ACL Legislative Day
March 14, 2016
Empire State Plaza, Albany, NY
Approximately 250 ACL Members attended more than 125 legislative appointments between 11:00am and 3:00pm on Monday, March 14, 2016.
Here are our 2016 Talking Points:
RESTORE THE $92.9 MILLION THAT HAS BEEN CUT FROM MENTAL HEALTH HOUSING PROGRAMS OVER THE PAST 25 YEARS
- Increases in funding have not kept pace with inflation over the past 25 years- so much so that mental health housing programs in New York now face approximately $92.9 million in cuts due to inflation.
- Housing programs are expected to serve much more challenging populations, manage the health and mental health for people with many co-occurring conditions, and manage complicated medications regimens that were never anticipated when the housing models were developed more than 30 years ago.
- Increasing administrative costs due to extensive changes in the publicly funded mental hygiene system are not funded, which puts mandates from the state and the needs of consumers in competition.
- The breakdown of the $92.9 million is:
- Add $23.2 million to the Community Residence-Single Room Occupancy (CR-SRO) programs.
- Add $40 million to the Supported Housing rate
- Add $17.0 million to the CR (Community Residence) program (includes both smaller CRs and Treatment Apartments).
- Add $12.7 million to the SP-SROs (permanent housing with supports).
SUPPORT GOVERNOR CUOMO’S 15 YEAR HOMELESS HOUSING INITIATIVE
- One out of every seven homeless people in the United States lives in New York State.
- Statewide there are roughly 67,000 people in shelters at any given time. The Governor’s proposal will address homelessness statewide.
- Supportive housing solves homelessness, improves neighborhoods, and saves tax dollars by decreasing spending at hospitals, jails and prisons.
- The Governor’s budget proposal includes an initiative to develop 6,000 new supportive housing units over the next five years along with the promise to create a total of 20,000 new units over the next fifteen years.
- This initiative, coupled with Mayor de Blasio’s initiative to create an additional 15,000 units specifically for New York City, when fully operationalized, would create a total of 35,000 new units to address the state’s homeless crisis.
FUNDING FOR INCREASES TO THE MINIMUM WAGE
- The Association for Community Living believes that workers should be able to earn a living wage.
- Community based nonprofits rely on state contracts and Medicaid payments as the primary, and in some cases, only source of revenue.
- There is no money in existing nonprofit providers of community services budgets to absorb increases to salaries without increases to revenues.
- Any increase to the minimum wage must be reflected with increases to state contracts and Medicaid payments so that nonprofit providers can continue to offer quality, cost-effective services in the community.
- The compression issue (comparison of wages for certain positions in relationship to the minimum wage) must be addressed when the legislature is considering any increase to the minimum wage.
HEALTH AND HUMAN SERVICES COLA
- The Governor’s budget proposal includes funding for a 0.2% Health and Human Services COLA.
- The percentage of the COLA is statutorily driven by the CPI and results in only $2.4 million for programs under the Office of Mental Health (OMH) this year.
- The statutory COLA has been deferred for the past seven years resulting in a loss of over $182 million to the community mental health system (14.4% cumulative).
- Community based providers must cover costs related to the many changes in the system (managed care, DSRIP, PPSs, HHs), but must use existing, limited resources that have not kept pace with inflation.
COMMUNITY REINVESTMENT OF HOSPITAL BED CLOSURES
- The Governor has proposed the reinvestment of $16 million from further state hospital bed reductions.
- This money is typically invested in the communities where the state hospital beds have been reduced and will fund an array of state and nonprofit crisis and respite beds, home and community based services waiver slots, supported housing, mental health urgent care walk-in centers, mobile engagement teams, first episode psychosis teams, family resource centers, evidence-based family support services, peer-operated recovery centers, suicide prevention services, community forensic and diversion
SOCIAL WORK EXEMPTION
- The Governor has proposed extending the social work exemption for another 5 years.
- Without this exemption, many positions will be opened up to a requirement to have licensed social workers – it would break the bank of many nonprofit providers, assuming you could even find enough licensed social workers.
- Without this exemption, social workers could be required for residential positions that do not require them now. These are para-professional positions.
- Clinics would have had to replace many non-licensed social workers with licensed social workers.
- There are not enough licensed social workers in New York State to fill all of the positions that would be impacted if the exemption is not extended.
- The Governor seeks to make savings by restricting the medication choices Medicaid beneficiaries and their prescribers are afforded.
- This proposal would exempt anti-psychotic and anti-depressant medications from this policy, many people with mental illness require different medications.
- The Association for Community Living believes that all beneficiaries should be able to get medications that have or will work best for them.
ACL 2015 LEGISLATIVE DAY REVIEW
On Monday, March 9, 2015, 250 ACL Members joined us for our Annual Legislative Day. After a descriptive briefing of our Legislative Priorities for our members from Doug Cooper, each group – with their own personalized agenda – moved on to their appointments, which were set up in advance by Lindsey Chase of ACL. They brought with them individualized briefing books for each legislator that showed the programs in each district and a summary of our priorities and our budget request – $82 million for all 4 types of OMH funded housing programs. We completed more than 130 legislative appointments between 11:00A.M. and 2:30P.M.
We were joined in our budget request by NYAPRS, MHA-NYS, NAMI-NYS, The Coalition of Behavioral Health Agencies and SHNNY, who all had legislative/lobby days within two weeks of ours. The Conference of Local Mental Hygiene Directors have been working with us, side by side, since last September, resulting in $10 million for Supported Housing in the Governor’s proposed budget. We heard from legislators all over the state that they are well aware of the housing issue. It’s working.
We are thankful to the ACL Members who came out and participated in what is ACL’s most important grassroots advocacy day of the year. Please MARK YOUR CALENDAR for next year – Monday, March 14, 2016— Because the more voices we have in Albany relaying the same message, the better chance we have to save and improve the most comprehensive mental health housing system in the nation!
SUMMARY OF ACL’s BUDGET PRIORITIES
- Add $29 million to the Supported Housing rate statewide in 2015 to make up for losses from inflation and to ensure that Supported Housing is sustained, basing future rates on a reasonable formula. Health Home care coordinators do not take the place of housing staff, while the new guidelines will place extra financial burdens on providers.
- Add $23.2 million for CR-SROs to make up for losses from inflation and so that they can better serve those with challenging needs. These provide a high level of service and can be very long-term stay or permanent.
- Add $17 million for the CR program (includes both CRs and Treatment Apartments) to make-up for losses from inflation and to incentivize providers to admit the most challenging clients safely. This would have the added value of ramping up the model’s efficiency in rehabilitating people more quickly, most likely an outcome that the MCOs will expect when this model is moved into Managed Care. This number subtracts the estimated BIP revenue. This would be the state share for an increase and would be used to leverage approximately $15.5 million in Federal Medicaid money.
- Add $12.7 million to SP-SROs, permanent housing with supports, to make up for losses from inflation and to better equip them to serve clients with more challenging service needs.
- Add 30,000 units to expand NYNY IV beyond the Executive Budget allocation of 5,000 for a total of 35,000 units, with 30,000 in New York City and 5,000 for upstate
- Support the $10 million enhancement in the executive budget proposal for OMH Supported Housing programs.
- Support the 2% COLA. Redirect this COLA so that it is not specific to any staff positions, but is flexible in use.
- Support the Governor’s proposal of $22 million in Wrap-Around Supports for Persons Discharged from Prisons: We support the proposed Executive Budget’s commitment for$22 million in new OMH funding to provide pre-discharge supports and planning, wraparound community-based services, and supported housing for individuals with psychiatric disabilities and/or diagnoses who are in the process of being discharged from state prisons. These funds are critically necessary to enhance appropriate discharge planning and successful reintegration into the community and to avoid an otherwise disproportionately high rate of recidivism.
SUMMARY OF ACL’s LEGISLATIVE PRIORITIES
- Presumptive Medicaid Eligibility: Presumptive eligibility for New Yorkers with behavioral health conditions leaving the prison system will extend 60 days of access to critically needed Medicaid funded community services and supports at the time an individual is released. This is critical in facilitating safe and healthy community transitions before a more formal application and approval for full Medicaid benefits occurs. This policy will greatly reduce avoidable relapses and re-incarcerations while saving the state considerable money from the preventable use of criminal justice or inpatient facilities.
- Prescriber Prevails: The policy of Prescriber Prevails puts doctor and patient choice ahead of decisions that would otherwise be made by Medicaid payers. Many consumers require very specific medications (brand name over generic drugs at times) in order to get and stay well and to avoid harmful side effects. For the third year in a row, the Executive Budget proposes to eliminate this important protection that ensures safety and choice.
- Prohibit Solitary Confinement for people with psychiatric or physical disabilities by passing 1346A. Symptoms associated with psychiatric disabilities are often viewed as antagonistic behavior by officers and result in inhumane 23 hour-a-day isolation for people with serious mental illness. Solitary confinement exacerbates trauma for persons with pre-existing psychiatric disabilities and has been shown to cause serious psychiatric symptoms and conditions for people with no such past histories. The state must offer treatment not torture to its most vulnerable.
- Approve Mental Health Tax Check off Bill – A.833/S.632. Stigma is the number one reason why two out of every three people who need mental health services never seek them. Combating stigma can promote recovery for New Yorkers by providing education and resources about mental health diagnoses and services, reinforcing dignity through media campaigns, and promoting community inclusion (access to housing, jobs) by humanizing people with psychiatric disabilities. Supporting a tax check off bill is recognition of the need to combat stigma for New Yorkers with mental health needs, the proceeds of which will be utilized for public awareness campaigns to work against negative stigmatization.