Listed below is our analysis of the budget passage. This truncated two and
half month window of the budget negotiation is a major priority to MHANYS.
Many of our signature programs are directly impacted by budget
negotiations. We are pleased that several priority areas were funded but of
course, there is unfortunately limited dollars available. Even when we are
pleased about our priorities being funded, we are keenly aware that this is
all in the context of a workforce that has received only one minor COLA
over the last eight years.

A lot of what was accomplished would not have been possible without
Legislative and Executive leadership. I also want to acknowledge our
members who came out in force at our Legislative Day and also met with
their legislators over the last three months to highlight our priorities.
Also, I would like to thank our colleagues at NYAPRS and Kevin Cleary
Government Relations for our partnership in highlighting and advocating
for our like minded budget priorities. For future updates and more
information, follow us on twitter @MHAacrossNYS

MHANYS Budget Analysis

Breaking News About Minimum Wage

Last night, we had put together a summary of the mental health budget but
had not yet heard about the impact of minimum wage. In light of today, we
are sharing some updated numbers about minimum wage. There was money added
in this year’s budget for not for profits to be able to apply to receive
funding for workforce that will be impacted by year one of the minimum wage
increase. This money was to be divided among impacted state agencies
including OMH, OPWDD, OCFS, DOH, DOL, OASAS, SOFA and OTDA.

Based on a calculation of CFR data from the State agencies, OMH will
receive $900,000 in the last quarter of the fiscal year (January 1
2017—March 31, 2017) to supplement the cost of minimum wage increases in
mental health for not for profits. In 2017-18 budget, there will be five
million dollars set aside for mental health workforce to supplement cost of
minimum wage and in 2018-19 budget, there will be a proposed $14.4 million
dollars added to mental health workforce for minimum wage increase.

The complexity of this issue will be something that will undoubtedly cause
a great deal of conversation and advocacy in the human service community.
As part of any increase in minimum wage in the not for profit sector, there
has to be an acknowledgement financially of the impact of compression to
the workforce. There are numbers that have been projected by colleagues in
the mental health community that are different than those generated by the
State including those around compression. Any future conversation much
include that analysis as well.

This is just the beginning of a significant conversation that will be
taking place over the next several years.

MHANYS Priority Program Funding:

With the passage of this year’s budget, we have highlighted some of the
other areas that most impact mental health beyond the minimum wage.

· Fully restoring funding for Mental Health Reinvestment

· Funding for the Joseph Dwyer Veterans Peer to Peer Program

· Funding for Crisis Intervention Teams

· Waiver that will allow for Correctional Facilities to provide
Medicaid up to thirty days prior to release

· Funding for Mental Health First Aid

· Prescriber Prevails for Medications on the Medicaid Formulary

· Carve out a percentage of funding from the Health Transformation
Funding for some Community Based Organizations

We are pleased that the Legislature and Executive have responded to many of
our priority areas. Of course the caveat is that we are talking about a
very small amount of money available at the Mental Hygiene Table. MHANYS
has voiced our concern for many years about those number as have many of
our legislative champions.

The sad reality is that we are not a popular constituency, we don’t have a
lot of money and we are not a strong voting bloc. We strongly believe that
much of this is also systemic in nature (as it impacts not only New York
State but around public mental health funding across the country) and it is
the result of stigma in the community against individuals with mental
illness. Our great hope is that over time, with mechanisms like the Mental
Health Tax Check Off Bill, this stigma and discrimination will be greatly
reduced and there will be increasing knowledge and resources for community
mental health services in New York and the country.

On the positive side, there is a growing recognition of mental health among
policy makers. We have had an increasing number of legislators and
executive staff who has been outspoken in their support of community mental
health. In addition, as we have proven with Community Reinvestment,
Timothy’s Law and most recently with the tax check off bill, when the
mental health community is all aligned with the same priorities, we are as
powerful as any constituency in Albany.

All that said, from the somewhat limited funding, MHANYS and NYAPRS working
together were able to advocate strongly for the needs of our members and
the community.

Among the highlights from the budget,

Full Restoration of Mental Health Reinvestment – 5.5 Million:

We started this legislative session with the ambitious goal of advocating
for $90 million for mental health community support services. We were well
aware of the odds against that number but felt we owed it to our besieged
community to start having this conversation with policy makers. Through
Media Events, Legislative Days, Press Conferences and our combined advocacy
with NYAPRS, we were able to raise the stakes and visibility of this issue.
We also knew going in that this is not a one time campaign; this is an
ongoing campaign that will involve thousands of like minded voices all
speaking about the need for this funding. That is what got us the original
Community Reinvestment.

One of the significant pieces that was funded as a result of all our
collective efforts was the addition of $5.5 million restored to community
reinvestment. This would not have happened without the heightened advocacy
around community mental health services. Through the work of MHANYS, NYAPRS
and Kevin Cleary Government Relations, we were able to identify $5.5
million in reinvestment dollars that was not identified for community
services funding.

Two hundred beds at $110,000 a bed were going to be closed as part of the
State commitment on reinvestment. However one hundred of those beds was
identified for individuals transitioning to nursing homes if appropriate.
Half of the funding for those 100 beds was originally proposed to go to
the nursing homes and not to community reinvestment. We are supportive of
the goal of transitioning older adults in the psychiatric hospitals into
nursing home when there is appropriate screenings, assessments and services
in place. As significant as that need is, we argued that the transition to
nursing homes should not be leveraged in any way to reduce reinvestment
funding.

As part of the three way agreement, the Legislature and Executive agreed to
restore the full $5.5 million dollars to community reinvestment. The
movement to raise the visibility of community mental health services was
clearly a major reason why funding was restored. What this really means is
that there will be $5.5 million dollars provided to the community to help
fund programs that have been a lifeblood to so many individuals in the
public mental health system bringing the full year commitment to $22
million dollars.

Joseph Dwyer Peer to Peer Veterans Mental Health Project—2.78 Million
Dollars:

Funding for the Dwyer project has long been a priority to MHANYS. The
concept of the Dwyer Peer to Peer Project helps provide the one on one peer
support for veterans in their community. This is incredibly important
because this project helps provide a safe haven for recovery without any
overarching stigma or discrimination to those who have given so much to our
country. People’s lives has been saved because of this project (as we heard
several times at our legislative conference) and we commend the Senate for
continuing to fund and expand the project. Also, we commend many of our
members statewide who have been running the programs in their community.
Additional funding will increase the ability to fund more projects in
counties throughout the State.

Crisis Intervention Teams – Total Funding of $1.5 Million Dollars:

Crisis Intervention Teams (CIT) is an evidenced based program that provides
35 hour training for police officers in how to respond to a mental health
crisis and work with individuals and families. At one time New York lagged
behind other States in CIT implementation but that has changed dramatically
in recent years. Several counties around the State now have police trained
in CIT. We are also pleased that both in the Assembly and Senate language
there is specific reference to the importance of Mental Health First Aid as
an adjunct to CIT. We have found that true in many of the Mental Health
First Aid training we have provided to law enforcement.

There have been too many crisis in recent years involving law enforcement
and individuals with mental illness that have ended tragically. The
movement to CIT and Mental Health First Aid have helped to provide the
training and expertise necessary to create a great understanding of how to
best respond to a mental health crisis that involves law enforcement while
also engaging families.

Criminal Justice Reform: Application for Medicaid before Jail or Prison
Release:

Over the last few years, MHANYS and NYAPRS have been working together on
ways for individuals with behavioral health who are incarcerated to
transition to the community with Medicaid already in place. Mechanisms like
presumptive eligibility and medication grant cards have been part of the
discussion. In this year’s budget, the Assembly introduced language that,
with wavier approval from CMS, allows for incarcerated individuals to be
able to apply for Medicaid benefits up to thirty days before jail or prison
release.

We have always maintained that the best way to provide community support
for incarcerated individuals is through the creation of pathways of care.
The idea of being able to have Medicaid eligibility status before release
as well as connectivity with the health home plus care manager before
release and guarantees of immediate engagement upon release will create a
‘pathway of care’ for an individual. This contrasts with individuals
released from correctional facilities who have to sometimes wait thirty to
sixty days before their Medicaid is approved. The 30 day waiver will have a
great impact on rapid service engagement. The State and legislature has
been working hard on this issue and hopefully this will provide another
tool to respond to that need.

We have been working with our partners at Legal Action Center and NYAPRS on
this legislation. Assemblyman Danny O’Donnell, Assembly staff and Senate
and the Governor’s Office have worked tirelessly to reach an agreement and
we are very hopeful of an outcome that could greatly impact incarcerated
individuals. I also want to acknowledge my colleague Harvey Rosenthal at
NYAPRS who worked around the clock to make sure this legislation came to
fruition.

Prescriber Prevails Protections:

This year, both house of the legislature restored a proposed cut in the
budget that would have limited prescriber prevails protections to just
mental heath medications. As we said when the budget was introduced, we are
appreciative of the State for keeping the protection of Prescriber Prevails
for mental health medications but as we know there are significant physical
health concerns for many individuals with mental illness and these
medications also need the protections of prescriber prevails. This
protection allows for an individual to get their appropriate medications
based on the prescriber’s recommendation and not on a plan formulary.

Mental Health First Aid for MHANYS – $100,000:

For the fourth straight year, the State Senate has supported MHANYS efforts
to spread Mental Health First Aid statewide by providing an allocation of
$100,000 to help in working with our members in fifty counties to become
Mental Health First Aid Trainers. In addition, as we referenced, the Crisis
Intervention Team funding has a component specifically geared to Mental
Health First Aid training. This is an important recognition of a tool that
has been incredibly effective in crisis response and mental health
education.

Health Transformation Funding – $40 Million Dollars for Community Based
Organizations:

MHANYS was part of a coalition of organizations led by the FQHC’s that have
been working with the Legislature and the State to set aside a part of the
Health Transformation Funding dollars for Community Based Organizations.
The funding provides $200 million for hospitals to merge and repurpose
themselves in the changing environment of health care. The frustration of
many of us in the community has been that much of the DSRIP and other
funding has gone to larger institutions and CBO’s have largely been left
out of that mix.

As a response to the advocacy of this coalition, $30 million dollars was
set aside specifically for Community Based Organizations (CBO’s) to utilize
in system restructuring. We are still determining which CBO’s will be
eligible to participate but it appears that Mental Health clinics will be
part of the eligible parties.

Other Updates:

The final budget bill extends the provision for exemption from licensure
for social workers and mental health practitioners for two years until July
1, 2018

The final budget bill also extends authority for four years for
Comprehensive Emergency Psychiatric Programs (CPEP)

$300,000 for Farm Net (Suicide Prevention Program for Farmers)

$450,000 for New York State Psychiatric Association/Medical Society/NASW
for their Veterans Project

$500,000 for Children’s Public Awareness

$2.2 Million Dollars for jail based restoration rejection

Part K – OMH Jail-Based Restoration

Part K

§ 1

Intentionally Omitted

Intentionally Omitted

Intentionally Omitted

Permit restoration to competency within a jail-based residential setting;
create a residential mental health pod unit within a county jail for those
felony defendants deemed incompetent to stand trial.

Summary:

With the limited funding that was provided to the Legislative Mental
Hygiene Committee Chairs, they deserve a great deal of credit for much of
that money going to MHANYS priority areas around community reinvestment,
veterans mental health, mental health first aid, CIT and Criminal Justice
Reform. We thank Assembly Mental Hygiene Chair, Gunther and Senate Chair
Ortt for their leadership as well as the work of the other members of the
committee. We are also appreciative of the Legislature for being responsive
to concerns about Prescriber Prevails and that a percentage of the Health
Transformation money being carved out from large institutions to community
based organizations. We are also appreciative of the Executive in working
with the Legislature in several of our priority areas.

We know this funding only touches the surface of what we really need. If
indeed the minimum wage increase has a deleterious effect to not for
profits, the impact could be devastating. Not only have not profits faced a
world with minimal funding increases (one small COLA for direct care staff
in seven years) but the possibility of now having to pay for minimum wage
increases will dramatically impact the financial viability of many of these
agencies.

We also don’t yet know the full impact of the minimum wage increase and
what it will mean for our existing workforce.

We will spend a lot of time off session promoting and advocating for a true
$90 million ask for a real community investment. If you want to show your
support for a campaign, please contact me at gliebman@mhanys.org

What’s Next

As we know the legislative session is really two session. January to April
1 is almost all budget related while April through late June is about
legislation.

MHANYS has three major legislative asks that you will be hearing about a
lot in the next several months:

1) Mental Health Education in Schools—To follow up from last year’s
successful campaign for a Mental Health Check Off, we intend to work with
our grass roots members across the State in raising awareness of the
significance of having mental health education taught in schools. We have
legislation in place that supports this call. S. 6046—Marcellino and A.3887
A Nolan. We will continue to rely on you for support. If you want to join
our mailing list on this issue, contact John Richter at jrichter@mhanys.org
Remember only a focused grass roots campaign that calls for the
participation of thousands of New Yorkers will make this happen.

2) Mandatory Continuing Education for Teachers through Mental Health
First Aid– This legislation would create mandatory Mental Health First
Aid training for all teachers as part of their continuing education
credits. This training would provide a much greater understanding of
students with behavioral health issues. S.6234 Hamilton and A. 9299 Crespo

This one two legislative punch would have an enormous impact in prevention
and early intervention efforts for youth with mental health related issues

3) Regulation of Step Therapy—It has always been a priority of MHANYS
to speak out against policies of Step Therapy and Fail First. Individuals
should not have to go through a protocol of generic or less expensive
medication before they have the medication that is most appropriate for
them. Individuals should not have to go through months or even years of
‘fail first’ before you get the most appropriate medication. We strongly
support this legislation S. 3419—Young and A. 2834 Titone A

For the most up to date information, follow us on Twitter @MHAacrossNYS

Glenn Liebman, CEO

 

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