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October 5, 2009 Health Care Agency Behavioral Health Services (BHS)

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October 5, 2009

Health Care AgencyBehavioral Health Services (BHS)

In Memory of Kymberli In Memory of Kymberli Kercher SmithKercher Smith

“Gardened Again Tended” by Mark Doyle

Recovery Arts

NAMI Walks 9-26-09

Tustin Facility Update Meeting 10-6-09

MHSA Issue Resolution Process

Spirituality Initiative

MHSOAC Site Visit

TAY Art Exhibit

Community Presentations

MHSOAC Response

By Famous

26 Service Providers

Art Exhibit

Community Response

By Famous

Health Care Agency Behavioral Health Services

Mental Health Services Act (MHSA)

MHSA Health ExpoThursday, September 24, 2009

10:00am –

2:00pm 505 E. Central Ave., Santa Ana, CA 92706

Mark Refowitz, BHS Director

Mike Geiss, Financial Consultant

October 5, 2009Mike Geiss

MHSA Revenues

MHSA Planning Estimates

MHSA Five Year Sustainability

Other Community Mental Health Revenues

Fiscal Policy Considerations

The MHSA created a 1% tax on income in excess of $1 million to expand mental health services

Two primary sources of deposits into State MHS Fund◦

1.76% of all

monthly personal income tax (PIT) payments (Cash Transfers)

Annual Adjustment based on actual tax returns

Settlement between monthly PIT payments and actual tax returns

Based on actual tax returns from two years prior

04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13

Cash Transfers $169.5 $894.6 $935.1 $983.9 $823.0 $840.0 $869.4 $907.2 $961.7

Annual Adjustment $83.6 $0.0 $0.0 $423.7 $438.4 $581.0 $72.0 ($134.0) $50.0

Interest $0.7 $11.2 $49.2 $94.4 $42.7 $8.8 $9.0 $9.0 $9.0

Total $253.8 $905.8 $984.3 $1,502.0 $1,304.1 $1,429.8 $950.4 $782.2 $1,020.7

a/ Governor's Budget cash transfers and interest through FY09/10 and annual adjustment through 11/12

Actual EstimatedFiscal Year

MHSA Estimated Revenues-Governor's May Revise (Best Case)a/

04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13

Cash Transfers $169.5 $894.6 $935.1 $983.9 $778.9 $755.5 $782.0 $816.0 $865.0

Annual Adjustment $83.6 $0.0 $0.0 $423.7 $438.4 $581.0 $72.0 ($180.9) $50.0

Interest $0.7 $11.2 $49.2 $94.4 $42.7 $8.8 $9.0 $9.0 $9.0

Total $253.8 $905.8 $984.3 $1,502.0 $1,260.0 $1,345.3 $863.0 $644.1 $924.0

MHSA Estimated Revenues (Conservative Estimate)

Fiscal YearActual Estimated

Funds are made available to each County through Planning Estimates

Planning Estimates represent the maximum funding for each County◦

Established by component, published by DMH

Generally, Planning Estimates are established on a cash basis◦

Sufficient revenues are in the State MHS Fund at the start of the fiscal year for distributions for the entire fiscal year

04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13

Planning $12.7

CSS $317.3 $320.5 $518.2 $650.0 $900.0 $783.6 $548.5 $465.1

PEI $115.0 $232.6 $330.0 $216.2 $137.1 $116.2

WET $100.0 $110.0

CFTN $345.0 $108.4

INN $71.0 $71.0 $119.6 $35.9 $30.6

Total $12.7 $317.3 $320.5 $1,078.2 $1,172.0 $1,301.0 $1,119.4 $721.5 $611.9

Fiscal YearActual Estimated

a/ Excludes State Administered projects (CSS MHSA Housing Program and PEI)

04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13

Planning $0.6

CSS $25.5 $25.8 $37.6 $52.2 $72.6 $63.2 $44.2 $37.5

PEI $9.8 $19.7 $27.7 $18.1 $11.5 $9.7

WET $8.3 $8.9

CFTN $28.3 $8.9

INN $5.8 $5.8 $9.8 $2.9 $2.5

Total $0.6 $25.5 $25.8 $84.0 $95.5 $106.1 $91.1 $58.6 $49.7

Fiscal YearActual Estimated

a/ Excludes State Administered projects (CSS MHSA Housing Program and PEI)

$0.0

$10.0

$20.0

$30.0

$40.0

$50.0

$60.0

$70.0

$80.0

07/08 08/09 09/10 10/11 11/12 12/13

Fiscal Year

CSSPEIINN

FY 2009-10 represents one-time spike in available funding

Orange County MHSA sustainable levels ($900 million statewide revenue)◦

CSS -

$50 to $55 million◦

PEI -

$13 to $15 million◦

Innovation -

$3 to $4 million

Realignment

Medi-Cal Federal Financial Participation

State General Fund

Mental Health Services Act

County Funds

Sales tax revenues declined 13% in FY 2008-09

Anticipate increase to begin in early 2010

Estimate overall decline in FY 2009-10 of 5% to 6% compared to FY 2008-09

Mental Health realignment trust fund will not receive increase in sales tax in the near term as Social Services caseload costs will be funded first

Vehicle license fees declined 8.5% in FY 2008-09

Estimate overall decline of VLF for mental health in FY 2009-10 of 1% to 2%

Estimate overall decline in FY 2009-10 total Realignment of 4% to 5%

Higher Federal Medical Assistance Percentage (federal share) through 12/31/10 (from 50% to 61.59%)

Results in increase in estimated FY 2009-10 Medi-Cal FFP in addition to caseload increases and cost increases

Medi-Cal becoming larger share of overall funding

Greater share of county discretionary funding required to match FFP

The required EPSDT SGF match is lower in years with higher FMAP

We anticipate that two reasons cited for the state reducing FY 2009-10 SGF managed care allocation will be permanent◦

Non-required services◦

Increased FMAP

MHSA, $0.00

Other SGF, $127.10

Managed Care SGF, $169.20

EPSDT SGF, $118.00

FFP, $539.70

Realignment, $1,036.30

Other, $242.30

FFP, $954.80

Realignment, $1,159.30

MHSA, $12.60 Other, $271.90

Other SGF, $107.20

Managed Care SGF, $222.40

EPSDT SGF, $365.20

FFP, $1,651.80

Realignment, $1,027.80

Other, $187.60

MHSA, $1,301.00

Other SGF, $56.30

Managed Care SGF, $113.40

EPSDT SGF, $349.00

FFP, $1,483.20

Realignment, $1,032.20

Other, $148.70

MHSA, $721.50

Other SGF, $53.60 Managed Care

SGF, $118.10

EPSDT SGF, $456.10

MHSA is and will continue to be a significant resource for mental health services and supports◦

Not only to expand services, but to assist in maintaining the safety net through transformed programs

Dedicated funding streams and entitlement program more reliable than SGF appropriations

Planning is essential in these economic times

Health Care Reform will likely have impact on mental health services

Technological Needs Coordinator

MHSA Technology Update

MHSA Technological Needs Proposal

Approved by the OC Board of Supervisors on 8/25/09

Sent to DMH for approval

On the OC MHSA Website

MHSA Technology UpdateMHSA Advisory Committees

Technological Advisory Committee

is working on increasing internet access to consumers and family members

Data Outcomes Committee

has had agenda setting meeting to gather information on current data outcome activities to present to community members

WET and Innovation Coordinator

Arts CommunityOlder AdultsTAYEarly ChildhoodLBGTQ CommunityKorean-AmericanVietnamese AmericanLatinoPersian and Arab

American

RefugeeDeaf and Hard of HearingNative AmericanCounty Behavioral Health

ProvidersCounty Contract AgenciesRegional Meetings

(N/S/E/W)Client and Family member

groupsCommunity partners

1.

PPT presentation on Innovation Component2.

Discussion of the Procedure for Submitting Ideas

3.

Open Discussion of Potential Innovation Programs

4.

Use of Innovation Submission Form5.

Scheduling of Follow Up Meeting if Necessary

Sharon Browning, Facilitator

Next Steering Committee meeting: Monday, November 2, 2009 1:00 PM –

4:00 PM