Proposed Budget Amendments Would Benefit Mental Health Services

On October 25 at 5:30 in room 354 of the City/County Building, Supervisor Heidi Wegleitner will present budget amendments to benefit human services at the Health and Human Needs Committee.  Here are the items.

HHN-O-09 (Wegleitner)
Increase operating expenditures by $780,000 to fund supportive services for affordable housing admissions and continued occupancy for persons on the Homeless Services Consortium of Dane County’s Priority List, including homeless veterans (42), chronically homeless (268), and homeless youth (71).

Other related amendments
HHN-O-01 (Levin)
Increase expenditures by $30,000 to expand HUD coordinated entry to areas outside the City of Madison.

HHN-O-07 (Wegleitner)
Increase operating expenditures by $300,000 to provide one buss passes for some of the 22,227 SNAP case units.

HHN-O-08 (Wegleitner)
At the end of fiscal year 2018, any surplus of deficit of general purpose revenue in the Human Services Fund, net of any deficit or surplus in the Badger Prairie Fund, shall be retained in the Human Services Fund. Any surplus will be applied in fiscal year 2019 to support programs of the Human Services Department. Only by a 2/3 vote of the County Board may surplus funds from the Human Services Reserve Fund be appropriated for other purposes.

HHN-C-01 (Wegleitner)
Increase expenditures and borrowing proceeds by $8,000,000 for planning and development of one or more 24/7 community-based crisis, assessment, and resource centers focused on supporting persons in the community, and diverting persons with mental health, substance abuse, or developmental disability issues who have contact with law enforcement from being arrested and/or admitted to
the County jail.

NOTE: Annually, approximately $6 million is transferred from the Human Services Fund to other areas of the Dane County budget.  The sheriff’s department often is the recipient.  The proposed budget amendment would keep any surplus in the Human Services Reserve Fund unless 2/3 of the county board approve a transfer.

UPDATE:  The amendment for planning and development of community-based crisis, assessment and resource centers failed.   An amendment for $40,000 for bus passes passed.

 

Walker Raises Medicaid Reimbursement Rates for Mental Health and Substance Abuse Services

Wisconsin’s rates have long been among the lowest in the country.  The result is that mental health services are curtailed because of lack of availability of those who can afford to provide the services.  See “Voices from the Front Lines: NAMI’s Lindsay Wallace” for a discussion of how the low rates affect people with mental illness in Dane County.

Gov. Walker has just announced that rates will be raised next year.  According to him, they will be competitive with those in neighboring states.  Click here to read the press release.  Here are excerpts.

“This morning, at the 13th Annual Mental Health and Substance Use Recovery Training Conference in Wisconsin Dells, Department of Health Services Secretary Linda Seemeyer announced an investment of about $17 million, including $7 million in state funding, to raise rates for professionals providing outpatient mental health and substance use disorder services.”

“Effective January 1, 2018, Wisconsin Medicaid will increase reimbursement for outpatient mental health and substance use disorder treatment. This policy change will increase the maximum allowable fee for each covered outpatient service, and simplify the current rate structure, moving from five different fees per service to two fees per service. The new rates are competitive with border-state Medicaid programs and Medicare reimbursement, supporting growth of the Wisconsin provider workforce.”

Click here to read a story in the Milwaukee Journal Sentinel that describes reactions by advocates to the increase.

UPDATE:  Wisconsin Health News provided this report about the state’s AG’s reaction to the opioid crisis.

“Attorney General Brad Schimel called for increased attention to prevention and higher reimbursement rates for addiction treatment at a Medical College of Wisconsin forum on the opioid epidemic.

‘We’re making great progress but I kind of liken this to a sinking rowboat,’ he said. ‘Law enforcement is bailing it out by arresting drug dealers. Treatment providers are bailing it out by helping people get treatment. But there’s a big hole in the bottom of the boat. And I think this is the most important piece of our efforts, it has to be the prevention side. We’ve got to get this message out to the public and to the medical community.’

Schimel also said that ‘we’re going to commit to dramatically raising the rates at which we reimburse people to provide mental health services’ and addiction treatment services to attract more workers to the field.

He and other attorneys general are putting pressure on insurers to make those changes, he said.”

UPDATE:  Wisconsin Health News (11/29) reported on problems identified by the Wisconsin Hospital Association.  Here is an excerpt from WHN‘s report.

“In comments submitted to DHS in mid-November, the association praised the increase. But they urged the department to add codes for psychiatrists, advanced practice psychiatric nurses and psychiatric physician assistants.

WHA general counsel Matthew Stanford wrote that the lack of codes for those professions is a “significant omission if the goal is to provide a comprehensive outpatient behavioral health reimbursement increase to address access difficulties – particularly Wisconsin’s acute shortage of psychiatrists.”

 

 

New Funding for Jail Diversion and Violence Reduction Stimulates Creative Responses

Nearly a year ago, Madison’s City Council approved $400,000 to fund the first steps of a violence reduction plan developed by the Focused Interruption Coalition.   Three agencies responded to the RFPs issued by the city with proposals that offer both new and  time-tested approaches to reducing recidivism, violence, and the trauma associated with it.

Below are the highlights of the proposals as reported by Abigail Becker in Cap Times. Click here to read “Three Agencies in the Running for Madison’s Long-term Peer Support Program.”

According to the proposal from Nehemiah Community Development Corporation , “Participants would receive peer counseling and case management in addition to help with housing, transportation, access to AODA and mental health services and priority entry into job skills training and placement programs.”

“The program would operate a 24/7 hotline with two dispatchers on call to respond to situations. Each peer support specialist would maintain a caseload of 10 to 15 participants, and services would be provided for no less than six months.”

Madison Urban Ministry (MUM)  would provide participants ” access to community engagement opportunities, peer support and mentoring, employment and housing opportunities and mental health and AODA support.”

MUM’s proposal is particularly strong in terms of job training and opportunities.  An  “innovative element to MUM’s proposal is the urban agriculture employment and vocational training program through the FAIR Initiative. The program would train up to five program participants in literacy and cultural competency skills and local food systems in addition to urban agriculture and entrepreneurial training. Participants would earn $13.01 per hour for the training.

Other employment learning opportunities could be available through FoodShare Employment Training, the Employment and Training Association and MUM’s Just Bakery vocational training program.”   In addition, MUM has a long and successful history offering programs that reduce recidivism.

“Zion City International Church Ministries proposed a program called Renewal After Prison, which is meant to teach skills to make the transition from incarceration successful and to stabilize an individual’s life through support services.”

“Under the program, participants would meet in one of four groups, three time per week for one year and will meet with a case manager until stable. The four groups serve as phases and include the initial transition, integration, family reunification and implementation. After a year, participants who are interested can become a peer support specialist.Under the program, participants would meet in one of four groups, three time per week for one year and will meet with a case manager until stable. The four groups serve as phases and include the initial transition, integration, family reunification and implementation. After a year, participants who are interested can become a peer support specialist.”

UPDATE:  Four city council members are proposing a cut of $250,000 in the $400,000 allocated for this effort.  Click here to read the story.

UPDATE: Nehemiah Community Development Corporation and Madison Urban Ministry were recommended by Madison’s Finance Committee to receive funding.  Click here to read the article.  (The cut of $250,000 was not approved.)

UPDATE:  Dane County DA’s office shows a poor response to the opportunities for diversion through restorative justice.  Click here to read an article in Cap Times.

Parisi Responds to Pressure from Jail Diversion Advocates: Sheriff’s Department Benefits

MOSES and other organizations have fought persistently for the right of people with mental illness to be treated in the community instead of being incarcerated.

County Executive Parisi seems to have heard the words.  He includes a focus on jail alternatives and re-entry services in his most recent budget proposals concerning the Dane County Jail.   But, the meaning remains elusive.  Most of the new funding would go to the criminal justice system.

Here are some of the highlights from Parisi’s proposal, as reported in the Wisconsin State Journal (10/1).   Click here to read the article.

His budget proposal would reduce the total number of beds by 91 which, according to him, “illustrates our commitment to alternatives and services to avoid re-incarceration.”

The new jail would have 64 mental health beds.  It currently has none, resulting in solitary confinement for inmates with mental health problems.  According to Sheriff Mahoney, the proposed space “will allow us to virtually eliminate solitary confinement.”

The budget includes $110,000 for re-entry case management services that would provide peer support counselors to help inmates transition back into the community and offer  help finding housing, mental health or substance abuse treatment services.

The budget also contains $68,000 to hire someone to  coordinate the Dane County Re-Entry Team, which is made up of staff from the Sheriff’s Office and Dane County Human Services.

Sheriff Mahoney’s budget includes $1.1 million for re-entry and diversion staff and programming. That staff would work with the team in the community (budgeted at $110,000) to provide a “seamless handoff” as inmates leave jail.

The budget also provides: $100,000 for a comprehensive review of local mental health resources to identify gaps in services and barriers to access; $100,000 to keep  Safe Haven open, and $15,000 to NAMI-Dane to expand its crisis intervention training course for police, public safety and medical personnel.

The math does not compute for anyone who wants more community treatment and less jail time for people with mental illness.  Sheriff Mahoney gains more than $1 million for diversion and programming.  An unspecified community team is budgeted at about 1/10 that amount for re-entry case management services.  That team is responsible for assisting inmates find mental health services and other help.  Those services receive a zero increase.

ANOTHER LOOK AT THE BUDGET: Here is hopeful language from Parisi’s budget statement concerning the crisis restoration center.

” Recently, there’s been discussion about the feasibility of a Mental Health Crisis Restoration Facility to further our community’s response to mental illness. Done in the context of a more thorough examination of available mental health resources in our community, this concept is worth exploring. A comprehensive review of existing mental health services and potential gaps in services would identify how such a facility could be operated in partnership with health care providers and community organizations. It could also shed appropriate focus on the need for all entities – including our health care providers – to reexamine how current mental health services are accessed and administered. There is room to do better. My budget includes $100,000 for a comprehensive review of existing mental health services in our community. This work will both identify potential gaps while evaluating how a potential Crisis Restoration Center or similar community run facility could help improve care and outcomes.”