Recommendations from the Contra Costa County Mental Health Commission
Submitted For:
LEGISLATION COMMITTEE,
Department:
County Administrator
Referral No.:
2020-08
Referral Name:
MHC Recommendations
Presenter:
L. DeLaney
Contact:
L. DeLaney, 925-335-1097
Referral History:
During the Contra Costa County Mental Health Commission meeting on February 5, 2020, two motions were passed for the Contra Costa County Board of Supervisors' Legislation Committee's consideration at its March meeting.
Referral Update:
The first motion relates to the use of Mental Health Services Act (MHSA) funds:
"We, the Contra Costa County Mental Health Commission, urge Contra Costa County Board of Supervisors and Behavioral Health Director to support our position regarding Mental Health Services Act (MHSA) programs and funding. We do not want the MHSA to be repurposed in any way from the original intent, purposes and funding requirements that were approved by Californians in 2004. Per the original intent services are to be consumer driven, family focused, based in the community, culturally and linguistically competent, and integrated with other appropriate health and social services. In addition, we want to emphasize that the requirement remain for the County’s MHSA Three Year Program and Expenditure Plan and Annual Updates be developed with the active participation of local stakeholders in a community program planning process, and approved by the Contra Costa County Board of Supervisors."
Attachment A includes the MHSA Three Year Program and Expenditure Plan for FY 2020-23, Outline of Draft Plan, prepared by CC Health Services, the "MHSA Three Year Program and Expenditure Plan" prepared by the Contra Costa Behavioral Health Division, and a copy of an article from POLITICO Pro related to the Governor's plans to revamp MHSA.
The CSAC Board of Directors is interested in what changes to MHSA that could be made by the Governor and Legislature that would not trigger a ballot measure. Merely clarifying the language would only require a majority vote of the Legislature. Furthering the intent of MHSa would require a 2/3 vote of the Legislature (e.g., expanding the definition of Substance Abuse Disorder treatment), and substantial change (such as changing the percent of fund balance allowed to be retained) would require a ballot measure. CSAC expects their Working Group (of which the County Administrator David Twa is a member) to be close to a final document for the CSAC Board to consider at an upcoming meeting.
The second motion relates to the Institutions for Mental Diseases (IMD) waiver:
"We, Contra Costa County Mental Health Commission, ask Contra Costa County Board of Supervisors to support permanent repeal of the Institute of Mental Diseases (IMD) Medi-Cal reimbursement exclusion as requested by the National Association of Attorney’s General (NAAG) letter to federal congressional leadership." (Attachment B)
Since Medicaid’s inception in 1965, federal policy has barred using federal Medicaid funds for care provided to most patients in mental health and substance use disorder residential and inpatient treatment facilities larger than 16 beds — known as “institutions for mental disease” (IMD). This federal policy is known as the IMD exclusion. In 2018, federal policy changed to allow states to seek a waiver of this rule if certain requirements are met. California’s Department of Health Care Services plans to assess stakeholder interest in pursuing such a waiver, which could offer an opportunity to free up local funds to invest in other community services and supports that many communities say are sorely lacking. Such a waiver would require that communities develop and demonstrate a robust continuum of care so that patients could be “stepped down” to community-based care as their condition improves.
Recommendation(s)/Next Step(s):
CONSIDER the recommendations of the Contra Costa County Mental Health Commission and direct staff, as needed.