In more ways that one, the recent budget settlement is about going back to work.  The state government ordered employees to report as normal this morning, and will be bringing back functions and services as able.  For the politicians, they now go to the task of explaining, spinning, selling their actions to their constituents.  For us?  It means trying to fully understand where the impacts of this budget will be felt, and setting the stage for next year.

Because Minnesota borrowed money to patch the budget, it is very unlikely that we have hit bottom in terms of service cuts and reductions.  State grants to counties have been cut, something that we tried very hard to avert.  Much like in the years leading up to the successful reforms of 2007, we find ourselves with a mental health system with less and less capacity to foster recovery and support people in the community.  What will it take to get another victory, and start investing in mental health again?

But there are bright spots, as well as concerns.  Counties will still have spending requirements for mental health services (known as maintenance of effort).  This has been a major point of contention, and we are very relieved to see this.  The efforts to repeal the expansion of Medical Assistance were turned back.  And some of the crisis grants that help get people to treatment instead of taxing the 911 system were preserved.

This is a very mixed verdict, and one that will be difficult for many of us.  MHAM is more determined than ever to make the case at the capitol for community mental health.  We are so grateful for everyone who called, wrote, and pushed their legislators to consider the impacts.  We hope you will stick with us over the break (we will update as needed, but less often than in session) as we get ready for another chance to make things better.

For more details, please read our update on the website.

More heat is on the way for Minnesota.  Please take care of yourself, and check in with folks who may be sensitive to heat.  For more information, please check out our entry from earlier this summer.  Keep drinking water, maybe check out a library or other public build that has AC, and stay safe.

In other news, we may have a budget and an end to the shutdown in sight.  You can find our more on our legislative update page.

It strongly appears that we are no closer to an approved budget, despite getting one week closer to the final deadline before a government shutdown. This week’s update has more details on what some of the court filings have been and the issues that remain.

We are encouraging anyone who can to join us on Tuesday evening for a candlelit vigil on the steps of the State Capitol Building.  We’ll be there with other groups in the Mental Health Legislative Network, reminding policymakers of the impact of both the cuts that are proposed as well as the interruption of a shutdown.  For more information, you can check out the event here.

This morning, Judge Kathleen Gearin made initial rulings on some of the petitions before the courts.  She dismissed arguments from both sides, refusing to appoint a mediator as Dayton had asked, but also declining to order a special session of the legislature.  She pointedly reminded both sides of their ability to solve these issues and spoke of her concern of the potential impact of a shutdown.

Right now, we do not know if there will be a shutdown.  We don’t know how long it would last if it happens.  We don’t know for sure what services will be “essential” and what will stop.

We do know that it will be a bad outcome for so many.   Interruption of services, financial strain on  community health providers, loss of health insurance…

Please check out our update this week on what we’re seeing, and how you can help get a budget that is fair to Minnesotans with mental illnesses.

This week’s update really puts a focus on how cuts in the last few years have effectively rolled back the bipartisan 2007 reforms.  $34 million of new grant money was going to really change the way that mental health services are delivered in the state, by putting more focus on the community providers and what we can do to keep people from needing in-patient care.

The good news is that it worked.  Hospital bed days were down, crisis services were started, and people got the help they needed, where they were. (Link goes to PDF)

The bad news is that last year’s cuts totaled 15 million.  The proposed HHS budget that Gov. Dayton vetoed for being too drastic would have cut even more than that.  In 2007, members from both parties and Governor Pawlenty proudly said that $34 million would change the system.

So what would these cuts do?

As promised and expected, Gov. Dayton signed an executive order to expand Medical Assistance (MA) eligibility for single adults under %75 of the poverty line.  Federal law will expand eligibility even more in the future, but these changes are not scheduled to take place until 2014.  In the mean time, states are being given options to begin the transition early.  Under Gov. Pawlenty, Minnesota had declined these funds, but signed a compromise that would let the next Governor to take action.

Dayton’s signature on this is a major step forward.  MA, unlike the weakened GAMC plan that emerged last session, is a comprehensive plan.  It allows eligible individuals to seek treatment at any number of hospitals and clinics, not just a handful of locations in the Twin Cities.  Unlike Minnesota Care, it offers real coverage for expensive inpatient hospitalization for those least able to afford it.  While we are still waiting on information about how long the transition will take place and individuals are enrolled, we are very heartened to have good news to share.  Particularly for individuals who have lost work or housing and are living with mental illnesses, Medical Assistance represents a better hope for good quality medical care.

This is going to be a difficult legislative session, as the Governor and Legislature wrestle with a 6.2 Billion deficit.  Further cuts are all but inevitable.  With expanded MA, more low income individuals will be able to access resources they need to keep themselves healthy and safe.  For Minnesotans with mental illnesses, this is a victory.

Please stay tuned for further updates and stay in contact with your state legislators.  You can find out who represents you here.  They need to hear from you early and often as they consider the steps necessary to balance the State’s budget.  Let them know why your services are important to you and your community.

The 2010 Legislative session was an extremely active and difficult session.  While the primary goal was to pass a bonding bill for long-term projects, spending on health and human services came into sharp debate.  Looking back at everything that happened, what will be the impact on mental health services?

We see four areas of major importance.  GAMC was the big concern early and late in the session, and we expect more news to come soon.  For more detailed history on what happened, you can read our previous entries here.  Right now, letters are going out informing people that GAMC is changing and that they must select a hospital home for clinic care.  Otherwise, they will be restricted to emergency only treatment.  What we don’t know is how the proposed patient limits will affect this process, or how many previously eligible individuals will complete their paperwork.  We suspect that this will be a major barrier.  What we do know is that this is bad news for people living in outstate Minnesota.  The four hospitals that agreed to this plan are all in the Metro area.  People can still go to the ER, but only for emergency treatment.  We are working to find other resources for people who need assistance with obtaining medication or other non-emergency care, but the outlook is not great.

Guardianship law was one of the few “wins” we had this session.  You can read our summary here.  This change introduces a basic level of accountability for guardians and protects the rights of individuals to make long-term choices about their health care.  We believe that it is an important piece of working towards models of care that better involve and respect the person’s wishes.  In addition, it showed that we can still make important policy changes, as long as they do not require funding.

MA expansion was brought up several times in the session, and has an uncertain future, even though it is strongly favored by providers.  We view it as the best long-term solution to the GAMC issue and it is required to happen in 2014.  At the end of session, the final compromise budget did not include early expansion of MA, but authorizes the Governor to trigger entry at a later time.  Gov. Pawlenty has staked out a public position against federal health care reform and is unlikely to do so.  However, the next Governor may not be opposed or simply not have any choice to refuse so much federal money.  You can read about the candidates’ stances on MA expansion here.

Funding for basic mental health services came into jeopardy this session.  When the state invested an additional $34 M in spending in the mental health system in 2007, it was seen as a major move forward.  Yet, we are now seeing major cuts that will quickly dwarf that investment.  It’s hard to interpret this as anything but a step backwards.  Some of these cuts are set to expire in 2011, but we know that it will take a lot of political will in order to resist sustaining those cuts as the budget crisis deepens.  State Operated Services will be redesigned and face cuts, despite delaying the inevitable by refusing to follow legislative and community input.  MHAM is pleased to be included with other advocates and stakeholders in helping outline what SOS truly needs to deliver.  While the cuts will be significant here, we are hopeful that an intelligent redesign process will limit the impact on consumers.

As these conversations continue through the election season and into the next session, we think that the State needs to face facts about budget cuts.  We believe that many of these shifts and cuts do not really last.  Property taxes are up sharply as counties try to recover from reduced aid from the state, and cuts to low-income health care typically raise the rates for those with insurance.  Supportive housing, PCA services, drop-in centers, and other long term/lower intensity services have all been on the chopping block.  But hospitalization, crisis response, and police involvement are far more expensive.  When these services are cut, the trade-offs have both human and financial costs, and we will work hard to push back against the band-aid approach to budgeting in the state.

Working towards the next legislative session, a few things are going to be different.

• There will be many new faces.  We will have a new Governor, but we will also have many new legislators as well.  Many retirements were announced as the end of session, and many elections will be hotly contested.  We see this as an opportunity to educate and inform new lawmakers about why mental health services are important and can reduce long-term costs.
• The deficit will be larger.  The funding “shifts” for K-12 education will come due, one-time funding has been used up, and tax revenues are still lower than in previous years.  The new Governor and the Legislature will have difficult decisions to make about how to balance the budget.
• Lastly, we hope that more of you will join us in calling, writing, and staying involved.  We know that contact from constituents made a big difference in outcomes this session.  We will continue our outreach across the state to LAC groups and other communities, and we would love to hear from you about getting involved.

With the regular session fast approaching its end, the Legislature and the Governor have still not come to a budget agreement.  Gov. Pawlenty vetoed the Health and Human Services bill that we recently wrote about.  However, most observers see signs of potential compromise, that the veto letter indicated a willingness to compromise.  What we are concerned with is that the Governor is looking for other funding sources to pay for Minnesota’s share of MA expansion.

• The hospital and insurance surcharges are a fundamentally fair way of collecting this money.  Most of the organizations affected will also benefit greatly from expanded MA.  This is a fair trade in which everyone benefits.
• Previous funding sources included large cuts to the Adult Mental Health Grants.  We oppose these cuts strongly, as it is not wise to provide health insurance at the same time that we eliminate necessary mental health services.

We need a budget signed into law, and we know that this will involve compromise.  But we would strongly oppose a return to raiding mental health services to solve the budget crisis.

Once again, the future of mental health services are back in the hands of Gov. Tim Pawlenty. The House and Senate Conference Committee finally finished their negotiation of the final bill that would go to the Governor.  You can see the full details here.  These discussions have been long and tense, and many of the most important programs for our community were up for cuts.

The final bill is better than the Governor’s original proposal, and it is much better than the House proposal too.  But it still reflects the political and economic environment we’re in, and it will be a challenge to deal with in the coming year.  Please contact the Governor’s office and let him know what you think.  The compromise bill proposes:

• Restored funding for the Adult Mental Health grants supports community programs such as CSPs, drop in centers, and case management.  These grants were cut earlier in the session to pay for the GAMC compromise bill.
• Restored funding for ACT teams in rural areas.
• Cuts to housing with support for adults with serious mental illnesses.  However, these cuts are for 2010 and are not projected to continue at this point. All the major proposals have cut this amount.

We are particularly concerned for out-state Minnesotans at this time.  The Governor has taken it upon himself to modify the conditions of the GAMC deal struck with legislators earlier in the session.  When no hospitals would agree to participate, he  managed to convince 4 metro hospitals to accept a limited number GAMC patients.  There are two serious problems with this.  Patient limits were not part of the legislated solution, and may cut individuals off from needed care.  Secondly, four metro hospitals do not replace a state-wide safety net.  This is an unacceptable plan to people who do not live near the Twin Cities.

We would like to thank the members of the conference committee for hearing the needs of Minnesotans with mental illnesses.  We urge the Governor to do the same,

Since the MN Supreme Court decision reversing unallotment came down, we have known that budget negotiations would have to go into the final hours of the session.  But we are also facing new uncertainty about Federal funds that both sides were counting on to solve this biennium’s shortfall.

This means that the budget gap is now at about $3 B.  Obviously, this is a significant amount concentrated into the final year of the biennium.

The  plan proposed by the MN House and Senate majority addressed this new amount.  It would ratify certain parts of the unallotments, such as delays and shifts in K-12 Education funding and in local government aid.  What is significant about this plan is that it spreads the cuts more evenly that other proposals we have seen this yea. In addition, it plans on eventual restoration of the most important mental health related county grants and it raises new revenues through income taxes.  If the $400 M in Federal money does arrive, some money is put back into health and human services.

Passed narrowly last night, it met an almost instant veto from Governor Pawlenty.  There appears to be very little forward movement or compromise appearing.  Pawlenty has asked again for the Legislature to ratify his solution, but it was voted down by large margins in the House.

As we’ve said before, we hope that you will ask your legislators about what they have done to make a workable compromise possible.  There’s too much at stake to continue our present course of disappearing services and lost independence.