Unlike most every other state agency, the Department of Behavioral Health was not required to submit a budget with reduction scenarios. In accordance with the recent settlement agreement with the U.S. Department of Justice and the U.S. Office of Civil Rights, the state has a series of obligations and requirements that it must comply with over the next five years.
The agency request for DBH reflects in large part the state’s efforts to begin conforming to the agreement, and these efforts are going to require significant new funding. It is important to note that though the General Assembly has been briefed on this settlement, it has not validated the amounts requested or the plan itself. The Legislature has already appropriated in the FY2010 amended and the FY2011 budgets, a total of $62 million in new funds for behavioral health.
For the amended FY11 budget, the agency is requesting nearly $27 million in state funds, $16.8 million of which is directly related to the settlement agreement. The remaining funds are being requested to cover the deficits left by the loss of the enhanced Medicaid match from the
American Recovery and Reinvestment Act stimulus of 2009. For the FY12 general budget, the agency is requesting nearly $130 million, $63 million of which is tied to the settlement agreement. The remaining funds being requested in FY12 are for adding additional beds for forensic services and to cover the remaining deficits left by the loss of the ARRA enhanced Medicaid funding.
DBH’s settlement agreement-related budget requests can be divided into two broad categories for both fiscal years — funding for mental health patients, and funding for those with developmental disabilities (DD).
For mental health, the agency is ultimately seeking to provide new community services (as opposed to institutional care) for 9,000 patients with serious and persistent mental illness (SPMI), along with enhancing its crisis services for this population and establishing stricter accountability and control measures. Some examples of the kinds of community services that are being required under the settlement agreement include the formation of various mental health support teams that will operate statewide, housing supports and rental subsidies, and transition planning services. In the amended FY11 agency budget request, the mental health component of the settlement agreement totals over $10.5 million, and over $36 million in the FY12 budget request.
For the DD component, the agency is seeking to move all DD patients out of state institutions and into community services. It is planning on achieving this goal primarily by expanding slots for its DD Medicaid Waiver programs, the NOW and COMP waivers. NOW is the New Options
Waiver, and COMP is the Comprehensive Supports Waiver Program, and these two waivers replaced the MRWP (Mentally Retarded Waiver
Program and CHSS (Community and Habilitation Supports Services) waivers respectively. Both NOW and COMP meet essentially the same core needs — offering home and community based services for people with mental or developmental disabilities. Services offered by both of these waivers include various types of therapies, community living support, specialized Medical Equipment and Supplies, employment training and support, and transportation. The COMP waiver is for individuals who need more comprehensive (e.g., out-of-home residential support) or intensive services to live in the community, while NOW is for individuals with less intense needs.
In addition to expanding waiver slots, the settlement agreement also calls for DBH to add additional family supports, increased training, and expands its crisis services for the DD population. In the amended FY11 agency budget request, the DD component of the settlement agreement totals nearly $6.3 million, and is over $27 million in the FY2012 budget request.
Cumulatively, this agreement would increase spending in behavioral health in excess of $500 million over five years.
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