.
Safe Space has been awarded a $150,500 grant from the New York Life Foundation to support education and employment programs for youth. Funding will be used specifically for Safe Space’s afterschool programs serving over 750 young children annually. They will also support the “Steps to Success” initiative, a job-readiness program designed for teenagers.
University Settlement invites you to join them for an interactive conference to learn about the impact of death in early childhood through adolescence, explore different modalities of working with bereaved children and families in a multicultural context, understand the ripple effect of community violence in urban environments, and meet others in your field. The conference is called “Can We Take the Bus to Heaven?” It will take place on Friday, February 11, 2011, from 8:30 a.m. – 1:30 p.m. at 84 Eldridge Street, New York City. Registration is $60.
Joe McLaughlin, Director of Youth Programs at the Center for Alternative Sentencing and Employment Services (CASES), was among recipients of the National Child Labor Committee’s prestigious Lewis Hine Awards for Service to Children and Youth. He was honored for his work of 20 years with youth in the court system. Under his leadership, CASES has created an array of innovative youth development programs including group counseling, art therapy, the nationally recognized Career Exploration Project, and education services.
The Institite for Community Living is hosting Elli Lilly's "Solutions to Wellness" program on Thursday, February 17, 2011, from 9:00 am to 4:00 pm at their Corporate Offices, 40 Rector Street, 8th Floor Training Room, New York, NY 10006. An agenda for the day as well as a brochure about the program are available. Breakfast and lunch will be served. The speaker will work with the attendees all day with various presentations on Recovery, introducing Team Solutions and Solutions for Wellness and Delivery Skills; simulations and an interactive Q&A session. Please RSVP to Ben Sher at firstname.lastname@example.org
Coalition Members advertise staff positions for free on The Coalition’s Job Board! Here's a sample: