HomeMy WebLinkAboutMINUTES - 04262005 - C24 t
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TO: BOARD OF SUPERVISORS ••--""'L-•.omaContra
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FROM. William Walker, M.D
Health Services Director ...... Costa
DATE: April 26, 2005 .y-o-u• yCounty
SUBJECT: Mental Health Services Act (Proposition 63): Funding Methodology ell q
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ADOPT the position that the methodology for implementation of the Mental Health
Services Act (Proposition 63) should ensure that Contra Costa County receives its fair
share of allocations.
AUTHORIZE and DIRECT the Chair of the Board of Supervisors to send a letter to that
effect to the State Department of Mental Health requesting their support in this issue.
FISCAL IMPACT:
Unknown at this time.
BACKGROUND:
Proposition 63 was passed by California voters in the November 2004 election. Now
known as the Mental Health Services Act (MHSA), the legislation provides public mental
health systems with a new funding stream by imposing a surcharge on the portion of
taxpayers' income that exceeds one million dollars. The new tax will generate an estimated
$750 million to $800 million statewide in FY 2005-2006, with an additional $100 million in
potential Medi-Cal revenue statewide. The MHSA is being be rolled out in phases. There is
a concern that the funding methodology for the MHSA currently under consideration by the
State Department of Mental Health (DMH) will result in Contra Costa not receiving its fair
share of the allocations.
CONTINUED ON ATTACHMENT:
_mZYES SIG ATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD OMMITTEE
:�70PROVE OTHER
SIGNATURE(S):
ACTION OF BOA ON APPROVE AS RECOMMENDED OTHER
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE
AND CORRECT COPY OF AN ACTION TAKEN
UNANIMOUS(ABSENT ) AND ENTERED ON THE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE
AYES: NOES: SHOWN.
ABSENT: ABSTAIN:
ATTESTEDCI-I
CONTACT: JO N SWEETEN,CLE K OF THE
BOARD OF SUPERVISORS AND
COUNTY ADMINISTRATOR
CC:
1
BY , EPUTY
r
Page 2
The first components counties are currently working on are 1) Community Program
Planning and 2) Community Services and Supports. Community Services & Supports is a
major portion of the MRSA, requiring counties to develop three-year plans for serving the
county's unserved and underserved consumers and family members, using an extensive
p planning lanning process. In February 2005 the State Department of Mental Health issued
allocations for the Community Program Planning component of the MHSA using a funding
methodology based on estimates from the 2000 Census on the mental health prevalence
of each county, up to 200% of poverty. Contra Costa was allocated $210,786 for
approximately one year of planning. Using this formula disadvantages Contra Costa
County and other high cost-of-living counties in the Bay Area. It also does not take into
account changes in the County's population since the 2000 Census. While the Community
Program Planning Component is a small portion of the overall MRSA, there is concern that
any future funding allocations for the major portions of the new dollars will be similarly
based.
On March 15, 2005 the State Department of Mental Health (DMH) released draft principles
regarding distribution of funds for the Community Services & Supports component of
MHSA (as described above). Funding distribution levels are to be determined on the basis
of: 1) the overall population of the county; 2) the need for mental health services in each
county; 3) a minimum funding base for small counties. The DMH "weighted need" formula
will be predicated upon the following factors: a) prevalence of mental illness among
different age groups and ethnic populations; b) degree of poverty in each county; c)
incidence of uninsured persons in each county; and d) resources available to each county
including Realignment and State funding.
Given the high cost of living and providing services in Contra Costa County and the Bay
Area, it is critical that DMH considers regional costs as a factor in the "weighted need."
Specifically, we would like to recommend that DMH consider regional consumer costs as a
factor in funding methodology. The DMH distribution formula for the MHSA should
continue to give weight to county populations size and should add a factor that addresses
regional cost differentials and county specific income levels required to achieve self-
sufficiency.
The Board of Supervisors
John Sweeten
County Administration Building Clerk of the Board
651 Pine Street,Room 106 Costa and
Martinez,California 94553-1293 County Administrator
County
{925)335-1900
John Gioia,1st District
Gayle B.Uilkema,2nd District
Mary N. ep Pi ho
,3rd District ,, - _ --•,.
Mark DeSaulnier,4th District 'A�
Federal D.Glover,5th District
April 26, 2005
Stephen W. Mayberg, PhD, Director
California Department of Mental Health
1600 91h Street, Room 151
Sacramento, CA 95 814
Dear Dr. Mayberg:
The County of Contra Costa is concerned with the policy direction that is being
considered by the State Department of Mental Health with regard to the funding formula
for the implementation of the Mental Health Services Act. As proposed,the funding
formula will disadvantage Bay Area counties including Contra Costa County the very
counties that actually supported the passage of the measure. A position paper on this
topic is included for your review.
Specifically, we are concerned that the proposed funding methodology for Community
Services and Supports as described in"Principles Regarding Distribution of Funds,
March 15, 2005"does not take into account the high cost of living and providing services
in Contra Costa County and the Bay Area. For example, the allocation to Contra Costa
County for the Community Planning portion of the MHSA was $210,786 for
approximately one-year of planning, based on data from the 2000 Census, using
prevalence data based on 200% of poverty. Contra Costa's actual costs for planning will
be considerably higher, as will many of our neighboring counties.
Any DMH distribution formula for the MHSA should continue to give weight to county
population size and should add a factor that addresses regional cost differentials and
county specific income levels required for self-sufficiency. The"Self Sufficiency
Standard for California 2003"(Diana Pearce,PhD, Jennifer Brooks, a Project of the
National Economic Development and Law Center)provides county-by-county
comparisons. For an adult with a pre-schooler the annual self-sufficiency wage ranges
from$21,729 - $23,730 for the lower cost counties including Kern, Fresno and Merced,
to $425705 for Contra Costa County(and even higher for others).
If the true goal of the Mental Health Services Act is transformation of our existing public
mental health system, we believe it is critical that the State Department of Mental Health
(DMH) considers regional costs as a factor in all funding formulas. Thank you for your
consideration of our request.
Sincerely,
r.
Gayle B. Uilkema, Chair
Contra Costa County Board of Supervisors
cc: Senator Tom Torlakson
Senator Don Perata
Assembly Member Joseph Canciamilla
Assembly Member Lonnie Hancock
Assembly Member Guy S. Houston
Cathy Christian,Nielsen-Merksamer, et.al.
•
:
CONTRA COSTA
HEALTH SERVICES
Contra Costa County
Mental Health Services Act (Proposition 63) Position Paper
Overview
The Mental Health Services Act(MRSA)provides funding to counties to expand and develop
critically needed innovative, integrated services for children,transition age youth, adults and
older adults. The vision statement of the State Department of Mental Health(DMH) for
MHSA is to "work with stakeholders to create a state-of-the-art, culturally competent system
that promotes recovery/wellness for adults and older adults with severe mental illness and
resiliency for children with serious emotional disorders and their families." Furthermore,
under the MRSA, DMH pledges to look beyond"business as usual"to help build a system
where access will be easier, services are more effective, out-of-home and institutional care are
reduced and stigma toward those with severe mental illness or serious emotional disturbance
no longer exists.
There is no doubt that this new funding stream offers California's public mental health system
an extraordinary opportunity to better serve our consumers and family members. However,
the methodology for determining each county's funding allocation and the subsequent level of
programs and services that can actually be provided presents a serious challenge to Contra
Costa County. while the actual financing methodology has not yet been announced, Contra
Costa County must advocate for its equitable share. Key concerns include:
■ The potential for a statewide allocation methodology tied to each county's prevalence
of the mentally ill population living at less than 200% of the Federal poverty level; and
■ whether funding will be regionally adjusted to reflect the Bay Area's high cost of
living.
Background on the Mental Health Services Act
In November 2004 California voters passed Proposition 63, the Mental Health Services Act.
The MHSA imposes an additional I%tax on individuals with taxable incomes in excess of$1
million and took effect on January 1, 2005. The Legislative Analyst's Office estimates that
the MHSA will generate in excess of$600 million annually statewide. Funds must be used
for new services and to expand services and supports without supplanting existing services
funding from state and local government. It is also anticipated that additional Federal
Medicaid revenue generated by new programs to the extent that the programs serve Medi-
Cal beneficiaries and services are reimbursable—could result in$100 million in additional
Federal revenue statewide. DMH has been charged with developing detailed requirements for
local MHSA services planning as well as funding methodologies.
April 1,2005 Page 1 of 4
Counties are required to develop and submit three year plans for the six components of the
MRSA including: 1) Community Program Planning; 2) Community Services and Supports for
children,transition age youth, adults and older adults; 3) Capital Facilities and Information
Technology; 4) Education and Training Programs; 5)Prevention and Early Intervention
Programs; and 6) Innovative Programs. These six components of the MHSA are being rolled
out in phases, with counties charged initially with the first two areas: community program
planning; and community services and supports. Local planning processes must be broad-
based and inclusive of consumers, family members, County and local agency/organization
stakeholders as well as ensuring outreach to underserved and unserved populations.
Discussion Points for Implementation of the MHSA
Method for projecting,counties prevalence of mental illness and allocation formula.
The MRSA requires the DMH to develop a methodology for distribution of funding
based on unmet needs of individuals with serious mental illness (as defined in W& I Code
Section 56003.3, b and c). For the purposes of planning dollars (component number 1 above),
DMH is using a formula based on each individual county's prevalence estimate for mental
illness households living at<200%of Federal poverty. In order to build such a"state-of-the-
art system" counties need to be assured that the funding allocation used by DMH matches the
needs of the county. If this formula is used for the overall funding of all six components of
the MHSA, this methodology will significantly disadvantage Contra Costa County.
According to the formula developed by State DMH,the prevalence of individuals at 200%
poverty with Serious Emotional Disturbance/Serious Mental Illness in Contra Costa County
was estimated at 16, 371 in July 2004. The 2004 prevalence estimates provided by DMH are
based on a projected 5.8%increase from the 2000 census data for all groups, even though the
growth rate for many subgroups is substantially higher than 5.8 %. Using a generic 5.8 %
growth rate for all groups within the county to account for population growth since the 2000
census grossly misrepresents the diverse growth patterns of Contra Costa County between
2000 and the present.
For example,the number of individuals in Contra Costa County who speak a language other
than English grew by approximately 47,000 individuals between 2000 and 2003, an increase
of almost 22 %. Similarly, the number of individuals who are of Hispanic origin grew by
more than 33,000 between 2000 and 2003, an increase of almost 20 %. Both of these groups
have low penetration rates in the Contra Costa County Mental Health Plan and will likely fall
into our target population for MHSA. This disproportionate growth rate needs to be taken
into account when making funding allocation formula decisions.
The number of families living in poverty has increased as well. The number of families
below the poverty line has grown from 9,865 to 15,625 between 2000 and 2003, a 58%
increase. Similarly, the number of individuals below poverty has grown from 52,078 to
83,356 during this time frame, an increase of 60%.1 Correspondingly,the number of
individuals on Medi-Cal in Contra Costa County has increased by 29 percent during the last
four years. This growing need would not be reflected using the current funding allocation
formula.
'American Community Survey,US Census Bureau(2003)
April 1,2005 Page 2 of 4
Contra Costa County also has a high level of homelessness, and these individuals would not
be reflected in the <200%poverty statistics. In February 2005, Contra Costa Public Health
officials reported that overall they found 6,927 homeless people in the county(an increase
from a less thorough count of 4,800 in 2004). Surely, this is an underserved population that
should be targeted through MRSA funding.
A final problem with allocating funding based on only the unserved population is that it
distorts the real problem, which is both unserved as well as underserved consumers. There
are many consumers in our system who receive very limited services. During 2003-2004,
43% of consumers received five or fewer hours of services, and almost two-thirds (63%) of
consumers received 15 or fewer hours of services at county-operated clinics.
The high cost of living in Contra Costa Coup , , along with other Bay Area counties.
There should be adjustments made to the formula to adjust for the extreme variation in the
cost of living between California counties. Using 200%of poverty as the determinant of
funding allocation unfairly penalizes counties that have a high cost of living. Many
individuals in Contra Costa County have incomes above the 200%poverty threshold, but it is
only a reflection of the general higher cost of living, especially for housing. Median home
prices in Contra Costa County were $465,000 in February 2005. The number of households
who were able to afford an existing single family home has decreased from 29%in 1999 to
only 15% in 2003, a number that has surely decreased with home price appreciation levels of
15% annually since 2003.
The median price for rent in 2003 was $1,119. For 38 percent of the renting population, over
a third of income is spent on rent. The American Community Survey(2003)by the US
Census Bureau listed Contra Costa, San Mateo, Santa Clara, Santa Cruz,Alameda, and San
Francisco counties in the top 10 ranking for median price for renter-occupied housing units.
As an alternative to the 200%of poverty determinant, we recommend that DMH considers
including the Self-Sufficiency Standard for California 20032 (SSSC) as a guideline for
funding methodology. The Self-Sufficiency Standard measures how much income is needed
for a family of a given composition in a given place to adequately meet their basic needs
without public or private assistance. The SSSC also takes into account the high cost of living
in the different counties of the Bay Area. According to the SSSC (page 1): "The poverty
measure, however,has become increasingly problematic as a measure of income adequacy.
Indeed the Census Bureau itself states, `the official poverty measure should be interpreted as a
statistical yardstick rather than a complete description of what people and families need to
live."
Summary
Overall,the 200%poverty level allocation formula is problematic for at least two reasons:
1. The formula that is used is based on faulty assumptions of population growth during
the time period between the last Census sampling in 2000 to the present. Contra Costa
2 Pearce,D.and Brooks,J,2003.Californians for Family Economic Self-Sufficiency,a project of the National
Economic Development and Law Center.
April 1,2005 Page 3 of 4
has seen substantially higher growth patterns in the very groups that have been
identified as unserved or underserved. The formula also does not take into account the
needs of the county's homeless population,nor does it take into account the issue of
providing more services to those who are currently underserved.
2. The higher cost of living in the Bay Area relative to other California counties severely
limits the number of individuals who fall into the 200%poverty group,which in turn
severely lowers the allocation to Contra Costa County and other Bay Area counties.
April 112005 Page 4 of 4