Mental Health Association (MHA) by ntx18253


									Mental Health Association (MHA)                                         (301) 424-0656
Serving Montgomery County, Maryland                                      Volume 9, Issue 3


 Access to the Public Mental Health System
 Integrated and Coordinated Early Childhood and School-Based Mental Health Services
 Juvenile Justice System Reform
 Affordable Alternative Housing Options for People with Mental Illness
 Subscription Information & Action Alert information

National Status Report
Budget Update

      The President’s FY09 budget would make deep cuts in funding for health programs and programs
       targeted to lower income children and families. Overall, the budget would cut funding in the
       Department of Health and Human Services (HHS) by more than $200 billion over five years
       through a proposed combination of administrative and legislative changes; most of these changes
       are in Medicare. In some cases, these cuts represent cost shifting from the federal to state
       governments, many of which will eventually be shifted to individuals or result in a reduction of
       services. Additionally, the Administration continues to make and assume regulatory policy
       changes that would in effect make it difficult if not impossible for states to expand coverage
       to the 3.6 million uninsured children above 200 percent of the federal poverty line (FPL).

      The budget fails to respond to the urgent need to ensure health coverage for the 9.4 million
       children who are currently uninsured. Last year, in his FY08 budget, President Bush proposed an
       increase of less than $5 billion over five years in funding for the State Children’s Health
       Insurance Program (SCHIP), a funding level that would have resulted in loss of coverage for
       many children currently covered by SCHIP. In his FY09 budget, President Bush proposes to add
       $19.7 billion to SCHIP over five years. However, this funding level is still an estimated $1.8
       billion short of what is needed for states to simply maintain their SCHIP programs, according to
       the Center on Budget and Policy Priorities.

      The President’s FY09 budget also calls for new changes that would restrict states’ efforts to
       cover uninsured children. It would place a “hard” gross income cap on state expansions of
       SCHIP programs that exceed 250 percent of the federal poverty line ($53,000 a year for a family
       of four), and it assumes adoption and tightening of a previous directive that would drastically
       circumscribe SCHIP eligibility. In August 2007, the Administration announced a new policy that
       precludes states from extending health coverage to children above 250 percent of the FPL unless
       several standards are met. Specifically, the directive mandates that 95 percent of all eligible
       children under 200 percent FPL must be covered before a state could expand coverage to children
       in families with incomes above 200 percent FPL, and a state must certify that coverage levels
       under employer-sponsored health insurance have not fallen by more than 2 percentage points over
       the previous two years, a benchmark that is clearly beyond the control of states. It also requires
       that before enrolling a child in SCHIP, states must institute a 12-month waiting period without
        any exceptions, even parental loss of employment or death. The President’s budget assumes
        adoption of this directive with changes that would make it extremely difficult and highly unlikely
        for states to cover children in families above 200% of the federal poverty line ($42,400 a year for
        a family of four). These changes in the President’s budget would affect at least 26 states that
        already cover children above 200 percent FPL.

       The President’s budget does include $450 million over five years in outreach grants to states,
        localities, schools, and community-based organizations to enroll uninsured children eligible
        for Medicaid and SCHIP. However, this funding amount is too small to substantially increase
        enrollment among the almost 6 million presently eligible but uninsured children in America.
        Additionally, the Administration failed to include effective mechanisms that will truly help states
        find and enroll low-income uninsured children such as “express lane” eligibility.

       The President’s FY09 budget also reduces the federal Medicaid matching rate (FMAP) for
        some administrative services that will adversely affect certain Medicaid enrollees such as children
        with disabilities, on top of the harm that will result from other regulatory changes promulgated by
        the Administration in recent months. These regulations chip away at the protections and services
        that have been a lifeline for children with physical, emotional and developmental disabilities, and
        for children who suffer a range of health problems as a result of abuse and neglect and other
        trauma. They do this by reducing or eliminating federal reimbursement for services such as case
        management, and outreach and enrollment performed by schools.

       As expected, the Administration continues to promote “market-based health care” in response
        to the crisis of the 47 million uninsured people in America by attempting to increase access to
        private insurance. Selected proposals include:

            o   replacing the existing tax exclusion for employer-sponsored insurance with a standard
            o   relaxing state regulation of health plans to increase competition among plans; and
            o   promoting use of health savings accounts, which are tax-advantaged medical savings
                accounts available to people who are enrolled in high deductible health plans, assuming
                they have sufficient income available to deposit such savings.

None of these proposals would make health coverage more affordable and accessible to the vast majority
of the uninsured in America, given that the average cost of a group health insurance policy for a family
today is more than $12,000 -- an amount that represents almost one entire year of income of a full-time
worker earning the minimum wage.

       The President’s budget effects major cuts in a number of rural health programs, and
        eliminates the Children’s Hospitals Graduate Medicaid Education program that currently
        trains 4,700 pediatricians and pediatric sub-specialists at children's teaching hospitals. While the
        President did propose one new initiative that would add dentists to the National Health Service
        Corps (NHSC) at a cost of $11 million, this was more than offset by a cut of $14 million to the
        overall NHSC budget. Additionally, the President’s 2009 budget would eliminate all programs
        authorized in the Title VII Health Professions, including Emergency Medical Services for
        Children ($19 million) and Newborn Hearing Screening ($12 million).

        (everything above from the Children’s Defense Fund website)

News and Noteworthy
      According to studies funded in part by the National Institutes of Health, people with
       schizophrenia have high rates of genetic deletions and duplications that likely disrupt the
       developing brain. These anomalies were found in 15 percent of adult onset schizophrenia
       patients and 20 percent of child and adolescent onset patients, compared with only 5 percent of
       healthy participants. Collectively, the mutations carried by patients were significantly more
       likely than those in healthy participants to disrupt genes involved in brain development, which
       affects about 1 percent of adults. “This is an important new finding in the genetics of
       schizophrenia, Identifying genes prone to harboring these mutations in brain development
       pathways holds promise for treatment and prevention of schizophrenia, as well as a wide range of
       other neurodevelopmental brain disorders,” said NIMH Director, Thomas R. Insel, M.D. (NIMH
       Science News on Schizophrenia, 3/27/08)

      Dr. John Kelsoe, a prominent psychiatric geneticist at the University of California, San Diego,
       has spent his career trying to identify the biological roots of bipolar disorder. In December he
       announced that he had discovered several gene mutations closely tied to the disease, and he began
       selling bipolar genetic tests to the public over the internet in February for $399. His company, La
       Jolla-based Psynomics, joins a legion of startups racing to exploit the boom in research
       connecting genetic variations to a host of health conditions. More than 1,000 at-home gene tests
       have burst onto the market in the past few years. The proliferation of these tests troubles many
       public health officials, medical ethicists and doctors. The tests receive almost no government
       oversight, even though many of them are being sold as tools for making serious medical
       decisions. Dr. Kelsoe acknowledges that bipolar disorder probably results from a combination of
       genetic factors and life experiences, and that the presence of these gene variations does not at all
       mean that someone will, in fact, develop the disease. Dr. Kelsoe said, “The goal of this is to try
       and help doctors make an accurate diagnosis more quickly so the patient can be treated
       appropriately.” (By Marcus Wohlsen, The Associated Press, 3/22/08).

State Status Report
Legislative Update

      HB 450 Department of Health & Mental Hygiene – Behavioral Health: The House passed
       bill, which would create a new Deputy Secretary of Behavioral Health and Disabilities within the
       Department of Health and Mental Hygiene. The bill passed the house with some amendments,
       and it will now be considered by the Senate Finance Committee. The Mental Health Association
       of Maryland supports this bill to enhance the integration and management of services for
       behavioral health, substance abuse, and developmental disabilities.

      SB 344 Flexible Leave Act: The bill passed the Senate with two amendments. The first limits
       the Flexible Leave Act to employers with 15 or more employees. The second limits it so that
       workers can only use their sick leave for their children (and not their parents/spouses). The
       House version (HB 40) also passed, but without amendments. Employers remain concerned
       about the bill’s impact. The Mental Health Association of Maryland supports it.

      SB 210/HB 372 Maryland Veterans Behavioral Health: The Governor’s Veterans Behavioral
       Health Initiative has passed the Senate in an amended fashion. The amended version is weaker
       than the initial proposal, but the bill is a move in the right direction.

      HB 1468 – Health Insurance – Outpatient Mental Health Treatment – Elimination of Tiered
       Co-payments: The bill would repeal specified minimum rates at which health insurance policies,
       contracts, and certificates must provide benefits, with respect to specified outpatient coverage, for
        covered expenses arising from services provided to treat mental illnesses, emotional disorders,
        substance abuse disorders; requiring health insurance policies, contracts and certificates to
        provide specified benefits at a minimum rate of 80%, with respect to specified outpatient
        coverage. The bill would change the outpatient reimbursement so that insurance companies and
        HMOs have to pay 80% of the reasonable cost for all outpatient visits, replacing the tiered
        percentages now in effect. The Mental Health Association of Maryland supports this bill.

On Monday, March 17, the House Appropriations Committee reported its recommendations on the budget
for the fiscal year 2009 to the House of Delegates. Its starting point was the budget plan passed by the
Senate the previous week. The Senate had cut about $226 million in general funds from the $15-billion
general fund budget proposed by the Governor, and authorized $160 million in transfers to the general
fund (the state’s total budget, including federal and other restricted “special” funds, is over $31 billion).
The House Appropriations Committee added $50 million to the transfers and cut another $40 million.
Some of the larger cuts were as follows:
      $65 million from contributions towards the state’s future liability for retiree health insurance.
         The Senate had cut only $38 million.
      $24 million from Medicaid. $20 reflects a lower estimate of program growth approved by the
         Senate. The extra $4 million cut by the House would be a limit on the increase in nursing home
         reimbursement rates.
The Appropriations Committee made some reductions to items the Senate had left alone. It cut $1.4
million from $2.6 million in funds proposed for mental health services for returning veterans.
Appropriations cut $1.1 million of a $12 million proposed increase for services for developmentally
disabled adults transitioning from the special education system.

Most of the Appropriations Committee’s modifications to the Senate plan are one-time-only effects.
They will improve the closing fund balance for FY 2009, but will not significantly affect the shortfalls
projected in future years. (Maryland Budget and Tax Policy Institute, Special Report, Maryland Budget
Update, 3/18/08)

County Status Report
Budget Update

       On March 17, County Executive Isiah Leggett announced a $3.77 billion tax-supported budget
        for the fiscal year that begins July 1, 2008, a lower increase than in the past 12 years. The budget
        would reduce spending requests by $155.4 million, which includes $33.2 million in FY 08
        reductions, and increase property taxes by $138 on the median County home while sustaining
        critical County services in such areas as education, public safety, and help for needy County
        residents. “Given the weakness in the housing market and in the national economy, we have a
        very difficult year ahead in matching our resources and our needs,” said the Executive. Nearly
        two-thirds of the total increase in County spending requested by Mr. Leggett goes to Montgomery
        County Public Schools. Tax-supported funding increases by $74.8 million. In order to preserve
        essential services, Mr. Leggett is recommending an increase in property taxes of $128 million.
        The budget includes an Emergency Medical Services (EMS) fee to provide an estimated $6
        million in additional resources over the first half-year of operation to sustain and grow the Fire
        and Rescue Services in the coming years. The EMS fee will be billed directly to individuals’
        health insurance companies, so no County resident without insurance will have to pay for
        transport to the hospital. Targeted reductions are included to certain Health and Human Services
        programs that sustain the County’s most important commitments and make improvements to
        other vital services. For the “Montgomery Cares” program of access to health care services for
        the uninsured, the budget maintains the more than 19,000 clients served annually. Mr. Leggett is
        also recommending community grants totaling $4.1 million for non-profit organizations that
       assist County agencies in addressing human service needs. Mr. Leggett is recommending the
       establishment of a Family Justice Center that would offer a more responsive, holistic approach to
       providing services to the victims of domestic violence. (Montgomery County, Maryland News
       Release, 3/17/08)
      The County Executive has directed department heads to focus on the achievement of “customer
       results.” As a first step, each department has identified not just their customers and the services
       they deliver to those customers, but most importantly, the impact those services are intended to
       achieve for those customers. Subsequently, departments identified “Headline Department
       Measures” to gauge the extent to which the desired customer results are being achieved, and the
       efficiency of each department in achieving its customer results. (County Executive’s Initiatives
       to Build Accountability for Results, March 2008)

National Status Report
Legislative Update

      HR 687 and SB 382 The Keeping Families Together Act: The bill would establish a State
       family support grant program to end the practice of parents giving legal custody of their seriously
       emotionally disabled children to State agencies for the purposes of obtaining mental health
       services for those children. The House referred the bill to the Subcommittee on Health in early
       February 2007. In the Senate, the bill was read twice and referred to the Committee on Health
       Education, Labor, and Pensions.
      HR 171 The Student Support Act: The legislation would direct the Secretary of Education to
       make grants to states for assistance in hiring additional school-based mental health and student
       service providers. Referred to the House Committee on Education and Labor in January 2007.
      S 1375 and HR 20 The Melanie Stokes Postpartum Depression Act: The bill will help to
       ensure that new mothers and their families are educated about postpartum depression, screened
       for symptoms, and provided with essential services, and to increase research at the National
       Institutes of Health on postpartum depression. Received in the Senate and read twice and referred
       to the Committee on Health, Education, Labor, and Pensions.

Budget Update

      The President’s 2008 budget includes a 29 percent cut in mental health programs targeted to meet
       the special emotional needs of children and adults and holds at 2006 funding levels the Children’s
       Mental Health Services Program and the Community Mental Health Services Block grant, which
       support comprehensive community-based systems of care for children with serious emotional
       disturbances. (Source: Children’s Defense Fund)

State Status Report
Legislative Update

      SB 65 Health Insurance – Small Group Market – Coverage of Child Dependents: The
       legislation requires the Maryland Health Care Commission to include specified coverage of child
       dependents in the Comprehensive Standard Health Benefit Plan. The bill received an unfavorable
       report in the Finance Committee on February 25.
      SB 78 Task Force to Study System Variables that Impact Student Achievement in
       Underperforming Public Schools: The bill establishes the membership, purposes, and staffing
       of the Task Force. The Bill is in the Senate, First Reading Education, Health and Environmental
       Affairs Committee, where it received an unfavorable report on March 10.
      HB 910 Health Care Providers – Disclosure of Medical Records – Children in Need of
       Assistance Proceedings: The bill authorizes health care providers to disclose specified medical
       records without the authorization of persons of interest in accordance with compulsory process in
       Children in Need of Assistance proceedings. The bill received a favorable report in the House
       Judiciary Committee, and was adopted. It passed on the second reading on March 15.
      HB 1404 Eliminating Barriers to Enrollment Act: The bill requires the Maryland Medical
       Assistance Program and the Maryland Children’s Health program to provide guaranteed
       eligibility to specified enrollees for up to 12 months and to provide presumptive eligibility to
       specified enrollees. In the House Health and Government Operations Committee. A hearing is
       scheduled for March 13, 2008.
      HB 285 and SB 96 - Education – Truancy Rates – Positive Behavioral Interventions and
       Support Programs and Behavior Modification Programs: The bill requires a county board of
       education to require a school that has a truancy rate that exceeds specified standards to implement
       a positive behavioral interventions and support program or an alternative research based positive
       and effective behavior modification program in collaboration with the State Department of
       Education. On February 18, the Senate had a third reading of the bill, and passed it 46-1. A first
       reading of the bill was scheduled in the House Ways and Means committee on February 19.
      HB 536 and SB 473 - Public Schools – Youth Risk Behavior Surveillance System – Passive
       Parental Consent. The bill would allow passive parental consent to the Youth Behavior
       Surveillance System survey, which measures youth behavior that puts them at risk. The bill
       received a favorable report with amendments on February 13 in the Senate education, Health and
       Environmental Matters Committee.

   Child Welfare

      HB 965 Child Abuse and Neglect – Additional Professions Required to Report: The bill
       expands the list of individuals who are required to notify the appropriate authorities in a specified
       manner if the individual, acting in a professional capacity in the State, has reason to believe a
       child has been subjected to abuse or neglect. The bill was withdrawn on March 17.

Budget Update

      Montgomery County continues to advocate for educational expenses including school
       construction projects and Geographic Cost of Education Index. (Reznik Report from Annapolis,
       February 2008)

News and Noteworthy

      The 2007-2008 Report for Children Entering School Ready to Learn-School Readiness
       Information was presented at the Maryland State Department of Education Board on March 26.
       (Montgomery County Collaboration Council, 3/2008)

National Status Report
Legislative Update
       HR 1593 Second Chance Act: The bill passed the Senate on March 11 and was sent to the
        House. The bill is a response to the number of people who return to their communities from
        prison and jail. The bill ensures people incarcerated in prison or jails have a safe and successful
        transition to their community. ( 3/2008)

Budget Update

       In FY09, the Presidents Budget proposes many juvenile justice program cuts including
        Delinquency Prevention Block Grants and Juvenile Justice by $217 million – 60%. (National
        Alliance to End Homelessness 3/2008)

State Report
Legislative Update

       HB 90 and SB 57 Child Welfare – Permanency Planning and Interstate Placement of Foster
        Children: On March 31, the bill was reported favorable by the Judicial Proceedings. The bill
        changes the factors a juvenile court is required to consider in making findings in permanency
        planning and review hearings; increases, from 7 to 10, the number of days’ notice a local
        department of social services is required to give to specified persons before permanency planning
        and review hearings; requiring the court to consult with the child on the record in an age
        appropriate manner at least every 12 months at a permanency planning or review hearing.
       HB 651 Department of Juvenile Services Educational Programs – Private Residential
        Rehabilitative Institutions Repeal: The bill repeals the requirement for private residential
        rehabilitative institutions to develop and implement a specified educational program. On March
        26, the third reading passed 131-3.

News and Noteworthy

       The Montgomery County Collaboration Council Policy Priorities for FY09 includes a Youth
        Development focus. The priority will focus on the After/Out-of-School Time system to expand
        and sustain programs that engage youth outside of the school day. Their strategy is to keep kids
        off the streets. The after school programs will provide youth a fun and safe place to participate in
        positive youth development and engage families and communities. (Montgomery County
        Collaboration Council Newsletter, 3/2008)

County Status Report

Budget Update

       The County FY09 Budget increased funding by $600,000 in new funding to address the need for
         out-of-school time and services provided by the Youth Opportunity Center. The budget will
         continue to provide nearly $5 million in the County’s Positive Youth Development program.
         (Montgomery County Press Release, 3/17/2008)

National Status Report
Legislative Update
      S 2684 Section Eight Voucher Reform Act: The bill would establish a clear funding policy to
       restore stability to voucher programs, promote affordable housing developments, and simple rent

Budget Update

      The FY09 Presidential Budget maintains the following funding for homeless programs: (National
       Alliance to End Homelessness 3/2008)
           o Increasing HUD’s homeless assistance programs by $50 million
           o $25 million for a prisoner reentry program
           o $7 million increase in Projects to Assist in the Transition for Homelessness to $60 million
           o $2 million increase for Homeless Veterans Reintegration Program to $26 million
           o Public Housing funding would be cut by $315 million which would eliminate the HOPE
               VI program
           o Housing for the Elderly would be cut by $195 million
           o Housing for people with Disabilities will be cut by $77 million to $160 million

News and Noteworthy

      On April 9, The National Alliance to End Homelessness Annual Awards Ceremony will be
       held at the John F. Kennedy Center for the Performing Arts in Washington, DC.
      The Department of Veterans Affairs reported there was a 21% decrease in 2007 for homeless
       veterans. Some factors that contribute to the decrease include data collection improvement,
       housing provided by Grant and Per Diem residential services, and a decrease in the
       population of World War II and Korean War veterans. (National Alliance to End
       Homelessness 3/2008)
      The District of Columbia has $19.2 million earmarked for the Housing First Fund which will
       be administered by the Department of Human Services. The Housing First Fund plans on
       placing 480 chronically homeless people in permanent housing in FY09. Mayor Fenty is
       adopting the philosophy used in 1990 in New York to provide people with the basic needs for
       housing. (Washington Post, 4/3/2008)

State Status Report
Legislative Update

      HB 946 Montgomery County - Housing Opportunities Commission - Service Contracts MC
       814-08: The bill strengthens the protection of outsourcing Housing Opportunity Jobs. The
       revamped administrative procedures include: the Executive Director have specific certifications;
       compare costs under specific circumstances; and receive approval to submit a proposal for
       solicitations. On March 13 the bill passed the third reading 139-0.

County Status Report
Budget Update

    FY09 County Budget includes $54 million in investments in the Montgomery Housing Initiative
      fund for rehabilitation and acquisition of the County’s affordable housing. (Montgomery County
      Press Release, 3/17/2008)

News and Noteworthy
     The Director of the Montgomery County Department of Health and Human Services submitted a
       report to The Montgomery County Council derived from DHHS and its partners within the
       Homeless Continuum of Care who came together to discuss realignment of the existing system
       and to suggest improvements necessary to make service delivery more effective relative to the
       Abt Associates Housing First report. Some of the recommendations are: (a) Align the homeless
       Continuum of Care to include a Housing First approach with the core mission of providing
       appropriate and rapid exit from homelessness; (b) Redeploy existing resources and add new
       resources to transition the current homeless system to a Housing First model; (c) Increase the
       number of affordable rental units and provide flexible funding for short term and long term,
       shallow and deep rental subsidies; provide case management that varies in time and intensity
       based on the needs of the family/individual; (d) Provide primary prevention, education and
       intervention services in the community to prevent families/individuals from entering the homeless
       system; (e) Expand the funding currently available for prevention to enable providers to assist at
       risk families/individuals before housing loss; (f) Develop more housing units owned by non-
       profits, the County and HOC to increase the number of units available for those with special
       needs and those who do not qualify for federal, state or county regulated programs and subsidies;
       (g) Reunify single adults with their children only in safe, permanent housing.

     Legislative information compiled by Colleen Fee, Jennifer Gauthier, Pat Crist and Jim Vurpillot

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