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Program Enhancements and Other Budget Adjustments
Department of Mental Health
The Department of Mental Health (DMH) ensures that a continuum of care exists throughout the state for children and adults who are mentally ill by providing oversight of community mental health programs and direct services through state mental hospitals. The Governor's Budget includes $5 billion ($2.1 billion General Fund) for the DMH in 2008-09, a net increase of $144.4 million ($143.8 million General Fund) from the revised 2007-08 budget and an increase of $159.4 million ($168.3 million General Fund) from the Budget Act of 2007.
This net change primarily reflects continued growth in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program, fully funding AB 3632 mental health services program mandates, employee compensation adjustments including funding for Coleman classifications, growth in the state hospitals including continued compliance with the Civil Rights of Institutionalized Persons Act (CRIPA), and the continued activation of Coalinga State Hospital.
CIVIL RIGHTS OF INSTITUTIONALIZED PERSONS ACT
The federal CRIPA authorizes the U.S. Attorney General to conduct investigations and litigation relating to confinement in state or locally operated institutions. Since June 2, 2006, California's state hospitals have operated under a Consent Judgment with the U.S. Department of Justice (USDOJ) in order to address deficiencies in patient treatment and care which were deemed to be violations of CRIPA. The DMH has agreed to bring all four of the hospitals that fall under the direction of the Consent Judgment into compliance by June 30, 2009.
In order to ensure that the state hospitals meet the wide-ranging treatment and performance requirements of the Consent Judgment, the Governor's Budget includes $5.2 million General Fund and 28.0 positions in 2008-09. These additional resources include positions dedicated to monitoring hospital compliance and to the continued implementation of the Wellness and Recovery Model Support System project, an expansive information technology network that will ensure state hospital compliance with CRIPA.
CONDITIONAL RELEASE PROGRAM
The Forensic Conditional Release Program (CONREP) mandates responsibility to the DMH for outpatient treatment and supervision of judicially committed patients including Mentally Disordered Offenders, individuals found Not Guilty By Reason of Insanity, Mentally Disordered Sex Offenders, and Sexually Violent Predators (SVPs). The Governor's Budget includes $1.8 million General Fund for an incremental 4-percent rate increase to cover the cost of clinical care incurred by county and private providers and to fund an estimated increase of 4 SVPs into the program. The rate increase will offset rising provider costs so that caseload within the program can be maintained.
STATE HOSPITALS
State hospitals operated by DMH provide long-term care and services to the mentally ill. The General Fund supports judicially committed, Penal Code, and SVP patients, while counties fund other civil commitments. In 2007-08, there is a decrease of $7.4 million General Fund and 89.3 positions to reflect a downward adjustment to the hospital population in the current year. The Governor's Budget includes $1.2 billion General Fund and 11,686.2 positions for 2008-09, an increase of $78.8 million and 559.5 positions from the revised 2007-08 budget, due primarily to the implementation of Phase IX of the Coalinga State Hospital activation plan and resources to comply with CRIPA. The patient population is projected to reach a total of 6,448 in 2008-09.
Continued Activation of Coalinga State Hospital
Coalinga State Hospital opened in September 2005 and began admitting SVP patients transferred from Atascadero State Hospital. However, patient transfers have been slower than anticipated due to difficulty in filling staff positions at Coalinga. The DMH has been working to address the delayed hiring of level-of-care staff necessary for bed activation by continuing aggressive recruitment efforts throughout California and the United States, using recruitment and retention differentials where appropriate, and contracting for nursing registry services as needed. As patient transfers to Coalinga increase, additional patients currently awaiting transfer from local jails will be admitted to the state hospital system. The Administration estimates that the population at Coalinga will be 1,257 patients in 2008-09, an increase of 360 patients over the population level included in the 2007 Budget Act.
Metropolitan State Hospital School Closure
The Governor's Budget reflects a decrease of $3.8 million General Fund to reflect closure of the school that currently provides education services to adolescents at Metropolitan State Hospital. Due to the declining adolescent population, coupled with efforts to place youth in the community, the DMH will cease operating this unit when all children are placed in the community. This is anticipated to occur in January 2008.
COMMUNITY MENTAL HEALTH SERVICES
The Administration recognizes the value of providing mental health services in communities to prevent commitment to a state hospital or incarceration. The Governor's Budget includes $3.6 billion ($815 million General Fund) for 2008-09, an increase of $61.5 million ($58.7 million General Fund) compared to the revised 2007-08 budget.
Early and Periodic Screening, Diagnosis and Treatment Program
The EPSDT Program is an entitlement program for children and adults under age 21. The program provides services to approximately 193,735 Medi-Cal-eligible children and young adults to correct or ameliorate diagnosed mental illnesses.
In 2007-08, there is a decrease of $5.5 million ($3.6 million General Fund) due to a reduction in estimated Mental Health Services Act (MHSA)-driven EPSDT costs. In 2008-09, there is an increase of $105.4 million ($51.4 million General Fund) above the Budget Act of 2007 attributable to increases in the cost and volume of claims, including the effect of the MHSA on EPSDT services. The EPSDT Program also is being reduced by $13.4 million ($6.7 million General Fund) in 2007-08 and by $92.6 million ($46.3 million General Fund) in 2008-09 as part of the budget balancing reductions.
Mental Health Managed Care
As part of the budget balancing reductions, the mental health managed care program is being reduced by $8.2 million General Fund in 2007-08, and by $46.7 million ($23.8 million General Fund) in 2008-09. These reductions will reduce the amount paid to county mental health plans.
Mental Health Services Act (Proposition 63)
Revenues to the Mental Health Services Fund are projected to decrease over previous estimates by $177.2 million in 2007-08 and $105.2 million in 2008-09, for total estimates of $1.6 billion in 2007-08 and $1.7 billion in 2008-09.
These funds are continuously appropriated to the DMH for county implementation of the MHSA. Almost all counties have completed their community planning processes. Counties are in the process of implementing the Community Services and Supports component of the MHSA, which provides additional mental health services to individuals with serious mental illness. The other four components (Prevention and Early Intervention, Workforce Education and Training, Capital Facilities and Technology Needs, and Innovation) are expected to be implemented by the end of 2007-08.
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