N.Y. Budget Prompts MH field to Focus on Community Reinvestment
Mental Health Weekly January 23, 2012
Following last week’s release of the New York State executive budget proposal which includes a commitment to supportive housing initiatives, and the establishment of a health insurance exchange, mental health advocates and providers vow to ensure that any savings generated from the governor’s proposal should be reinvested into the community to support recovery efforts.
Gov. Andrew Cuomo last week unveiled the FY 2012-2013 executive budget proposal which calls for relief in health care spending by reducing the growth in the local share of Medicaid payments by 1 percent annually beginning in 2013-2014, fully eliminating all growth by 2015-2016, and beginning a phased takeover of local government administration of the Medicaid program.
Cuomo’s proposal also includes a move to care management for all Medicaid recipients, which is expected to be completed in 2015-2016. Last year Cuomo established the Medicaid Redesign Team (MRT) bringing together stakeholders and experts throughout the state to work to reform the system and reduce costs.
The legislation noted that consistent with the recommendations of the MRT, the state Office of Mental Health (OMH) and the New York State Office of Alcoholism and Substance Abuse Services now have the authority to contract jointly with Managed Behavioral Health Organizations (BHOs). These BHOs will be charged with managing behavioral health services for individuals with substance abuse issues and serious mental illness.
“Overall I think the budget is basically a mixed bag, but there are good things in it for our community,” Harvey Rosenthal, executive director of the New York Psychiatric Association of Psychiatric Rehabilitation Services (NYAPRS), told MHW.
While the governor’s proposed budget does not include a Cost of Living Adjustment (COLA) increase, Rosenthal said he is encouraged that providers will be eligible for increases next year based upon costs and good outcomes. They had not received increases over the past three or four years, he said. Last year other groups did receive COLA; this time now the governor is going across-the-board [with the elimination of COLA increases],” he said.
Next year, programs that are cost-effective and provide good outcomes will receive a COLA.
Rosenthal added, “It’s going to put a hardship on programs; what takes the sting out is the [expectation] of increases next year. The governor does what he says. If he promises an increase, we’re probably going to get it.”
During his state of the state address on Jan. 4, Cuomo laid out a strategy to move consumers with mental illness into the most integrated setting consistent with the Olmstead agenda, Rosenthal said of the Supreme Court decision to hold states legally liable to be able to serve people in the most integrated settings. The proposal includes a commitment over the next three years to move 1,000 nursing home residents and 5,100 adult home and state residents into community housing, and create 3,400 (NYNY III) beds, Rosenthal said. The state is also expected to close the Hudson River Psychiatric Center in Poughkeepsie and….Kingsboro Psychiatric Center in Brooklyn, he said.
“Reinvestment into the community is front and center for most advocates,” said Rosenthal. “If we’re going to produce savings by reducing the use of state and Medicaid hospitals, we have to put more into the community to help people manage and improve their health. You can’t close the door on a hospital without improving things in the community.”
NYAPRS is planning its legislative rally on January 31 with the theme, “Reinvest in Recovery.” “We’re expecting anywhere from 800 to 900 attendees,” said Rosenthal.
Assessing Budget Impact
“It’s very early in the budget negotiations process,” Lauri Cole, executive director of the New York State Council for Community Behavioral Healthcare, told MHW. “We are still reviewing and analyzing the details to try and understand the impact on our programs and services.”
Cole said the budget does offer very important elements for “vulnerable” New Yorkers. “For instance, the budget proposal includes language
establishing a state-run health insurance exchange,” she said. “The exchange is a critical step in New York’s ongoing efforts to provide health insurance coverage to those in need.”
New York was a leader in state efforts to enroll more citizens in the Medicaid program, now required under National Health Reform, she said. “We altered federal poverty levels to increase eligibility for uninsured New Yorkers several years ago,” she said. “Now we need the exchange legislation to continue this very positive trend.”
The governor’s office estimates the exchange will result in coverage for some one million New Yorkers, she said, adding that individuals and small employers will see significant reductions in the cost of coverage when the exchange is fully implemented.
“This will be another huge step in the right direction. We urge all of the members of the New York State legislature to support the governor’s
proposal and pass health insurance exchange legislation quickly,” said Cole.
The Council is disappointed the budget proposal does not appear to include a proposal to extend by three years the exemption, which currently
expires in 2013, for the state’s workforce from having to comply with requirements embedded in the Social Work Licensing Law, said Cole. “We
believe that will create an extreme hardship for the health, behavioral health and social service sectors in New York,” said Cole.
“This fall a Medicaid Redesign Team workgroup was brought together to examine state and community workforce issues and they recommended
the proposal be included in the governor’s budget,” she said. “But in the end the executive proposal did not include it. We will continue to fight for it.”
Reducing Unnecessary ER Admissions
Gov. Cuomo is intending to reduce unnecessary hospital and emergency room care through a series of initiatives, including health homes and managed care, noted Cole. “The NYS Council believes that a portion of the money saved from these reform efforts should be reinvested in strengthening the not for-profit providers who provide community care that is generating those savings. We need more community housing, treatment and recovery services,” she said.
The budget proposes a behavioral health advisory council with broad powers to address system issues, set agendas and come up with a five-year plan pertaining to multiple state agencies and accompanying systems of care, she noted.
The National Alliance on Mental Illness (NAMI)-NYS also supports reinvestment into the community. “We feel very strongly that any savings obtained through efficiencies or other means should be reinvested in mental health services,” Donald Capone, executive director of NAMINYS, told MHW.
Meanwhile, NAMI-NYS would like more information, for example, about the governor’s proposal to include funding for regional First Episode Psychosis Teams and Suicide prevention programs to assist individuals with psychotic disorders, he said.
The budget proposal would also support a centralized 24-hour hotline for reporting abuse and neglect allegations. “We need to get together with people in the administration to understand how much money will be spent, and will it go towards training,” he said. “The devil is in the details is very applicable here.” Nevertheless, Capone said NAMI-NYS is very supportive of a hotline designated for calls of report and neglect.
The state’s planned closing of the inpatient psychiatric center at Brooklyn’s Kingsboro Psychiatric Center and service reduction is also concerning, he said. “We’ve heard [state officials] are making services available at South Beach Psychiatric Center, a facility in Staten Island. Advocates are trying to obtain more information about travel provisions for consumers in the Brooklyn facility, he said.
Meanwhile, NAMI-NYS is planning to testify at the upcoming legislative budget hearings scheduled to begin this week. The advocacy group plans to attend a hearing on Feb. 14, he said. •