(August 10, 2005)—Congress has adjourned for its annual August break,
to resume work September 6 on budget reconciliation, appropriations and other
bills. The recess offers an excellent opportunity to call on Senators and Representatives
in their states and districts and explain how important their votes on these
measures will be for children and adults with mental disorders.
Medicaid Integrity Threatened by Budget Reconciliation
Congress hopes to meet a September 16 deadline to produce a budget-reconciliation
bill called for by the House and Senate committees with jurisdiction over Medicaid.
A resolution passed earlier this year calls for approximately $10 billion in
budget cuts over five years, without identifying which federal programs must
be reduced. But all indications are that Medicaid will occupy a central spot
on the cutting table.
Background
Reform of the federal-state Medicaid program is a focus for Congress, the Administration
and stakeholders. Recently, the Department of Health and Human Services (HHS)
sidestepped a challenge to the proposed cuts by Senators Gordon Smith (R-OR)
and Jeff Bingaman (D-NM) by creating a so-called bipartisan Medicaid Commission.
Led by HHS Secretary Michael Leavitt, the commission has a September 1 deadline
to report on savings to address the budget resolution and a December 31 deadline
for a report on Medicaid’s long-term outlook. It is unclear what, if
any, impact the commission will have in determining how $10 billion can be
stripped from Medicaid. The National Governors Association also has a set
of draft reform recommendations.
Medicaid is the single largest source of funding for mental health care and
the single most important source of revenue for state mental health systems.
Moreover, individuals with mental illnesses represent a significant proportion
of all Americans covered by Medicaid. Sixteen percent of adult beneficiaries
and 8 percent of children on Medicaid use mental health or substance abuse
services.
Medicaid is also a valued source for essential mental health services, financing
a full range of community-based rehabilitative services needed by people with
mental illnesses. Access to Medicaid coverage is critical for thousands of
families who each year have had to relinquish custody of their children to
the state to get health and mental health services the child needs—a
choice that is neither humane nor consistent with good public policy.
Medicaid is vital to the millions of people with mental illnesses, including
those who are eligible because they receive Supplemental Security Income (SSI),
are in the foster care system and or have high medical costs. Some population
groups qualify only for services mandated by the federal law, while others
can also receive services covered under state option. There is little effective
difference between the two groups; all have low incomes and all need appropriate
mental health care and have no other source of coverage.
Message to Congress: Preserve Medicaid Integrity
Preserve the guarantee of access to Medicaid. Most of Medicaid’s mental
health services are covered under states’ optional eligibility categories.
The mandatory services relevant to mental health care are physician services
and inpatient and outpatient general hospital care. Mandatory and optional
Medicaid beneficiaries are similar with respect to their health care needs.
Proposals that would create lower benefit packages for people who qualify under
a state’s options would dismantle the integrity of Medicaid by restricting
access to mental health care for low-income individuals who have a significant
need for treatment.
Resist efforts to undermine EPSDT. Twenty-five percent of American children
under age 21 are enrolled in Medicaid. Under Medicaid’s Early and Periodic
Screening, Diagnosis and Treatment (EPSDT) program, they are entitled to all
medically necessary services for conditions identified by an EPSDT screen,
regardless of whether the optional services are included in the state’s
Medicaid plan. This critical entitlement is designed to help ameliorate
health and mental health problems early in children and/or provide appropriate
care
for chronic conditions. A 2001 General Accounting Report highlighted the
importance of this requirement and profiled insufficient state activity
in meeting it.
More, not less, must be done to meet this requirement.
Retain Targeted Case Management (TCM) as an optional service. TCM has
been used to help beneficiaries increase daily-task functioning, residential
stability
and independence, and to reduce hospitalizations. The President’s FY
2006 budget proposal for Medicaid “savings” would shift TCM into
Medicaid’s administrative costs. This would inhibit case managers’ ability
to link consumers to services, such as housing, education and food stamps,
that are not covered by Medicaid. It would also put state agency personnel,
rather than qualified targeted case managers, in charge of coordinating
necessary health care and social supports for beneficiaries. Case management
is a critical
component of an effective system of mental health service delivery.
What You Can Do
Now is the time to make your voice heard as Congress considers measures that
could drastically limit the services on which Medicaid beneficiaries with mental
illnesses rely for their health and mental health care.
Call or visit members of your Congressional delegation while they’re
at home between now and Labor Day—especially if you live in one of the
states or districts represented on committees listed below. Any legislative
proposals developed by these committees to identify budget savings should not
come at the expense of the millions of beneficiaries with mental illnesses
who could lose access to Medicaid’s critical safety net.
Take action Now!
Urge your lawmakers to:
Reject efforts to cut Medicaid spending by reducing individuals’ access
to vital services, whether mandatory or optional for
any population.
Safeguard EPSDT and other Medicaid services that are often
a beneficiary’s
only way to access community-based care.
Reject the Administration’s
proposed shift of Targeted Case Management to an administrative
function as part of budget reconciliation.
You can find contact information for your lawmaker’s home office at
congress.org.
Senate Finance Committee (or go to congress.org) http://www.congress.org/congressorg/directory/committees.tt?commid=sfina
Charles Grassley (R-IA)- Chair
Orrin Hatch (R-UT)
Trent Lott (R-MS)
Olympia Snowe (R-ME)
Jon Kyl (R-AZ)
Craig Thomas (R-WY)
Rick Santorum (R-PA)
Bill Frist (R-TN)
Gordon Smith (R-OR)
Jim Bunning (R-OR)
Mike Crapo (R-ID)
Max Baucus (D-MT)-Ranking Member
John Rockefeller IV - (D-WV)
Kent Conrad (D-ND)
James Jeffords (D-VT)
Jeff Bingaman (D-NM)
John Kerry (D-MA)
Blanche Lincoln (D-AR)
Ron Wyden (D-OR)
Charles Schumer (D-NY)
House Energy and Commerce Committee (or go to congress.org) http://www.congress.org/congressorg/directory/committees.tt?commid=hcomm
Joe Barton (R-TX-6th), Chair
Rep. Ralph Hall (R-TX-4th)
Rep. Michael Bilirakis (R-FL-9th)
Rep. Fred Upton (R-MI-6th)
Rep. Cliff Stearns (R-FL-6th)
Rep. Paul Gillmor (R-OH-5th)
Rep. Nathan Deal (R-GA-10th)
Rep. Edward Whitfield (R-KY-1st)
Rep. Charles Norwood (R-GA-9th)
Rep. Barbara Cubin (R-WY-At-Large)
Rep. John Shimkus (R-IL-19th)
Rep. Heather Wilson (R-NM-1st)
Rep. John Shadegg (R-AZ-3rd)
Rep. Charles Pickering (R-MS-3rd)
Rep. Vito Fossella (R-NY-13th)
Rep. Roy Blunt (R-MO-7th)
Rep. Steve Buyer (R-IN-4th)
Rep. George Radanovich (R-CA-19th)
Rep. Charles Bass (R-NH-2nd)
Rep. Joseph Pitts (R-PA-16th)
Rep. Mary Bono (R-CA-45th)
Rep. Greg Walden (R-OR-2nd)
Rep. Lee Terry (R-NE-2nd)
Rep. Michael Ferguson (R-NJ-7th)
Rep. Michael Rogers (R-MI-8th)
Rep. C.L. Otter (R-ID-1st)
Rep. Sue Myrick (R-NC-9th)
Rep. John Sullivan (R-OK-1st)
Rep. Timothy Murphy (R-PA-18th)
Rep. Michael Burgess (R-TX-26th)
Rep. Marsha Blackburn (R-TN-7th)
John D. Dingell (D-MI-15th), Ranking Member
Rep. Henry Waxman (D-CA-30th)
Rep. Edward Markey (D-MA-7th)
Rep. Rick Boucher (D-VA-9th)
Rep. Edolphus Towns (D-NY-10th)
Rep. Frank Pallone (D-NJ-6th)
Rep. Sherrod Brown (D-OH-13th)
Rep. Bart Gordon (D-TN-6th)
Rep. Bobby Rush (D-IL-1st)
Rep. Anna Eshoo (D-CA-14th)
Rep. Bart Stupak (D-MI-1st)
Rep. Eliot Engel (D-NY-17th)
Rep. Albert Wynn (D-MD-4th)
Rep. Gene Green (D-TX-29th)
Rep. Ted Strickland (D-OH-6th)
Rep. Diana DeGette (D-CO-1st)
Rep. Lois Capps (D-CA-23rd)
Rep. Mike Doyle (D-PA-14th)
Rep. Thomas Allen (D-ME-1st)
Rep. Jim Davis (D-FL-11th)
Rep. Janice Schakowsky (D-IL-9th)
Rep. Hilda Solis (D-CA-32nd)
Rep. Charles Gonzalez (D-TX-20th)
Rep. Jay Inslee (D-WA-1st)
Rep. Tammy Baldwin (D-WI-2nd)
Rep. Mike Ross (D-AR-4th)
Mental Health Funding Awaits Senate Action
With the Roberts Supreme Court nomination slated to take up considerable Senate
floor time, it is unclear when a number of mandatory fiscal year 2006 appropriations
bills reported out of their respective committees will be considered and whether
they will be conferenced individually or combined in an omnibus appropriations
bill. Among them is one that would fund the Substance Abuse and Mental Health
Services Administration.
The funding bills passed by the House and approved by the Senate Appropriations
Committee are similar. Both restore many of the cuts to SAMHSA’s discretionary
budget (Programs of Regional and National Significance) proposed by the President.
Both also level fund most of SAMHSA’s programs. The only glaring difference
is the funding level for the Safe Schools and Healthy Students program, which
provides grants to local school districts to address the problem of school
violence. The House approved approximately $10 million less than last fiscal
year.
Unfortunately, no new funding was approved for SAMHSA’s programs and
services beyond the program that supports development of state interagency
collaborative plans (State Incentive Transformation Grants). Increases to federal
programs that fund direct services are critical to make a dent in the ever-increasing
unmet treatment needs of children and adults with mental illnesses.
Please refer to the June
29 Bazelon Center alert [http://www.bazelon.org/takeaction/2005/6-30funds.htm]
for more information on specific funding levels for SAMHS’s programs
and services.
Funding Sought for Criminal Justice/ Mental Health Collaboration
Mental health advocacy groups continue urging Congress to fund the Mentally
Ill Offender Treatment and Crime Reduction Act, signed by the President late
last Congress. The grant program would finance a range of criminal justice
and mental health collaborations that expand the criminal justice continuum
(pre-booking, including crisis intervention teams, post-booking, mental health
courts, other court-based approaches, re-entry and transition). Additionally,
law- enforcement training can be supported if the program receives its first-ever
finding.
The appropriations bill with jurisdiction over this grant has passed the House
and awaits a Senate vote. Although no money was listed specifically for this
grant in either bill, favorable language was in the House report (H. Rept.
109-118) and it was listed among a number of other potential earmarks under
the Department of Justice. In the Senate, chief grant sponsor and appropriator
Mike DeWine (R-OH) remains vocal on the need for funding in FY 06.
What You Can Do
Advocates should continue reminding members of Congress of
the importance of funds to help states and localities address the revolving
criminal justice
door through linkage to the treatment and social supports that offenders
with mental illnesses need to live without recidivism.
Specific grant awards, if any, are likely to be determined during the conference
to reconcile differences between the House and Senate versions of funding for
the Department of Justice.
Sponsors Needed for the Keeping Families Together Act
Too many families have had to relinquish custody of their children to the
state in order to access necessary mental health services. To end this tragedy,
the Keeping Families Together Act (S. 380, H.R. 832) was introduced in both
houses. The bills have a growing list of bipartisan congressional supporters,
but more sponsors are needed to move the bill through the legislative process.
The Keeping Families Together Act would fund six-year comprehensive interagency
system-of-care grants (Family Support Grants) for states to build new infrastructure.
The program would also establish a federal task force to examine relevant mental
health issues in the child welfare and juvenile justice arenas. Importantly,
this legislation would require annual reporting by the states to HHS on the
success of the grants.
What You Can Do
Please encourage your Senators and Representative to sign on as sponsors
of the Keeping Families Together Act if they haven’t done so already.
Medicare Prescription Drug Training Workshops
The Centers for Medicare and Medicaid Services (CMS) is hosting free educational
workshops throughout August and September on the new Medicare prescription
drug coverage, which begins January 1, 2006. The workshops are designed for
agencies, organizations and providers who assist people with Medicare.
The workshops are scheduled for:
Tuesday, August 2, 2005- Lake Buena Vista, Florida
Tuesday, August 9, 2005- San Diego, California
Friday, August 12, 2005- Chicago, Illinois
Wednesday, September 7, 2005- Westminister (Denver), Colorado
For more information contact The National Medicare & You Training Program
Workshop Team at 1800-866-1696 or visit http://www.2005medicaretraining.com
Fair Use Policy
Please feel free to forward our alerts as long as you credit
the Bazelon Center with a link to our website: http://www.bazelon.org
Fair Use Policy
Please feel free to forward our alerts as long as you credit the Bazelon Center with a link to our website: http://www.bazelon.org
Judge David L. Bazelon Center for Mental Health Law
1101 15th Street, NW, Suite
1212
Washington, DC 20005
