As many of you know, State Operated Services has been up for redesign.  In our 2010 Legislative report, the Mental Health Legislative Network asked that whatever plan came out of that process be judged on how well it reflected the input of consumers and advocates.  We believe that the people who are most affected by services changes and cuts are the people who are currently using those services.

Now that the report is out, we are greatly disappointed.  We were aware that with the budget cut, SOS was going to reduce services and we had made some recommendations as to what we thought could be done.  However, the deeper issue is that we have noticed community input is going unheard.  We came to the table in good faith, participating in the community listening sessions held around the state.  But we do not see that reflected in these changes.  As it stands, it appears that the proposal leads us to more restrictive settings and services  and away from community based models.  Recovery is spoken of as a goal, but the spending looks like confinement and triage.

We will be asking tough questions about how this proposal was formed, and why it looks so different from the trajectory we have been on towards more independence and crisis management, instead of bringing back a state hospital system.

Similarly, a deal for GAMC was announced last Friday.  The text of the bill was not released until Wednesday night, and many things had changed by then.  For one, Adult Mental Health grants were back in the bill as a funding source.  We strongly oppose reductions in these services as a funding mechanism for other programs, but are not optimistic.  These grants have already been reduced by unallotment and may see further reductions in the omnibus budget.

We are not pleased with many aspects of this bill.  There is significant concern that this new model of care will not be ready by June 1, and that is largely unproven for this population.

This has become the session of bad negotiation.  There appears to be a great deal of horse trading going on, but the consistent factors have been an unwillingness to consider revenue, repeated cuts to critical services, and the direction of these cuts coming from the Governor and DHS alone.

Right now, MHAM is going back out to the community, and especially to Local Advisory Councils and talking about what services are most important and how these changes may affect people.  We hope to mobilize and inform more consumers so that they can be at the table when these deals are made.  It’s critical that we start now, even against these headwinds.  Grassroots take time to grow, and we will continue working with our fellow advocates and consumers at the Capitol, trying to be heard.

Last Friday, a new proposed solution to GAMC was unveiled.  Legislators from both parties and the Governor held a joint press conference, signaling that the long standing conflict over this program may be coming to an end.

The proposed solution is a block grant to hospitals that had high GAMC patient populations.  This money would go towards what would otherwise be uncompensated care.  Details on which providers would receive funding have not been fully released.  As Sen. Berglin noted, this plan still places a high burden on the health care system, and these costs will come back to anyone who pays for medical care in the state.

There are many questions left unanswered at this point.  We are still looking at what services these hospitals will be accountable for delivering, and what the impact will be of removing the direct link between funding and individual need.  However, we are relieved to see some forward progress on this issue, and commend the legislators who worked so hard to make a solution possible.  We are also pleased to see that the funding source been shifted towards the general fund.  Previous proposals had tapped county funding that provides critical social and health services.

The Senate Health and Human Services Budget Division will hear testimony on this plan tomorrow at 9 AM.

Please check back as we get more specifics on this bill and how it will impact Minnesotans with mental illnesses.

Sadly, a vote to override the Governor’s veto of GAMC restoration has failed in the house.  While 38 Republican members joined the DFL in voting for the bill originally, none were willing to vote for override.

While we are disappointed not to see a solution for GAMC, we are hopeful that this action will send people back to the drawing board to come up with a new plan.  The important thing to remember is that while partisan issues that bogged down this particular solution, there is broad recognition that there needs to be some kind of fix.  Consumers, hospital groups, county representatives, and legislators all know that we need some mechanism to provide and pay for critical care for the poor.

In Executive Director Ed Eide’s testimony to the Health and Human Services Committee of the MN Senate, he explained how uncompensated care functions as a tax on everyone who gets medical care in the state.  Hospitals and clinics must make up the cost of uncompensated care, and will do so with patient dollars.  The question is how fairly will we distribute this cost.  There is some indication that the compromise would be a managed care proposal, not a fee-for-service model.  We believe it is important to remember that while some GAMC recipients have chronic care issues that require frequent care, many are visiting emergency rooms only when their condition has substantially deteriorated.

We know by the number of unclaimed notification of coverage letters that the state has been making payments for managed care that homeless recipients were not benefiting from.  We encourage lawmakers to carefully consider the varying needs of GAMC recipients to understand what models of care will work best to reduce costs.

Thank you to everyone who contacted their legislators on this important issue.  We will continue to watch for new proposals, and speak out for those who rely on this safety net.

The Minnesota Senate has voted to override Gov. Pawlenty’s veto of a modified GAMC program, and the bill moves again to the House. While the bill passed with votes on both sides of the aisle, some members are now withdrawing their support. A 125 to 9 vote to approve this bill now appears to be three votes shy becoming law.

Please call your representative today to make sure they are supporting the GAMC bill. We expect a vote to come very soon, so please call now. As we’ve said before, it is not a perfect solution, but it protects patients and hospitals, and allows the system to be reformed, not scrapped.

At MHAM, we are saddened to see representatives who have publicly expressed how necessary this bill is to their communities turn around and drop their support at the very moment that it matters.

Ask your representative how they voted on HF 2680 and if they plan to support the override. If they are unwilling to support an override, ask that they work with the Governor to find a workable solution.

A few points to remember:

• This fix is cheaper per person than using MinnesotaCare.
• Uncompensated care acts as tax on everyone with health insurance in the form of higher rates.
• In any given year, 70,000 to 80,000 Minnesotans will rely on GAMC.
• Hospitals and advocates agree that MinnesotaCare is not likely to work for GAMC patients who require infrequent but emergency care.
• GAMC is a necessary part of our State’s safety net. This bill will let us improve on it in coming years.

Thank you for your support! We expect this to come to a vote early next week, possibly on Monday.

Both the House and Senate voted to restore GAMC cuts yesterday. This was a bi-partisan vote and passed overwhelmingly. For that we are happy!

However there is bad news. The Governor vetoed it. The next step is an override attempt. This will happen soon.

The state will save money with this new temporary GAMC program, because it will reduce the amount of emergency care that will be needed if it is gone. If you care about the health of poor people, please contact you elected representative and ask them to support the override.

This cannot happen without you.

Find your legislator’s contact information and call, email or send a letter today.

Thank you!

Kathleen Gearin, chief judge of Ramsey County, issued a temporary restraining order yesterday to restore funding to a program that provides food assistance to Minnesotans with complex medical dietary needs. The ruling specifically noted the constitutionality of unallotment as a law, but noted several issues with the way in which it was recently used by Governor Pawlenty. She interpreted that the use of this power is intended to be limited to addressing unforeseen budget shortfalls: “[unallotment] is not meant to be used as a weapon by the executive branch to break a stalemate in budget negotiations with the Legislature or to rewrite the appropriations bill.”

More coverage on this story can be found at MinnPost, the Star Tribune, and MPR News.

Judge Gearin also noted that simply reversing unallotment entirely is not within the boundaries of the judiciary, and that it will be necessary for the Legislature and the Governor to revisit the budget in a much more comprehensive way. While 2010 is scheduled to be a relatively calmer bonding session, this ruling could signal a much more active session as 2009 cuts are reconsidered. As we have said before, some compromise on the budget will continue to be necessary. However, we are greatly concerned by cuts that disproportionally affect Minnesotans with mental illnesses, such as the elimination of General Assistance Medical Care. GAMC is a much larger budget item, and is unlikely to be restored in a similar fashion. But we believe this underscores how critical it is to find a workable solution that acknowledges the necessity of these services.

There’s a long way to go before we know the final outcome. While the grant of a stay does send a signal about the judge’s assessment of the likely final outcome, the Governor has already announced his intent to respond. In addition, this suit is limited to one relatively small program of the many that were cut. But it reminds us that the budget of the state and many social services are still hanging in the balance. For anyone who cares about mental health services in Minnesota, it is critical to remain informed about the budget process and to talk to your legislators about the programs that you value.

Please check back soon, as we will continue to post here and send out email to our Public Policy Update subscribers. We expect to have more information shortly about cuts to the Personal Care Assistance program, which provides a measure of independence for many people with disabilities, including serious mental illnesses.

The 2010 Legislative Session has not formally opened, but action is already heating up. Yesterday, Sen. Linda Berglin and Reps. Erin Murphy and Tom Huntley set forth a proposal to help save General Assistance Medical Care. The event has been widely reported, including at MinnPost , the Star Tribune, and the PioneerPress.

As you may be aware, funding for GAMC was cut by Gov. Pawlenty through the un-allotment process. This program has helped Minnesotans who lack the means to pay for necessary medical care, but are not eligible for federal relief. Currently, the Governor has proposed transitioning GAMC recipients to Minnesota Care, but this falls short for several reasons. Low income patients are unlikely to be able to pay the premiums, and the Health Care Access Fund that supports MN CARE is already facing budget shortfalls.

With a mix of funding sources, the new plan for GAMC seeks to restore coverage to those who would have no other options, encourage transition to federal assistance for those who are eligible, and share the costs of this care in a fair manner. Federal funds, county contributions, and a surcharge on providers would all contribute, and the plan is currently tax neutral, an important compromise to the Govenor’s stated position on health care.

This proposal recognizes the unique health care needs of persons with mental illnesses. There are provisions for better urgently required care to avoid hospitalization, and payments for medication. This is what we’ve always known. We need better access to timely care and ongoing support. The alternative is waiting until a person is in even further crisis.

As the plan authors note, the federal proposals currently in discussion would likely solve these issues in the future by expanding federal Medical Assistance. But until then, we need to find real solutions for the populations served by GAMC. Cutting people off from necessary care and unleashing a wave of uncompensated care on hospitals and counties is the worst case scenario.

It’s likely that many proposals on this issue will emerge in this session and much will change before anything is signed into law, but at the Mental Health Association, we are pressing for stable sources of care for persons with mental illnesses, and cost cutting that focuses on preventive care, not slashing services.

Please contact your legislators today, and make sure that they know your priorities going into the 2010 legislative session. Minnesota needs GAMC. The cost of inaction is just too high.

Stay up to date with the issues with MHAM Public Policy Alerts. In the coming weeks, look for information on the critical issues for 2010, including more on GAMC, Personal Care Assistance, changes to State Operated Services, Maintenance of Effort Agreements, and the Acute Care Needs Report.

(This post was originally sent to our Public Policy Alerts email list. Sign up through MyMHAM to stay up to date with developments affecting persons with mental illnesses in Minnesota.)