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Home My WebLink AboutMINUTES - 01171995 - 2.2 TO. BOARD OF SUPERVISORS a� �. ROM: Mark Finucane, Director Contra Health Services Department Costa DATE'. December 23, 1994 C / SUBJECT: BUDGET IMPACT FROM SOBKY V. SMOLEY SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATION: Accept the report and recommendation of the Health Services Department, Community Substance Abuse Services Division, regarding the federal court order arising from Sobky v. Smoley. This court order will result in all alcohol/drug state'general fund dollars being dedicated exclusively to drug Medi-Cal services. Since the vast majority of these services are methadone maintenance in nature, the projected increased expenditure for methadone maintenance in FY 1994-95 alone is $912,000. In order to mitigate this State cost shift, Contra Costa County,needs to adopt one, or a combination of several, of the following policy directives. 1. Request emergency legislation and/or legal action which requires that the State pay for any increased costs associated with the Sobky v. Smoley suit. The State lost the suit through non-compliance with federal statutes and must be required to mitigate damages in a manner which will not shift costs to the counties. A cost shift would only serve to displace other alcohol and drug patients who are presently receiving critical services in other non- methadone programs. 2. Request emergency legislation which limits the time that methadone maintenance clients can receive free drug Medi-Cal services to two years. Since this is an optional benefit in the State Health Plan, it is assumed that modification in the entitlement can be made and are within the law. Currently, an underfunded and inequitable system exists which results in full funding for life of methadone maintenance clients but provides no comparable state general fund dollars for residential and prevention services which reach many more clients because they are limited in duration. 3. Request emergency legislation deleting completely the drug Medi-Cal optional benefit of methadone maintenance. Risks of this option are that approximately $756,000 in federal matching dollars would be lost and the burgeoning HIV population would have more restricted access to subsidized methadone services. 4. Allocate additional county dollars to subsidize the increased costs associated with this entitlement. CONTINUED ON ATTACHMENT: ^ YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(Sl: V ACTION OF BOARD ON January 17, 1995 APPROVED AS RECOMMENDED OTHER X SEE ADDENDUM FOR ACTION ON THE VARIOUS POLICY DIRECTIVES AND REPORT VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. CC,. Health Services Department ATTESTED January 17, 1995 PHIL BATCHELOR, CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR M382/7-83 BY ,DEPUTY Budget Impact from Sobky v. Smoley December 23, 1994 Page 2 5. Reduce all other non-categorical alcohol/drug programs by an amount which would offset the increase in the costs of methadone maintenance drug Medi-Cal. 6. Approve and authorize the Health Services Director or designee (Chuck Deutschman) to execute on behalf of the County Contract Amendment Agreement No. 24-469-11 effective January 1, 1995, to amend Contract No. 24-469-10 with Bay Area Addiction Research and Treatment, Inc. (effective July 1, 1993, through June 30, 1995) to increase payment limit by $912,600 from $1,198,800 to a new payment limit of$2,111,400. The payment limit increase of$912,600 is funded by $456,300 of Federal Financial Participation and by $456,300 of State General Funds. BACKGROUND: On December 7, 1994, Contra Costa County, Community Substance Abuse Services Division of the Health Services Department, received from the Department of Alcohol and Drug Programs a copy of the Eastern District Federal Court's Order for Permanent Injunction Re: 42 U.S.C. Section 1396a(a)(8) and (10) in the case of Sobky v. Smoley. The cover memo states, "The Order requires that all Medi-Cal eligible individuals meeting appropriate lawful standards for participation in methadone maintenance programs shall receive methadone maintenance treatment services with reasonable promptness and shall not be placed on waiting lists for such services due to lack of funding for such services." A federal court suit was filed against the state on behalf of persons receiving or wishing to receive outpatient methadone maintenance treatment. The suit asserted a statewide "right to treatment". The court either found or consented to an agreement between the disputing parties that there existed a requirement for "accessibility and statewideness" in drug Medi-Cal methadone maintenance services. The State Department of Alcohol and Drug Programs' (ADP) response to this court ruling includes elements that seriously threaten counties' abilities to carry out their existing range of critical prevention, early intervention and treatment programs. The State Department of Alcohol and Drug Programs (ADP) conducted the drug Medi-Cal system with disregard for federal statutes for many years and, thus, should bear the responsibility for additional funds necessary to gain compliance with the court suit. It is reprehensible to demand that the counties dismantle their existing alcohol and other drug prevention safety net in order to shore up services for the methadone maintenance population exclusively. The court order is retroactive to July 1, 1994, and since that time the methadone maintenance population in our two contract programs located in Pittsburg and Richmond has increased from approximately 225 to 560. Without legislative relief, this increase in capacity will result in cost overruns of approximately $456,000. ADDENDUM TO ITEM 2.2 FROM JANUARY 17, 1995 AGENDA The Board ACCEPTED the above report and recommendation and SUPPORTED above policy directives as follows : 1 . SUPPORTED No. 1, with amendment to provide that legal action is to be informally considered, but before any action is taken formally, the merits would be discussed with the Board and evaluated; 2 . SUPPORTED 3 . SUPPORTED 4 . DID NOT APPROVE 5. RENUMBERED 5 to 5A, and did not approve. 6. RENUMBERED 6 to 5B, and APPROVED, as amended, to read: "APPROVE AND AUTHORIZE the Health Services Director or designee (Chuck Deutschman) to execute on behalf of the County, upon the receipt of additional State funds, Contract Amendment Agreement No. 24-469-11 effective January 1, 1995, to amend Contract No. 24-469-10 with Bay Area Addiction Research and Treatment, Inc. (effective July 1, 1993, through June 30, 1995) to increase payment limit by $912, 600 from $1, 198, 800 to a new payment limit of $2, 111, 400 . The payment limit increase of $912, 600 is funded by $456, 300 of Federal Financial Participation and by $456, 300 of State General Funds, and DIRECT the Health Services Director to report to the Board on precisely what action was taken in regard to this contract. Date: REQUEST TO SPEAK FORm (Two [2] Minute Limit) Complete this form and place it in the box near the speakers' rostrum before addressing the Board. Name: cava.- Cv Phone: Address: City: I am speaking for: ❑ Myself OR ❑ Organization: NAME OF ORGANIZATION CHECK ONE: ❑ I wish to speak on Agenda Item # My comments will be: ❑ General ❑ For ❑ Against �,�LCM-�No �''`' '� El wish to speak on the subject of: U c►- o l< V ono I do not wish to speak but leave these comments for the Board to consider: