The Mental Health and Mental Retardation Authority of Harris County

Okay - everyone just stop! Take a deep breath and look around. The 77th Legislative Session is over and the Appropriations Bill providing funding and direction for fiscal years 2002 and 2003 has been passed. The results - not what was wanted or needed - but, in truth, a whole lot better than it could have been. As the budgetary smoke clears, let's look around and see what has happened.

But first, let's be honest, this was one of the most difficult budget sessions in many, many years. The competing demands of the business of Texas Government (everything that falls under the State "umbrella") were enormous. And, the available revenues to address the myriad of needs - many very legitimate and deserving - were simply inadequate. So, what happened, the successes of the session were due in no small part to the statewide Community Advocacy Coalition effort (many think the best, most cohesive ever) and the local, area-by-area versions that occurred throughout the state. People with mental disabilities had friends, advocates, and spokespersons both external to and inside the Legislature that made the difference.

First and foremost, the Legislature made up the TDMHMR deficits from the current biennium (the one we are in now). In addition, approximately $41 million additional general revenue funds were appropriated for community mental health services for the biennium to offset the projected losses due to the new Medicaid Rehab rate structure, being implemented Sept. 1, 2001, (which wasn't even in the original TDMHMR biennial appropriations request) as well as put a little "new" funding to assist covering a portion of the inflationary increased costs with consumer pharmaceuticals (medications). The Community Mental Retardation Services line item was increased around $75 million for the biennium to expand Home and Community Services (HCS) with around $70 million of these funds available to match and, then, create over 600 new placement slots, and some $5 million to increase HCS provider rates. Under the Texas Council of Mentally Impaired Offenders, approximately $35 million new GR dollars were appropriated to provide mental health services for people on parole or probation, both adults and children. Finally, as a part of the Medicaid reform effort, almost $200 million was appropriated to address various Medicaid provider rate increases (no doubt some will positively impact community center-provided services). Unfortunately, the Pay Raise Rider for community MHMR center employees (to provide additional funds to "track" state employee pay increases) was not passed, meaning any salary adjustments will have to come out of existing dollars or new, earned revenues, as will other inflationary increases (i.e. mileage reimbursement adjustments).

Okay - you're right - the "new" mental health service dollars under TDMHMR are really "maintenance funding" - they don't really expand either the array of services under the benefit package for the indigent consumers or the number who may be meaningfully served. Likewise, the roughly 600 plus HCS slots are a mere drop in the bucket when more than 2,600 are on the waiting list for HCS in Harris County alone and over 16,000 statewide.

But - again, it's important to stop and realize the real economic climate faced by the 77th Legislature - the competing demands for new resources were so much greater than the severely limited available resources. We could have seen major cuts in services. So, let's say thanks! Thanks to our champions within the House and Senate that ensured our consumer's needs were not forgotten amidst all the competing pressures and made certain that those "new" funds which were appropriated will generally permit us to "hold the line." First and foremost - it's time to say thanks to those who worked so hard and made this happen.

But, as the "smoke clears," we will see that the modest successes will not be sufficient for us to avoid some significant pain and re-entrenchment in the publicly available services for persons who are indigent with either mental illness or mental retardation over the next two years of the biennium. Nowhere will this be more painfully felt than in the area of services for children and their families. In their efforts to "squeeze" every available federal reimbursement dollar, and make every General Revenue (GR) dollar "count," the Legislature went through and "scrubbed" down areas where they believed additional federal reimbursements could be produced. Children's Mental Health services were reduced in GR with an "offset" increase in expected CHIP reimbursements, and Early Childhood Intervention services were similarly reduced in GR with an "offset" increase in expected Medicaid earnings. That means that current indigent recipients who are receiving GR funded services will have to be reduced starting Sept. 1, 2001, or, converted to federal coverage programs, or, have those slots reduced and third party covered slots implemented - or the provider system reduced because the revenue to balance with expenses will, simply put, not be there.

The deficits seen during FY2001 cannot be continued. Expenses must be brought into alignment with available revenues. Ensuring that the benefit package provided is consistent with the funds available to cover the service by the payor source will be critical. One of the areas of readjustment this next fiscal year will be in the area of pharmacy services. Several changes are underway which will maximize other funding coverage and reduce the drain on GR. Clarifying the available GR to provide indigent care services versus funds necessary to match Medicaid will also be essential. With the new Medicaid rate methodology for rehab (paralleling that for service coordination) and its settle-up provision, ensuring the correct fit of cost to reimbursement levels will necessitate active, regular monitoring. And, with the implementation of the cost accounting methodology and reporting requirements to TDMHMR, issues around productivity and cost per unit of services/per consumer will demand attention to ensure that our provider network falls within acceptable and appropriate levels. It will be hard to explain to those consumers and families who look to the public system as to what happened, what didn't happen, and what the impact is/will be on the availability of services and supports to address their needs.

With the end of the Session, everyone is simply exhausted: the Legislators and their staff; the TDMHMR staff; the advocate, consumer, and family organizations; other professional colleagues, and a host of concerned friends. The Appropriations process was an epic struggle where there was no true "winner" (lots of opportunities to be a "loser"), only a "best fit" between too few resources and too much need. Compounded by Texas having one of the fastest growing populations in the nation - and one, if not, the highest percentage of uninsured, healthcare and behavioral healthcare will continue to be hot-button, bubbling issues. There wasn't enough money (anticipated revenue) under the current tax structure - some say there won't be enough under this current structure to meet Texans' needs - let alone to adequately address the needs of the mentally disabled.

We've got to say thanks for what was accomplished but redouble our efforts to ensure that the revenue may be there in future sessions to more adequately and appropriately meet the needs of those with mental disabilities in Texas. Like an automobile engine, if we keep reducing the amount of oil in the engine, eventually it reaches critical mass, burns up, and shuts down. In the process, efficiency of response reduces and functioning is much less than desirable. The "engine" of the public "safety net" is its people - both its consumers and its staff. As the safety net becomes even more thinly stretched, people are placed in harms way. But thanks to a true team effort, the "net" shouldn't rip open in the next two years. Tighter, yes - stressed, yes - but still able to function. To all who helped - for all who can't say so - Thanks!