[NYAPRS Enews] NYS Exec Budget Proposal: NYAPRS' First Look

[Harvey Rosenthal]

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To:            NYAPRS Members and Friends               January 21, 2014

From:        Harvey Rosenthal and Briana Gilmore

First Look at 2014-15 NYS Executive Budget Proposal:

*         $180+ Million in New Community Based Behavioral Health Resources

*         Reinvestment of State and Medicaid Hospital Savings

*         Community Housing and Supports for Adult and Nursing Home Residents

*         Supported Housing Rent Increase for Downstate Providers

*         No 2014 COLA; Commitment to Performance Based Increases in 2015

NYS Governor Andrew Cuomo's budget proposal for the coming fiscal year addresses numerous long sought budget priorities for NYAPRS members.
Since our origins in 1981, we have long pushed for the state to move resources from institutional settings like state and Medicaid hospitals and adult and nursing homes into the expansion of community recovery services and supports. And we have worked hard over the past 2 decades to help championed the rise and growth of a broad array of rehabilitation, employment, housing and peer run initiatives.

This year's Executive Budget proposal represents the largest single investment and/or reinvestment in community recovery initiatives in decades. The OMH budget increases by 1.6% or $52 million

That's why we need a huge turnout at next Tuesday's NYAPRS Annual Albany Legislative Day: to promote and to protect these proposals from those who would oppose movement of resources of this magnitude to the community.

We are expecting upwards of 16 buses and many more vans from Long Island, New York City, Westchester/Putnam, the Hudson Valley, the Southern Tier, the North County, Central and Western New York. Please join them and help fill up the same Hart Auditorium from which the Governor is presenting his budget today.

For more information, please see
http://www.nyaprs.org/documents/GetOnTheBus2014_000.pdf

Also, come join tomorrow's 10:00 am NYAPRS member webinar at time and number to get a more detailed briefing by Harvey and Briana and some tips on how best to advocate with your legislators next week.
For more details, please go to https://www4.gotomeeting.com/register/449826751
Here're the headlines, as we see them in our first look this afternoon.

COMMUNITY REINVESTMENT

1.   $25 Million in Community Reinvestment of State Hospital Resources

*         This year will see another level of state operated inpatient reductions amidst the Governor's commitment to offer hospital workers a variety of options to support recovery in local communities. Redirected resources are expected to serve an additional 3,000 individuals.

*         While plans to close Elmira, Binghamton and St. Lawrence psychiatric centers in their entirety were put on hold by the Governor, he has previously announced that 3 adult wards will be closed in each of these facilities, amounting to 79 beds and roughly $9 million in resources to expand regional community services.

*         We are expecting a total of up to 400 beds to close in other facilities and that, taken together, this will help make up the $25 million identified in this year's budget proposal. Per bed reinvestment formula rises from $75,000 to $110,000.

*         The budget narrative suggests that these new or expanded services will correspond to the recommendations of the regional 'RCE' planning groups, most notably crisis and respite beds, supported housing, urgent care walk in centers, mobile engagement teams, peer support, suicide prevention, forensic diversion and transportation.

*         There are no details yet regarding how much of these resources are to be delivered by re-deployed state workers and how much will be new cash expansions of local nonprofit services. NYAPRS has insisted on a clear blend of both and will work with the Administration and Legislature to nail this down.

*         There are no explicit details about where the provisions of the Governor's Olmstead Plan fit in here; in that plan, OMH set a goal of transitioning 10% of the 1,328 'long stay' state hospital inpatients to appropriate community housing and services over the next 2 years. This should mean that approximately 650 individuals should get transitional supports in the coming year.



2.   Over $120 Million in Medicaid Behavioral Health Service Expansions

*         $30 million for Ramp Up of 1915.i Home and Community Based Services

o   NYAPRS has long advocated for New York State's adoption of the 1915.i HCBS federal option that permits the most flexible use of Medicaid to fund a broad array of community recovery supports that are currently funded by state and local aid.

o   New York's plan to integrate and manage physical and behavioral health services via new managed care designs called Health and Recovery Plans (HARPs) will heavily depend on access to and expansion of these 1915.i services, which include housing, employment, rehabilitation, crisis and peer run supports as well as self-directed care.

o   We expect that health plans will use some of these funds in the coming year to build up their recovery networks in advance of the HARP's 2015 start. Look for special emphasis on peer services and crisis outreach and respite.



*         $10 million to help Medicaid Health Plans, health homes and behavioral healthcare providers prepare for HARP implementation.



*         $15 million to help boost health home IT and infrastructure systems



*         $15 million in Integrated Health/Behavioral Health initiatives



*         Vital Access Provider Program: $40 million safety net provider deemed essential to provision of local services...can include qualified hospitals, nursing homes, DTCs, home care providers as well as those providers who offer access to services for underserved communities



*         OASAS Restructuring: $5 million



*         Health Home Plus: $10 million to enhance support to individuals with greater levels of need, including those leaving state psychiatric centers, who are at risk for incarceration or who are court mandated via Kendra's Law



3.   Reinvestment of Medicaid Funds from Closing Behavioral Health Hospital Beds

*         Not a lot of detail here but this is a state commitment in budget language to implement allocation plans to meet service needs resulting from a reduction in local Medicaid inpatient behavioral health services.

DEMONSTRATION PROGRAMS

$7 million for 2 demonstration programs, one for a behavioral health care management program for people with serious MH conditions and one for a mental health and medical care management program for transitioning adult home residents.

COMMUNITY BASED HOUSING EXPANSION, ENHANCEMENT

1.   $40 million in community housing and supports for current residents of adult homes ($30 million) and nursing homes ($10 million) with psychiatric disabilities

a.   200 new supported housing units for nursing home residents; 600 by end of 2015

b.   500 new supported housing units for adult home residents; 1,750 by end of 2015

c.   300 new NY/NY housing beds for homeless

2.   $6.5 million for a downstate supported housing rent increases at $550 per bed

COMMITMENT TO 2015 PERFORMANCE BASED INCREASES

1.   Cost of Living Deferred to 2015-15 saving the state an estimated $72 million.

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