Getting Serious About Mental Health

New state funding and programs mean improved outlook for mental health care

The 2007 legislative session resulted in promising changes in mental health. The new funding may be Minnesota’s largest-ever increase for mental health ($34 million for FY08-09, $46 million for FY2010-11, excluding COLAs). In addition, several important changes proposed by a broad coalition of mental health stakeholders are beginning to take hold.

GAMC and Minnesota Care adopt “model” benefit set. The Minnesota Mental Health Action Group (MMHAG), a collaboration of consumers, mental health advocacy organizations, providers, government, and private and public mental health care entities, has developed a “model benefit set” that would provide adequate treatment and crucial supports throughout one’s illness. A number of these benefits have been added to Medical Assistance (MA). This year, MMHAG’s influence spread further, as the 2007 legislature extended all MA mental health benefits to General Assistance Medical Care (GAMC) and Minnesota Care. The expanded benefits include services such as crisis intervention, case management, and adult and children’s in-home aides. (Changes are effective January 1, 2008, or in some cases January 1, 2009.)

New projects will integrate physical and mental health care. A crucial goal of the mental health community has been to create a system of care that recognizes mental illnesses as illnesses and treats the whole person. Those with severe mental illnesses have a disproportionate rate of other health problems that go untreated; their lives, on average, are 25 years shorter. Not surprisingly, when mental and physical health care are coordinated, people’s health improves greatly. Impressed by these realities, the legislature authorized up to three MA projects to better integrate physical and mental health care. Consumer participation in the new integrated care networks will be voluntary. The legislation also authorizes DHS to undertake reforms in financing and delivering services. (The integrated care projects will be implemented in January 2009.)

Mental health peer specialists. Minnesota will be one of the first state governments to sponsor a peer specialist training and certification program. This milestone legislation was spearheaded by the Consumer Survivor Network. Peer services will include nonclinical peer counseling to promote socialization, recovery, self-sufficiency and self-advocacy, and development of natural supports. (The effective date is July 1, 2007, subject to federal approval.)

Medical Assistance eligibility while in jail suspended rather than terminated. Previously, MA eligibility was terminated for an individual in jail or a correctional facility. The new provision allows suspension instead, which will facilitate reinstatement when released. (Effective July 1, 2007)

Other Medical Assistance changes include:

• Intensive outpatient treatment using dialectical behavioral therapy was added to the benefit set for all state health programs (to start in January 2008 if federally approved).

• Coverage for children’s treatment foster care is still awaiting federal approval. (Effective date moved to July 1, 2009)

• Early intervention behavioral therapy for autism, which has seen repeated delays in approval and implementation, has unfortunately been repealed as a benefit.

Cost of living adjustments. Many providers have badly needed rate increases in order to keep programs operating and retain staff. The 2007 legislature increased rates for Adult Mental Health Rehabilitation Services (AMHRS) and Children’s Transitional Services and Supports (CTSS), and increased children’s and adult mental health grants to counties/providers. Also, CTSS and AMHRS services were added to the critical access provider increase that passed in 2006. (These changes take effect, variously, between October 1, 2007 and July 1, 2008.)

Regional children’s mental health initiative. A two-year pilot project in southeast Minnesota will focus on developing children’s mental health services, improving service coordination, streamlining service delivery and operations, and establishing a regional network for out-of-home placement services. $1 million is allocated for the biennium. (Effective July 1, 2007)

Voluntary placement in children’s residential treatment. Counties must use a placement agreement when placing a child in mental health residential treatment. Under new legislation, the agreement gives the county physical care, custody and control but must not require parents or guardians to transfer legal custody. (Effective July 1, 2007)

Many other significant pieces of mental health legislation were passed this session. You can find a more detailed legislative summary at www.dhs. state.mn.us or at the Minnesota Legal Advocacy Project “What’s New” at www.lsapmn.org

Patricia M. Siebert is a staff attorney at the Minnesota Disability Law Center