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Bazelon Center Mental Health Policy Reporter

Volume V: Issue 1: January 10, 2006

In this issue:

January 10, 2006—The first session of the 109th Congress closed just days before Christmas. Lawmakers were busy right up to the end on major legislation affecting people with mental disabilities, including budget reconciliation and mental health funding. The outcome was not encouraging for struggling public mental health systems and people who need mental health care.

Congress will reconvene on January 31. It will have the President’s new budget to review along with leftover bills and various new legislative proposals —all in the context of this year’s midterm elections. Early on, lawmakers will likely take on the unfinished budget bill with its deep cuts in Medicaid and other programs serving vulnerable low-income populations. Accordingly, the Bazelon Center and the Campaign for Mental Health Reform will give high priority to preserving the integrity of Medicaid.

Mental Health Funding Levels Out in FY ’06

One piece of legislation that was finalized at the end of 2005 is the appropriations bill that funds the Center for Mental Health Services (CMHS) within the Substance Abuse and Mental Health Services Administration (SAMHSA). It gave increases only to the State Incentive Transformation Grants (up $6 million) and the suicide-prevention program (up $10 million).

All other CMHS programs were funded at the fiscal 2005 level, but an across-the-board one-percent cut left final amounts slightly less. Funded are the jail diversion program, which finances community efforts to divert mentally ill offenders from the criminal justice system into community-based mental health treatment; the seniors mental health program, which provides community-based services to older Americans in need of mental health treatment; the PATH program, which offers outreach and services to individuals who are homeless or at risk of being homeless; the children’s mental health program, which supports comprehensive systems of care for children with severe emotional disturbance; the mental health block grant, which provides community-based care to children and adults with severe mental illnesses; the protection and advocacy program; consumer-run technical assistance centers; the school anti-violence program; and the post traumatic stress disorders program.

The chart shows funding for CMHS programs (in millions of dollars).    

Budget Reconciliation Continues to Threaten Low-Income People

On the February 1st the House is scheduled to vote on the 2006 budget reconciliation bill with its draconian cuts to many programs on which people with mental disabilities rely. In late December the conference report was approved by the Senate with an amendment that pushed it back to the House for consideration anew (see the Bazelon Center’s December 23 Action Alert). This vote will coincide with Congressional efforts to enact tax cuts —cuts that would more than offset any savings from reductions in spending for Medicaid and other human service programs.

The legislation is a disaster for low-income families, seniors and children who rely on Medicaid and other entitlement programs. See our update on mental health-related legislation and other documents in our action alerts archive for details about the harmful proposed policy changes.

The budget reconciliation bill would also revise the Temporary Assistance for Needy Families (TANF) program for five years, eroding states’ flexibility to provide appropriate assistance to help TANF recipients with disabilities find and maintain employment. Although the changes in the conference bill are not as disastrous as provisions in the House-passed version (increased work rates, full family sanctions), the underlying emphasis is on state caseload reduction. With several government studies showing that TANF recipients are three times more likely to have at least one physical or mental impairment than adults who do not receive TANF, this change could do more harm than current law if the Department of Health and Human Services sets restrictive standards for what (such as mental health or substance abuse treatment) may be treated as a work activity.

The bill does contain one positive element: a provision from the Family Opportunity Act that would allow families with incomes slightly over the Medicaid income-eligibility levels to buy into the program. This would reduce the number of parents who need to relinquish custody to the state to obtain mental health services for their child. The bill also provides for up to 10 states to receive home- and community-based waivers for children with a serious emotional disturbance who currently receive or are at risk of needing services in a residential treatment center—a significant change from the rule limiting eligibility for the waivers to hospitalized children.

Criminal Justice Diversion Grants

The Mentally Ill Offender Treatment and Crime Reduction Act (P.L. 108-414, sponsored by Senator Mike DeWine and Representative Ted Strickland) was enacted at the end of the 108th congress but too late in the FY 2005 appropriations cycle to secure funding. The program received its first federal funding ($5 million) in the fiscal year 2006 appropriations bill that funds the Department of Justice. The program authorizes grants to states and localities to develop collaborative mental health and criminal justice responses to offenders with mental illnesses. It will provide funds for states and localities to intervene at any point in the continuum of criminal justice contact (pre-booking, post-booking, mental health courts and other court-based approaches, re-entry and transitional programs). Crisis intervention teams and law enforcement training can also be funded.
While the funding is minimal, launching a new grant program is a major accomplishment in the face of extreme federal deficit. Credit goes to Senator Mike DeWine (R-OH) for fighting for these monies. 

Limited Parity Law Renewed

Stalled again is legislation to end health insurance discrimination by requiring health plans to cover mental health services at parity with other health care. In the meantime, before adjourning,  Congress renewed the limited parity law enacted in 1996 resetting its expiration to December 31, 2006. The 1996 Mental Health Parity Act provides for equal annual and lifetime limits on coverage of medical and mental health services, but does not address parity in co-payments, deductibles and number of visits or sessions.

SAMHSA Renewal Anticipated

The second session of the 109th Congress could address renewal of Substance Abuse and Mental Health Services Administration (SAMHSA) programs. The last renewal was enacted in 2000. The Bazelon Center and the Campaign for Mental Health Reform have drafted a package of legislative changes. The proposals focus on interagency collaboration within the public system, moving towards a recovery-oriented mental health system and greater access to community-based mental health services and supports. The reform package builds on the principles in the report by the President’s Commission on Mental Health.

Newsbytes

IDEA Regulations

Final regulations implementing the reauthorized Individuals with Disabilities Education Act (Part B) have been delayed beyond the December 2005 deadline and may not be released before the summer of 2006. The IDEA was renewed in December 2004, and many of its provisions became effective on July 1, 2005. The delay in implementing regulations has caused stakeholders some concern, given the significant number of changes in the law, including those pertaining to school discipline and students’ individualized education plans. See the Bazelon Center’s Alert summarizing the changes and our comments on the proposed rules.

Medicare Part D Off to a Disorganized Start

People who are dually eligible for Medicaid and Medicare lost Medicaid coverage of their prescription drugs on January 1. They should have been automatically enrolled in a Part D plan. Supposedly, even people who have not yet received cards for the Medicare drug plan in which they have been auto-enrolled can still get their prescriptions filled this month. The Center for Medicaid and Medicare Services (CMS) has authorized pharmacists to fill their prescriptions for the time being, until their enrollment takes effect.

The transition appears rocky, however. Many have not received notices with the name of their plan or have been overcharged for their medications or turned away by pharmacies. CMS officials have promised improvements, but the disorganized start of the program is a nightmare for many low-income people who with serious mental or physical health conditions.

Advocates Can Press States to Intervene

According to an article in The New York Times, at least four states (Maine, New Hampshire, North Dakota and Vermont) have committed to pay for the drugs needed by low-income people until CMS can fix the problems. Advocates for Medicaid recipients in other states could pressure their Governors’ offices to follow the lead of these four states.

Ultimately, if the Medicare Part D plan in which someone has been enrolled automatically does not provide adequate coverage, the person can switch to a different plan. The Bazelon Center has a worksheet that people looking to switch —and other Medicare-eligible individuals who have not yet chosen a plan— can use to compare plans before making a decision. English and Spanish versions of the worksheet and instructions for using it are available at http://www.bazelon.org/issues/drugs.

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