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| Line Item | Description | FY01 | FY05 | H1 for FY06 | House Budget for FY06 |
|---|---|---|---|---|---|
| 5011-0100 | Admin. | $35,892,669 | $35,376,100 | $37,144,330 | $36,789,608 |
| 5011-0300 | Pharmaceut. Admin. | 538,675 | -- | -- | -- |
| 5042-5000 | Child & Adolescent | 55,867,543 | 70,273,272* | 71,417,409 | 71,382,402 |
| 5042-5002 | Child/Adol. Reserve | 4000-0160** | -- | -- | -- |
| 5046-0000 | Community Mntl. Hlth. | 249,588,678 | 274,852,252 | 287,340,397 | 288,219,968 |
| 5046-1000 | Rental Subsides | 3,107,550 | -- | -- | -- |
| 5046-1100 | Ret. Rev. - Fed Reimb. | 700,000 | -- | -- | -- |
| 5046-2000 | Homeless Services | 21,944,454 | 22,182,363 | 22,210,643 | 22,210,686 |
| 5046-4000 | Choice Ret. Rev. | 125,000 | 125,000 | 125,000 | 125,000 |
| 5046-9999 | Insurance Assess. |
7,854,766 | *** | *** | *** |
| 5047-0001 | Emergency Programs | 32,341,278 | 31,485,703 | 31,482,359 | 31,482,359 |
| 5047-0002 | Ret. Rev. | 6,000,000 | 4,500,000 | 4,500,000 | 4,500,000 |
| 5055-0000 | Forensic Services | 7,311,564 | 6,028,399 | 6,051,792 | 6,050,905 |
| 5095-0015 | Facilities | 163,365,262 | 152,420,140 | 159,579,782 | 159,553,290 |
| 5095-0016 | Medfield Consolidation | -- | -- | -- | -- |
| DMH | Totals: | $584,637,439 | $595,543,229 | $619,851,712 | 620,314,218 |
| * This FY05 figure includes $1.7 million
received in an FY05 supplemental. ** An Executive Office of Health and Human Services (EOHHS) line item, funded at $10 million in FY01. *** Line item 5046-9999 was consolidated with 5011-0100 in FY05. |
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This chapter focuses on the House of Representatives’ FY06 budget recommendations for the Department of Mental Health (DMH). For additional information on the impacts of FY01–FY05 budget cuts and more details about program services, go to the People First website at www.mass.gov/mddc/peoplefirst/index.html and click on the DMH chapter in the Volume I table of contents.
HOUSE BUDGET OVERVIEW
Maintenance Funding—No Help for the Waiting Lists
The House budget for FY06 is nearly identical with H1 for FY06. The House budget recommends $24,770,989 (4%) above the FY05 funding level, just $462,506 more than H1 for FY06. Both are maintenance budgets that provide no restorations nor expansions to address service cuts or waiting lists of 11,000–20,000 people in need of residential and case management services.
Unlike H1for FY06, the House budget maintains research programs at Harvard and the University of Massachusetts that H1 for FY06 would close, but it does so by sacrificing roughly $975,000 that H1 FOR FY06 had included in Community Mental Health to start up 15 community-residential placements. The placements would serve adults who have been “stuck” in acute hospital settings with nowhere to be discharged to.
DMH has a multi-year Olmstead1 initiative, which calls for 268 adult continuing care inpatient clients to be moved into community residential placements by the close of FY06. DMH reports that it will have developed 239 of these placements by the end of FY05 and an additional $1.885 million is needed in FY06 to create the final 29. The House budget does provide the $8,442,083 needed in FY06 to annualize— continue funding for another year—the Olmstead placements already created, but notfunding to create the remaining 29. The House budget also does not create a State Mental Health Disposition Fund—a funding stream to support more community-based housing—so that people with mental illness can benefit from the sale and development of state hospital sites.
Neither the House budget nor H1 for FY06 provide new funding for child/adolescent
services. At any one time there are 100 children “stuck” in
private acute hospital care because there are no supports for them to
return home. The Center for Public Representation (CPR) is now in federal
court with a class action suit on behalf of Medicaid-eligible children
with serious mental illness who could benefit from home-based services.
CPR estimates hundreds more are “stuck” in group homes, state-run
hospitals, and residential schools. The suit, Rosie D. v. Romney,
went to trial in federal court in Springfield on April 25, 2005. CPR
estimates the state could save $22 million a year in hospital costs and
$40 million in other residential care if it provided more home-based
care.2
On the positive side, the House budget includes language in the Executive Office of Health and Human Services (EOHHS) operations account (line item 4000-0300) that gives the DMH commissioner authority to approve or disapprove restrictions on medications to treat mental illness, including “prior authorization” requirements.
Line Item Analysis
Accounts: Administration and Insurance Assessments
Line Items: 5011-0100 and 5046-9999
The Administration line funds approximately 420 administrative and programmatic
full-time equivalent staff (FTEs) at DMH. Insurance Assessments are also
funded here.
| Line Item | Description | FY01 | FY05 | H1 for FY06 | House Budget for FY06 |
|---|---|---|---|---|---|
| 5011-0100 | Admin. | $35,892,669 | $35,376,100 | $37,144,330 | $36,789,608 |
| 5046-9999 | Insurance Assess. |
7,854,766 | *** | *** | *** |
| *** In FY03, 5011-0100 was consolidated with 5046-9999—raw numbers are not directly comparable across years. | |||||
FY06 Needs
DMH cannot afford another below-maintenance budget for this account without further jeopardizing program support positions.
House Budget Recommendations
The House budget recommends $354,722 less than does H1 for FY06, which
is $1,413,508 above FY05 funding. This amount is more than $400,000 below
FY06 maintenance needs and would cut 6 FTEs. Most of the increase above
the FY05 funding level is for chargebacks—charges DMH must pay
EOHHS for centralized administrative services—and for annualized
payroll expenses, to pay for a full
year of employment expenses for positions that had been backfilled in
FY05.
Account: Child and Adolescent Services
Line Item: 5042-5000
The Child and Adolescent Services account funds community-based and inpatient mental health services for children and adolescents, including: respite; case management; court clinics; and individual/family flexible, residential, inpatient, community, and school supports. About 8,000 children (ages birth–18) are served—7,800 in the community and 200 on an inpatient basis.
| Line Item | Description | FY01 | FY05 | H1 for FY06 | House Budget for FY06 |
|---|---|---|---|---|---|
| 5042-5000 | Child & Adolescent | 55,867,543 | 70,273,272* | 71,417,409 | 71,382,402 |
| 5042-5002 | Child/Adol. Reserve | 4000-0160** | -- | -- | -- |
| * This FY05 figure includes $1.7 million
received in an FY05 supplemental. *** Line item 5046-9999 was consolidated with 5011-0100 in FY05. |
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FY06 Needs
Advocates are calling for increased support for Department of Social Services (DSS) programs and substance abuse treatment for children with co-occurring disorders (e.g., mental illness and substance abuse). In addition, there is a new focus on the needs of “transition age kids.” These are youth with mental health needs moving into adult services—often through the courts and homeless systems— after aging out of DSS, the Department of Youth Services (DYS), or the schools. These adolescents are becoming “the new homeless.” Advocates would like to see a new line item at DHM for“transition age services,” funded at $3 million.
Meanwhile, DMH has requested an additional $265,589 to cover 3 programs within this account:
House Budget Recommendations
Both the House budget and H1 for FY06 recommend over $2.8 million more for this account in FY06 than the original appropriation in FY05. The House budget proposal, however, is $35,007 below that in H1 for FY06. There is no expansion in these recommendations. The increase would annualize the $1.7 million supplemental budget DMH received in FY05 by providing a full year of funding for Intensive Residential Treatment needs (that were originally under-funded). It also includes maintenance expenses, such as $619,736 to annualize the POS Salary Reserve originally funded in FY05.
Account: Community Mental Health Services
Line Item: 5046-0000
The Community Mental Health Services account funds 7,000 residential placements statewide in small, community-based settings that provide support services for people with serious mental illness. Annually, 11,800 adults are served with residential placements. Outpatient services are also provided.
| Line Item | Description | FY01 | FY05 | H1 for FY06 | House Budget for FY06 |
|---|---|---|---|---|---|
| 5046-0000 | Community Mntl. Hlth. | 249,588,678 | 274,852,252 | 287,340,397 | 288,219,968 |
FY06 Needs
DMH has acknowledged the need for $7 million in new funds for this account in FY06, to support:
Advocates are seeking additional funds to address the more intensive needs of individuals who are transitioning from restrictive settings to community placements. Community service programs need more resources to handle needs for emergency services, respite care, care coordination, and rehabilitation.
House Budget Recommendations
The House budget recommends $879,571 more than in H1 for FY06, and $13,367,716 above FY05 funding. DMH reports that the apparent increase is really mostly maintenance funding, including annualization of 155 community placements begun in FY05 at $7.46 million and annualization of PACT (Program of Aggressive Community Treatment teams) at $1.1 million. (“Annualization” is a full year of funding for services newly created or provided part way through the previous year.) This maintenance funding also includes payroll adjustments necessitated by passage of the salary reserve in the FY05 budget, and by a new collective bargaining agreement with unionized workers.
The major difference between the House budget and H1 for FY06 is that
the House budget does not eliminate $1.9 million in research funding
that H1 for FY06 cuts, and the House budget fails to fund the 15 new
community residential placements that H1 for FY06 does fund (by de-funding
the research programs). The 15 placements are part of DMH’s Olmstead
implementation plan to move discharge-ready adults from hospital beds
into the community (29 placements are called for in FY06). Neither
budget serves anyone from the long waiting lists for services.
Account: Homeless Services
Line Item: 5046-2000
The Homeless Services account provides residential/housing, employment, and outreach services to homeless individuals with mental illnesses throughout the state. Residential/housing services are provided to 2,400 formerly homeless individuals, while outreach services reach 1,500 persons.
| Line Item | Description | FY01 | FY05 | H1 for FY06 | House Budget for FY06 |
|---|---|---|---|---|---|
| 5046-2000 | Homeless Services | 21,944,454 | 22,182,363 | 22,210,643 | 22,210,686 |
FY06 Needs
DMH has acknowledged need for an additional $600,000 in FY06 to fund homelessness prevention through a tenancy preservation program in which DMH works with district courts to prevent evictions. Advocates call for restoration of homeless mentally ill funding. In FY03, the legislature cut one-third ($1,107,550) of the rental assistance funding for DMH clients at the Department of Housing and Community Development (DHCD, line item 7004-9033). Over 300 subsidies were eliminated and program rent shares for all tenants were raised from 25–30% to 35% of income.
House Budget Recommendations
Both the House budget and H1 for FY06 provide $28,280 above the FY05 funding level. These funds maintain the salary increase made possible by the FY05 POS Salary Reserve initiative.
Account: Emergency Programs
Line Item: 5047-0001
The Emergency Programs account includes $22.2 million to fund contracted emergency services providers (ESPs) through an interagency agreement with the Office of Medicaid (MassHealth). This acute care—which serves as a front door to DMH and Medicaid services—is provided in general hospitals across the state, with 26 sites in total. The account also includes $9.3 million for community-based services (the same services as those funded by line item 5046-0000, see above).
| Line Item | Description | FY01 | FY05 | H1 for FY06 | House Budget for FY06 |
|---|---|---|---|---|---|
| 5047-0001 | Emergency Programs | 32,341,278 | 31,485,703 | 31,482,359 | 31,482,359 |
FY06 Needs
FY05 funding is still $855,575 below FY01, unadjusted for inflation. DMH has acknowledged need for an additional $6.5 million in FY06 to enhance services at some sites and make offerings consistent statewide. Mental health advocates are calling for a redesign of the Emergency Service System to enhance elder services and improve mobile access, crisis stabilization, and diversionary services.
House Budget Recommendations
Both the House budget and H1 for FY06 recommend funding that is nearly level with the FY05 allocation.
Account: Retained Revenue
Line Item: 5047-0002
The Retained Revenue account funds Community Mental Health services. The account collects federal financial participation (ffp) dollars generated through MassHealth from the Emergency Services and Acute Inpatient Care Program (line item 5047-0001). Approximately $7 million is generated each year—the funds are used to augment the community system.
| Line Item | Description | FY01 | FY05 | H1 for FY06 | House Budget for FY06 |
|---|---|---|---|---|---|
| 5047-0002 | Ret. Rev. | 6,000,000 | 4,500,000 | 4,500,000 | 4,500,000 |
FY06 Needs
For FY06, advocates across the board are requesting more funds for the community mental health system. Restoration of the $6 million ceiling for this line item is considered a good place to start.
House Budget Recommendations
Both the House budget and H1 for FY06 maintain the FY05 revenue ceiling on this $4.5 million account.
Account: Forensic Services
Line Item: 5055-0000
The Forensic Services account funds the Division of Forensic Mental Health, which provides court clinics (forensic evaluations) and consultations to county jails. March 2003 statistics show 1,999 inmates—20.85% of the total Department of Corrections (DOC) population—with open mental health cases. Of these, 1,391 inmates (14.5%) are on psychotropic medication.
| Line Item | Description | FY01 | FY05 | H1 for FY06 | House Budget for FY06 |
|---|---|---|---|---|---|
| 5055-0000 | Forensic Services | 7,311,564 | 6,028,399 | 6,051,792 | 6,050,905 |
FY06 Needs
Advocates call for more consultation and training for prison staff in the areas of screening, crisis intervention, and maintaining inmates on their medication. Prison staff often have little understanding of mental illness. Advocates also call for additional funding to increase mental health community diversion and re-entry services within the adult and juvenile court systems. DMH has acknowledged the need for an additional $3.463 million to fund juvenile court diversion for children ages 12 and under. Youth advocates report that last year 230 kids under age 12 went to juvenile court for low-risk crimes and found no community diversionary services available to them.
House Budget Recommendations
Both the House budget and H1 for FY06 recommend no funding expansion. The slight increase in each is for annualization of FY05’s POS Salary Reserve and other maintenance payroll adjustments.
Account: Facilities
Line Item: 5095-0015
The Facilities account funds the operation of adult inpatient facilities and community health centers.Since the FY03 closure of Medfield State Hospital, only Taunton, Worcester, and Westboro remain. Additional inpatient units exist at Lindemann (42 beds), Tewksbury (144 beds), and Shattuck (125 beds) state facilities. Parkview Hospital (30 beds) in Springfield is also contracted. The population served is the long-term chronically ill.
| Line Item | Description | FY01 | FY05 | H1 for FY06 | House Budget for FY06 |
|---|---|---|---|---|---|
| 5095-0015 | Facilities | 163,365,262 | 152,420,140 | 159,579,782 | 159,553,290 |
FY06 Needs
Advocates want people with mental illness to benefit from the sale
and development of state hospitals. They recommend that at least 25%
of the developed property value be set aside to be used in a housing
trust, or alternately that at least 25% of the housing developed is set
aside to serve the mentally ill. Advocates would like the creation of
a State Mental Health Disposition Fund (and a
State Mental Retardation Disposition Fund) to create a dedicated funding
stream to meet the state’s obligations under the U.S. Supreme Court’s
Olmstead decision. Olmstead says that Massachusetts must provide equitable
community-based services, including housing, to people with disabilities.
House Budget Recommendations
Both the House budget and H1 for FY06 recommend over $7.1 million above the FY05 allocation (although the House budget plan is $26,492 below that in H1 for FY06). DMH reports that the House budget proposal is $129,714 below its FY06 maintenance estimate. Of the proposed increase, $2,446,835 is for collective bargaining agreements with unionized workers and $4.348 million is to maintain the salary increase made possible by the FY05 POS Salary Reserve. Neither budget includes language to create housing for people with mental illness (or mental retardation) from the funds generated by the sale and development of state hospital sites.
1. Olmstead is the 1999 U.S. Supreme Court decision that requires states to provide services to people with disabilities in the most integrated setting appropriate to their needs.
2. Goldberg, “Outcry of ‘stuck kids’ Goes to Court,” The Boston Globe. April 25, 2005
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