Wisconsin Department of Health Services Children s Mental Health

Wisconsin Department of Health Services Children’s Mental Health Overview Kevin Moore Deputy Secretary July 17, 2013

Mental Health Organization Within DHS l Division of Mental Health and Substance Abuse Services (DMHSAS) – – 2 Division Administrator: Deputy Administrator: Linda Harris Patrick Cork Protecting and promoting the health and safety of the people of Wisconsin

Key Areas of DMHSAS Psychiatric Hospitals • • 3 Mendota Mental Health Institute Winnebago Mental Health Institute Secure Treatment Facilities • Wisconsin Resource Center • Sand Ridge Secure Treatment Center • Mendota Juvenile Treatment Center Community Programs • Bureau of Prevention, Treatment & Recovery • Community Forensics • Client Rights Office Protecting and promoting the health and safety of the people of Wisconsin

DMHSAS Budget (SFY 12) Total Budget = $312. 9 million 4 Protecting and promoting the health and safety of the people of Wisconsin

DMHSAS Position Authority (SFY 12) Total Positions = 2, 450 FTE 5 Protecting and promoting the health and safety of the people of Wisconsin

Department’s Potential Clientele l Total Wisconsin Residents: 5. 7 million l l l l 6 Adults: Children: 4. 3 million 1. 4 million Residents w/ Any Mental Health Needs: 1, 140, 000 (20%) Residents w/ Serious Mental Health Needs: 328, 900 (5. 8%) Adults w/ Serious Mental Health Needs: 233, 700 (5. 4% of adults) Children w/ Serious Mental Health Needs: 95, 200 (6. 8% of children) Residents Aged 12+ w/ Substance Abuse Issues: 505, 000 (8. 9%) Protecting and promoting the health and safety of the people of Wisconsin

State Psychiatric Hospitals Department of Health Services

State Psychiatric Hospitals Mendota Mental Health Institute l l l 8 Location: Madison Mission: Court-ordered mental health treatment for persons committed under civil and forensic laws. Budget (FY 12): $66. 8 m AF, $45. 2 m GPR Positions: 687. 93 FTE Rate: $999/day (adult) Population: 226 (29 civil, 197 forensic as of July 1, 2011) Protecting and promoting the health and safety of the people of Wisconsin

State Psychiatric Hospitals Winnebago Mental Health Institute l l l 9 Location: Oshkosh Mission: Court-ordered mental health treatment for persons committed under civil and forensic laws. Budget (FY 12): $53. 1 m AF, $30. 6 m GPR Positions: 604. 86 FTE Rate: $999/day (adult) Population: 167 (49 civil, 118 forensic as of July 1, 2011) Protecting and promoting the health and safety of the people of Wisconsin

State Psychiatric Hospitals Populations Served in the Institutes l Civil Patients (WI Stats Chapter 51) – – 10 Courts commit mentally ill persons found to be a danger to self or others to the care of the county. Counties can choose to admit persons to a state Institute for treatment; counties control discharge and approve aftercare placements in the community. Local law enforcement can also initiate “emergency detentions”, with approval and fiscal authorization of the county (can last no more than 72 hours without court review). Institute treatment costs for civil patients paid for by the counties through daily rates charged by the DHS Institutes. Medicaid and other third-party payers are also billed by DHS when appropriate, and revenues obtained offset county costs. Protecting and promoting the health and safety of the people of Wisconsin

State Psychiatric Hospitals Populations Served in the Institutes l Forensic Patients (WI Stats Chapter 971) – Circuit courts commit persons accused of crimes to the care and custody of DHS, as follows: l Competency Evaluation [s. 971. 14(2)] – Court commits defendant to DHS for 14 days for evaluation of competency to stand trial. Placement may be inpatient or outpatient as determined by DHS. l Restoration to Competency Treatment [s. 971. 14(5)] – Court commits defendant to DHS for up to 12 months. Placement may be inpatient or outpatient as determined by DHS. – Reports to court at 3, 6, 9 -month intervals re: competency l Not Guilty by Reason of Mental Disease or Defect (NGI) [s. 971. 17] – Court commits defendant to DHS; placement for treatment by court may be inpatient at MHIs or community-based in Conditional Release Program. – Commitment can sometimes be for life. – 11 Institute treatment costs forensic patients paid for with state GPR funds. Protecting and promoting the health and safety of the people of Wisconsin

Secure Treatment Facilities Department of Health Services

Secure Treatment Facilities Mendota Juvenile Treatment Center (MJTC) l l l l 13 Location: Madison Mission: Secure mental health treatment of juvenile offenders. Budget (FY 12): $5. 0 million PR Positions: 0. 5 FTE Cost per day: $400 Population: 29 (as of July 1, 2011) Also provides enhanced aftercare services. MJTC Protecting and promoting the health and safety of the people of Wisconsin

Secure Treatment Facilities Population Served at MJTC l l 14 Adolescent males who have been adjudicated delinquent and are in need of intensive treatment services. MJTC Referrals made by the DOC Division of Juvenile Corrections. Protecting and promoting the health and safety of the people of Wisconsin

Community Programs Department of Health Services

Community Programs Bureau of Prevention, Treatment and Recovery l l l 16 Budget (FY 12): $68. 9 m AF, $21. 3 m GPR Positions: 39. 32 FTE Major Functions: • Federally Designated State Mental Health and Substance Abuse Authorities • Grants Management and Contract Administration for Federal Block Grants and Discretionary Grants • Contract Administration for Community Mental Health & Substance Abuse Grants & Services (e. g. , Intoxicated Driver Program, Crisis/Hospital Diversion Programs, Institute for Mental Disease (IMD) funding, Preadmission Screening & Resident Review, Women’s and TANF Recipient’s Substance Abuse Treatment Programs) • Development and Technical Assistance for the Mental Health & Substance Abuse Administrative Rules and State Statutes • Staff Support to the State Councils (Alcohol & Other Drug Abuse Council & Wisconsin Council on Mental Health) • Planning, Development and Provision of Technical Assistance for the Public Mental Health/Substance Abuse Services System Protecting and promoting the health and safety of the people of Wisconsin

Medicaid Reform and the Affordable Care Act Department of Health Services

Medicaid and the Affordable Care Act Proposed Eligibility Modifications Adults l Parents and Caretakers – 100% FPL l Childless Adults – 100% FPL l Adults above these levels will have access to affordable health insurance through the federal health insurance exchange Children l No eligibility changes for children up to 300% FPL l Children in families above 300% FPL will no longer be able to buy into BC Plus, but can seek coverage in exchange No change in coverage levels for elderly or disabled individuals 18 Protecting and promoting the health and safety of the people of Wisconsin

Medicaid and the Affordable Care Act Net Impact of Governor’s Reforms l l Percentage of uninsured non-elderly adults drops from 14% to 7%. l Overall enrollment in Medicaid for adults drops 5, 400. l 19 Through Medicaid and the Federal Health Insurance Exchange 224, 580 more individuals will have access to affordable health coverage. Projected 30, 000 -40, 000 new children will be covered under Medicaid from the “Woodwork” effect. Protecting and promoting the health and safety of the people of Wisconsin

Medicaid and the Affordable Care Act ACA & Essential Health Benefits The Affordable Care Act and its implementing regulations, building on the Mental Health Parity and Addiction Equity Act, will expand coverage of mental health and substance abuse disorder benefits and federal parity protections in three distinct ways: l Including mental health and substance use disorder benefits in the Essential Health Benefits; l Applying federal parity protections to mental health and substance use disorder benefits in the individual and small group markets; l Providing more Americans with access to quality health care that includes coverage for mental health and substance use disorder services. Source: ASPE Source, Affordable Care Act Will Expand Mental Health and Substance Use Disorder Benefits and Parity Protections for 62 Million Americans ; http: //aspe. hhs. gov/health/reports/2013/mental/rb_mental. pdf 20 Protecting and promoting the health and safety of the people of Wisconsin

Governor Walker’s Mental Health Reform Package Department of Health Services

Governor Walker’s Mental Health Reform Package l Governor’s proposal was developed with input from individuals and groups throughout Wisconsin: – – – 22 Mental health providers and physicians Consumers K-12 social workers and psychologists Law Enforcement Officials Community-based service providers Protecting and promoting the health and safety of the people of Wisconsin 10/24/08

Governor Walker’s Mental Health Reform Package Coordinated Service Teams (CST) Background: l l CST is targeted to children and families involved in two or more systems of care (such as mental health, long-term care, juvenile justice, child welfare, substance abuse or special education) who have complex needs. l Counties or tribes may operate CSTs. l 23 Coordinated Service Teams are evidence-based practice wraparound models of care for kids with behavioral health issues. Currently there are 44 programs that receive some state funding support (including Milwaukee and Dane counties) in 2011. Protecting and promoting the health and safety of the people of Wisconsin

Governor Walker’s Mental Health Reform Package Coordinated Service Teams (CST) l Governor Walker’s Proposal: – – The Governor’s budget expands the use of Coordinate Service Teams (CST) statewide. Investment: l l 24 FY 2015 Total GPR: $1, 250, 000 GPR: $2, 500, 000 Signed into law as part of 2013 Act 20. Protecting and promoting the health and safety of the people of Wisconsin

Governor Walker’s Mental Health Reform Package Office of Children’s Mental Health l The Office of Children’s Mental Health will assure the coordination and integration of services across state agencies: – – The office will support administrative efficiencies to allow for a reduction in duplication of efforts among state organizations devoted to children’s programming. – The office will improve access to appropriate services to children. – 25 The office will facilitate communication with all state agencies serving children, coordinate initiatives, and monitor program performance focused on children’s mental health. The office will be staffed by a Director appointed by the Governor, and three liaison staff. It will report directly to the Governor’s office. Protecting and promoting the health and safety of the people of Wisconsin

Governor Walker’s Mental Health Reform Package Office of Children’s Mental Health l Investment: l l – 26 GPR: $185, 200 $350, 200 $535, 400 Staffing: – l FY 2014 FY 2015 2013 -2015 1 Office Director 3 Liaison Staff Signed into law as part of 2013 Act 20. Protecting and promoting the health and safety of the people of Wisconsin

Governor Walker’s Mental Health Reform Package In-Home Counseling for Children Background: l l 27 In-home counseling within Medicaid is typically targeted to children in need of family therapy, or children involved in the child welfare system. Currently, in-home counseling is only available to children diagnosed with a severe emotional disturbance. This policy excludes children in need of service who have less serious psychiatric histories. Protecting and promoting the health and safety of the people of Wisconsin

Governor Walker’s Mental Health Reform Package In-Home Counseling for Children l Governor Walker’s Proposal: – The Governor’s budget would allow the home to be a service delivery location for Medicaid eligible children in need of mental health services. – This model of service delivery is used extensively across the country, and is used to promote family therapy approaches between family members. – Investment: l l l FY 2014 GPR: FY 2015 GPR: 2013 -15 GPR: $262, 000 FED: $393, 000 $524, 000 FED: $786, 000 AF: $655, 000 AF: $1, 310, 000* *In home counseling for children is a Medicaid benefit. State funding is matched at the state’s current Medicaid matching rate l 28 Signed into law as part of 2013 Act 20. Protecting and promoting the health and safety of the people of Wisconsin

Governor Walker’s Mental Health Reform Package Comprehensive Community Services (CCS) l l Comprehensive Community Services (CCS) is a publicly operated program for adults and children with mental illness and/or substance abuse issues. Many services are provided in home and/or in the community as opposed to a clinician’s office. – – l l 29 CCS service plans typically include a mix of access to and maintenance of psychiatric medication, counseling and supportive education, mental health psychotherapy, and case management service. CCS also allows for residential services and other evidence-based mental health and substance abuse treatment. CCS is unique in that each community bases its behavioral services on local resources and need. In 2011, 1, 469 Wisconsin residents were served by Comprehensive Community Services. Protecting and promoting the health and safety of the people of Wisconsin

Governor Walker’s Mental Health Reform Package Comprehensive Community Services (CCS) l Governor Walker’s Proposal: – The Governor’s plan expands the use of Comprehensive Community Services statewide. – In addition, the budget will provide state funding for current programs, saving counties with CCS programs over $6 million. Roll out of CCS is budgeted to begin in the second year of the biennium. – Investment: l FY 2015 GPR: $10, 202, 000 FED: $6, 499, 900 AF: $16, 701, 900* *CCS is considered a psychosocial rehabilitation service and is reimbursable via Medicaid. 30 Protecting and promoting the health and safety of the people of Wisconsin

Governor Walker’s Mental Health Reform Package Comprehensive Community Services (CCS) l Signed into law as part of 2013 Act 20 with the following modifications: Require DHS to submit a report to the Joint Committee on Finance no later than March 1, 2014, that addresses the following issues relating to the proposal: A. a description of the criteria DHS will apply in its CCS regionalization model; B. a description of how the regions will be established and the degree of county participation in that process; C. an updated list of the counties which, by that date, have indicated they will offer CCS on a regional basis according to DHS-established criteria; and D. an evaluation of the long-term costs of the proposed regional model. 31 Protecting and promoting the health and safety of the people of Wisconsin 10/24/08

Governor Walker’s Mental Health Reform Package Comprehensive Community Services (CCS) l l 32 In addition, transfer the GPR funding in the bill for the Governor's CCS proposal ($10, 202, 000 in 2014 -15) to the Joint Committee on Finance supplemental appropriation and require DHS to submit a request for the release of these funds under a 14 -day passive review process after DHS submits the report to the Committee. Department is working with stakeholders, advocates and providers and intends to submit its report and request the release of the funding for the 2014 -15 fiscal year. Protecting and promoting the health and safety of the people of Wisconsin 10/24/08

Governor Walker’s Mental Health Reform Package Peer-Run Respite Centers l l The services are delivered by people who themselves have been successful in the recovery process (certified peer counselors). l The services are community-based, residential settings that offer a small number of beds to people before or during a crisis situation, or to those having difficulty coping with mental illness. l 33 Peer Respite Centers are an innovative service designed to improve quality of life and reduce emergency room visits. Because services are peer-run and community-based, Peer Respite Centers show promise in the continuum of crisis programming. Protecting and promoting the health and safety of the people of Wisconsin

Governor Walker’s Mental Health Reform Package Peer-Run Respite Centers l Governor Walker’s Proposal: – – The Governor’s budget invests in the development of Peer Respite Centers. Investment: l l 34 FY 2015 Total: GPR: $64, 600 $1, 282, 700 $1, 347, 300 Signed into law as part of 2013 Act 20. Protecting and promoting the health and safety of the people of Wisconsin

Opportunities… l Corrections: – l Education: – l Are we maximizing resources across programs so the focus is on positive outcomes for children and their families? Social Services: – 35 Is there more we can do to help children earlier so they remain part of the community and out of the correctional system? Are state and local agencies working in collaboration to find solutions that address the mental health and behavioral needs of children and their parents? Protecting and promoting the health and safety of the people of Wisconsin 10/24/08

The Future… l This budget, combined with the direction of the Department, establishes children’s mental health as a priority: – – Significant investment in services for children. Continued development of Trauma-Informed care services inside and outside of Medicaid: l l 36 Foster Care “Medical Home” First Lady’s Fostering Futures Initiative Protecting and promoting the health and safety of the people of Wisconsin 10/24/08

Children’s Mental Health Overview Questions and Comments 37 Protecting and promoting the health and safety of the people of Wisconsin

Wisconsin Department of Health Services Children’s Mental Health Overview Kevin Moore Deputy Secretary July 17, 2013