Mental health services in Minnesota unexpectedly lost ground today, as the House Health and Human Services Finance Division introduced their proposed budget. The bottom line is that the House is aiming to take more away from mental health services than the Governor.

We find it hard to believe that the same Legislators that worked so diligently to try to find some solution for GAMC would abandon the critical programs that help keep Minnesotans independent and prevent hospitalization or other high-cost crisis situations. This news requires our immediate and strong response. Please call your Representative immediately, and tell them what mental health services mean to you and what you think about these cuts:

• Supportive long-term housing is important because it provides stability and a chance to recover. It is the single most important priority we have for our community.
• Instead, State Operated Services hospital system escapes unscathed from cuts. This rewards them for ignoring the Legislature, and refusing to deliver the services that we need.
• ACT Teams help defuse crisis situations, and find treatment for those who need it most.
• Cuts to county mental health grants attack the backbone of mental health services in Minnesota, delivered in the communities where we live. They provide services such as clinics, case managers, and housing that help us recover.
• These cuts come on top of 9 million of reductions to mental health grants in the GAMC compromise bill above and beyond lost reimbursement for services. GAMC was redesigned by cannibalizing the mental health system. In total, these grants will have been cut by over a quarter.
• Mental health services stand alone in receiving additional cuts beyond what the Governor proposed. Nursing Homes and Disability services stand to retain 100 Million that would have been cut. Mental health services are valuable, too. We can’t be the only target.
• Ultimately, this is a revenue problem. The dismantling of successful programs that help save money in the long-term is not an appropriate response to a temporary and politically exacerbated revenue shortfall.
• Expanding Medical Assistance may be a positive part of extending services to those who can’t afford them, but other cuts to hospitals and providers will weaken the system at the same time we’re adding more patients.

Tom Johnson, one of our client advocates, puts it well. You can treat a disease, and that’s part of the solution. But you also have to believe in people, too.

These cuts hit the very services that help Minnesotans with mental illnesses believe in themselves again and find recovery. At the same time, this plan will overwhelm and erode the emergency safety net that is supposed to treat them when they need it most.

The House plan is unacceptable to our community. It represents more hospitalization, less management of our conditions, and more costs.

Please call today, and send this information on to anyone who wants better lives for Minnesotans with mental illnesses.

When the national mental health parity law went into effect last year, many of us were relieved our health insurance companies could no longer treat the mental health coverage they offered any differently from traditional coverage.  While this was a big step for health insurance companies, the law did not apply to other types of insurance, such as long-term disability insurance.

Long-term disability insurance is usually offered through work, though you can purchase it individually.  It is intended to provide income to employees who develop a disability that prevents them from working.  The type of disability covered varies from company to company, and from plan to plan.  Not all disability insurance offers coverage for mental health.

When an employer purchases disability insurance coverage for their employees, they may choose to purchase a plan that has limited coverage.  Perhaps the plan offers only two years of disability payments for mental health disabilities but offers unlimited coverage for physical disabilities.  Employees don’t always know what their policy covers, or for how long.  Be sure to read your insurance plan’s policy.  What is covered?  How long can you expect to be covered?  Under which circumstances will your coverage end?

If you are currently receiving private disability benefits and have a limited coverage plan, it is good to start planning as soon as possible for when it will end.  Will you need to move somewhere more affordable?  If so, now is a good time to contact your local public housing authority and get on the subsidized housing waiting list, if it is open. Have you applied for social security disability?  The application process can take a few weeks, so apply before your insurance runs out. If you have applied and been rejected, do you think it is possible you may be able to work?  If so, there are a number of programs specifically for people who have mental illnesses geared towards getting into the workforce again.

If you need help finding resources or planning for when your insurance coverage ends, contact an MHAM advocate at 612-334-6840 between 9 and 4:30, Monday through Friday

As the SOS redesign continues, we have had many opportunities to speak about what is important to mental health consumers in Minnesota. Our refrain has been: long term care and housing with supports. We believe that supportive environments, aimed at long-term stability is what consumers need from the system. This puts the focus on the client and their independence, while hopefully reducing the need for acute services. In particular, we are hoping to reverse direction, and restore funding for CADI Waivers, and other options that put Minnesotans with mental illnesses back into their communities, and provide them with the support to stay there successfully. As Executive Director Ed Eide stated in a recent Star Tribune article, the alternative has been to warehouse patients indefinitely in restrictive settings.

We strongly believe that this kind of focus is what needs to be at the heart of the redesign process. Preserving jobs and programs are important but the provision of quality services at an appropriate level is paramount. We are calling for many of the cuts to be reversed, but we’re also showing the need to get better results with that funding. We can only really talk about appropriate staffing once we know what services we need.

We have continued our conversations with policy makers in St. Paul as well as consumers and providers around the state, seeking to build consensus around what are the best options for positively transforming SOS. As the legislative process to decide what to do with SOS continues, we will continue to provide ideas and feedback.

Another recent development has been around the revised GAMC system. As you may remember, patients are being shifted towards hospital-based care organizations that would try to move care out of the Emergency Rooms and towards clinics and less intensive settings. However, recent roadblocks have come up. The House Heath Care and Human Services Finance Division heard testimony last Thursday that many rural hospitals would refuse to participate because they did not think they could set up services quickly enough or have enough of their costs covered. Now, HCMC has signaled that it will also decline to participate. As one of the largest providers of GAMC services in the state, HCMC has played a critical role in this program. It is hard to imagine a successful care plan for low income Minnesotans that does not involve them.

Under Federal Health Care Reform, the state has the option of covering single adults with up to 133% of poverty level income under Medical Assistance (Medicaid). There are some issues with this plan, namely timely implementation and fully understanding the costs until 2014 when that expansion will be required. However, as more hospitals refuse the GAMC compromise, this option may require a second look.

Gov. Pawlenty signed HF 3128 into law on Thursday, providing critical reforms to the guardianship process in Minnesota.

This bill denies guardians the right to void advance health care directives, and restricts the circumstances in which a court may do so. It increases the rights of persons under guardianship who have formalized their concerns and wishes into a Health Care Directive. It also requires notice if a proposed guardian has been removed with cause in the past.

These changes allow persons with chronic mental health conditions to make decisions about their care when they are capable of doing so, and formalizing those wishes in a way that must be respected even if they are placed under guardianship in the future. At MHAM, we believe strongly that people have the right to be involved in creating their own care plan, and that these agreements can be an important part of staying healthy in the long-term. It also makes it easier for courts to spot proposed guardians who have not lived up to their duties in the past, so that they are not assigned to new clients. We know that it’s critical for appointed guardians to be held accountable for the decisions they make.

MHAM is pleased to see these needed changes make it into law, and thanks the sponsors of the bill: Sen. Mee Moua, Sen. Linda Higgens, and Rep. Debra Hillstrom.

For more information about advance health care directives and planning your medical care, please contact us at 612-331-6840 or 800-862-1799.

Sen. Linda Berglin announced a plan to slow and redirect the SOS redesign process. With a close eye to preserving some of the programs that were identified for elimination, she and other senators stated their intent to pass legislation requiring a different strategy from DHS and SOS. The group is mostly from the DFL, but some Republicans are joining in stating that the process must be slowed or changed. Jim Abeler (R-Anoka) noted that DHS has a tendency to answer to the Governor, and not sufficiently include direction from the Legislature.

Specifically, DHS failed to heed the Legislature’s requirement that they address the issues of lost federal money because of facilities not eligible for MA certification. Berglin stated: “They didn’t do it, so I’ve done it for them.” The plan would also preserve dental services within SOS, and seek to increase Federal billing in order to pay for the retention of services.

We still have concerns. The “PERTS” model of care is still being discussed, even though we have remarkably little information about how that will be different from successful models already in place.

The other concern is looking at what is driving these efforts. For SOS leadership, the primary concern seems to be in providing highly intensive and rapid services, and significant reductions in the budget. However, the truth of the matter is that most people receiving SOS services have long-term needs. For some of the legislators stepping up to slow the process, the concern is saving local jobs. We’re not unsympathetic to preserving jobs and keeping qualified providers in the mental health system. However, the primary driver here has to be the delivery of appropriate services to clients. After so many cuts in the last year, we need to get the absolute most services per dollar we can.

MHAM and other advocates are sending our counter proposal to the Legislature. We take these concerns, and try to show what a patient centered vision of SOS might look like. Please stay tuned as we move forward!

By Brett Dumke, MHAM Education Coordinator

Who will develop the next generation of medications for mental illness? That was the question posed by the Director of the National Institute of Mental Health (NIMH), Dr. Thomas Insel, on a recent NIMH blog posting. Dr. Insel commented on the recent decision of two major pharmaceutical companies to terminate their psychiatric medication development programs and the likelihood of others to do so as well. If new drug innovation comes to a screeching halt, it will have a profound impact for individuals who have not responded well to medications that are currently available. In order to fill this void, the National Institutes of Health (NIH) and NIMH may have to play a key part in all phases of drug development in the coming years.  MHAM will continue to monitor this alarming trend and will provide updates when they develop.

With spring’s arrival the gardeners come out of hibernation, the birds return, the leaves unfold…and the college acceptance letters arrive.  As students across Minnesota discover where they’ll be going this fall, it is a great time to begin planning for the transition to college.

The first year of college can be challenging.  Not only do new students have intense academic pressure to cope with, but they are adjusting to a new location, new people, and separation from family.  Adapting to these changes is difficult for most people, but for a person with a mental illness, it can be even more complicated.  On top of everything else, they have to arrange for academic accommodations, continued treatment, and sufficient emotional support.  For students facing college with the added challenge of a mental illness, planning ahead can save a lot of stress down the road.

Many students with mental illnesses aren’t aware they have the right under the Americans with Disabilities Act (ADA) to request accommodations from public and non-religiously affiliated private colleges and universities.  An accommodation is an adjustment in how things are done that allows a student with a disability equal access to academic programs.  Each college may have it’s own standard for what is considered reasonable.  Generally, an accommodation can’t change the nature of the program or give select students an unfair advantage.

To find out if an accommodation would be useful to you, take a moment to think about your experience as a student so far.  What have you struggled with? What types of support helped? Did the support come from outside resources (family, friends, therapist) or from within the school (teachers, students, tutors)?  What helped you be successful?

There are many types of accommodations commonly requested by students.  Some find it helpful to record lectures, others request extra time for exams or a modified course schedule.  Some accommodations are personal, and can be made independent of the college (taking evening courses, adjusting your medication regime, getting a private tutor).

Before you request an accommodation, take a moment to consider your need for privacy.  What information are you comfortable sharing with professors, administrators, or your fellow students? Be aware your college may require you provide medical documentation before they provide an accommodation.  The disability support services office at your college should be able to assist you in making an accommodations request.

In some cases, you may need to leave college for an extended period of time for your mental health.  Take time to review the medical leave policy at your college.  If you take medical leave, they should allow you to return to college without a penalty or disciplinary actions.

It’s important to take a look at your insurance coverage before you attend college.  Will you be covered by your parent’s plan? Will your plan cover out-of-state providers?  Can you get prescriptions filled at the pharmacies in your new town?  If you will not be covered by health insurance, does your college offer free or low-cost mental health services to students?  If not, will you qualify for any state health insurance plans?

Whether you are covered or not, emotional support can be extremely valuable during transitions.  Before you go, check in with your friends.  What’s the best way to stay in touch?  Even one email a week can make a difference.

A little advanced planning can make a big life change a lot less stressful.  If you need help planning your transition, contact an advocate from MHAM at 612-331-6840.  Advocates are available Monday-Friday, 9-4:30.

You can find more information about accommodations and attending college with a disability at: Minnesota State Colleges and Universities, Parent Advocacy Coalition for Educational Rights (PACER) , and the Association of Higher Education and Disability (AHEAD).

We’ve all heard about health care reform passing in Congress and being signed into law.  We’ve also heard a lot of conflicting reports on what will happen.  The reality is going to be somewhere in the middle of the rhetoric. At MHAM, we see the following as the key impacts on mental health services in Minnesota:

• Expanded funding and eligibility for Medicare and Medicaid.  Right now, this may be one of the big impacts: as federal money comes into Minnesota, we need to make a strong case for why some of those dollars should stay in health care and human services, and help ease the cuts we have seen in the past biennium.  As we’ve noted, DFL leaders in Minnesota are very optimistic about the state’s ability to conform to new standards for treatment of chronic illnesses, including mental health and concurrent conditions.  This may also help ease the continuing GAMC crisis, by moving more of that population onto federal programs.

• Moving towards more parity for mental health.  While the authors  clearly intended to end specific exclusions of illnesses and expand coverage of pre-existing conditions, insurance companies announced attempts to find alternate ways of denying coverage. The Administration pushed back, and the insurance companies have retreated on these claims.  We will be alert to future conflicts over the intent of the legislation: fighting enhanced coverage for children with serious conditions is widely unpopular, but other provisions may not attract such immediate condemnation.

• Broadens requirements for coverage of preventive health care.  Insurance companies will be required to fully cover (with no co-pay or deductible) services that are shown to be effective in improving public health. Currently, this would include screening for depression in many circumstances.

• Extends coverage under group plans to age 26.  Children can stay on their parent’s health plans until age 26.  For many young people, especially in a slow job market, it has been difficult to maintain health insurance.  While these are relatively healthy years for most people, it is also an age when mental health conditions may emerge or require treatment.

• Prohibits rescission.  Rescission is the practice of ending a health care policy retroactively when large claims are made on the basis that the person did not correctly apply for the policy, even if it has been a long time since coverage started.  If a person gets very sick, some insurance companies will review their application, searching for any mistakes.  While it is important that people are honest and pay in fairly for their coverage, this practice exemplified the lack of power individuals had when seeking health care.  This is also a critical reform for anyone who may encounter a period of higher claims, such as inpatient hospitalization or intensive services for mental illnesses.

These bills are quite complex, and as we’re already seeing, may have effects different than President Obama intended.  The debate has been extremely contentious, and companies with their profits at risk are not going to simply back down.  It is important for mental health advocates to continue to be visible in the ongoing debate about how health care reform is going to work. For instance, Medicaid is being expanded, but it will take action by the state to make sure that there are workers available for the program that assesses applicants for eligibility. MHAM will work to make sure the promise of these changes is not lost for Minnesotans with mental illnesses.

For more information, you may want to attend (or listen to the online audio) of the Minnesota Senate Health and Human Services Budget Division on April 8th.  Sen. Linda Berglin is holding a meeting focused on the effects of these bills on the state.

As we’ve talked about previously, General Assistance Medical Care (GAMC) is changing dramatically this year.  This Friday, Governor Pawlenty signed SF 460 into law.  The state will pay hospitals, beginning in June, through block grant payments, for services to their GAMC patients.  The largest providers of services to GAMC patients, 17 hospitals, will become Coordinated Care Organizations (CCO).   Hospitals that served fewer GAMC patients will be able to receive funding, for six months, from an uncompensated care pool and will be able to later become a CCO.  They will be responsible for the entire health of the patients and some care will be delivered through clinics not the emergency department.

These payments to hospitals will be significantly less than they have been in the past, but do alleviate some of the uncompensated care costs they would have suffered under the Governor’s plan to auto-enroll GAMC patients into MNCare.  This bill also keeps the Health Care Access Fund intact.  Drug coverage will also be maintained for recipients, the majority of whom are mentally ill or suffer from chronic diseases and depend upon prescriptions to manage their illnesses.

While this solution is better than nothing, we are going to be working hard to identify opportunities in the recently passed federal health care reform bills for better models of care.

The compromise has preserved benefits though May, although current enrollees should expect a letter from the state that explains a timeline for benefit changes.  Prospective patients should apply through their county, and they will be directed to programs for which they are eligible.  More information can be found on the MN DHS website.

MHAM is relieved to see signs of progress after many setbacks.  Thank you to everyone who contacted their legislators and got involved: public pressure helps make sure that things get done right.

General Assistance Medical Care (GAMC) has passed both the House and Senate.  Given the Governor’s prior support of this plan, we expect it to be signed into law shortly before the plan is set to expire at the end of the month.  While we continue to have serious concerns about the effect of cuts to county mental health grants, we are thankful that some organized system of care will be available to those who have relied on GAMC.

Federal Health Care Reform appears to be moving forward, with the main bill signed and the addendum bill on its way.  Rep. Tom Huntley, chair of the House Health Care and Human Services Finance Division has noted that Minnesota is in good shape to capture additional federal dollars for Medical Assistance patients with chronic conditions (including mental illnesses).  While details are still coming out about the exact budget impact, we hope that as the pressure on the state is eased, some of the cuts to mental health services will be reconsidered.  Health Care Reform will have many other effects on our community, especially in terms of the availability of coverage.  We will post more here in the coming days.

Finally, the debate over State Operated Services continues.  There are no clear resolutions yet, but preliminary negotiations are underway to save some facilities by transferring operation to private companies or counties.  Your voices are still needed in making sure that the final redesign will reflect the needs of consumers. Our goals remain focused on ensuring the availability of appropriate services, transparency in how SOS is run, and the minimization of the state as a direct provider.  We have heard about many challenges and difficulties in the current system.  This is all the more reason that when we redesign SOS, we get it right.

Keep calling, writing, and staying involved…