Statement of Problem

Document Sample
Statement of Problem Powered By Docstoc
					Financing Interagency Systems
            of Care

             Chris Koyanagi
   Bazelon Center for Mental Health Law

              NASMHPD Meeting
                San Francisco
                June 23, 2004
Extent of the Problem
   Prevalence of kids MH disorders:
       20% some mh disorder
       10% significantly impaired
       5% are severely impaired
       Same in young children as in older
Statement of Problem
   How resources are distributed, organized and
    disbursed makes little sense
       High level of support for residential
       Crisis-focused response
       Significant gaps as funding drives system
   Conflicting agency goals; overlapping case
   Lack of Access
       Custody relinquishment
Statement of Problem
   Child eligible for some federal
    programs, not others—creates gaps
   Children provided services that can be
    funded; not what is needed
   Families have limited choices, see long
    delay in identification & services
   Families cannot receive supports
   States have found ways to address these
   Integrate resources behind common plan for
    each and family
   All collaborating systems are committed to
    same goals and objectives
   Flexible funding approaches focused on
   Continuous efforts to improve quality
   Clear vision of goals and how to finance
   Collaborations (agencies and families)
   Understand resource options fully
   Funding strategy to merge and
    maximize different streams
   Rigorous cost accounting to show how
    program requirements are met, while
    funds are flexible
First steps
   Maximize Medicaid and S-CHIP
   Combine with Title IV-E
   Maximize Title IV-B & Safe/Stable
    Families Act
   Ensure IDEA services are furnished
   Other federal sources:
       Maternal and child health
       TANF
       Housing
       Child care block grant
       Vocational rehabilitation
       ESEA, Title I
       Social Services block grant
   More flexible funds:
       MH/SA block grants
       Juvenile justice block grants
       Federal discretionary grants
       State and local general funds
Medicaid: primary funder
   Clinic
   Rehabilitation
   Prescription drugs
   Transportation
   Residential
   Waivers
Service                       Code   Service                      Code
Screening                           Day treatment                 
Assess/eval/diagnosis               Comm-based wraparound         
Anticipatory guidance               Multi-systemic therapy        
Service planning                    Crisis residential            
Indiv, grp, fam therp               Ther. Recreation              
Crisis intervention+mobile          Dev delay/prevent             
Case man (+ACT & intensive)         Home visits, newborn          
Targeted case management            Social skills/daily living    
Meds management +meds               Supported employment          
Intensive in-home                   Supported housing             
SA-OP tx (+ integrated tx)          Respite care, not in-home     
Parent ed. on disorder               Ther. foster care
Parent hotlines                     Group home servs              
Behavioral aide                     Sex offender treatment        
No Specific Code: Covered
   Engaging natural supports
       Service planning/wraparound
   Summer/after school programs/therapeutic
    nurseries and preschools
       Day treatment
   Therapeutic Foster Care
       Rehabilitation funds services/treatment
   Family Supports
       Psychoeducation
       Services to benefit child
Non-Covered Activities
   Education (tutoring)
   Job training
   Services for family members who are
    not themselves Medicaid eligible
   Room and board – foster care or group
   Purchase of goods or opportunities for
Rules are Important For…
   Respite
   Family support services
   Behavioral aides
   Targeted Case management
   School-based
   Vocational programs for transition youth
Careful Rulemaking
   Respite
       Child respite, not family
       Prevents permanent disruption/placement
       Supervision and structured services
   Family support
       Psycho-education on child disorder
       Services tied directly to help child
   Behavioral Aides
       Prevent removal from home
       Social skills development, anger management, etc.
New Rules: TCM
   Appropriate target group
   Coordinating health/mental health as
    well as other services/supports
   Provider may be MH, CW, JJ or other
   Must not be possible to fund thru
    another source and a non-health
    related service
Limits: School-Based
   Services listed in state plan
   Those included in IEP
   Provider meets Medicaid qualifications
   Cannot be offered free to other non-
    Medicaid children
       This does not apply to special education
Vocational Services
   No job training
   Services and supports to youth in
    training or job
       Social skills training
       Getting along on the job
       Getting to job appropriately
       Behavioral supports
       Anger management
Home & Community-Based
   Expands Medicaid coverage
   Expands service array
       Respite
       Family support
       Supported employment
   Reduces costs
       KS: $12,900 compared with $25,600
       VT: $23,344 compared with $52,988
       NY $40,000 compared with $77,429
Child Welfare programs
   Title IV-E services, for example:
       Screening, assessment, etc.
       Behavioral aide
       Social skills training
       After school, summer programs
       Service team meetings
       Wraparound facilitation
       Respite for foster family
       Parent-to-parent support/engaging natural
Child Welfare
   Training and Admin funds
       Wraparound facilitation
       Service team meetings
       Intensive case management
       Engaging natural supports
       Family participation in policy/program
       Advocacy services
       TA, MIS
Child Welfare
   IV-B & Promoting Safe-Stable Families
       Wide array of community services
       Pays for non-Medicaid costs:
            Family Services
            Respite
            Resources for family organization
   Waivers with MH services funding
       Child/adults in guardianship care (DE)
       Capped flexible allocations to local CW agencies
        (IN, NC, OH, OR)
       MC payment systems (CO, CT, MI, WA)
       Intensive services (CA, MS)
Creating Flexibility
   Blend
   Braid
   Case rates
   Administrative services organizations
   Capitation, at-risk, managed care
Financing Approaches
   Blending
       Combines funds from several agencies into
        unified funding stream so they are
       Generally small pots of money
       Agencies reluctant to give up control
       Provides greatest flexibility
Financing Approaches
   Braiding
       Combines funds so different sources remain visible
        but used in combination
       Complete flexibility given to service team
       Single billing process
       Consistent data collection, management &
        reporting for local providers
       Need capacity to track expenditures & match to
        funding source
       Map funding opportunities and constraints
Financing Approaches
   Case rates
       Wraparound Milwaukee
   ASOs
       Assists in braiding funds
       Ensures appropriate service at appropriate
       No risk
       New Jersey (MH-CW)
Capitation: At risk contracts
   Systems of care as at-risk providers in
    network (single case rate)
   System of care is managed care entity
    (Wraparound Milwaukee)
   All system of care services covered in
    MC contract; system bill FFS
   Success stories: Colorado, Arizona
Other Interesting Strategies
   Embedding staff
       Allows MH staff to furnish services
       Allows billing to Medicaid
       Opens doors to reluctant partners
   Dedicated taxes
       Florida (Hillsborough county)
       California (pending initiative)
       Missouri developing
   Need new commitment to funding child
   Mechanisms exist
   Opportunities maximized when agencies
    collaborate on funding
   Tough fiscal times can create
    opportunities for collaboration and for
    innovation in approach

Shared By: