Children’s Mental Health and Transforming the Mental Health System
While there was not a specific line item focused on children’s mental health in the budget recommendations, several of the House and Senate recommendations could impact how children are treated as part of Virginia’s mental health system. As there is on-going attention to transforming the mental health system we must make sure that children are not an afterthought.
Same-Day Access
The Senate retained the Governor’s proposed funding ($8.2 million) to implement “Same-Day Access” services at 25 of our 40 Community Services Boards. In contrast, the House funded “Same-Day Access” at $5.4 million and used $3 million to expand income eligibility criteria for GAP (Governor’s Access Program) from 80 to 100% of the federal poverty level and added addiction and recovery services. GAP provides primary care, outpatient medical services, prescription drugs and behavioral health services to adults with serious mental illness that meet income eligibility criteria.
Same-day access is the first step in implementing a comprehensive state system that is consistent, readily accessible and provides a comprehensive array of community treatment options. With same-day access, children and adults will be able to walk in to any CSB, receive an assessment that day and begin initial treatment within 10 days.
Implementation plans for the mental health system
Both chambers removed the Governor’s proposed $4.5 million to to hire an independent contractor to conduct a gap analysis and design the state’s community mental health services delivery system. Instead, the Senate directed $500,000 to support the efforts of SJ47 Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century, which is leading the efforts to transform the system. The House directed $500,000 GF for the Secretary of Health and Human Resources to prepare an implementation plan to transform the behavioral health system of care into a model which reflects best practice and state-of-the-art services by treating individuals in the community when appropriate. Report is due Sept 1, 2017 and will include financial realignment of the system.
The Senate also added $1 M to contract with a health policy organization to develop a population health strategy that would build on a vision of integrated care and would develop an implementation strategy within the overall population health plan specifically for behavioral health. A report to the Joint Subcommittee to Respond to Federal Health Care Changes and for Health and Human Resources Oversight by December 1, 2017.
These studies should consider the structure and financing of the mental health services delivery system, including the children’s mental health system in the Commonwealth.
State Mental Health Hospitals
The Senate added an additional $2.5 million to improve the salaries of high-turnover positions within our mental health hospitals. The House included $268,985 GF for additional child psychiatric services at the Commonwealth Center for Children and Adolescents.
Both House and Senate added $1 million GF for local hospital inpatient services for children to divert and discharge these individuals from state mental health hospitals.
Medicaid
In light of the changing landscape at the federal level, the Senate and House added language to create a Joint Subcommittee between the Senate Finance and House Appropriations Committees to respond to federal health care changes and Health and Human Resources Oversight. The Jt. Subcommittee will monitor federal changes to ACA repeal, Medicaid and CHIP and make recommendations to the General Assembly. While this budget language is similar many respects, there are key differences. The Senate version states that the Joint Subcommittee shall evaluate proposals that would block grant the Medicaid program. The House language states that the Jt. Subcommittee shall provide ongoing oversight of initiatives and operation of Medicaid and the Children’s Health Insurance Program (CHIP).
Additionally, the House and Senate removed he Governor’s language allowing Medicaid Expansion by Oct 1, 2017, if an enhanced match is still available. Lastly, the House added $1.3 million GF and $1.3 NGF to fund positions at DMAS to implement JLARC recommendations to improve the fiscal management of the Medicaid program.
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