An Evolving Semi-Monthly Update on Community Behavioral Health in New York
August 20, 2012
Immediately after Mitt Romney announced Paul Ryan as his running mate on the Republican ticket, facts statements and opinions have been traded back and forth on the healthcare budget reforms proposed by Paul Ryan in comparison to President Obama’s policy positions. In fact, it seems almost impossible to avoid hearing a pundit, blogger or tweeter’s view on the recommended changes to healthcare and social services, particularly Medicare and Medicaid, proposed in the Ryan budget. In spite of all this, you do not necessarily hear a lot about these budgetary impacts to behavioral health services and supports. Here is a quick Q&A analysis:
What would happen if the Medicaid program were changed to a block grant program?
The Ryan budget plan, which was passed by the House of Representatives only, proposes to convert Medicaid to a block grant program. Rather than being reimbursed under a fee-for-service system with federal matching funds, states would receive a fixed amount of funding to be spent on Medicaid. In New York State the federal government reimburses at a 50% rate; however the federal match can reach almost 75% in other states. While Medicaid block grants would be indexed for inflation and population growth, state funding would no longer be based on enrollment patterns or healthcare needs. Since behavioral health services are an optional Medicaid benefit, these means that individuals with mental health and substance use conditions could be at-risk of losing access to treatment if states were to cut back on these benefits, particularly if they could no longer afford to fund them. In addition, Ryan proposes to repeal the expansion of Medicaid under the President Obama’s Affordable Care Act (ACA). According to the Center on Budget and Policy Priorities a total of $2.4 trillion would be cut from Medicaid and other health care: $810 billion from block granting and $1.6 trillion from repealing Medicaid expansion under the ACA. New York State would lose about $5.7 billion annually in federal Medicaid funds (about 23%).
What if Medicare became a voucher-based system?
Medicare currently functions as a single payer system for people over the age of 65. Under the Ryan plan, seniors would instead receive an individual subsidy (calculated by age, income and health status) to purchase health insurance either in the private market or for traditional Medicare; however, it is uncertain if this benefit would remain affordable in the future. It would increase as one ages, but not necessarily in line with projected healthcare costs over time. Therefore, seniors (including dually eligible individuals) could very well be subject to higher out-of-pocket costs. This plan would not start until 2022, so current enrollees would not be affected; however Americans age 55 and younger would be subject to this proposal if it were to be implemented. Additionally, the eligibility age would eventually be raised to 67 too. The Ryan plan also keeps the $716 billion in Medicare savings that President Obama proposed in the ACA. These savings would be achieved by ending subsidy payments to providers under the Medicare Advantage program, which has turned out to be more costly than traditional Medicare.
How else would states and localities be affected?
Besides the reforms to Medicaid and Medicare, and the repeal of ACA, Ryan’s budget proposal would make deep cuts to non-defense discretionary programs at about $1.2 trillion or 22% over a 9 year period (implementation would begin in 2014). According to the Center on Budget and Policy Priorities, aid to states and localities would see a $247 billion cut in federal aid. This would mean that the mental health and substance abuse block grants that SAMHSA uses to help states provide community-based mental health and substance use services could be drastically reduced. The same would apply to the supportive housing and low-income housing programs that HUD grants to states and localities or the behavioral health services at the VA. According to the Center on Budget and Policy Priorities, New York State would lose about $2.4 billion in federal aid in 2014. In addition, these cuts would occur on top of the cuts already agreed to by President Obama and Congress under the Budget Control Act (BCA) last year.
You can also read more about the budgetary impact to these and other programs in the National Council for Behavioral Healthcare’s most recent Public Policy Update.
On August 6, 2012, Governor Cuomo announced that New York State has put forward a massive waiver amendment application to allow the state to reinvest $10 billion in federal Medicaid savings into health and behavioral health programs. These funds are just a portion of the savings that are projected over a five year period from the state’s Medicaid Redesign Team (MRT) reforms. In total, the state and federal government would save over $17 billion each. If the Medicaid 1115 waiver amendment application is approved, community-based behavioral health services could be infused with $525 million in Health Homes development funding to enhance consumer engagement and public education, staff training and retraining, clinical connectivity/HIT implementation, and joint governance technical assistance and Implementation.
The plan also includes a considerable expansion in supportive housing development. In total, $750 million would be used to create 3,000 new units of supportive housing services over five years. The waiver amendment contains planning grants and operational funding of $375 million to grow new care models. Examples include peer services, intensive residential services for substance use disorders or medical respite care for chronically homeless individuals. In addition, $1 billion would be made available to help financially challenged providers transition to the new healthcare system under an initiative called Expand Vital Access/Safety Net Program. Approval of the wavier is not guaranteed, therefore we urge you to send letters of support for it, highlighting these initiatives to firstname.lastname@example.org by Friday, August 24, 2012. Here is The Coalition’s letter in support of the waiver application.
On July 31, 2012, the U.S. Department of Housing and Urban Development (HUD) published its interim rule to implement changes made by the HEARTH Act of 2009 (Housing Emergency Assistance and Rapid Transition from Homelessness). In short, the rule codifies the newly consolidated Continuum of Care (CoC) programs administered by HUD under the McKinney-Vento Homeless Assistance Act: Supportive Housing, Shelter Plus Care and Moderate Rehabilitation/Single Room Occupancy (SRO).
Under the ruling, COC’s may use HUD funding for permanent housing (supportive or rapid-rehousing), transitional housing, supportive services, eligible HMIS costs and certain homeless prevention programs. Overall, the changes are welcome, but some provisions will require further clarification from HUD. The interim rule is effective on August 30, 2012, and public comments are due Monday, October 1, 2012. At a later date, HUD will publish final regulations on the consolidated CoC program. Stay tuned for more updates.
For the first time ever, OASAS and OMH will conduct a joint public hearing on their Statewide Comprehensive Plans. The hearing and subsequent plans are intended to address issues concerning the future direction of mental health and substance use disorder services and systems. OASAS and OMH seek your ideas on issues related to the far-reaching changes now underway. The two agencies especially welcome your thoughts on the following questions:
The hearing will take place on September 6, 2012 from 9:30 a.m. to 12:30 p.m. at multiple locations throughout the state linked up by videoconferencing. You can register here.
The latest addition to The Coalition Briefs Blog features a letter to the editor that was printed in the New York Post on Friday, August 17 by Jason Lippman, Senior Associate for Policy and Advocacy at The Coalition. It is written in response to the editorial by Michael Benjamin (“Help Them Before They Kill,” Post Opinion, Aug. 14), which dealt with the recent and tragic killings in the news involving people with mental illness. The letter addresses the issues regarding involuntary commitment (Kendra’s Law) and the need to expand community-based services. Most of the letter was printed in the Post, but the full text can be found on our blog.
The Coalition is proud to announce that the Association to Benefit Children (ABC) has joined us as a new member. ABC is dedicated to bringing joy and warmth to disadvantaged children and their families through compassionate, sustainable, comprehensive and integrated services. Their programs are designed to permanently break the cycles of abuse, neglect, sickness and homelessness.
ABC’s humane and innovative programs include early childhood education for infants, toddlers and preschoolers; as well as educational advocacy, housing assistance, mental health services, family support and preservation, crisis intervention, therapeutic out-of-school and summer day camp programs, youth leadership development and mentoring. Please welcome our newest member.
Last month, Governor Cuomo named Donna Frescatore as the Executive Director of New York Health Benefit Exchange. Prior to her appointment, Ms. Frescatore’s was serving as the Assistant Deputy Secretary of Health to Jim Introne. Before joining the Cuomo Administration, Donna was the Medicaid Director and Deputy Commissioner of the Office of Health Insurance Programs and at the NYS Department of Health (DOH). We wish her well in her new role.
Paolo del Vecchio, M.S.W., has been named as the next Director of SAMHSA's Center for Mental Health Services (CMHS). Over the course of his 17 years in CMHS, Paulo has served as the Acting Director, the Associate Director for Consumer Affairs, and the Acting Director for the Office of External Liaison, and was the first Consumer Affairs Specialist hired by SAMHSA. You can read more about him here.
Fred Scaglione, Editor of the New York Nonprofit Press (NYNP) has authored a new mystery book entitled “Home Visit (A Stevie Corra Casework Mystery).” It involves the sudden disappearance of a 16 year-old from a Brooklyn group home and the caseworker whose job it is to find him. The book takes you on an adventure through the world of neighborhood drug deals, murder, dangerous dead ends, with a tantalizing love interest thrown into the mix! Word has it that a Coalition book review is in the works, and will be out soon.
Coalition Member Updates
Coalition Board Member Fern Zagor was named as the new President and Chief Executive Officer of Staten Island Mental Health Society (SIMHS) effective August 1. Ms. Zagor has held the position of Executive Vice President and Chief Operating Officer (COO) at SIMHS since 2005, with responsibility for the daily operations of its 20 mental health and related programs that serve more than 5,300 children with special needs and their families at 22 borough-wide locations.
Michelle Yanche was promoted to Assistant Executive Director for Government and External Relations at Good Shepherd Services. This move is part of a larger strategy as the agency seeks to strengthen its presence in the city and beyond, by expanding its advocacy efforts and work with government and private donors. Good Shepherd Services' Government and External Relations team will also include Amy Cohen, who recently joined the agency as Director of Government Contracts and Program Development, and Susan Maher Singh, who has been named the new Director of Public Policy. You can read more about this in the New York Nonprofit Press (NYNP).
Changes are also underway at Palladia, where Debra Pantin was named Chief Operating Officer (COO). This newly titled position was created to consolidate management services within the agency, and will encompass the departments of: Asset Management and Operations, IT Services, Quality Assurance/Compliance, Human Resources and Behavioral health/Healthcare Delivery. Susan Wiviott has joined Palladia as its Chief Program Officer, responsible for oversight of the agency’s 28 program sites. In addition, Evan Zuckerman joined Palladia in May 2012 as Chief Financial Officer, (CFO) to manage and provide oversight for all of Palladia's assets, including the agency's nearly $50 million annual operating budget.
The Mental Health Association (MHA) of Westchester presents "Surfing the Tsunami: Riding the Wave of Integrated Health Care" - MHA's Ira S. Stevens 32nd Memorial Conference. Now that the Supreme Court has ruled on the constitutionality of the Affordable Care Act, we will all be impacted by health care reform. Don’t miss MHA’s conference on how changes at the national level will influence state regulations and local services, and how the workforce must change to meet its changing role. The conference will be held on September 7, 2012, from 8:30 am - 4:00 pm at the DoubleTree by Hilton, Tarrytown, New York. For more information contact Chuck Rosenow at RosenowC@mhawestchester.org or 914-345-5900 ext. 7528, or visit www.mhawestchester.org.
The NFL Life Line, a partnership between the National Football League and Link2Health Solutions, Inc. (L2HS) a subsidiary of the Mental Health Association of New York City (MHA-NYC), is officially launched! This crisis service is for members of the NFL family – current and former players, NFL team and league staff and their family members. Calls to the NFL Lifeline will be answered by MHA-NYC’s crisis communication center. More information can be found at www.NFLLifeline.org.
Services for the UnderServed (SUS) has received 3-year CARF (Commission on Accreditation of Rehabilitation Facilities) accreditation for its mental health residences in the area of community housing; IRA’s (Individualized Residential Alternatives) in the area of Community Services: Community Integration; employment programs in the areas of community employment services: job development, job supports, job-site training and comprehensive vocational evaluation services; clubhouse in the area of community services: community integration; and day habilitation programs in the area of community services: community integration.
The Children’s Village was named as 1 of 10 semifinalists for the 2012 New York Community Trust-New York Magazine Nonprofit Excellence Awards. The Awards program honors outstanding management practices and educates nonprofit managers and board leaders throughout New York's nonprofit community about excellent management practices.
Union Settlement Association has been awarded a $50,000 renewal grant by the Stella and Charles Guttman Foundation to support the agency's college transition program. The program helps guide low-income, minority high school graduates from East Harlem and surrounding communities through the transition to college, especially during their first year.
The Center for Urban Community Services, along with the New York State Office of Mental Health (OMH) and the New York City Department of Health and Mental Hygiene (DOHMH) are pleased to introduce an exciting educational initiative: the Academy for Justice-Informed Practice. This program will help New York City community providers develop skills and acquire information needed to effectively work with people with mental illness who have histories of incarceration and/or criminal justice involvement. You and your colleagues are invited to register for the free trainings in September. Please visit: http://OMHDOHMH.kintera.org/AcademyforJusticeInformedCare to register.
Coalition Members advertise staff positions for free on The Coalition’s Job Board! Here's a sample: