Harris County Commissioners Court

82nd Legislative Session Priorities

Funding for Mental Health

Services Presented by

Amanda Jones, JDLegislative Coordinator

Harris County Office of Legislative Relations

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Texas Faces $18 - $20 Billion Revenue Shortfall

• Dept. of State Health Services (DSHS) proposed $134 million cut to mental health services & $3.8 million cut to substance abuse treatment.• Texas Dept. of Criminal Justice also proposed cuts to residential and community-based substance abuse treatment programs of more than $47 million & $4 million cut to services for special needs offenders.

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A Crisis-Driven System

• Texas spends more for mental health services at the institutional than community-based level. • Costs at the state mental hospitals account for almost ½ of all mental health funding. (FY 2009-10 Appropriations Bill.)

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Forensic Commitments • The state hospitals have civil and

forensic caseloads.• Forensic commitments relate to criminal

justice system.• Defendants receive court-ordered

competency restoration services in order to stand trial on a criminal offense.

• If the length of time involved in the competency restoration process is more than 1 year, person loses SSI & Medicaid & must restart “disability determination” process.

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Forensic Patients’ Length of Stay Far Exceeds Non-forensic Patients

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Profile of the Forensic Commitments

Of FY 2009 Forensic Commitments in Harris County,

• 77 percent were male; • 60 percent were African American;• 71 percent were committed for more

than 90 days.

DSHS Continuity of Care Committee found that 80 percent of forensic commitments for 1 yr or more had a diagnosis of schizophrenia.

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Recidivism Rates

• Persons who had been under forensic commitment in Harris County from 2002 to 2005 had an average of 1.74 arrests per year & 0.94 forensic commitments per year during 5-year period.

• DSHS Continuity of Care Committee found that 190 of FY 2009 forensic caseload had a history that included 5 or more forensic commitments (Average length of stay per commitment = 2.2 years.)

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• 869 nonviolent, mentally ill defendants took up an estimated 125,190 forensic bed days in FY 2009.

Costs of Forensic Commitments

• Texas may spend an estimated $129 million to restore the competency of 1,738 criminal defendants over the next biennium.

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• 78th Legislature cut mental health funding by $40 million and eliminated in-home & family support for mentally ill. • With no access to services in the community, persons with severe mental illness entered the criminal justice system.

Impact of Proposed Mental Health Cuts

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History Shows Mental Health Cuts Drive Up Forensic Caseloads

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• Access to an intermediate level of care for persons w/ severe & persistent mental illness would reduce recycling in & out of criminal justice, state hospital, & emergency systems & waiting lists for forensic beds. • Medicaid offers a financing option, Home & Community-based Services (HCBS).

An Alternative That Would Reduce Waiting List for Forensic Beds

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Cost of Home & Community-based Services (HCBS)

Cost of ONE Forensic Commitment

+ federal Medicaid match

1 person could receive 5 ½ years of HCBS

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The Price Tag

The cost of providing Medicaid Home & Community-based Services for these 1,738 forensic patients would be an estimated $91 million in General Revenue LESS than the forensic commitment process. HCBS also would draw down $23.6 million in new federal funds over a biennium.

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Medicaid HCBS

• HCBS Eligibility: Medicaid enrolled & Meet state-defined needs-based test.

• Individually-tailored benefit package.• State can cap enrollment. • Texas could implement HCBS through

Medicaid waiver authority or Medicaid State Plan Amendment.

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Healthcare Reform & HCBS

• Healthcare reform offers another implementation option - partial rollout of Medicaid expansion category, childless adults with incomes up to 133 percent FPL.

• For example, increasing income eligibility for Medicaid Aged and Disability Category would increase access to HCBS for those whose SSI benefits exceed income cutoffs.

• The newly eligible (partial rollout of expansion population) would qualify for 100 percent federal match in 2014.