1. Mental Health in Florida Presented by: Mike Hansen, CEO/President Florida Council for Community Mental Health nami Florida Annual Conference Saturday, December, 2014 | Orlando, Florida

2. A Viable System of Mental Health Services Avoids: Higher crime rates and strain on law enforcement The use of jails as defacto hospitals Increased use of hospital emergency room services Increasing the homeless population Decreased community quality of life

3. Risks to Mental Health Delivery Systems Infrastructure: Inadequate state funding Florida ranks 49 th in per capita mental health funding No rate increases for funding of mental health services for 20 years Failure to optimize Medicaid resources

4. 2014-2015 DCF/ME Behavioral Health Needs Assessment Survey: Unfunded Service Need$125,866,311 Unmet Service Need$512,208,011 Total Service Need$638,074,322

5. Top Nine DCF BH Service Needs: Service/Program Funds Needed% of Total Crisis Stabilization Beds $104.23 mil16.3% Residential Care $80.06 mil12.6% Outpatient $73.89 mil11.6% Medical $52.76 mil8.3% Case Management $34.07 mil5.3% Crisis Support/Emergency $29.75 mil4.7% Detox $29.09 mil4.6% FACT $22.08 mil3.5% Prevention $17.75 mil2.8% Subtotal $444.26 mil69.7% Other Services/Programs $193.80 mil30.3% TOTAL $638.07 million100%

6. Medicaid Rates: Service/ProcedureActualMedicaid% of CostReimbursementCost Medication Management$118.69$60.0050.6% Psych Eval by MD$368.41$210.0057% Psych Eval by ARNP$314.77$150.0047.7% Adult Case Mgt$17.75$12.0067.6% Child Case Mgt$19.89$12.0060.3% Psychosocial Rehab$17.10$9.0052.6% Individual Therapy$25.01$18.3373.3% Bio Psychosocial Assessment$99.11$48.0048.4% Medication Asst. Treatment$87.66$67.4877.0% TBOs$24.43$10.0040.93%

7. Crisis Stabilization Unit Facts: Thank you for your support in the last legislative session! Number of CSUs65 Number of Licensed CSU Beds1,096 Number of State Funded Beds651 Statewide Utilization (All funders)87% DCF Average Reimbursement$298.69 Medicare Rate$751.61 Medicaid HMO Rate$800.00 - $1,000.00

8. Three Year Plan: Governor’s Tax Cut + Demands = $300 million unspent *State of Florida, Long-Range Financial Outlook Fall 2014 Report Adopted by the Legislative Budget Commission September, 2014 View the entire document here. View the entire document here.

9. *State of Florida, Long-Range Financial Outlook Fall 2014 Report Adopted by the Legislative Budget Commission September, 2014 View the entire document here. View the entire document here.

10. *State of Florida, Long-Range Financial Outlook Fall 2014 Report Adopted by the Legislative Budget Commission September, 2014 View the entire document here. View the entire document here.

11. *State of Florida, Long-Range Financial Outlook Fall 2014 Report Adopted by the Legislative Budget Commission September, 2014 View the entire document here. New Issues by GAAA Section Fiscal Year 2015-2016 TOTAL Fiscal Year 2016-2017 TOTAL Fiscal Year 2017-2018 TOTAL Section 2 - Pre K-12 Education236.382.640.2 Section 2 - Higher Education214.5130.7155.7 Section 2 - Education Fixed Capital Outlay0.0 Section 2 - Human Services257.4458.6520.2 Section 4 - Criminal Justice25.622.721.9 Section 7 - Judicial Branch0.0 Section 5 & 6 - Transportation & Economic Development 77.554.352.1 Section 5 - Natural Resources172.0170.8171.3 Section 6 - General Government44.471.266.6 Section 2 & 6 - Administered Funds – Statewide Issues 191.5174.8176.6 TOTAL NEW ISSUES1,219.21,165.71,204.6 Tier 2 Issues – Critical Needs and Other High Priority Needs

12. *State of Florida, Long-Range Financial Outlook Fall 2014 Report Adopted by the Legislative Budget Commission September, 2014 View the entire document here. View the entire document here.

13. *State of Florida, Long-Range Financial Outlook Fall 2014 Report Adopted by the Legislative Budget Commission September, 2014 View the entire document here. View the entire document here.

14. Medicaid Low Income Pool (LIP) Existing $2.1 billion goes away! Prior-year LIP funding$1 billion + Physician UPL$200 million + Hospital payments$960 million TOTAL$2.1 Billion *State of Florida, Long-Range Financial Outlook Fall 2014 Report Adopted by the Legislative Budget Commission September, 2014 View the entire document here. View the entire document here.

15. How Do We Dig Out?

16. The Florida Excellence In Behavioral Health Act Medicaid Expansion Medicaid Rate Increase Jail Diversion

17. Medicaid Expansion: Opportunities for state to cover the working poor Increase eligibility to 138% 100% Federal funding for 2 years – 90% after that and never goes down Has minimal impact on county cost share!

18. Projected Consequences of Not Expanding Medicaid in Florida: Uninsured not qualifying for coverage (thousands) Federal Medicaid funding lost (billions) Hospital reimbursement lost (billions) 2016 2013-202220162013-2022 1,060$6.7$66.1$2.1$22.6 Robert Wood Johnson Foundation, August 2014

19. Jail Diversion: On any given day in Florida, of persons with a serious mental illness, there are approximately 16,000 prison inmates, 15,000 local jail detainees, and 40,000 individuals under court supervision in the community. Annually as many as 125,000 people with a mental illness, requiring treatment, are arrested and booked into Florida jails. A recent study conducted in jails in Pennsylvania, found that 31% of women and 14% of men being booked into local jails, had a major mental illness.

20. Jail Diversion continued: These are individuals who have many of the same characteristics of the state hospital patients of the past. With adequate community treatment and support services we believe that many in the community can be effectively served. Public safety can be preserved, and they can be successful in the community. In the end, we will be making a wiser expenditure of public funds.

21. Florida Sheriffs Association 2015 Top Legislative Priority Mental Health Issues in the Criminal Justice System Support legislation that: Establishes arrest, jail and court programs targeted at providing mental health treatment services to persons involved in the criminal justice system, with an emphasis on crime prevention and reducing arrest recidivism. Establishes connections between Sheriffs’ Offices and community service providers and ensures offenders selected for community mental health treatment do not pose a threat to public safety.

22. FCCMH Criminal Justice Initiative Request Governor Scott to include the following in his 2015-16 Budget: $12.5 Million GR to be allocated as follows: $4 Million- Funding for community treatment services including; Mobile Crisis response and Assisted Outpatient Treatment (AOP) for persons who are high users of inpatient, CSU, and Court related services. $6 Million- Funding for the expansion of the CJ/MH/SA Reinvestment Grant Program. Expanded jail diversion, Crisis Intervention Training (CIT), treatment and support services for persons with MH/SA disorders involved in the CJ System. $2.5 Million- funding for community re-entry programs treating mentally ill released from prison or county jails, probation or community control

23. Florida Council’s Survey Response: Surveyed national models and programs operating in Florida to determine an approach that we will advocate for this coming legislative session: Current programs in Florida were surveyed to determine what programs existed, how they were designed and staffed, and who funded them.

24. Survey Response continued: Of programs operating and responding to the survey: 33% provided Diversion at Arrest 77% provided Diversion at the Jails 88% provided both Court and pre-trial diversion 55% had clients court ordered into treatment 44% of programs served individuals on Probation 66% of the programs served individuals who were forensic commitment diversions (Persons who were deemed by the courts to be incompetent to stand trial by virtue of a mental illness.)

25. Survey Response continued : Effective Community Based models include the following Essential Components: Crisis Intervention Training (CIT) Intensive case management Supported housing and employment Accessible and appropriate medications Peer support/ mentors Integrated treatment- (provide mental health and addictions treatment) Multi-disciplinary teams

26. We Want To Partner With Consumers, Family Members, and other stakeholders

27. You Have a Partner In Your Area! Download the FCCMH Member map here.

28. 316 East Park Avenue Tallahassee, FL 32301 880-224-6048 www.fccmh.org Email Mike @ mike@fccmh.org www.fccmh.org