Today, Governor Cuomo introduced this year’s proposed Executive Budget.
According to the Executive’s projection, there is an estimate of a $4.4
billion budget deficit. Below are some of the highlights of the budget as
it impacts mental health. We will have a more in-depth review in the coming days.

Workforce

This year’s budget continues the State’s commitment to the 3.25 percent
increase for the direct care workforce and the clinical staff that will be
reflected on April 1. In terms of the Consolidated Fiscal Report, this is
the 100, 200 and 300 series. While the January 1 increase reflected a 3.25
percent increase for the 100 and 200 series, the April 1 increase reflects
an additional 3.25 percent increase for the 100 and 200 series but also
includes a 3.25% increase for the 300 series (largely clinical staff).
This was a major priority for MHANYS.

MHANYS Response

We are very supportive of the work of the Governor and the Legislature in
their commitment to funding of the workforce. However we also recognize
that this is a first step. The State must continue their commitment to
providing a living wage in order to recruit and retain a quality workforce. We
are in a workforce crisis. MHANYS and other behavioral health
organizations are calling for an additional 3.25 percent increase on January
1, 2019 for the 100, 200 and 300 series (similar to the funding that will
be provided this April 1) which is estimated at $11.8 million dollars.

We are also asking for some language around tuition reimbursement for the
workforce as well. This workforce is desperately in need of funding for
tuition, career ladders and enhanced training as well as credentialing. We
urge the State to move forward in all those fronts

Housing

This year’s budget provides $10 million for existing supported housing and
SRO programs. This is consistent with the last several years.

MHANYS Response

As part of the Bring It Home campaign, we recognize that the $10 million
dollars does not begin to meet the needs of housing providers and the
indivdiuals they serve, many of who have not received funding increases in
many years. As we know, community based residential programs are the most
inexpensive, humane and appropriate way to provide housing. The cost of an
emergency room, a hospital bed or prison is cost prohibitive and is
certainly much more deleterious than community housing. We will continue to
work with ACL and the other members of the campaign to dramatically enhance
the funding.

Reinvestment

This year there continues to be the reinvestment of hopstial bed closures
to community funding. The proposal this year is to close 100 beds resulting
in an additional 11 million dollars added for community reinvestment. We
have been very supportive of reinvesting the funding back to the community.
To the credit of the State, this has resulted in over one hundred million
dollars added to community funding for mental health over the last five
years.

MHANYS Response

We are appreciative of this funding but we also note that the Article 7
languages does not specifically link the bed closures to an exact dollar
amount. We are advocating that this loophole end during budget negotiation
and that there is specific reference to a value of $110,000 a bed for each
bed that is reinvested

Crisis Respite Beds

$50 million in capital spending expansion of crisis respite capacity

MHANYS Response

There is clearly a need for crisis respite beds and we are supportive of
the expansion of the program. We should also look at a statewide crisis
response number and links to teams across the State. From our experience at
MHANYS, we receive calls from exasperated individuals who do not know where
to turn when they or their loved one is in crisis. A centralized repository
for concerns would be very helpful in responding to the mental health
crisis at the grass root level.

Public Awareness including Mental Health Education in Schools and
Mental 
Health First Aid

MHANYS Response

Unfortunately, there is no funding related to issues of public awareness.
Despite recent legislative successes, public awareness and anti-stigma work
continues to get limited funding. In recent years, we have relied on
funding from the Legislature particularly the Senate in raising awareness
for Mental Health First Aid and Suicide Prevention. We need a strong
statewide campaign to address these concerns.

ACT Teams Expansion

The budget proposes twenty new ACT Teams in New York State that would
serve 1280 individuals. Ten of the teams would be in New York City and the
rest would be in the rest of the State.

MHANYS Response

ACT teams have proven to be a very effective strategy for engagement.
Several MHAs have run successful ACT teams for many years.

Jail-Based Restoration

The budget language would create a jail-based restoration program that
would create specialized residential units in jails. Currently, many of
these individuals are housing in OMH inpatient hospitals

MHANYS Response

This is the third year this program is being introduced. In the past, the
Counties and advocacy groups have been strongly opposed. Unless there is a
dramatic change, I would imagine this would be consistent with the past.

Health Care

The Governor’s proposed global cap is 3.2% which is $593 million dollars.
The Governor has also introduced a Health Care Shortfall Fund of one
billion dollars which will be held in reserve in anticipation of the impact
of the federal government cuts to New York. The Shortfall Funds will be
paid through the funding from insurance coverage from not for profit to for
profit status.

Other initiatives include efficiencies in long-term care and managing
enrollment grants in managed long-term care.

MHANYS Response

We will be reviewing this proposal and come up with specific
recommendations.

Prescriber Prevails

The Governor’s budget proposes the elimination of Prescriber Prevails from
all medication including mental health. In last year’s proposed budget,
prescriber prevails was included for mental health medication. This year it
is not included

MHANYS Response

We will advocate with many of the partners in our community to raise our
voices in support of Prescriber Prevails across mental health and other
medications. Physicians in consultation with their patient should make
final determinations of their medications, not an insurance plan.

Telepsychiatry

Proposes the expansion of Medicaid coverage for telepsychiatry for home
settings

MHANYS Response

We are very supportive and want to ensure that telepsychiatry is utilized
as much as feasible. Though there is nothing like a personal interaction
between a physician and their client, the low number of psychiatrists
especially in rural areas necessitates other remedies.

Addictions Disorders

There are several initiatives in the budget related to addiction disorders.
Among the new initiatives include 200 new residential inpatient treatment
beds, 18 family support navigation programs, ten news regional coalitions
and partnerships, twenty peer engagement programs and 250 new peer
advocates. In addition, there are seven new Problem Gambling Resource
Centers

MHANYS Response

We are glad to see the State is providing the resources to effect some real
change in the treatment of individuals with addiction disorders. There is
no doubt that there has to be increased capacity for those who are addicted
to opioids as well as to those who are problem gamblers. A high percentage
of those with addictions disorder have a co-occurring mental health issue
and the system desperately needs to have all of the systems work together
to enhance recovery options. In addition, the ability to provide medication
treatment for those with addictions is of paramount importance. Continued
access without prior approval to Suboxone and other life-saving
medications are significant to recovery.

Summary

In the backdrop of the second worst deficit, Governor Cuomo has had in his
eight years in office, there was a collective sigh of relief that there
were not proposed budget cuts that we would have to fight this legislative
session. We were certainly pleased that the State is upholding their
commitment to the workforce funding as well as the continued investment in
reinvestment dollars. However, we are disappointed by the lack of
additional funding for the housing providers and the peers and families
involved in their program. We are also concerned that there is the proposed
elimination of prescriber prevails for all medication including mental
health medications.

Our advocacy for this budget season becomes clear around an additional
workforce enhancement for January of 2019 for the behavioral direct care
and clinical staffs; increased funding for the housing provider community
and prescriber prevails for mental health and other medications. There will
also be several other budget items we will be advocating for including
Veterans Mental Health, Mental Health First Aid, CIT, Geriatric Mental
Health and Suicide Prevention.

We are also very much focused on the July 1st implementation date of Mental
Health In Schools Education Reform. We have not yet found any additional
funding for this initiative but it will be a priority during this
legislative session to ensure funding for this initiative.

At this point, we still don’t know the implications of the cuts to Medicaid
and we will have to review for impact including the proposed one billion
dollar contingency fund for health care. We will provide a comprehensive
review in the coming days.

Action, Action, Action

Much has changed in recent years due to your grassroots works. One way to
raise your voice is to please join the over 200 people across New York
State who will come up for MHANYS Mental Health Legislative day on March 14th.
Registration will be up soon.

Glenn Liebman, CEO

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