32nd Annual Legislative Breakfast“The Future of Mental Health Services in NC”April 17, 2010<br />North Carolina Center for...
Joshua:The Public in Public Policy<br />
Mental Health Reform in NC:Key Dates<br /><ul><li>Olmstead:  A 1999 U.S. Supreme Court decision
2001 State Law on Mental Health Reform
2008 Investigative Series in The News & Observer
Deaths of Patients in State Facilities
2008 Gubernatorial Election
2009 Budget Shortfall</li></li></ul><li>The System of Care<br /><ul><li>1.27 million North Carolinians need     MH/DD/SA s...
560,000 need MH services
106,000 need DD services
606,000 need SA services
306,000 children are in need of services</li></li></ul><li>
State-Operated Facilities<br />
Mental Health Services Funded by Medicaid<br />Intermediate care facility services for the mentally retarded (ICF-MR)<br /...
Medicaid: The Largest Funder of Mental Health Care<br /><ul><li>N.C.’s Medicaid budget already is $250 million over budget...
The federal government has been picking up an extra portion of state Medicaid costs with federal economic stimulus dollars...
The number of those eligible for Medicaid increases as unemployment rises and as the number of elderly grow because Medica...
1915(b)(c) Innovations Waivers<br />Pros:<br /><ul><li>Control Medicaid costs
LMEs pick providers, set rates
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Presentation on the Future of Mental Health Services in N.C.

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Speech to the 32nd Annual Legislative Breakfast“The Future of Mental Health Services in North Carolina”
Friday Center, Chapel Hill
7:45-10:30am, April 17, 2010

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Presentation on the Future of Mental Health Services in N.C.

  1. 1. 32nd Annual Legislative Breakfast“The Future of Mental Health Services in NC”April 17, 2010<br />North Carolina Center for Public Policy Research<br />by Mebane Rash, Attorney and Editor of North Carolina Insight<br />
  2. 2. Joshua:The Public in Public Policy<br />
  3. 3. Mental Health Reform in NC:Key Dates<br /><ul><li>Olmstead: A 1999 U.S. Supreme Court decision
  4. 4. 2001 State Law on Mental Health Reform
  5. 5. 2008 Investigative Series in The News & Observer
  6. 6. Deaths of Patients in State Facilities
  7. 7. 2008 Gubernatorial Election
  8. 8. 2009 Budget Shortfall</li></li></ul><li>The System of Care<br /><ul><li>1.27 million North Carolinians need MH/DD/SA services, 14% of NC’s population
  9. 9. 560,000 need MH services
  10. 10. 106,000 need DD services
  11. 11. 606,000 need SA services
  12. 12. 306,000 children are in need of services</li></li></ul><li>
  13. 13. State-Operated Facilities<br />
  14. 14.
  15. 15. Mental Health Services Funded by Medicaid<br />Intermediate care facility services for the mentally retarded (ICF-MR)<br />Inpatient hospital and nursing facility services for individuals 60 years of age or over in an institution for mental diseases<br />Inpatient psychiatric services for individuals under age 21<br />Outpatient prescription drugs<br />Physical therapy and related services<br />Personal care services<br />Diagnostic, screening, preventive, and rehabilitative services<br />Case management services<br />Other medical or remedial care<br />Home and community-based services to individuals with mental retardation or developmental disabilities<br />
  16. 16. Medicaid: The Largest Funder of Mental Health Care<br /><ul><li>N.C.’s Medicaid budget already is $250 million over budget for the fiscal year ending June 2010.
  17. 17. The federal government has been picking up an extra portion of state Medicaid costs with federal economic stimulus dollars. This subsidy will end in December 2010.
  18. 18. The number of those eligible for Medicaid increases as unemployment rises and as the number of elderly grow because Medicaid pays for long-term care for the elderly.</li></li></ul><li>The Cost of Medicaid: % Paid by Federal and State Government<br />
  19. 19. 1915(b)(c) Innovations Waivers<br />Pros:<br /><ul><li>Control Medicaid costs
  20. 20. LMEs pick providers, set rates
  21. 21. Better use of data
  22. 22. Hopefully, improves quality of services</li></ul>Cons:<br /><ul><li>Waiting lists?
  23. 23. Caps on services?
  24. 24. Risk for LMEs, counties?</li></li></ul><li>Lawsuits Shape Public Policy<br />Lawsuit #1: Reverse-Olmstead lawsuits to prevent the state from cutting off services that allow clients to live in the community<br />Lawsuit #2: Challenging the state’s budget cuts and new independent evaluations of whether personal care services are needed for 40,000 clients<br />
  25. 25. CABHAs:Critical Access Behavioral Health Agencies<br />Pros:<br /><ul><li>Appropriate medical and clinical treatment
  26. 26. Reduce unnecessary services
  27. 27. Approved by federal government
  28. 28. Need ability to control costs</li></ul>Cons:<br /><ul><li>Enough psychiatrists for medical director positions?
  29. 29. Consumer choice?
  30. 30. Small providers?</li></li></ul><li>Mental Health Study Commission<br /><ul><li>Stakeholder Inclusion
  31. 31. Independent Staffing
  32. 32. Strong Leadership
  33. 33. 7 Long Range Plans</li></li></ul><li>
  34. 34. Four Systemic Questions That Need To Be Answered for Successful Mental Health Reform<br /><ul><li>Governance – What is the responsibility of each level of government (local, state, and federal) for the welfare of those with mental illnesses?
  35. 35. Coverage – Which individuals and disabilities should be included in government-provided mental health care, and what services should be paid for by the government?
  36. 36. Work Force – Is there an adequate supply of trained workers who can care for the mentally ill and provide treatment?
  37. 37. Funding – How will the necessary services be paid for?</li></li></ul><li>Part II of the Center’s Study<br />Mental Health, Developmental Disabilities, and Substance Abuse Services in North Carolina: A Look at the System and the Numbers<br />The Privatization of Mental Health Services in North Carolina<br />Mental Health and Medicaid in North Carolina: Services and Support Under Federal Law<br />The Genesis of Community-Based Mental Health Services in North Carolina: The History, Structure, and Accountability of Local Management Entities<br />The North Carolina Mental Health Study Commission: A Better Model Because of Stakeholder Inclusion, Independent Staffing, and Strong Leadership<br />Using Local Hospital Beds for Short-Term Inpatient Psychiatric Care: Background and Issues<br />
  38. 38. Part III of the Center’s Study <br />Work Force Needs: Update research on the available work force for mental health services. Will include future projections of shortages. <br />Sidebar: The need for Transition Services for Juveniles, and whether this is connected to rising suicide rates in ages 16-20 as adolescents transition to adult services in North Carolina.<br /> 50-State Research: We will examine mental health reform in all 50 states – including an in-depth look at 3 states where mental health reform has worked and 3 where it hasn’t worked.<br />Qualitative Research with Policymakers, Providers, and Consumers in North Carolina: Interviews of legislators, executive branch officials, LMEs, providers, advocacy groups, and consumers. We will visit all four state psychiatric hospitals, as many LMEs as possible, providers, and key advocacy groups. <br />Findings and Recommendations:Based on our research on the needs of the patients, the funding streams, experiences in other states, and interviews with those in the field, we will make findings and recommendations designed to improve the provision of mental health services in North Carolina. <br />
  39. 39. Mark Long<br />
  40. 40. Contact Information<br />Mebane Rash <br />Attorney and Editor of North Carolina Insight<br />NC Center for Public Policy Research<br />PO Box 430<br />Raleigh, NC 27602<br />919-832-2839<br />mrash@nccppr.org<br />

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