AND GET STARTED HERE.
BUT THAT'S OKAY [inaudible]
HI.
SORRY TO BREAK UP ALL THE
CONVERSATION THERE.
GREAT WELL THANK YOU THANK YOU
VERY MUCH AND GOOD AFTERNOON
EVERYONE SPECIALNESS A RAINY DAY.
THAT THE RANGE COULD CONTINUE
FOR A LITTLE WHILE LONGER LOOKS
LIKE -- BUT
WITH THE TODAY ARE A JOINT
HEARING WITH THE SENATE HEALTH
THAT SIMPLY HEALTH AND WE'LL BE
TALKING ABOUT MENTAL HEALTH
TODAY.
A LITTLE HEALTHY CALIFORNIA
TODAY IS THE FIRST HEARING IN
THIS ON THIS SUBJECT THIS IS A
MEANT TO BE AS AS BACKGROUND.
AND THEN --
NEXT THURSDAY NEXT TUESDAY WHAT
DAY WAS THAT WEDNESDAY I'M SORRY
NEXT WEDNESDAY --
WE WILL HAVE A SECOND HEARING ON
THIS ON THIS SAYS --
AND LOOKING AT SPECIFIC PROGRAMS
AND HOW THINGS HOW WE'RE
ACTUALLY DOING HERE IN
CALIFORNIA SO.
IT'S WITH THAT I'D LIKE TO HAVE
A COUPLE OPENING --
COMMENTS I MADE A PASS AT OUT
THEN I'LL PASS IT TO A DOCTOR
PAN AND WE'LL GO FROM THERE SO --
MENTAL HEALTH CONDITIONS AFFECT
A VAST NUMBER OF PEOPLE THE
UNITED STATES AND ESPECIALLY
COMMON AMONG LOW INCOME
INDIVIDUALS WHO ARE ELIGIBLE FOR
MEDICARE.
MEDI CAL PLAYS A KEY ROLE IN
COPA COVERING MENTAL HEALTH CARE.
MIDDLE HEALTH CARE SERVICES ARE
A CORE COMPONENT OF THE PROGRAM
AND MEDI CAL IS THE MAJOR SOURCE
OF COVERAGE FOR LOW INCOME
CALIFORNIANS.
THIS JOINT INFORMATIONAL HEARING
IS INTENDED TO PROVIDE AN
OVERVIEW OF THE MEDI CAL MENTAL
HEALTH --
BENEFIT DELIVERY SYSTEM WE HEAR
HOW MENTAL HEALTH SERVICES ARE
DELIVERED.
HOW THEY'RE ADMINISTERED OTHER
FINANCED AND HOW QUALITY IS
MEASURED AND INSURED?
THIS HEARING WILL SET THE STAGE
FOR A SUBSEQUENT HEARINGS --
THAT FRONT AND FOR A NUMBER OF
BILLS THAT HAVE BEEN --
I LIKE TO PASS A DOCTOR PAN
WOULD YOU HAVE ANY OPENING
COMMENTS.
THANK YOU SO VERY MUCH --
DOCTOR WOULDN'T I WANT TO THANK
YOU AND YOUR STAFF FOR PUTTING
THIS HEARING TOGETHER ABOUT THIS
ONE AND ALSO TO THE FOR THIS.
FOLLOW OPEN AS WELL AS SCHEDULED
THE NEXT WEEK --
NUMBER THE MEDI CAL DELIVERY
SYSTEM ITSELF IS COMPLEX AND
CERTAINLY I GETS MORE
COMPLICATED WHEN YOU ADD IN THE
MENTAL HEALTH DELIVERY SYSTEM.
I KNOW TODAY I THINK WE'LL BE
HEARING ABOUT THE VARIOUS --
DOLLY FUNDING STREAMS BUT ALSO
DIFFERENT REQUIREMENTS I THINK
ONE OF THE THINGS THAT I'M
HEARING FROM MEMBERS OF MY OWN --
HOUSE -- IS
THAT IN THE SENATE IS THAT --
THERE'S A GREAT DESIRE --
TO TRY TO IMPROVE OUR ABILITY TO
DELIVER MENTAL HEALTH SERVICES
SUBSTANCE --
YOU SERVICES AS WELL WE HAVE
THAT HOPE YOU A CRISIS GOING ON
AND WE KNOW OUR WE'RE DEALING
WITH --
HOMELESSNESS FOR IT WELL IT'S
NOT ALL.
PEOPLE WANT TO SEE ABOUT GETTING
PEOPLE SERVICES WERE TALKING
ABOUT AS CRIMINAL JUSTICE AND
BEING SURE PEOPLE GET THE CARE
THEY NEED --
AFTER THAT --
IN TERMS OF REHABILITATION AND
AFTER THE LEAVE US.
THE JAILS ARE PRISONS
UNFORTUNATELY OFTEN IT TOO MANY
LOCALITIES THE JAIL IS THE
LARGEST MENTAL HEALTH PROVIDER
IN IN IN THAT WITH CALORIE.
AND SO THIS INTERSECTS SO MANY
DIFFERENT PLACES AND SO
CERTAINLY IT'S OF GREAT PUBLIC
INTEREST. TO FIGURE OUT HOW WE
ARE DOING OUR HOW WE ARE.
HOW MENTAL HEALTH SYSTEM WORKS
HOUSE BE FINANCE AND ALSO HOW WE
HOLD PEOPLE ACCOUNTABLE --
THAT AND I THINK THERE'S BEEN SO
CERTAINLY SOME CONCERNS ABOUT
THE LEVEL COUNT ABILITY ABOUT
HOW THE ONLY FUNDS ARE BEING
SPENT BUT SERVICES ARE BEING
DELIVERED.
SO I APPRECIATE THAT TODAY WE'RE
GONNA BE HEARING THAT BACKGROUND
OF HOW THIS IS SET UP AND THEN
THINKING ABOUT HOW WE MOVE
FORWARD AND ASSURE THAT --
THERE IS ACCOUNTABILITY AND THAT --
WE CAN ACTUALLY ESTABLISH A
STATE PRIORITIES FOR MENTAL
HEALTH -- TO
BE SURE WE ADDRESS THE THE
ISSUES THAT ARE FACING THE
PEOPLE OF THE STATE OF
CALIFORNIA --
SO AGAIN THANK YOU SO MUCH FOR
PUTTING THIS HERE FROM THE
SENATE HEALTH COMMITTEE FOR
BEING PRESS AS WELL.
THANK YOU VERY MUCH DOCTOR PENS
OR ANY OF THE OTHER OF OUR
COLLEAGUES WOULD LIKE TO MAKE
ANY REMARKS MISS RODRIGUEZ
[inaudible]
YOUR I JUST WANNA.
BOB WE'RE GONNA BE.
THERE FOR HEALTH CARE COVERAGE
YOU KNOW WHAT THE **** Là MIND
OF ROMANOV WHICH IS HEARING.
IS A YEAR AGO THEY RESPOND OR
THE RISK LA COUNTY OR WHATEVER
MEMORIES.
OF WE HAVE TO USE FOR THE CALL
BACK TO THE SITE WATER
INDICATIONS AND WE WERE
TRANSPORT THOSE PATIENTS.
INSTEAD OF TO THE HOSPITAL
SETTING TO THE MENTAL HEALTH
FACILITIES THAT THAT'S WHERE
THEY NEEDED TO BE WE JUST TALKED
ABOUT.
YOU KNOW OUR COUNTY JAILS ARE
OVER BURDENED WITH A LOT OF
MENTAL HEALTH PATIENTS NOT TO
MENTION --
PROBABLY ANY EMERGENCY ROOMS IN
CALIFORNIA THERE'S PROBABLY.
A GOOD PERCENTAGE OF THE
PATIENTS IN THERE HAVE MENTAL
HEALTH ISSUES BUT BECAUSE OF THE
WAY WE'RE DELIVERING SERVICE.
WE NEED TO FIND OUT BETTER WAYS
LIKE I SAID I DON'T KNOW WHY WE
WENT AWAY AND GOT RID OF THOSE
TYPE OF TEAMS ARE OUT THERE
TWENTY FOUR SEVEN IN OUR
COMMUNITIES BUT OF WE CAN FIND A
WAY TO BRING THOSE BACK.
I THINK THAT'S ONE WAY WE CAN
HELP ALLEVIATE SOME OF THIS
CONGESTION AND ISSUES THAT WE
SEE IN OUR HOSPITALS AND FORTY
OR COUNTY JAIL SYSTEMS.
SO THANK YOU VERY MUCH LOOK FOR
FOR THE DISCUSSION AS WE MOVE
FORWARD THANK YOU.
THANK YOU ANYONE ELSE.
SO WE HAVE FOUR PANELS TODAY AND
AND SO WHAT WE'LL DO IS AFTER
EACH PANEL WILL GIVE OPPORTUNITY
FOR MEMBERS ASK QUESTIONS --
THAT'S OKAY --
OUR FIRST PRESENTER --
CATHERINE TEAR.
PLEASE COME ON UP.
CATHERINE IS THE ASSOCIATE
DIRECTOR OF HIGH VALUE CARE
CALIFORNIA HEALTH CARE FROM FROM
CALIFORNIA FOUNDATION.
THANK YOU VERY MUCH THANK YOU.
FOR HEALTH CARE FOUNDATION.
THANK YOU --
CHAIRMAN WOULD CHAIRMAN PAN
MEMBERS OF THE COMMITTEES.
HAPPY TO BE HERE ON BEHALF OF
THE CALIFORNIA HEALTHCARE
FOUNDATION TO OFFER SOME HIGH
LEVEL BACKGROUND INFORMATION ON
PREVALENCE.
OF MENTAL ILLNESS AND ACCESS TO
CARE IN CALIFORNIA.
CALIFORNIA HEALTHCARE FOUNDATION
IS A NONPROFIT INDEPENDENT
PHILANTHROPY WITH OFFICES HERE
IN SACRAMENTO AND OAKLAND WE'RE
DEDICATED TO ADVANCING
MEANINGFUL MEASURABLE
IMPROVEMENT IN THE WAY THE
HEALTHCARE DELIVERY SYSTEM
SERVES THE PEOPLE OF CALIFORNIA.
PARTICULARLY PEOPLE WITH LOW
INCOME AND FOR WHOM THE STATUS
QUO IS NOT PROVIDING GOOD
SERVICE.
I'M GOING TO MOVE.
FAIRLY QUICKLY OF THROUGH THE
SLIDES BUT I WANTED FIRST TO SAY
A WORD ABOUT MY SOURCES.
MOST OF THE INFORMATION --
THAT I'M GOING TO PROVIDE TODAY
CAN BE FOUND IN MENTAL HEALTH
CARE IN CALIFORNIA FOR TOO MANY
CARE NOT THERE WHICH IS ONE OF
THE FOUNDATIONS ALMANAC
PUBLICATIONS.
THAT WE PUBLISHED ABOUT A YEAR
AGO.
AND THOSE COMPILE THE MOST
RECENT AVAILABLE DATE ON
DIFFERENT TOPICS TO SHINE A
LIGHT ON THE STATUS OF HEALTH
CARE IN THE STATE.
DATA IN THE ALMANAC COME FROM A
WIDE VARIETY OF SOURCES FEDERAL
DATA LIKE THE CENSUS --
FROM THE SUBSTANCE ABUSE AND
MENTAL HEALTH STRAIGHT XIN STATE
PROGRAMMATIC DATA FROM
DEPARTMENT OF HEALTH CARE
SERVICES DEPARTMENT OF PUBLIC
HEALTH OFSHE POT AND OTHERS.
MUCH OF THE DATA THAT WE
PUBLISHED LAST YEAR'S FROM
TWENTY FOURTEEN AND TWENTY
FIFTEEN IT IS STILL THE MOST
RECENT AVAILABLE.
BUT THERE HAVE BEEN OBVIOUSLY
VERY IMPORTANT CHANGES SINCE
THEN MOST NOTABLY THE EXPANSION
OF MEDICARE ALL --
AS WELL AS OTHER CHANGES IN OUR
ENFORCEMENT OF PARITY LAWS AND
OTHER THINGS OF THAT IS WORTH
KEEPING IN MIND.
I ALSO WANT TO OFFER A FEW
PIECES OF INFORMATION FROM A
RECENT STATEWIDE POLL THAT THE
CALIFORNIA HEALTHCARE FOUNDATION
IN THE KAISER FAMILY FOUNDATION --
PUBLISHED IN JANUARY WHEN PEOPLE
WERE ASKED WHAT DO YOU MOST WANT
THE NEW GOVERNOR AND LEGISLATURE
TO WORK ON WHEN IT COMES TO
HEALTHCARE.
THE TOP RESPONSE WAS MAKING SURE
PEOPLE WITH MENTAL HEALTH
PROBLEMS CAN GET TREATMENT.
SO I'M VERY GRATEFUL TO THE
COMMITTEES FOR HOLDING THESE
IMPORTANT HEARINGS AT THIS TIME.
AS FAR AS YOU CAN SEE ON THE
SIDE I'M GOING TO TALK FIRST
ABOUT PREVALENCE THAN ABOUT
ACCESS TO CARE AND A LITTLE BIT
ABOUT MEDI CAL.
IN TWENTY FOURTEEN ONE IN TWENTY
FOUR ADULTS IN CALIFORNIA THAT'S
ABOUT 4% OF ALL ADULTS
EXPERIENCED A SERIOUS MENTAL
ILLNESS.
THAT'S DEFINED IS A DIAGNOSABLE
MENTAL BEHAVIORAL OR EMOTIONAL
DISORDER RESULTING IN FUNCTIONAL
IMPAIRMENT THAT INTERFERES WITH
OUR LIMITS MAJOR LIFE ACTIVITIES.
A MUCH LARGER PERCENTAGE ABOUT
ONE IN SIX OR 15% OF THE
CALIFORNIA DEL POPULATION
EXPERIENCED ANY MENTAL ILLNESS
AGAIN.
THEY HAVE A MENTAL BEHAVIORAL OR
EMOTIONAL DISORDER THE
REGARDLESS OF THE LEVEL OF
IMPAIRMENT.
AMONG CHILDREN THOSE WITH THE
GREEN FIGURES. ONE IN THIRTEEN
MORE THAN 7% HAD A SERIOUS
EMOTIONAL DISTURBANCE THAT'S
ESSENTIALLY EQUIVALENT OF THE
SERIOUS MENTAL ILLNESS DIAGNOSIS
FOR ADULTS.
THERE IS NOT AN EQUIVALENT ANY
MENTAL ILLNESS --
CATEGORIZATION FOR CHILDREN SO
THIS IS THE DATA THAT WE HAVE.
FOR THE MOST PART AND YOU'LL
HEAR ME SAY THIS A FEW MORE TO
OVERALL ESTIMATES ARE NOT.
ARE NOT REALLY AT ALL CHANGED
FROM THE LAST TIME THAT THE
CALIFORNIA FOUND CARE HEALTHCARE
FOUNDATION RAN THE STATE A WHICH
WAS BASED ON TWO THOUSAND NINE
DATA SO OVERALL WE ARE SEEING.
CONSISTENT LEVELS OF PREVALENCE
WHICH IS WHAT YOU WOULD EXPECT
FROM MAJOR CHRONIC ILLNESSES.
HOWEVER THE RATES DO VERY ACROSS
THE STATE IN A COUPLE OF WAYS
FIRST BY REGION THE RATE OF
SERIOUS EMOTIONAL DISTURBANCE
AMONG CHILDREN THOSE ARE THE
GREEN BARS.
VARIES FROM A HIGH OF EIGHT
POINT 1% SAN JOAQUIN VALLEY DOWN
TO A LOW OF SEVEN POINT 1% IN
THE BAY AREA. FOR ADULTS THAT'S
THE ORANGE BARS THERE'S A RANGE
FROM ABOUT FIVE AND A HALF
PERCENT IN THE NORTHERN IN
SIERRA REGION DOWN TO THREE AND
A HALF PERCENT IN THE GREATER
BAY AREA SO THERE IS.
A IT IS A DIFFERENCE IN FOR A
QUICK NOTE FOR THE PURPOSES OF
THIS REPORT NORTHERN AND SIERRA
WHICH WILL COME BACK TO AGAIN IS
ONE REGION.
IT INCLUDES THE COUNTIES NORTH
OF SACRAMENTO AS WELL AS THE
EASTERN SIERRA COUNTIES DOWN TO
THE INLAND EMPIRE.
AND I DIDN'T INCLUDE THE SLIDE
BUT AMONG ADULTS CALIFORNIA
WOMEN WERE MORE LIKELY THAN MEN
TO EXPERIENCE A SERIOUS MENTAL
ILLNESS ABOUT FOUR POINT 8%
VERSUS A THREE POINT 6% FOR MEN
AND AGAIN.
THESE RATES ARE LARGELY
UNCHANGED SINCE.
TWO THOUSAND NINE THIS SLIDE
SHOWS VARIATION BY RACE AND
ETHNICITY CHILDREN ON THE LEFT
ADULTS ON THE RIGHT CHILDREN WE
DON'T SEE A TREMENDOUS --
DIFFERENCE BY RACE AND ETHNICITY
THERE IS SOME WE SEE GREATER
VARIABILITY IN THE RATES OF
SERIOUS MENTAL ILLNESS IN ADULTS
BY RACE AND ETHNICITY WITH
NATIVE AMERICAN AFRICAN AMERICAN
AND MULTI RACIAL ADULTS.
EXPERIENCING THE HIGHEST RATES
ASIAN AND PACIFIC ISLANDERS WITH
THE LOWEST RATES OF SERIOUS
MENTAL ILLNESS.
AND ONCE AGAIN WE SAW THE SAME
DISCREPANCIES IN TWO THOUSAND
NINE SO NOT MUCH CHANGE --
CHAIR WOULD MENTIONED PREVALENCE
VARYING BY INCOME IT'S VERY TRUE
WE DO SEE SIGNIFICANT
DIFFERENCES WITH THE HIGHEST
RATES OF THE LOWEST INCOME
LEVELS.
FOR CHILDREN THE GREEN BARS YOU
CAN SEE THAT ONE IN TEN CHILDREN
BELOW THE POVERTY LEVEL SUFFERED
FROM A SERIOUS EMOTIONAL
DISTURBANCE.
THE ORANGE BARS SHOW ALMOST AS
MANY ADULTS ABOUT 9% OF PEOPLE
BELOW A 100% OF THE FEDERAL
POVERTY LEVEL EXPERIENCING
SERIOUS MENTAL ILLNESS.
I'VE SAID THE PREVALENCE RATES
OVERALL ARE UNCHANGED I WANT TO
SHOW YOU ONE EXCEPTION.
THE RATES OF MAJOR DEPRESSIVE
EPISODES IN ADOLESCENTS HAVE
INCREASED DRAMATICALLY IN
200-082-0009 EIGHT ABOUT EIGHT
POINT 2% OF TEENS REPORTED
EXPERIENCING A MAJOR DEPRESSIVE
EPISODE IN THIS I WANT TO BE
CLEAR IS NOT.
THE NORMAL ADJUSTMENTS OF
ADOLESCENCE AND MOODINESS
ILLNESS --
BUT AS YOU CAN SEE IN TWENTY
FOURTEEN TWENTY FIFTEEN THAT
RATE IS UP TO TWELVE AND A HALF
PERCENT SO SORRY TWELVE POINT 3%
IN CALIFORNIA.
OF ONE IN EIGHT ADOLESCENCE
WHICH IS A 50% INCREASE OVER
THAT SHORT PERIOD OF TIME.
WE'VE SEEN THESE NUMBERS
INCREASING NATIONALLY AS WELL --
AND IT'S OBVIOUSLY A SERIOUS
AREA OF CONCERN I SHOULD POINT
OUT THAT THIS IS FROM A
DIFFERENT SOURCE THAN THE OTHER
PREVALENT SLIDE SO THEY MAY NOT
BE DIRECTLY COMPARABLE THIS IS
FROM SAMPSON REPORTING.
ALTHOUGH OUR HEARING TODAY'S
FOCUSED ON MENTAL HEALTH WE ARE
I THINK ALL AWARE THAT VERY
FREQUENTLY PEOPLE WITH MENTAL
ILLNESS HAVE CO OCCURRING
SUBSTANCE USE DISORDER.
AND THAT'S WHAT'S REPRESENTED
HERE ON THE SLIDE THESE
STATISTICS SHOW THAT ABOUT A
THIRD OF ADULTS WITH SERIOUS
MENTAL ILLNESS ALSO HAVE A
DIAGNOSED SUBSTANCE USE DISORDER.
FOR YOUTH THAT NUMBER IS ABOUT
10%.
MOST PEOPLE WITH SERIOUS MENTAL
ILLNESS AND SUBSTANCE USE
DISORDER ARE NOT SUICIDAL.
BUT MOST PEOPLE WHO DIE BY
SUICIDE DO HAVE A MENTAL OR
EMOTIONAL DISORDER AN ESTIMATED
THIRTY TO UP 270% EXPERIENCE
DEPRESSION OR BIPOLAR ILLNESS.
AND ON THE SUBSTANCE USE
DISORDER SIDE PEOPLE SUBSTANCE
USE DISORDER ABOUT SIX TIMES
MORE LIKELY TO COMMIT SUICIDE
THAN THOSE WITHOUT.
SO SUICIDE STATISTICS ARE QUITE
RELEVANT WHEN WE TALK ABOUT
MENTAL HEALTH IN CALIFORNIA
ALTHOUGH THEY REPRESENT
OBVIOUSLY THE EXTREME EDGE SORT
OF THE TIP OF THE ICEBERG.
CALIFORNIA SUICIDE RATE WHICH IS
BETWEEN TEN AND ELEVEN PER ONE
HUNDRED THOUSAND INDIVIDUALS IN
THE STATE HAS BEEN STABLE FOR A
LONG TIME THE NUMBERS DON'T
CHANGE MUCH.
IT'S LOWER THAN THE NATIONAL
RATE --
WHICH IS NOT SHOWN HERE.
BUT YOU CAN SEE THE RATES ARE
NOT EVENLY DISTRIBUTED IN
PARTICULAR ON THE VERY
CONSIDERABLY BY REGION LA COUNTY
HAS THE LOWEST RATE AT SEVEN PER
HUNDRED THOUSAND THE NORTHERN
SIERRA REGION IS THREE TIMES AS
HIGH AND DOUBLE THE STATE
AVERAGE.
SUICIDE RATES ALSO VERY BY
GENDER.
AND BY RACE AND RACE AND
ETHNICITY.
MALES HAVE THREE TIMES THE RATE
OF SUICIDE OF WOMEN ALTHOUGH IT
THIS ISN'T ON THE SLIDE AMONG
HIGH SCHOOL STUDENTS YOU SEE
MUCH HIGHER RATES --
SELF REPORTED ATTEMPTS OF
SUICIDE ARE MUCH ARE TWICE AS
HIGH AMONG GIRLS AS AMONG BOYS --
RATES OF SUICIDE ARE HIGHEST BY
ETHNICITY FOR NATIVE AMERICAN
AND WHITE GROUPS.
THAT'S OF THOUGH THERE'S THE
BLUE BARS ON THE SLIDE.
I'M NOT GONNA SHIFTED TO TALK TO
A TOPIC I KNOW IS OF UTMOST
INTEREST EVERYONE HERE WHICH IS
ACCESS TO CARE FOR MENTAL
ILLNESS.
AND I WILL SAY THAT THE NUMBERS
ARE NOT GREAT --
THIS SLIDE SHOWS THE JUST OVER A
THIRD OF CALIFORNIAN AND ADULTS
WITH A MENTAL ILLNESS RECEIVED
TREATMENT OR COUNSELING DURING
THE PRIOR YEAR.
AND THIS IS A COMPETENT OF DATA
FROM TWENTY ELEVEN TO TWENTY
FIFTEEN SO IT'S NOT A SINGLE
YEAR BUT REPORTING BACK IS A
SELF REPORT BASED ON THE PAST
YEAR.
THIS IS LOWER THAN THE NATIONAL
RATE WHICH IS ABOUT 43% AND
AGAIN IS THE SAME AS IT WAS IN.
TWO THOUSAND NINE THIS
DIFFICULTY IN ACCESSING CARE WAS
ALSO REFLECTED IN THE POLL
RESULTS I MENTIONED EARLIER
WHICH FOUND THAT ABOUT HALF OF
CALIFORNIANS BELIEVE THAT QUOTE.
MOST CALIFORNIANS WHO NEED
MENTAL HEALTH OR SUBSTANCE YOU
SERVICES ARE NOT ABLE TO GET
THEM.
AND ONE THING WE FOUND IN THAT
POLL WAS THAT OF HE REPORTED%
THAT THEY WENT OUT TO TRY AND
SEEK TREATMENT.
THEY WERE EVEN MORE LIKELY TO
SAY THAT IT'S HARD TO GET SO
THIS IS A PERCEPTION --
IN THE GENERAL POPULATION AND
IT'S BORNE OUT BY PEOPLE'S
ACTUAL EXPERIENCE.
I DIDN'T INCLUDE THE SLIDE BUT
ON THE POSITIVE SIDE I WILL SAY
THAT FOR ADULTS WITH MAJOR
DEPRESSION AGAIN THIS SLIDE IS
FOR PEOPLE WITH ANY MENTAL
ILLNESS.
BUT FOR PEOPLE WITH MAJOR
DEPRESSION ADULTS THE NUMBERS
ARE REVERSED AND ABOUT TWO
THIRDS OF PEOPLE DO REPORT
GETTING TREATMENT SO THAT'S GOOD --
AS YOU KNOW DEPRESSION IS ONE OF
THE MOST COMMON FORMS OF MENTAL
ILLNESS AND STRONGLY ASSOCIATED
NOT ONLY WITH SUICIDE BUT ALSO
WITH CARDIOVASCULAR DEATH --
LESS PROMISING THOUGH WE SEE --
THE SAME NUMBERS THESE ARE FOR
ADOLESCENTS SO I MENTIONED
EARLIER HAVE THIS INCREASED RATE
OF MAJOR DEPRESSION AS WE'VE
SEEN.
AND ONLY ONE THIRD OF THOSE
CALIFORNIA ADOLESCENTS WHO
REPORTED SYMPTOMS OF MAJOR
DEPRESSIVE EPISODES DURING THE
PAST YEAR HAD RECEIVED TREATMENT --
AND THAT IT CAN IS LOWER THAN
THE NATIONAL RATE WHERE STILL
LOW BUT IT'S CLOSER 240% THAN
THE 32% WE SEE HERE.
MYCO PRESENTERS ARE GOING TO
SAY A WHOLE LOT MORE AND A LOT
MORE DETAIL ABOUT OUR PUBLIC
SYSTEMS OF CARE BUT I WANTED TO
GET A FEW POINTS IN.
THE FIRST IS THE RELATIVE SIZE
OF THE ALL HEALTH BUDGET.
AND THE MENTAL HEALTH BUDGETS NO
THESE ARE U. S. THIS IS U. S.
STATUS OF THIS IS REALLY AT A
HIGH LEVEL WE DON'T HAVE SIMILAR
DATA FOR CALIFORNIA.
BUT I FIRST WANTED TO POINT OUT
THE RELATIVE SIZE OF THE SPEND
HERE.
TOTAL U. S. MENTAL HEALTH
EXPENDITURES THIS IS FOR TWENTY
FIFTEEN WERE PROJECTED TO BE
ABOUT A HUNDRED AND EIGHTY SIX
BILLION DOLLARS THAT 6% OF THE
TOTAL HEALTHCARE EXPENDITURES
FOR THE NATION SO --
I TRIED TO MAKE THE SLIDE WITH
AS BUT THEN YOU COULDN'T READ
THE LITTLE ONE SO THEY'RE THE
SAME SIZE BUT REALLY ONE IS
REALLY 6% OF THE OTHER.
THE SECOND POINT IS THAT MUCH
MORE THAN OTHER KINDS OF HEALTH
CARE SERVICES MENTAL HEALTH CARE
SERVICES ARE PROVIDED THROUGH
PUBLIC PROGRAMS --
IN THE CIRCLE ON THE RIGHT YOU
CAN SEE THAT MEDICAID AND SO
CALLED OTHER PUBLIC PROGRAMS
THAT WOULD INCLUDE FEDERAL
GRANTS --
ANOTHER FUNDING SOURCES.
ARE PROJECT WERE PROJECTED TO
PLAY IT PAID FOR SLIGHTLY MORE
THAN HALF OF MENTAL HEALTH
EXPENDITURES AGAIN THIS WAS --
FOR TWENTY FIFTEEN AND THAT'S
VERY DIFFERENT FROM WHAT WE SEE
ON THE OVERALL HEALTH CARE SIDE
SO -- THIS
IS A PUBLIC SYSTEM MORE THAN OUR
OTHER HEALTHCARE SYSTEMS EVEN
MORE THAN OUR OTHER HEALTHCARE
SYSTEMS.
AND THIS IS AGAIN A VERY HIGH
LEVEL SLIDE SHOWING THE GROWTH
IN THE NUMBER OF MEDI CAL
ENROLLEES WHO ARE SERVED BY THE
SPECIALTY MENTAL HEALTH SYSTEM.
IN MEDI CAL WHICH AS YOU ALL
KNOW IS RUN BY THE COUNTIES NO
HERE MUCH MORE ABOUT IN A BIT.
WELL JUST A FEW YEARS AGO --
THE ON THE BAR TO THE LEFT OF
THAT SYSTEM WAS FAIRLY EVENLY
SPLIT SPLIT BETWEEN CHILDREN AND
ADULTS WITH MEDI CAL EXPANSION
THE NUMBER OF ADULTS BEING
SERVED HAS REALLY SOARED.
SINCE TWENTY TWELVE THE NUMBER
OF CHILDREN IS INCREASED BY
ABOUT 17% ADULT NUMBERS HAVE
INCREASED ALMOST 50%.
NOW MANY OF THESE INDIVIDUALS
MIGHT HAVE BEEN SERVED ALREADY
THROUGH OTHER MENTAL HEALTH
FUNDING SOURCES.
BUT THEY'RE NOW ELIGIBLE FOR
MEDI CAL AND ALL OF ITS BENEFITS
AND THE SHIFT MEANS --
THAT THEY HAVE ACCESS TO
PHYSICAL HEALTH CARE SIR I HAVE
HAD ACCESS TO BEFORE EITHER.
THAT'S IMPORTANT BECAUSE WE HAVE
A FUNDAMENTAL.
TREMENDOUS DISPARITY IN HOW LONG
PEOPLE WITH SERIOUS MENTAL
ILLNESS AND SUBSTANCE USE
DISORDER AS WELL.
LIVE IN THE SOCIETY AGAIN THESE
ARE NATIONAL NOT CALIFORNIA
STATISTICS BUT AS YOU CAN SEE
AMERICANS WITH A SERIOUS MENTAL
ILLNESS DIE TWENTY FIVE YEARS
EARLIER THAN PEOPLE WITHOUT.
THE NUMBER FOR SUBSTANCE USE
DISORDER ACTUALLY SORRY IT'S A
DUBBED DRUG DEPENDENCE DIAGNOSIS
IS ACTUALLY HOW THAT STUDY WAS
DONE -- DIED
ALMOST TWENTY THREE YEARS
EARLIER AND IMPORTANT TO NOTE
THAT FOR THE MOST PART PEOPLE
ARE DYING NOT OF OVERDOSES OR
SUICIDE OR ACCIDENTS BUT RATHER
THE SAME THINGS AS THE REST OF
THE POPULATION ONLY A LOT
YOUNGER HEART DISEASE.
STROKE DIABETES AND RESPIRATORY
PROBLEMS SO ONE THING THAT WILL
BE CRITICALLY IMPORTANT I THINK
IN LOOKING AT THE SYSTEM IS HOW
PEOPLE CAN RECEIVE BETTER
INTEGRATED CARE PHYSICAL HEALTH
CARE MENTAL HEALTH CARE
SUBSTANCE USE DISORDER SERVICES.
WE SEE THESE DISPARITIES IN
HEALTH OUTCOMES REFLECTED IN OUR
SPENDING THIS IS BACK TO MEN
MEDI CAL DATA THIS IS FROM --
TWENTY ELEVEN YOU CAN SEE THE
TOTAL COSTS OF CARE FOR A PERSON
WITH DIABETES ALONE IS SORT OF
ON THE IS ON THE LEFT HAND BAR.
WHEN YOU LOOK AT THE MIDDLE BAR
THAT SOMEONE WHO HAS DIABETES
AND ALSO HAS SERIOUS MENTAL
ILLNESSES AND THE COSTS ARE
TWICE AS HIGH MORE THAN DOUBLE
AND FINALLY THE BAR ON THE RIGHT
HAND SIDE IS A PERSON WHO HAS
DIABETES AND IS ALSO?
A HAS SERIOUS MENTAL ILLNESS
DIAGNOSIS AND AN S. U. D.
DIAGNOSIS AND AGAIN THE COST UP
TO TWO AND A HALF TIMES AS HIGH.
WHAT I WOULD NOTE HERE IS THAT
THE MAJORITY OF THE INCREASE
THERE IS IN THAT YELLOW BAR
WHICH IS OTHER MEDICAL CARE IT'S
NOT?
MENTAL HEALTH SERVICES WHICH IS
JUST A LITTLE BAR BLUE BAR AT
THE TOP IT'S IN THE
PRESCRIPTIONS AND ALSO IN THE
OTHER MEDICAL CARE THAT WE SEE
THE DIFFERENCE.
SO AGAIN THIS SUGGESTS THE NEED
TO LOOK AT HOW WE INTEGRATE CARE
WE ARE ACCRUING COSTS ON THE
PHYSICAL HEALTH SIDE NOT JUST ON
THE MENTAL HEALTH SIDE.
IN CLOSING I REALLY WANT TO
EMPHASIZE THAT WHILE THESE DATA
AS A WHOLE DO SHOW CONTINUING
GAPS IN ACCESS TO CARE.
AND RISING RATES OF ILLNESS FOR
SOME POPULATIONS WE KNOW THAT
PEOPLE WITH SUBSTANCE USE
DISORDER IN WITH MENTAL ILLNESS
DO RECOVER.
THEY WORK AND VOTE AND RAISE
FAMILIES AND PARTICIPATE FULLY
IN OUR SOCIETY AND PROVIDERS OF
CARE ALL OVER THE STATE ARE
WORKING TO PROVIDE AND ARRANGE
TOP OF THE LINE CARE FOR PEOPLE
WHO NEED IT.
AGAIN THE POLL RESULTS I THINK A
REALLY INSTRUCTIVE HERE ABOUT
75% OF CALIFORNIANS BELIEVE THE
COUNSELING AND MEDICAL TREATMENT
IS EFFECTIVE IN HELPING PEOPLE
WITH MEDICAL CAN MENTAL HEALTH
CONDITIONS.
LEAD HEALTHY AND PRODUCTIVE
LIVES.
I THINK WE CAN ALL AGREE THOUGH
THAT OUR SYSTEMS MAKE IT EASY
FOR PEOPLE TO ACCESS ALL THE
CARE THAT WE NEED AND THE
CALIFORNIA CAN DO BETTER AND DO
MORE.
SO I THANK YOU FOR YOU TIME
TODAY I'M HAPPY TO TAKE ANY
QUESTIONS THANK YOU VERY MUCH
APPRECIATE THAT INFORMATION IS
SERVED WITH QUESTIONS FROM
[inaudible]
PANEL [inaudible]
MISS WALDRON.
THANK YOU I'M JUST BRIEFLY WHEN
YOU WERE SHOWING THE YOU KNOW
THE RATES OF MENTAL ILLNESS
BETWEEN ADULTS AND CHILDREN IT
WAS KIND OF STARK IN LEE --
INTERESTING HOW HIGH THE RATES
ARE IN THE CHILDREN THAT ARE OF
OF COMING --
DOES THAT INCLUDE THE SEPT
FIGURE INCLUDE --
AUTISM SPECTRUM AS WELL DESIGN
INCLUDED IN THE MENTAL ILLNESS
PORTION OR I SHOULD CHECK THAT
TO BE ABSOLUTELY SURE I DON'T
THINK IT DOES I THINK THAT
DEFINITION DOES NOT INCLUDE
AUTISM ALTHOUGH THERE MAY BE
SOME OVERLAP BUT I WILL CHECK
AND GET BACK TO THEM.
MINE I'M ARE THERE OTHER THAN I
ALSO -- I
KNOW IN THE LAST YEAR SO WE'VE
LOOKED INTO YOU KNOW THE
ACQUIRED STRESS OF YOU KNOW
CHILDREN NOW GROWING UP --
FORGET THE ACRONYM THAT SEES
FOUR ACES YES YEAH --
I WOULD ASSUME.
THAT THAT'S IN A ONE OF THE
REASONS WHY I MEAN TO THE AS FAR
AS THE THE DATA --
HAVE THE BROKEN IT DOWN YOU KNOW
TO MAYBE THAT'S WHY SOME OF THE
REGIONS ARE THAT WAY I DON'T
KNOW BECAUSE IT LOOKS LIKE SOME
OF THE URBAN CITIES ACTUALLY
DOING BETTER THAN THE RURAL.
YEAH THE DATA THAT WE HAVE --
COME FROM SORT OF A GOOD A
COMPLEX ANALYSIS DONE BY CHARLES
HOLZER AND LONG NGUYEN IS THE
SAME DATE OF ITS STATE IS USED
IN THE PAST THEY DON'T ACTUALLY
ALLOW FOR THAT KIND OF A
RELATIONSHIP SO I HESITATE TO
EXACTLY ON ON THE Y. FOR IT --
BUT IT'S TRUE THERE IS
SIGNIFICANT VARIATION --
CERTAINLY BY INCOME AND I THINK
THAT.
IT'S NOT NOT A LOGICAL TO ASSUME
THAT THAT'S IN SOME WAYS RELATED --
TO TO THE STRESSES OF POVERTY.
OKAY AND THEN JUST LAST REALLY
QUICKLY --
BECAUSE WHEN WE LOOK AT THE
COSTS THE OVERALL COST OF THE
THE PUBLIC YOU KNOW MONIES AND
AND THE THE COST OF THE
TREATMENT FOR MENTAL HEALTH.
WE KNOW THAT THEY WOULD NEED TO
BE THE WRAPAROUND SERVICES AND
PEOPLE NEED TO STAY IN THEIR
TREATMENTS --
WOULD THE EXTRA COSTS LIKE.
THE IT THE S. U. D. TREATMENTS
OR ANYTHING TO DO WITH PHYSICAL
HEALTH OR SOCIAL BESIDES THE
PSYCHIATRIC MENTAL HEALTH WOULD
THAT BE ADDITIONAL COSTS ON TOP.
OF THE COSTS THAT WAS SHOWN OR
IS THAT INCLUDED IN THAT.
AS OF RIGHT IS THIS IN THE MEDI
CAL DATA OR IN THAT GLOBAL DATA
IN THE GLOBAL.
THE GLOBAL DATA REALLY JUST
BREAKS DOWN THE OVERALL HEALTH
SPENDING AND MENTAL HEALTH
SPENDING BY SOURCES BUT IT'S
VERY HIGH LEVELS SO --
I THINK THERE'S I I DON'T
CONSIDER TO BE EXTREMELY PRECISE
BUT IT DOESN'T INCLUDE SUBSTANCE
USE DISORDER TREATMENT.
INFORMATION ON SO THAT WOULD BE.
IF YOU ADDED THAT IN IT WOULD BE
MORE THAN THE 6% OF HELL OVER OF
OVERALL HEALTH CARE SPENDING
THANK YOU IT DOES HIGHLIGHT THE
ENORMOUS --
OBSTACLES THAT WE HAVE TO DEAL
WITH IN THIS ISSUE SO THANK YOU
[inaudible]
SHE THANK YOU THANK YOU SO MUCH
FOR YOUR PRESENTATION --
FEW QUESTIONS HAVE FIRST OF ALL
IN TERMS OF WHEN YOU LOOK AT THE
PREVALENCE DATA --
FOR EXAMPLE YOU'RE LOOKING AT
ADULTS SPIED RECENT DATA SOURCE
FOR US I HAVE A CHANCE TO GO
BACK AND LOOK AT THE ORIGINAL
SOURCE BUT FOR EXAMPLE WE KNOW
THERE'S TREMENDOUS STIGMA --
NON THE GENERAL POPULATION BUT
FOR EXAMPLE THE API COMMUNITY SO
I DON'T KNOW TO WHAT DEGREE THE
LOW LEVEL OF ADULTS WITH MENTAL
ILLNESS AND AMONG ASIANS AND
PACIFIC ISLANDERS SO LOW IS THAT
ACTUALLY REALITY OR IS THAT
BECAUSE THAT'S WHAT PEOPLE
REPORTING ARE NOT REPORTING --
SO I DON'T KNOW IF YOU CAN
COMMENT ON THAT.
YEAH I CAN COMMENT ON A TWO
POINT OF OBVIOUSLY WE'VE HAD THE
SAME QUESTION THE THAT I CAN
SHARE WITH YOU --
SEPARATELY A DETAILED
DESCRIPTION OF THE OF THE
METHODOLOGY FOR THESE --
RATES THEY'RE BASED ON A SOCIO
DEMOGRAPHIC RISK MODEL SO
THEY'RE NOT SELF REPORT OR
SURVEY SO THEY PROBABLY DON'T
LIKE THEY DON'T --
THEY ARE AFFECTED.
BY IMMEDIATE STIGMA OF PEOPLE
NOT DISCLOSING A SURVEY FOR
INSTANCE.
BUT I AM.
I IMAGINE THEY ARE THEY THE
UNDERLYING MODEL IS BASED TO
SOME YES SO --
I DON'T WANT TO SPECULATE ON
EXACTLY HOW THAT BY A SHOWS UP
BUT OKAY WE KNOW THAT WE KNOW
THAT STIGMA DOES AFFECT.
IN GENERAL IS A CHALLENGE IN
GETTING TRUE REPORTS BOTH IN
SELF REPORTED DATA.
AND IN --
THESE DEMOGRAPHIC MORRIS WELL
AND ALSO I MEAN IT'S NOTJUST
SELF REPORT IT'S IF YOU'RE
BASING ON ARE YOU SEEKING
SERVICES.
AND ALL THAT FACTORS IN RIGHT
NOW.
I KNOW THAT PEOPLE DON'T EVEN
SEE SERVICES BECAUSE THEY DON'T
WANT TO ADMIT THAT THAT'S GOING
ON A FAMILY MEMBERS WILL
PRESSURE THEM NOT --
TO THE OTHER QUESTION I GUESS
AND I KNOW THAT --
SUMMER WALDRON BROUGHT THIS UP
AND AND TERMS OF THIS TRANSITION
FROM CHILDREN BEING AROUND 7%
AND AND ADULTS --
YEAH I'D BE INTERESTED IN
KNOWING HOW MUCH --
HOW MANY LIKE DEVELOPMENTAL
ISSUES GET CAUGHT UP AT IN WHEN
YOU SAY BECAUSE --
IN THAT DEFINITION ABOUT --
THEIR EMOTIONAL --
BECAUSE WHAT WHAT'S THAT GETS UP
BECAUSE WE KNOW FOR EXAMPLE --
SOME OF THE MORE I GUESS WELL
RECOGNIZED --
MENTAL HEALTH.
ISSUES LIKE SCHIZOPHRENIA SO FOR
ACTUALLY IN ADOLESCENCE SO WHEN
4% THE QUESTION IS IS THAT
WHAT'S REALLY GOING ON IN THAT
TRADITION WHY IS WIRED ADULTS
ACTUALLY LOWER THAN.
KIDS WHEN WE ACTUALLY KNOW A LOT
OF MENTAL ILLNESSES.
ACTUALLY COME AND ADOLESCENCE OR
YOUNG ADULTHOOD SO.
THAT SEEMS LOW COUNTER INTUITIVE
AND I THINK IT MAY HAVE TO DO
WITH DEFINITIONS.
I THINK IT DOES HAVE TO DO WITH
DEFINITIONS AND AND IS SERIOUS
EMOTIONAL DISTURBANCE AND
SERIOUS MENTAL ILLNESS IN ADULTS
ARE NOT THE SAME I MEAN THESE
ARE.
THESE ARE DIFFERENT DEFINITIONS --
IN THE IN THE DSM --
I WOULD OFFER A MINUTE.
I I THINK MY COLLEAGUES FROM THE
COUNTIES MAY BE ABLE TO SPEAK --
WELL TO HOW THAT TRANSIT I SEE A
AND ADULTS BUT KNOW YOUR POINT
IS WELL TAKEN OBVIOUSLY THAT.
THERE ARE A LOT OF SERIOUS
MENTAL ILLNESS DOES DEVELOP AS
PEOPLE GET OLDER SO YOU WOULDN'T
NECESSARILY.
IF THE DEFINITIONS WERE THE SAME
YOU WOULD NOT EXPECT TO SEE THAT
DROP OFF BUT THEY ARE DIFFERENT
DEFINITIONS.
FOR OKAY --
THE OTHER QUESTION TERMS A
SUICIDE RATES --
I SEND IS THAT COMPLETED SUICIDE
DIVERSES SUICIDALITY BECAUSE ONE
COULD ARGUE THAT --
FOR EXAMPLE NO RATES OF
DEPRESSION ARE HIGHER AMONG
WOMEN BUT MEN MAY USE MORE
VIOLENT MEANS OF ATTEMPTING
SUICIDE THEREFORE MORE LIKELY TO
COMPLETE IT AND I DON'T KNOW IF
THAT'S PERHAPS PART OF THE
REASON WE SEE SOME OF THE
VARIATION AND ALSO I DON'T KNOW
IF THAT HAS.
ANYTHING TO DO ALSO WITH THE
REGIONAL VARIATION AS WELL IF IT
LOOKING AT SO IT OUTSIDE RATE IS
IT IT IS IT'S WHAT SUICIDALITY
COMPARED TO COMPLETION OF
SUICIDE.
YEAH THOSE THOSE TWO SLIDES THAT
SHOWED SUICIDE RATES BY REGION
AND BY GENDER AND ETHNICITY WORK
COMPLETED SUICIDE SUICIDALITY
YOU'RE EXACTLY RIGHT.
IS IT IS A DIFFERENT THING A
BIGGER AND IT DOES HAVE THOSE --
THOSE DIFFERENTIALS IN TERMS OF
GENDER SO --
PARTICULARLY TEENAGERS GIRLS
MORE LAW ASIDE BOYS MORE LIKELY
TO COMPLETE CITIES.
OKAY.
WE CAN WE WON'T GET INTO MEANS
WE CAN.
ENGAGE IN TO TRY TO REDUCE
ACTION COMPLETION.
AS WELL AS PREVENTION OF
SUICIDALITY AND FINALLY --
IN TERMS OF THE FUNDING --
FOR EXAMPLE FOR MENTAL HEALTH I
MADE REFERENCE MY INTRODUCTION
MARX IS THIS INCLUDE FOR EXAMPLE --
THE RESOURCES USED.
BY CRIMINAL JUSTICE SO WE TALK
ABOUT THE FACT THAT OUR JAILS
ARE OFTEN ARE MAJOR MENTAL
HEALTH PROVIDERS COURSE PEOPLE
WONDER INCARCERATED DON'T GET
MEDI CAL --
REINCORPORATE IN THAT SPENDING
AS WELL INTO THIS GRAPH OR IS
THIS MAINLY LOOKING AT
REIMBURSEMENT --
FOR SERVICES AND COMMUNITY.
YET THE THE VERY HIGH LEVEL --
NATIONAL CHARTS THAT JUST SHOW
THE OVERALL HEALTH SPENDING
BUDGET THE OVERALL MENTAL HEALTH
SPENDING BUDGET ARE REALLY
PULLED FROM THE HEALTH CARE
SYSTEM SO WOULD NOT INCLUDE
OTHER.
OTHER SOURCES THAT MIGHT BE
SPENDING ON ON MENTAL HEALTH
SERVICES OUTSIDE JUST MAKE NOTE
THAT PUBLIC SPEND ON MENTAL
HEALTH IS MUCH LARGER THAN WE
MAY BE SEEING HERE MAYBE WE
SHOULD TRY TO FIGURE THAT OUT
THAT CERTAINLY I KNOW.
OUR CRIMINAL JUSTICE SYSTEM
SPENDS A LOT OF NOT ONLY EFFORT
OF MENTAL HEALTH ACTUALLY
PROVIDING MENTAL HEALTH IN OUR
PRISONS AND JAILS AND SO.
MAYBE WE SHOULD AS WE THINK
ABOUT WATER APPROACHES ARE AND
WHAT MUCH WERE.
CURRENTLY SPENDING HOW MUCH WE
SHOULD BE SPENDING WE SHOULD BE
THINKING ABOUT HOW MUCH WE'RE
CURRENTLY SPENDING NOW THANK YOU
[inaudible]
IT'S COUPLE QUESTIONS IN
PERSONAL THINK AGAIN THANK YOU
AGAIN FOR YOUR OF YOUR REPORT
IT'S VERY VERY INTERESTING AND
BUT ALSO VERY SOBERING IN MANY
WAYS AND ONE OF THE THINGS THAT --
JUMPS OUT AT ME REPRESENTING A
BIG PART OR CALIFORNIA AS THE
HIGH NUMBER OF SUICIDE THAT HIGH
SUICIDE RATE THERE --
AND THEY'RE TO THOSE DID THOSE
VERY BY AGE CHUBBY OBVIOUSLY BE
SAW IN EUROPE IN THE SUBSEQUENT
CHARTER SAW --
YOU KNOW ETHNICITY AND BUT WE
DIDN'T.
DO THEY ARE YOU SEEN. FOR
EXAMPLE THE MAN WHO.
YEAH.
COMMIT SUICIDE.
IS THERE AN EIGHT WE HAVE AGE
DATE ON THAT AND AND WHAT WHAT
WE SEEN WHAT WOULD YOU HAVE
ANYTHING TO ACCOUNT FOR THIS
BECAUSE IT IS.
IT IS TWICE THE STATE AVERAGE
YEAH -- THE
DATA THAT WE HAVE IN THOSE DATA
ARE AND I'M JUST GONNA CHECK
FROM THE OF SUBSTANCE ABUSE
MENTAL HEALTH SERVICES
ADMINISTRATION I BELIEVE BUT I
WANT TO DO A QUICK CHECK ON THAT --
IBM THE COME BACK AND CHECK ON
THAT -- WE
DO SEE VARIATION BY AGE WE DO
NOT HAVE DATA THAT CROSS
REFERENCES --
THAT THE DOES ACROSS THE REGION
IN AGE FOR INSTANCE OR REGION
AND GENDER SO I'M NOT SURE I CAN
DIG DOWN TOO MUCH FURTHER WE CAN
CERTAINLY LOOK INTO THAT --
AND SEE WHAT ELSE WE CAN WHAT
OTHER DATA WE CAN PULL THAT
GIVES MORE OF A MORE OF A
PICTURE FOR THE NORTHERN SIERRA
REGION IN PARTICULAR.
I GUESS --
LIKE I DID DID YOU BEGIN TO
WONDER I THINK WE STRUGGLE IN
NORTHERN CALIFORNIA WITH
PROVIDERS --
IN GENERAL --
AND I LOOK AT YOUR DATA IN
GENERAL THE FOR IT ENJOY A CROP
ROUGHLY A THIRD OF THE PEOPLE
WHO WHO.
ARE UP THERE RECOGNIZES NEEDING
CARE OR GETTING AT I DO WONDER
HOW THAT RICK HOW THAT.
RATE GOES FOR OTHER PARTS OF THE
STATE OF I KNOW FROM MY AND OUR
PERSONAL EXPERIENCE IN THE NORTH
THE NORTH PART OF STATE IT'S
IT'S HARD GETTING PROVIDERS IT'S
A REAL CHALLENGE SO --
YOU BASED A LOT OF DATA WAS
BASED ON TWO THOUSAND FOURTEEN
FIFTEEN NUMBERS.
ANY IDEA WHAT WHAT THE TRENDS
ARE WITHOUT.
YOU KNOW WITHOUT GOING TOO FAR
OUT ON A LIMB --
WHERE WHERE DO YOU SEE SOME OF
THE TRENDS GOING?
I THINK.
BECAUSE BASED ON WHAT WE'VE SEEN
IN PAST VERSIONS OF THIS I THINK
THE OVERALL PREVALENCE OF
ILLNESS I THINK IS PRETTY STATIC
AND AGAIN.
I DON'T THINK THAT'S SURPRISING
IS -- MENTAL
ILLNESS IS A MAJOR CHRONIC
ILLNESS HAS ALWAYS BEEN WITH US
AND I DON'T EXPECT THAT IT IS IT
IT.
IS THAT IT WILL GO AWAY NOR --
SHOULD THAT BE OUR GOAL --
I DO THINK THAT WE SHOULD I HOPE --
WITH THE EXPANSION OF MEDICARE
ALL AND GIVING PEOPLE MORE
ACCESS TO SERVICES.
I WOULD EXPECT TO SEE AND HOPE
TO SEE INCREASED RATES OF
TREATMENT INCREASED RATES OF
ACCESS TO CARE FOR PEOPLE BUT I
THINK THAT REMAINS TO BE SEEN.
AND I THINK THAT'S A MY
COLLEAGUES TO FOLLOW UP ON
ADDITIONAL PANELS WILL MAY HAVE
MORE OF RECENT DATA FROM THE
MEDICARE PROGRAM IN PARTICULAR.
I KNOW THAT THE CALIFORNIA
HEALTH CARE FOUNDATIONS
WORKFORCE COMMISSION.
TALKED ABOUT --
IT HAD A WHOLE A GROUP THE
SUBGROUP WORKING ON ON THE
MENTAL HEALTH ISSUES AND
BEHAVIORAL HEALTH.
IN THE WORK FORCE PERSPECTIVE
AND THERE THERE IS A SIGNIFICANT
SHORTAGE OF OF A PROVIDERS AND
SO PART OF THE STRATEGY IS
OBVIOUSLY TO GET MORE PROVIDERS
AND IN THE COMMUNITIES.
YEAH THERE'S NO QUESTION OTHER
WASN'T WASN'T TIME TODAY TO ADD
IN THE WHOLE WORKFORCE PEACE BUT
I I APPRECIATE THAT YOU RAISE IT
BECAUSE IT IS.
A VERY REAL CHALLENGE ACROSS THE
STATE --
PARTICULARLY IN RURAL AREAS --
WHERE VERY VERY DIFFICULT TO
MATCH PEOPLE --
TO AN ADEQUATE NUMBER PROVIDERS
IN THE MENTAL HEALTH ARENA
SUBSTANCE USE DISORDER AS WELL.
IT'S A REALLY IT REALLY IS A A
BIG CHALLENGE FOR THE STATE.
WELL THANK YOU VERY MUCH IT IS
ARE THERE ANY OTHER QUESTIONS.
OKAY.
C. NOT APPRECIATED THANK YOU
VERY MUCH.
WHO HAD TO BRING UP OUR SECOND
PANEL --
JENNIFER AND AND DID FOR CAN AND
AMY MILLER SO WE WILL THIS PANEL
WILL PROVIDE AN OVERVIEW OF
MEDIC --
MEDI CAL MENTAL HEALTH CARE
DELIVERY SYSTEM THE BENEFITS
THAT ARE PROVIDED AND HOW CARE
IS DELIVERED.
OUR TWO SPEAKERS --
JENNIFER CAN'T --
DIRECTOR OF THE DEPARTMENT
HEALTHCARE SERVICES IN AMY
MILLER WHO WAS BEHAVIORAL HEALTH
DIRECTOR OF MONTEREY COUNTY --
WHENEVER YOU'RE READY
[inaudible]
DIRECTOR CAN.
I SEE SLIDES COMING UP I'M JUST
KIDDING AS I TRAVEL LATELY I
DON'T BRING SLIDES --
SO GOOD AFTERNOON JENNIFER CAN --
DIRECTOR FOR THE DEPARTMENT OF
HEALTH CARE SERVICES --
FOR THOSE THAT ARE --
AND FAMILIAR WITH OUR DEPARTMENT --
IN THE HIGHEST --
OVERVIEW I LIKE SIX DELIVERY
SYSTEM SO TODAY WERE OBVIOUSLY --
LOOKING MORE CLOSELY AT THE
MENTAL HEALTH DELIVERY SYSTEM
THAT WE ADMINISTER AS A STATE
DEPARTMENT BUT WE HAVE FEE FOR
SERVICE MANAGE CARE MENTAL
HEALTH SUBSTANCE USE DELIVERY
AND THAT BREAKS DOWN AND TO THE
COUNTIES THAT ARE DOING AN
ORGANIZED DELIVERY SYSTEM VERSUS --
COUNTIES THAT ARE STILL IN A
STATE PLAN STD MODEL --
CALIFORNIA CHILDREN'S SERVICES
PROGRAM AND THEN DENTAL SO WHEN
YOU TALK ABOUT THE BROAD
SPECTRUM OF SERVICES THAT ARE
AVAILABLE TO BENEFICIARIES
THROUGH THE MEDICAL PROGRAM IN
CALIFORNIA WHICH CURRENTLY
STANDS AT ABOUT THIRTEEN POINT
TWO MILLION.
BENEFICIARIES --
THEY CAN TOUCH ONE IF NOT ALL
SIX OF THE DELIVERY SYSTEMS
INCLUDING OTHERS THAT ARE
OUTSIDE OF OUR DEPARTMENT
DIRECTLY SUCH AS I JUST US OR
THE DEVELOPMENTAL CENTERS
THROUGH --
DDS.
SO WHEN WE TALK ABOUT --
MENTAL HEALTH IN PARTICULAR
THERE ARE SOME FUNDAMENTAL --
ITEMS THAT KIND OF BOTH GUIDE
OUR WORK AS WELL AS KIND OF SET
THE FOUNDATIONAL --
ASPECTS OF THE PROGRAM IN TERMS
OF FINANCING IN OVERSIGHT SO WE
OPERATE --
ARE COUNTY MENTAL HEALTH
PROGRAMS THROUGH AND NINETEEN
FIFTEEN BE WAIVER THIS IS A
WAIVER THAT IS ALLOWED. TO US
THROUGH THE FEDERAL GOVERNMENT
AND ESSENTIALLY AND SHORTHAND
FORM IT ALLOWS FOR THE COUNTIES
TO OPERATE A COUNTY ORGANIZED
SYSTEM FOR MENTAL HEALTH FOR
SPECIALTY MENTAL HEALTH SERVICES.
AND IN DOING SO THEY'RE ALLOWED
TO CONTRACT WITH --
TO RECIPIENT COUNTY CONTRACTED
NETWORK --
AS OPPOSED TO HAVING BASICALLY
IT ANY ACCESS AS A AS IS
TRADITIONALLY ALLOWED UNDER MEDI
CAL -- ARE
MANAGED CARE PROGRAM SO OUR
MEDICAL MANAGED CARE PROGRAM
WHICH IS TWENTY FOUR CONTRACTING
PLANS --
THEY OPERATE THROUGH AN ELEVEN
FIFTEEN WAIVER AUTHORITY AND SO
WHAT YOU SAW IT IN TWENTY
FOURTEEN WITH THE IMPLEMENTATION
OF THE AFFORDABLE CARE ACT.
ARE COUNTY MENTAL HEALTH PLANS
HAVE BEEN DELIVERING SPECIAL TO
MENTAL HEALTH SERVICES FOR BOTH
PEDIATRIC IN A BOOK DON'T
POPULATION SINCE THE MID
NINETIES --
WHEN WE ALLOWED FOR THE --
ESSENTIAL HEALTH BENEFITS AND
THE INCREASED --
CAPACITY FOR BENEFICIARIES TO
HAVE MILD TO MODERATE BEHAVIORAL
HEALTH SERVICES WE ALLOWED FOR
THE TWENTY FOUR CONTRACTING
MANAGED CARE PLANS TO OFFER THE
COURT I SAID QUOTE UNQUOTE MILD
TO MODERATE BENEFIT BECAUSE I
THINK WE WOULD ALL ARGUE THAT.
IT'S NOT NECESSARILY THAT EASY
TO IDENTIFY SOMEONE WITH A MILE
BEHAVIORAL HEALTH ISSUE AS
OPPOSED TO A MODERATE AND THEN
ONCE YOU GO FROM MODERATE.
TO SERIOUS IT ACTUALLY IS --
REALLY HAS HALF AS WE HAVE
TWENTY FOUR MANAGED CARE PLANS
THAT PROVIDE THE BULK OF MEDICAL
SERVICES TO ABOUT ELEVEN MILLION
BENEFICIARIES IN THE STATE.
AND THEY INTERACT WITH THE
COUNTY MENTAL HEALTH PLANS OF
WHICH THERE'S FIFTY SIX NOT --
FIFTY EIGHT I'LL LET YOU GUESS
WHICH COUNTIES HAVE CONSOLIDATED
PLANS BUT THERE'S ONLY FIFTY SIX
OF THEM --
AND THERE ARE MEMORANDUMS OF
UNDERSTANDING SO THAT YOU WILL
HAVE A RECIPIENT PERHAPS WITH A
SERIOUS MENTAL ILLNESS --
SUCH AS SCHIZOPHRENIA --
AND I WILL USE THE COUNTY OF
MONTEREY AS AN EXAMPLE --
IF YOU HAVE SOMEONE WITH
SCHIZOPHRENIA AND MONTEREY THEY
THE COUNTY WILL BE PROVIDING THE
SPECIAL TO MENTAL HEALTH
SERVICES FOR THAT BENEFICIARY
BUT THE REST OF THE CARE WILL BE
PROVIDED THROUGH CENTRAL
CALIFORNIA ALLIANCE FOR HEALTH
WHICH HAS THE RESPONSIBILITY FOR
THEIR OVERALL PHYSICAL HEALTH
AND SO.
THE COUNTY AND THE PLAN HAVE TO
WORK TOGETHER TO COORDINATE THAT
CARE -- AND
THEN.
ALL OF THIS IS FINANCED THROUGH
AND I KNOW THAT THE AGENDA --
TALKS ABOUT IT A LITTE BIT AND
I KNOW THAT THE ELIA WILL SPEAK
TO THIS IN THE SECOND PANEL OR
THE NEXT PANEL --
THERE ARE A VARIETY OF FUN
SOURCES THAT HELP GUIDE THIS
WORK THAT IS DELIVERED BETWEEN
BOTH THE MANAGED CARE PLANS AND
THE COUNTY MENTAL HEALTH PLANS.
THERE ARE --
TWO KINDS OF REALIGNMENTS FUN
FUNDS THERE ARE --
THERE THEN THERE'S OTHER COUNTY
GENERAL FUND --
I LIKE TO SAY THAT COUNTIES --
WHEN SERVING THESE --
BENEFICIARIES THEY CAN USE WHAT
WE CALL BRAIDED FUNDING WHICH
MEANS YOU CAN HAVE.
YOU CAN BILL MEDI CAL FOR
CERTAIN SERVICES THAT ARE
AUTHORIZED UNDER THE NINETEEN
FIFTEEN WAIVER ANNA AND COVERED
UNDER THE STATE PLAN THEN
THERE'S OTHER SERVICES THAT YOU
MAY WANT TO PROVIDED THAT
BENEFICIARY.
IN WHICH THEY CAN USE MENTAL
HEALTH SERVICES ACT FUNDING
WHICH IS MORE FUNGIBLE AND MORE
FLEXIBLE YOU CAN USE BLOCK GRANT
FUNDING YOU CAN USE COUNTY
REALIGNMENT DOLLARS IF THE
PERSON STAINED AND INSTITUTE FOR
MENTAL DISEASE AND THOSE ARE NOT.
CAPABLE THERE'S A LOT OF
COMPLEXITY --
I CANNOT STRESS ENOUGH THAT THIS
IS PROBABLY ONE OF THE MOST
COMPLEX AREAS OF OUR PROGRAM
THAT WE ADMINISTER BETWEEN US
AND THE COUNTIES --
SO THE OVERSIGHT --
THE MECHANICS THE FINANCING THE
CLAIMING --
IS SOMETHING THAT WE DO IN
PARTNERSHIP WITH THE COUNTIES
AND THEN --
VICE VERSA --
WE ALSO WORK VERY CLOSELY WITH
THE MANAGED CARE WATER IT --
TO ALSO BIG POPULATION RULES
THAT I WOULD --
REMIND THIS COMMITTEE OF THERE
IS A DIFFERENCE BETWEEN THE
PEDIATRIC POPULATION AND THE
ADULT POPULATION AS IT PERTAINS
TO SPECIALTY MENTAL HEALTH
SERVICES.
SO UNDER ON THE AGENDA WHICH IS --
DOES A REALLY NICE JOB OF TRYING
TO BREAK IT OUT --
IT PRETTY SIMPLISTIC MANNER IN
TERMS OF THE SPECIFIC DISEASES
THAT ARE CATEGORIZED AS MEETING
THE DEFINITION OF SPECIAL TO
MENTAL HEALTH SERVICES. FOR
CHILDREN UNDER THE AGE OF TWENTY
ONE DO TWO EPS D. T. THESE.
AND THE SCOPE OF WHAT CAN BE
PROVIDED TO THAT INDIVIDUAL IS
MUCH BROADER THE STANDARDS ARE
MUCH MORE FLEXIBLE IN ORDER TO
DELIVER THOSE SERVICES AND THEN
ONE AN INDIVIDUAL.
BECOMES AN ADULT AT THE AGE OF
TWENTY ONE THE CRITERIA FOR BOTH
THE SERVICES PROVIDED AS WELL AS
THE FLEXIBILITY CHANGES --
FAIRLY DRAMATICALLY AND SO I
WOULD --
ARGUE THAT THAT IS ALSO A VERY
SIGNIFICANT DISTINCTION FOR
INDIVIDUALS LIKE IF WE WERE
TALKING ABOUT SOMEONE THAT WAS.
RECENTLY DIAGNOSED WITH
SCHIZOPHRENIA AND WE WERE
WHISPERING --
ON THE PREVIOUS PANEL IN TERMS
OF THAT WHEN AN INDIVIDUAL FIRST
HAS -- AS A
SCHIZOPHRENIC --
BEHAVIOR PATTERN --
EPISODE IS USUALLY AROUND THE
AGE OF EIGHTEEN OR NINETEEN
IRONICALLY AND IN SOME CASES --
TRAGICALLY THAT IS KIND OF AT
THE END OF YOUR ABILITY TO
RECEIVE SERVICES UNDER THE EPS
D. T. TYPE OF SCHEME AS OPPOSED
TO GOING INTO AN ADULT SO --
I'M HAPPY --
TO ANSWER MORE QUESTIONS AND
THEN THE ONLY THING THAT I WOULD
LIKE TO KIND OF STRESS TO IN
TERMS OF DATA AND I KNOW THAT --
WE PROVIDED THIS TO THE
COMMITTEE AND ARE CERTAINLY
HAPPY TO FOLLOW UP AS WELL IS
THAT SINCE WE INSTITUTED THE
MILD TO MODERATE BENEFIT AND THE
MANAGED CARE PLANS WE HAVE BEEN
TRACKING THE UTILIZATION ACROSS
THE PLANS --
AND HAVE SEEN SOME PRETTY
SIGNIFICANT INCREASES IN BOTH
YOUTH AND ADULT --
TAKE UP RATES AND SO WHEN YOU
TALK ABOUT --
KIDS UNDER THE AGE OF TWENTY ONE
GETTING CARE THROUGH THE MEDICAL
MANAGED CARE --
BENEFIT WE STARTED IN THE FIRST
YEAR TWENTY THIRTEEN FOURTEEN
WITH ONLY TWELVE THOUSAND NINE
HUNDRED AND FIFTY SIX CHILDREN --
THAT HAS GROWN TO THE LAST YEAR
AND SEVENTY THREE THOUSAND
CHILDREN.
ON THE ADULT SIDE IT STARTED
AROUND THIRTY TWO THOUSAND
INDIVIDUALS USING THE MILD TO
MODERATE BENEFIT AND NOW WE'RE
OVER A HUNDRED AND TWO HUNDRED
AND EIGHTY SEVEN THOUSAND SO IN
THE COURSE OF THE YEARS SINCE WE
HAVE IMPLEMENTED THE AFFORDABLE
CARE ACT AND INSTITUTED THAT
BENEFIT --
WE HAVE SEEN A GROWING AMOUNT OF
UTILIZATION OF THOSE SERVICES
WHICH WE THINK IS ACTUALLY --
A VERY SIGNIFICANT POSITIVE
BENEFIT THE INDIVIDUALS THAT ARE
RECEIVING CARE THROUGH THE SHORT
DOYLE SYSTEM WHICH IS THE COUNTY
MENTAL HEALTH --
SYSTEM HAS REMAINED FAIRLY
STEADY AND STATIC AND SO THAT
CERTAINLY SUPPORTS THE DATA
REFERENCE BY C. H. C. F..
BUT WHAT HAS BEEN INTERESTING IS
THAT INDIVIDUALS ARE GETTING
SERVICES IN BOTH AREAS SO THERE
IS A SMALL AND GROWING NUMBER OF
POPULATION THAT IS NOT ONLY
GETTING SERVICES AND THE SPECIAL
TO MENTAL HEALTH.
AREA BUT THEY'RE ALSO GETTING
CARE FROM THEM MANAGED CARE PLAN
SO THEY'RE ACTUALLY USING BOTH
SIDES OF THE BEHAVIORAL HEALTH
SYSTEM WHICH WE ALSO THINK IS
BOTH ENCOURAGING AND POSITIVE.
SO WITH THAT I WILL STOP AND
HAPPILY US INTO QUESTIONS.
QUESTIONS UNTIL THE END PANEL
OKAY THANKS PLEASE DOCTOR.
SO I'M AMY MILLER THE DIRECTOR
BEAVER HEALTH MONTEREY COUNTY
AND THE PRESIDENT ELECT OF CV
HDA.
SO THANK YOU FOR TAKING TIME TO
TRY TO EXPLAIN WHAT IS A VERY
VERY COMPLEX SERVICE DELIVERY
SYSTEM AND I THINK I WANT TO SAY
BEFORE I START TALKING ABOUT ALL
OF OUR COMPLEXITY I THINK THE
FUTURE LOOKS VERY BRIGHT.
YOU KNOW PARTNERING WITH DH CS
TO LOOK AT SOME SIGNIFICANT
CHANGES TO OUR WAIVER AND REDUCE
THIS COMPLEXITY.
SO WE CAN YOU KNOW BETTER SERVE
THE BENEFITS AND FUNDING NOT
NECESSARILY GO UP.
SOME OF THIS IS ALREADY IT SAID
BUT BEHAVIORAL HEALTH SYSTEMS
OVERALL WORK CARVE OUT SO WE'RE
CONSIDERED A PREPAID INPATIENT
HEALTH PLAN.
OUR FIRST OBLIGATION IS COVERING
ALL IN PATIENT COSTS --
SO WE OPERATE A NETWORK OF
PROVIDERS YOU GUYS ARE ASKING
SOME QUESTIONS ABOUT NETWORK
ADEQUACY AND CERTAINLY WE SEE --
IN MORE URBAN COUNTIES WE SEE A
LOT OF PEOPLE WORKING WITH
CONTRACTED PROVIDERS THAT THAT
REALLY THRIVE BUT IN RURAL
COUNTIES.
MANY OF THE COUNTY SYSTEMS ARE
YOU KNOW SOLELY COUNTY STAFF
MEMBERS PROVIDING THOSE SERVICES.
SO THERE IS QUITE A BIT OF
DIVERSITY IN THE STATE IN ORDER
TO RESPONSE TO THE DIFFERENT
GEOGRAPHY.
THIS IS THAT REALLY IMPORTANT
GRAPHICS SO DIRECTOR CAN'T
ALREADY TALKED ABOUT THIS BUT
OUR WORLD IS KIND OF COMPLICATED
BECAUSE WE'RE SORT OF A SPECTRUM
MENTAL HEALTH SERVICES.
SO COUNTIES HAVE YOU KNOW THE
PURPLE IN THE LIGHT I MEAN
EXCUSE ME THE ORANGE IN THE
LIGHTER ORANGE WITH --
THE MODERATE AND SEVERE MENTAL
ILLNESS SO YOU'RE FAMILIAR WITH
THOSE DISORDERS VERY VERY SEVERE
DEPRESSION BIPOLAR SCHIZOPHRENIA.
WE DO NOT HAVE THE MILD MODERATE --
BUT BEHAVIOR HEALTH IS KIND OF
CONFUSING BECAUSE I THINK WE'RE
STILL STRUGGLING TO SAY WHAT IS
MILD MODERATE VERSUS SEVERE YOU
KNOW IT'S NOT LIKE AN A. ONE C.
SCORE YOU GET AN EXACT NUMBER.
AND YOU CAN SAY THAT PERSON'S
ALWAYS GOING TO BE EXACTLY THIS
WAY WE SEE A LOT OF MOVEMENT
WITH BENEFICIARIES THEIR NEEDS
CHANGING.
AND CERTAINLY IF WE'RE NOT ABLE
TO SERVE THEM WELL CONTINUE ON
WE SEE PEOPLE BECOMING MORE
SEVERE.
AND UTILIZING CRISIS SERVICES
WHICH IS NOT WHERE WE WANT TO
SEE PEOPLE WE WANT TO COMING
INTO OUR OPEN ACCESS STORES.
YOUR CLINICS ARE SCHOOL BASED
PROGRAMS NOT TO EMERGENCY ROOMS
ARE INTERACTING WITH LAW
ENFORCEMENT.
ALSO COUNTIES --
HAD PREVENTION FUNDS THROUGH AND
WE JUST SAY DOLLARS THAT PROVIDE
QUITE A BIT A ROBUST PROGRAMMING.
THIS IS MY ONE OF MY BEST
EFFORTS TO DESCRIBE HOW
COMPLICATED OUR FUNDING IS.
SO EACH PERSON THAT WE SERVE HAS
A DIFFERENT EIGHT CODE AND EIGHT
CO DETERMINES HOW MUCH FEDERAL
FINANCING YOU'RE ABLE TO PULL
DOWN.
SO LIKE THE PERSON IN JAIL WE DO
SOME JAIL SERVICES AS YOUNG
CLINICIAN I USED TO GO TO THE
JAIL AND DO ASSESSMENTS TRY TO
HELP PEOPLE LIAISON OUT THAT
WOULD NOT BE A CLEAN MOBILE
SERVICE ABOUT BE SOMETHING THE
COUNTY WOULD DO.
IS THE RIGHT THING TO DO AND
THERE'D BE ZERO DOLLARS
ASSOCIATED WITH THAT USING
REALIGNMENT OR OTHER FUNDING
SOURCES --
BUT EACH PERSON HAS --
IF THEIR NEWLY ELIGIBLE THAT
HIGHER EIGHT CODE IF YOU'RE
UNDOCUMENTED THAT'S THE PERSON
ON THE AND THAT'S 0% SO WHEN
WE'RE SERVING AND DOCUMENTED --
WE HAVE TO DO THAT WITH OUR
REALIGNMENT FUNDING SO IT'S KIND
OF A COMPLEX RUBRIC AS A
BUSINESS PERSON THERAPIST
CONVERTED TO BUSINESS PERSON I
USED TO BE YOUNG THERAPIST NOW
RUN THE SYSTEM.
NO IT'S IT'S HERE.
WHO'S THE PERSON ON THE FAR LEFT
IS THAT THE DATA DOESN'T GIVE ME
SERVICES YEAH SO YOU KNOW IF.
SOMETIMES I MEAN ACA'S REALLY
HELPED US OUT TO THE GROWTH THAT
YOU SEEN WITH A CA BASED ON
POVERTY BUT WHEN I WAS STARTING
IN THE SYSTEM SO OFTEN YOU'D SEE
PEOPLE WHERE THE FATHER WOULD
NEVER BE ELIGIBLE FOR MEDI CAL.
YEAH SO EASY IS A BIG GAME
CHANGER FOR US SO YOU HAVE A
MOTHER ELIGIBLE BASED ON THE
FACT THAT SHE'S A MOTHER TO BE A
50% EIGHT CODE THE KID WOULD
HAVE A HIGHER AID CODE AND THE
DAD WOULD GET NOTHING.
AND THEN CLEANING FOR THOSE
FAMILY SERVICES ON OUR CURRENT
BILLING ENVIRONMENT CAN BE VERY
VERY COMPLEX --
SO YOU'LL OFTEN SEE COUNTY IS DO
THE RIGHT THING FOR THE THE
CLIENT WITHIN WHILE FOLLOWING
ALL RULES ESTABLISHED BY
JENNIFER CAM.
FOR FIND IT DIFFICULT BEING NEXT
YEAR BOX.
AND THEN ONE OF THE OTHER KEY
THINGS I WANT TO POINT OUT.
IS SO ARE FUNDING RUBRICS WE USE
ALL THESE DIFFERENT TYPES OF
FUNDING SOURCES --
TO PULL DOWN FEDERAL FUNDING.
SO -- WE
LOOK AT THE MENTAL HEALTH
SERVICES ACT WHICH IS ONE POINT
SEVEN BILLION DOLLARS.
REALIGNMENT FROM TWO THOUSAND
ELEVEN ONE POINT THREE NINETEEN
NINETY ONE REALIGNMENT ONE POINT
THREE WERE USING THOSE DIFFERENT
LOCAL SOURCES TO PULL AS MUCH
FEDERAL MONEY AS POSSIBLE SO
THAT BEHAVIORAL HEALTH DIRECTOR
IN A COUNTY WITH HIGH POVERTY
RATE.
ALMOST HALF MY POPULATIONS ON
MEDI CAL I CONSIDER ALMOST A
MORAL OBLIGATION TO POINT AS
MUCH FEDERAL FINANCING AS
POSSIBLE IN ORDER TO MAKE THE
PROGRAM SUSTAINABLE --
BECAUSE WITHOUT THAT FEDERAL
FINANCING YOU CAN'T REALLY
EXPANDED PROVIDE SERVICES WE'VE
CERTAINLY SEEN DEMANDS FOR
SERVICES INCREASE.
THE GOING BACK TO RUNNING A
WEIRD BUSINESS IN OUR WORLD
ECONOMY GOES DOWN SAR FUNDING
GOES DOWN BUT DEMAND GOES UP.
SO THAT'S THAT'S NOT BEEN FUN.
VERY VERY COMPLEX FUNDING FOR US.
WE LOOK AT WHAT WE DOING A
SPECIALTY MENTAL HEALTH SERVICES
ALREADY MATURE DOING UP.
ASSESSMENTS AND PREVENTION
SERVICES WE'RE DOING A LOT OF
COUNSELING THROUGH AND I JUST
SAY WERE DOING WHAT ARE CALLED
FULL SERVICE PARTNERSHIPS THAT
THE WHATEVER IT TAKES MODEL.
THE PROVIDES A VERY VERY
INTENSIVE SERVICE LEVEL XIN
PEOPLE MENTION SOME OF THE
MOBILE RESPONSE TEAMS IN
PARTNERSHIP WITH LAW ENFORCEMENT
OR COMMUNITY BASED --
SYMBOLS DOING ASSESSMENTS AND
EMERGENCY ROOM.
COUNTY BEHAVIOR HEALTH PLANS
COVER ALL INPATIENT PSYCHIATRIC
SERVICES AND THEN WE ALSO DO
RESIDENTIAL SERVICES SO IN MY
COUNTY I HAVE QUITE AN EXTENSIVE.
MEMBER SIDE OF BENEFICIARIES IN
STATE HOSPITALS ARE I AM D.
PLACEMENTS WERE YOU YOU'RE NOT
ABLE TO PULL IN FEDERAL FUNDING
FUNDING FOR THAT.
SUCH ALL REALIGNMENT DOLLARS
THAT'S MY VERY HIGH AND
BENEFICIARIES THEY CAN'T SAFELY
BE IN THE COMMUNITY AT A LOWER
LEVEL OF KERR.
SO IT'S A VERY EXPENSIVE SERVICE
LINE THE COUNTIES MANAGE WE
MANAGE THAT RISK --
THERE'S A BIG DIFFERENCE IN
TERMS OF WHAT'S HAPPENING FOR
CHILDREN'S I THINK THAT
COMMITTEE WAS ASKING SOME
QUESTIONS ABOUT.
YOU KNOW WHAT'S WHAT'S THE
DIFFERENCE IN TERMS OF THE
PREVALENCE RATE FOR KIDS VERSES
ADULTS.
THE SYSTEM IS MUCH MORE OPEN
RESPIRE FOR TO BE VERY OPEN FOR
CHILDREN.
SO EXAMPLE IN MY COUNTY WE
ASSESS A 100% OF FOSTER KIDS
KIDS THAT ARE BROUGHT INTO
FOSTER CARE.
YOU KNOW TO SEE IF THEY HAVE A
MENTAL ILLNESS MORE PREVENTION
PERSPECTIVES WE KNOW IF WE DELAY
ACCESS TO CARE VERY EASY FOR YOU
KNOW SYMPTOMS TO EMERGE LATER ON
IN THE KID FALL BETWEEN THE
CRACKS OF THE EPS D. T. CRITERIA.
IS PRETTY GENEROUS IN ALLOWING
US TO PROVIDE SERVICES TO THE
EXTENT THAT FUNDS ARE AVAILABLE.
NOTE BEAT TO EXTENT FUNDS ARE
AVAILABLE ASTRA --
SO IN IN OUR CHILDREN SERVICES
THERE'S A LOT OF SCHOOL BASED
MENTAL HEALTH SERVICES THERE'S
SO MUCH GOING ON AND COUNTIES
THAT YOU WOULDN'T REALLY KNOW IS
US.
SO OFTEN YOU'LL HAVE SCHOOL
BASED THERAPIST THEIR COUNTY
EMPLOYEES THAT WHERE SCHOOL
BADGES THEIR BILLING SPECIALTY
MENTAL HEALTH MEDI CAL BUT
THEY'RE REALLY TRANSPARENT TO
THE POPULATION IN TERMS OF WHO'S
FUNDING THEN WHY THEY'RE THERE.
WE ALSO DO LIKE I MENTIONED A
LOT OF PARTNERSHIP WITH SOCIAL
SERVICES --
IT A LOT OF SUPPORT FOR THE
JUVENILE JUSTICE POPULATION BOTH
PREVENTION AND YOU KNOW ENSURING
THAT THEIR SERVICES TO KIDS.
AND THEN MANY COUNTIES HAVE A
LOT OF INNOVATION TRANSITION AGE
YOU SERVICES AND SERVICES
SPECIFICALLY TO LGBT Q. YOU NEED
CAR MORE FLEXIBILITY AND WEBER
PROVIDING SERVICES --
ANY JUST A IT'S BEEN SO
ESSENTIAL FOR US THIS COUNTY IS
ONE OF THE THINGS THAT A LOT OF
US ARE RUNNING IS SORT OF
CONSUMER RUN WELLNESS CENTER SO
OPEN ACCESS CLINICS THAT'S NOT A
MEDI CAL BENEFIT THAT'S MORE
THROUGH AN HSA BUT THIS KIND OF
IS THE RUN.
DOWN OF DIFFERENT SORTS OF
SERVICES ANOTHER THING THAT YOU
MIGHT NOT KNOW THAT WE PAY --
FOR IS WE PAY FOR BOARDING CARE
PATCHES.
SO WHEN A CLIENT LIVES IN A
BOARDING CARE THAT THAT.
SO PERSONAL SEVERE MENTAL
ILLNESS THAT TAKES UP MOST OF
THEIR SS I CHECKS ON AVERAGE
CLIENT WOULD GET ABOUT TEN
DOLLARS A WEEK LEFT OVER --
THE REST IS GOING TO THE BOARD
AND CARE AND EVEN THAT IS NOT
FISCALLY SUSTAINABLE FOR BORDEN
CARES.
SO WE OFTEN PATCH ABOUT TWENTY
FIVE TO FIFTY DOLLARS A DAY JUST
SO THE BOARDING CARE CAN KIND OF
MAKE ENDS MEET SO THOSE ARE
PEOPLE THAT FRANKLY WOULD BE
HOMELESS IF WE WERE USING OUR
REALIGNMENT DOLLARS AGAIN NOT
SOMETHING BILLABLE TO MEDI CAL.
TO KEEP THEM SAFELY HOUSED IN
THE COMMUNITY.
SO JUST ANOTHER EXAMPLE
SOMETHING YOU MIGHT NOT KNOW
WE'RE DOING --
SO WE ALSO PAY FOR STATE HOUSE
THIS IS ACTUALLY YOLO COUNTY
GRAPHIC I THINK IT'S A REALLY
GREAT WAY TO EXPLAIN --
SOME OF OUR SYSTEMS OVERALL.
YOU'LL SEE --
YOU'LL COUNTY IS THREE CLIENTS
IN THE STATE HOSPITAL AND THAT'S
FIVE HUNDRED SIXTY THOUSAND
DOLLARS IN TOTAL SPENDING FOR
THREE PEOPLE.
VERSUS PREVENTION THEY'RE
SERVING TEN THOUSAND CLIENTS
HUNDRED THIRTY TWO DOLLARS PER
PERSON THIS IS SOMETHING WE ALL
STRUGGLE WITH WE DON'T WANT IT
TO LOOK LIKE THIS RIGHT WE LOVE
TO RE DIRECT MORE DOLLARS TO
PREVENTION.
MORE DOLLARS TO BUY SHORT TERM
CARE -- BUT
WE'VE GOT SOME REALLY COMPLEX
CLIENTS THAT WE SERVE THE
UNFORTUNATELY HAVE TO BE IN THE
STATE HOSPITAL THERE'S REALLY
NOT ANOTHER OPTION FOR US --
AND I THINK I WANNA SAY THE
BEHAVIORAL HEALTH DIRECTOR.
YOU KNOW I GET BY ONLY UP WITH
MY FRIENDS AND SO PARTNERING
WITH LOCAL SCHOOLS PARTNERING
WITH DSS.
PARTNERING WITH PROBATION AND
ALSO PARKING WITH PRIMARY CARE
THERE'S A LOT OF INNOVATION
HAPPENING A LOCAL COUNTY IS WITH
DIFFERENT LEVELS OF INTEGRATION
SOME PEOPLE PLACING.
THERAPISTS IN PRIMARY CARE
SETTINGS OTHER PEOPLE DOING
REVERSE INTEGRATION I'VE OPENED
A CLINIC WHERE PEOPLE WITH
SEVERE MENTAL ILLNESS SO
JENNIFER'S EXAMPLE THE PERSON
WITH SCHIZOPHRENIA WHERE CCH
WOULD BE FISCALLY RESPONSIBLE.
FOR THEIR PHYSICAL HEALTH
SERVICES I'VE BUILT A REVERSE
INTEGRATION CLINIC SO THEY CAN
GET THEIR PHYSICAL HEALTH NEEDS
MET IN A BEHAVIOR HEALTH CLINICS
WE SAW THE UTILIZATION RATE WAS
SO LOW. FOR BENEFICIARIES AND I
USE SOME OF MY MONEY TO PAY THE
DIFFERENCE BECAUSE THE
PRODUCTIVITY.
IS SO LOW IN THAT PRIMARY CARE
SETTING THEY'RE NOT BE ABLE TO
RUN THROUGH TWENTY CLIENTS.
A DAY IS MORE LIKE IT TEN CLIENT
THE DAY YOU KNOW TO KEEP PEOPLE
ALIVE -- ALL
FAMILIAR WITH THAT TWENTY FIVE
YEARS OF LIFE LOSS FOR PEOPLE
SEVERE MENTAL ILLNESS NOBODY
DIES OF SCHIZOPHRENIA.
YOU DIE OF UNTREATED CANCER
UNTREATED HEART DISEASE WE KNOW
THE SOLUTION RIGHT IT'S PRETTY
ACCESSIBLE CARE BUT FOR PERSONAL
SEVERE MENTAL ILLNESS THERE SO
MANY BARRIERS TO GETTING THEM
INTO THAT PRIMARY CARE CLINIC.
YOU THERE'S A LOT OF COUNTY
INNOVATION HAPPENING TO MAKE
THAT. TO MAKE THAT CHANGE --
I THINK WE WANTED TO SAY THAT
WHEN PEOPLE ASK HOW DO WE GET
INTO YOUR SERVICES SO LIKE I
SAID I HAVE MY FRIENDS MY
PARTNERS THOSE ARE OPEN DOORS I
HAVE STAFF CO LOCATED AT CHILD
WELFARE COLOCATED THAT PROBATION --
WE ALSO RUN A TWENTY FOUR HOUR
ACCESS LINE AND THEN OPEN
CLINICS SO IN MY COUNTY MY
REGIONAL CLINICS WE ALSO HAVE
WALK IN HOURS SO PEOPLE CAN CALL
FOR APPOINTMENTS ARE ACTUALLY
JUST WALK AND WE FOUND THAT
REALLY HELPFUL TO HELP US
ADDRESS SOME OF OUR HEALTHEQUITY
GOALS.
WHERE THE LATINO POPULATION
WHICH IS STARKLY UNDERSERVED IN
CALIFORNIA IT'S BEEN MORE OPEN
TO THE WALK IN CLINIC TYPE MODEL?
I KINDA WENT OVER THAT THE WORK
WE'RE SORT OF ALL OVER THE PLACE
[inaudible]
NOW QUESTION.
VERY GOOD --
I KNOW CENTER MORNING TO HAVE.
THANK YOU MISTER CHAIRMAN CO
CHAIRS FOR ORGANIZING THIS AND I
WANT TO THINK DIRECTOR CAN'T FOR
THE WORK YOU'RE DEPARTMENT DOES
AND WELCOME DOCTOR MILLER WHO.
PREVENTS AMAZING SERVICES AND
THE COUNTY I REPRESENT MONTEREY
COUNTY -- IT
REALLY IS A PATCHWORK IN I THINK.
PRESSES POLICYMAKERS.
IT'S SO HARD TO LEARN THE
ALPHABET SOUP AND WERE YOU GONNA
FOR FAMILIES CAN BE EVEN MORE
CHALLENGING.
SO THANK YOU --
FOR THE SERVICE --
THAT YOU'RE PROVIDING.
I THINK IN NEAR --
CATEGORIZATION OF ALLIES --
AND OTHERS ALSO NONPROFIT SECTOR
THAT YEAH IS HELPING --
THE MARIN COUNTY TRANSPORTATION --
PROVIDE SOME SPECIALTY SERVICES
ALSO FOR THE THE MENTAL HEALTH
COMMUNITY.
ON THIS MAY BE DRAWING DOWN TOO
FAR BUT I'VE.
LEARNED FROM CONSTITUENTS
SUFFERING FROM SEVERE MENTAL
ILLNESS.
THAT THEIR MEDICATION REFILLS --
ON A THIRTY DAY CYCLE.
IN THIS SOMETIMES OF THE
POPULATION FOR WHOM IT IS MOST
DIFFICULT TO GET TO THE PHARMACY.
TO REFILL STANDARD PRESCRIPTIONS.
THAT THEY'RE REFILLING EVERY
MONTH AND THERE'S NOT A
LIKELIHOOD THAT THEY'RE GONNA BE.
CURED FIFTEEN DAYS INTO A THIRTY
DAY PRESCRIPTION.
I DON'T KNOW IF YOU ARE DIRECTOR
CAN'T KNOW IS THAT IS MY
INFORMATION ACCURATE.
MAYBE SOMETHING YOU COULD LOOK
INTO I DON'T KNOW IF YOU HAVE AT
YOUR FINGER TIPS BUT I KNOW.
IN THE PLANS THAT MANY OF US ARE
UNDER WE CAN DO MAIL ORDER
NINETY DAY PRESCRIPTIONS.
DINO SEARCH IS AVAILABLE THROUGH
HE'S GETTING THEIR PRESCRIPTIONS
THURMOND ACCOUNT IT'S PROBABLY A
COMBINATION --
IN SO WE CAN CERTAINLY LOOK INTO
IT IT MAY BE THAT --
THE PROVIDERS ONLY WRITING IN
THIRTY DAYS SCRIPT SOMETIMES IF
YOU HAVE SOMEONE WHERE YOU'RE
TRYING TO TITRATE AND MAKE SURE
THAT THE MEDICATION IS ACTUALLY
APPROPRIATE THEY COULD BE
WRITING IT IN CERTAIN AMOUNTS
AND THEN --
WE ACTUALLY PAY FOR THE PHARMACY
ON THE MEDICAL SIDE AND SO IT
DEPENDS ON THE DRUG AND
DEPENDING ON THE UTILIZATION
CONTROLS THAT WE HAVE FOR THAT
PARTICULAR SCRIPTS WE MAY HAVE
WE MADE BECAUSE WE MIGHT HAVE TO
FILL OUT TIRES EACH THIRTY DAYS.
TO YEAH IT DOESN'T DRIVELIKE I
KNOW THAT WE PROVIDED SOME
INFORMATION --
TO THE COMMITTEE AROUND THE CAR
ABOUT BECAUSE WE PAY FOR ALL OF
THE ANTI PSYCHOTICS ARE NOT
INCLUDED IN THE MEDI CAL MANAGED
CARE --
PHARMACY BENEFIT AND WE SPEND --
FOR ABOUT FORTY CARVED OUT.
DRUGS --
IT'S OVER A BILLION DOLLARS AND
SO SOME OF THOSE PRESCRIPTIONS
WE PROBABLY ONLY ALLOCATING
THIRTY DAY INCREMENTS BUT I CAN
CERTAINLY GET BACK YOU ON THAT.
AND APPRECIATE THAT AND AGAIN.
NINE I CERTAINLY UNDERSTAND THE
NEED FOR A A PHYSICIAN A
TREATING PSYCHIATRIST IF THEY'RE
ADJUSTING CORRECT RESTRICTIONS
NOT WANTING TO PRESCRIBE.
BEYOND MAYBE EVEN A WEEK'S WORTH
OR WHATEVER.
BUT FOR SOMEBODY'S ON A STANDARD.
REFILL --
EIGHT IT DOES JUST PROVIDE A
PARTICULAR HARD TO GET TO THE
PHARMACY.
IN MANY NOT ONLY --
DEALING WITH THEIR MENTAL HEALTH
DISABILITY THAT OTHER PHYSICAL
DISABILITY SO AND WE DO HAVE
MAIL ORDER AVAILABLE TO SO IT
MAY JUST BE THAT WE NEED.
TO BETTER --
MAKE SURE THAT PEOPLE UNDERSTAND
THAT BENEFITS AVAILABLE.
THAT BE GREAT IF WE COULD LEARN
SOME MORE ABOUT THAT IN AGAIN I
DON'T HAVE FURTHER QUESTIONS AT
THIS TIME AGAINST WANT TO THANK
YOU BOTH FOR YOUR TREMENDOUS
LEADERSHIP IN.
THIS IS A FRONTIER UNFORTUNATELY
THAT WE'RE STILL TRYING TO
FIGURE OUT IN FROM THE EARLIER
SLIDES.
BEING CONTINUED GROWTH I DON'T
KNOW THAT ANYONE HAS A GOOD.
UNDERSTANDING OF WHY OUR SOCIETY
IS PRODUCING.
SO MANY CHILDREN AND ADOLESCENTS
AND ADULTS --
MOVING FROM MILD TO MODERATE TO
SEVERE MENTAL HEALTH CHALLENGES
BUT IT SEEMS LIKE.
SOME OF THE EARLY DETECTION AND
PREVENTION PROGRAMS ARE AT LEAST
IN EFFORT TO TRY --
TO REACH FAMILIES SOME
PARTICULAR FORMER BOSS SOMETHING
CAN MAYBE BE MANAGED IN NOT NOT
MANIFEST INTO A GREATER
CHALLENGE BUT AGAIN THANK YOU
BOTH FOR YOUR SERVICE.
THANK YOU MISTER CHAIR
[inaudible]
ASSEMBLYMEMBER CARILLO
[inaudible]
HELLO -- I'M
VERY CURIOUS ABOUT THE SLIDE
THAT SENATOR LEAVE UP I HAD A
QUESTION ON THE ONE WITH THE
FAMILIES AND THE LITTLE BECAUSE
THE LITTLE HUMANS --
THE THE FAMILY UNIT --
MALE FEMALE CHILD.
ARE WE TO UNDERSTAND THAT IN A
FAMILY UNIT.
RECEIVE CARE BUT THE MALE OR THE
FATHER.
DOES NOT.
YEAH BUT INDIVIDUALLY AS A MALE
HE CAN RECEIVE CARE IT'S REALLY
ALL BASED OUR WHOLE WORLD IS
MEDI CAL EIGHT CODES SO MEDI CAL
EIGHT CODES ARE WHEN PEOPLE SIGN
UP FOR MEDI CAL IF THEIR NEWLY
ELIGIBLE UNDER THE ACA THEY HAVE
A VERY HIGH REIMBURSEMENT RATE
BUT THAT'S REALLY.
ABOUT THEIR LEVEL OF POVERTY AND
THEN THEIR ABILITY TO RENEW MEDI
CAL BECAUSE THEY HAVE TO RENEW
EVERY YEAR.
AND SO WE OFTEN SEE YOU KNOW
PEOPLE NOT RESPONDING TO THE
PAPER WORK AND GETTING IT
RENEWED AND WE SEE CHANGES IN
ELIGIBILITY SO SOMETHING THAT
UNFORTUNATELY WE IN BEHAVIOR HOW
SPEND QUITE A BIT OF TIME ON SO
MAKING SURE THAT PEOPLE
UNDERSTAND THE WEIRD GOVERNMENT
FORMS.
WE'VE ALSO SEEN IN A WEIRD
GOVERNMENT.
FOR A POLISH KNOWLEDGE SAY THAT
AND YOU.
ALL GOVERNMENT FORMS ARE
WONDERFUL FOR SHORT --
BUT THEN WE'VE ALSO SEEN SOME
FEAR RIGHT SO WE'VE ACTUALLY
SEEN A DECLINE MEDI CAL
ENROLLMENT SOMEWHAT LOCALLY WITH
PEOPLE BEING AFRAID BECAUSE
UNDOCUMENTED CHILDREN ARE
ELIGIBLE FOR MEDI CAL BUT FOR
AND UNDOCUMENTED FAMILY THAT'S
THE ONLY WAY SIR THEIR FAMILIES
KNOWN TO THE GOVERNMENT AND SO
WE'VE SEEN.
A DECREASE IN THE NUMBER OF
CHILDREN ENROLLED IN MEDICARE
WE'RE TRYING TO DO SOME PUBLIC
INFORMATION CAMPAIGNS.
YOU KNOW TO CHANGE THAT BUT
THERE'S A LOT OF DIFFICULT CAL.
SO THE COMPLEX WORLD WHEN I HAVE
PEOPLE IN HUMANS WALKING INTO MY
CLINIC.
AND ABOVE THEM IS DIFFERENT
NEEDS IN DIFFERENT AID CODES AND
WE'RE TRYING TO MAKE IT ALL
RECONCILE AT THE END OF THE YEAR
SO THAT'S WHY WHEN YOU HEAR US
TALK ABOUT PAYMENT REFORM IN OUR
PASSION FOR THAT.
WOULD SORT OF LIKE TO LEVEL THE
PLAYING FIELD AND USE YOU KNOW
THE DOLLARS THAT WE HAVE I
REDUCING A LOT OF THE PAPERWORK
BURDEN AND POTENTIALLY SERVING
UP MANY MORE BENEFICIARIES.
IT IF I IF I MAY IT JUST BRINGS
UP --
ADDITIONAL STUDIES THAT HAVE
BEEN MADE THAT HAVE IMPACTED LOW
INCOME COMMUNITIES OF COLOR IN
WHICH THE IN ORDER FOR A MOTHER
OR A CHILD TO RECEIVE AID.
WHETHER IT'S THROUGH MEDICAL OR
OTHER TYPES OF SERVICE.
THE THE FATHER HAS OFTEN BEEN
EXCLUDED FROM THAT FORMULA.
AND HAS CREATED A A SYSTEM.
THAT -- IS
NOT HELPFUL TO FAMILIES AND SO
I'M JUST CURIOUS AS TO HOW WE
FIX IT AND MAKE SURE THAT THE
FAMILY UNIT ITSELF IS ABLE TO
RECEIVE CARE ONE AND I MIGHT.
I MIGHT JUST HAVE BEEN A LITTLE
BIT --
BECAUSE THIS IS.
A HEARING ON MENTAL HEALTH AND
NOT ON MEDICAL ELEGY WE THERE'S
MIXED FAMILIES SO --
WE HAVE MORE GENEROUS
ELIGIBILITY IN INCOME STANDARDS
FOR WOMEN AND CHILDREN SO
DEPENDING ON YOUR STATUS YOU MAY
BE MEDICARE ELIGIBLE FOR A
PERIOD OF TIME THAT OTHERWISE IF
YOU ARE SINGLE YOU WOULDN'T BE --
SO WE HAVE ACTUALLY FAMILIES IN
WHICH THE BILL BOTH PARENTS
COULD BE WORKING BUT BECAUSE THE
MOTHER'S PREGNANT SHE CAN HAVE
LESS INCOME SHE CAN HAVE MORE
INCOME THAN YOU OTHERWISE WOULD
BECAUSE OF HER PREGNANCY STATUS
THAT WE WOULD PUT HER INTO MEDI
CAL.
THE FATHER MAY BE EARNING JUST
ENOUGH THAT HE'S NOT ELIGIBLE
FOR MEDICARE I'LL SO HE'S MAYBE
COVER TO COVER CALIFORNIA SO WE
HAVE A LOT OF FAMILIES THAT WE
OURSELVES BLEND --
I WOULD ALSO JUST SAY BASED ON
THE SPECIALTY MENTAL HEALTH
SERVICES CRITERIA YOU WOULD HAVE.
AN ADULT'S LIKE THE FATHER COULD
BE -- MILDLY
DEPRESSED AND HE WOULDN'T MEET
THE MEDICAL NECESSITY CRITERIA
IN WHICH THE COUNTY WOULD BE
ABLE TO PROVIDE SERVICES AT ALL
THAT WOULD FALL TO THE PLANT'S
RESPONSIBILITY BECAUSE THEY'RE
GOING TO BE ENROLLED IN A
MANAGED CARE PLAN EITHER THROUGH.
MEDI CAL OR THROUGH COVER
CALIFORNIA AND SO THIS IS WHERE
IT REALLY DOES GET --
VERY VERY COMPLICATED BUT I
THINK YOU KNOW BOTTOM LINE IS IS
IN CALIFORNIA WE'VE MADE --
ALMOST FOUR MILLION INDIVIDUALS
ELIGIBLE FOR MEDICAL THAT WERE
OTHERWISE NOT ELIGIBLE PRIOR TO
THE AFFORDABLE CARE ACT AND SO
THE EXPANSION.
AND USE OF SERVICES NOT ONLY IN
THE MANAGED CARE MEDICAL MANAGED
CARE THEY WERE REFERENCE BUT THE
AVAILABILITY OF SERVICES OVERALL
HAVE CERTAINLY CHANGED THIS
DYNAMIC QUITE A BIT BUT YOU WILL
ALWAYS -- DO
YOU ALWAYS HAVE FAMILIES THAT
ARE IMITATION STATUS --
ONE PARENT MAY HAVE A HIGHER
INCOME BUT BECAUSE OF THE
PREGNANCY STATUS WE MIGHT HAVE
PEOPLE I'M STRADDLING BETWEEN
MEDI CAL AND OTHER COVERAGE SO I
CAN EXAMPLE OF INNOVATION THAT
WE DO TO MAKE THINGS HAPPEN IN
MY EARLY INTERVENTION PROGRAM
SOME OF THE SERVICES MIGHT BE
BUILT. TO THE CHILD'S BUT THEY
ARE CALLED COLLATERAL SERVICES
WERE YOU'RE HELPING THE WHOLE
FAMILY.
SO WE DO THAT TO THE EXTENT
POSSIBLE TO REALLY HELP KEEP
FAMILIES TOGETHER AND THAT'S A
REALLY IMPORTANT THING THAT WE
DO WITH AND ARE ESPECIALLY
CHILDREN SYSTEM OF CARE.
THERE ARE SLIGHT WORKAROUNDS
THAT ARE THE OKAY THANKYOU AND
I APOLOGIZE I THINK SOME OF US
IN THE SENATE HAVE TO RUN OUT
FOR TRAINING THAT'S MANDATE IS --
TO SHORTLY --
SO FIRST OF ALL I JUST WANT --
TO ANDMADE THAT --
DOCTOR CAN'T THAT YOU SAID THAT --
AND I APPRECIATE THE INCREASE
THAT THERE'S NOW WHAT AFFECTS ME
SEVENTY THREE THOUSAND MILD TO
MODERATE CHILDREN TO BE SERVED
BY MEDI CAL MANAGED CARE IS THAT
CORRECT --
THERE ARE APPROXIMATELY SEVENTY
THREE THOUSAND CHILDREN THAT ARE
GETTING MILD TO MODERATE
SERVICES --
THEY MAY ALSO --
BE USING SERVICES IN THE SHORT
DOYLE SYSTEM BECAUSE OF THE PST
T. BENEFIT BUT WE HAVE SEEN THE
UTILIZATION INCREASE FROM.
LIKE I SAID AS THAT'S ADULTS TO
GET MY THOUGHTS OUT OF THE WAY
IT STARTED AT TWELVE THOUSAND
IT'S I JUST MAKE NOTE I
APPRECIATE THAT THAT THE
INCREASE AND THAT THAT'S GOOD --
THAT WOULD MAKE NOTE THAT IF YOU
JUST ATTACKED THE NAPKIN
CALCULATION WE HAVE NINE POINT
THREE MILLION CHILDREN --
WE WERE JUST PERCENT OF DATA
THAT SAYS THAT IT'S PROBABLY
ABOVE SEVEN POINT 3% HAVE SEVERE
EMOTIONAL DISTURBANCE.
AND YOU DO THE MATH THAT'S ABOUT
THREE HUNDRED FIFTY THOUSAND
CHILDREN.
NOW OBVIOUSLY NOT ALL OF OUR
MILD MODERATE THERE'S THESE MORE
SEVERE BUT SET UP BUT MY GUESS
IS IS THAT --
WE'RE STILL SERVING ONLY A
FRACTION OF THE CHILDREN.
ERVING. TO BE FAIR THAT'S ONLY
IF THAT'S ONLY IN THE MANAGED
CARE MODERATE MODERATE THERE'S
TWO HUNDRED AND FORTY TWO
THOUSAND CHILDREN THAT ARE
GETTING SHORT OIL SERVICES OKAY.
AND THAT'S ON THAT'S ADDITIVES
THAT'S OKAY ALL RIGHT SO THE
OTHER TO A QUESTION I HAVE THIS
AND I REALIZE WE'RE GOING TO
HAVE ANOTHER PANEL WITH LA --
ONE FINANCING BUT SINCE YOU'RE
HERE AND THERE AND FINANCING --
YOU DO THE FINANCING SO THE WAY
WE FINANCE ON THE MEDICAL SIDE
IS -- BASED
ON THAT REALIGNMENT DOLLARS HOW
ARE THOSE DOLLARS ARE BASICALLY
I GUESS THE QUESTION IS IS THAT --
OUR IS THE AMOUNT OF MONEY
AVAILABLE --
AT EACH COUNTY RELATED TO THE
ACTUAL NEED IN THE COUNTY.
OKAY RIGHT SO I THINK THERE'S A
PROBLEM THERE RIGHT SO I MEAN I
MEAN I REALIZE THAT WHAT HAPPENS
IS THAT YOU KNOW WE HAVE THIS
REALIGNMENT OF WATER YOU KNOW
THAT'S GOING TO CLOSE DOWN A
WATERFALL RIGHT YOU KNOW IS THE
SPOT TO SPOT.
BUT WE DO HAVE A DISCONNECT
BETWEEN THE FUNDING AND COUNTIES
AND THE NECESSARY TO DEMAND
RIGHT DEPENDING ON HOW THAT.
HOW THE MONEY THE KIND OF FALLS
DOWN YOU COULD HAVE EITHER MORE
OR LESS?
IF WE THE CHALLENGE OF BEING A
BEHAVIORAL HEALTH PROVIDER IS IF
WE DO REALLY REALLY WELL IF WE
SO IT'S GOT A DIFFICULT
RELATIONSHIP I KEEP A LOT OF
PEOPLE OUT OF JAIL I'M SPENDING
MORE MY REALIGNMENT DOLLARS ON
THAT POPULATION.
AND LIKE YOU ALREADY ARTICULATED
YOU KNOW THE JAIL SPENDING IS
TOTALLY SEPARATE SO IT'S A
REALLY BIG CHALLENGE FOR US IS
COUNTY SYSTEM THAT THE FUNDING
DOESN'T AT ALL MATCH.
YOU KNOW THE INCREASE IN
POPULATION AND THE NEED TO AND
THAT IS WILL TALK ABOUT LATER
WITH PERFORMANCE METRICS.
YOU KNOW TWENTY NEW PEOPLE WALK
THROUGH THE DOOR AND WE JUST
NEED TO FIGURE IT OUT RIGHT SO
WHEN DEMAND INCREASES WE JUST
HAVE TO TRY TO INNOVATE MAKE
ADJUSTMENTS TO THE BEST WE CAN.
YOU KNOW AS RESPOND TO NETWORK
ADEQUACY STANDARDS SO I THINK WE
NEED TO LOOK AT THAT.
WE NEED TO KNOW WHAT WE NEED TO
KNOW WHAT THE NEED IS.
SIMPLE THING SAY IT'S HOW
COMPLEX TO DO BUT WE NEED TO
FIGURE OUT AND FIGURE OUT WHERE
TO DISPARITIES ARE RIGHT WHERE I
THINK YOU KNOW A LOT OF COUNTIES
I CAN SAY VERY SPECIFICALLY MY
COUNTY I'M STRUGGLING IS THE
INCREASED COSTS OF LIKE THE AYE
INDIAN STATE HOSPITAL.
PLACEMENT SO LIKE ONE
REALIGNMENT CATEGORY THAT'S FOR
THE ADULT POPULATION I GET
THIRTEEN MILLION AND I SPENT
TWELVE MILLION LAST YEAR ON
PLACEMENTS.
SOME TRYING TO INNOVATE RIGHT
I'VE DEVELOPED A NEW TEAM THAT'S
GOING TO TRY TO GET PEOPLE OUT
OF THAT LEVEL OF CARE.
BUT AS WE SEE THAT WE'RE KEEPING
PEOPLE ALIVE LONGER THEY'RE
GETTING INTO VERY VERY EXPENSIVE
PLACEMENTS AND BECAUSE THEY ONCE
HAD A MENTAL ILLNESS.
THEY'RE ENDING UP COSTING A
COUPLE HUNDRED THOUSAND DOLLARS
A YEAR WHEN NOW THEY MIGHT HAVE
TO MENTION OTHER PROBLEMS BUT IF
I WASN'T PAYING FOR THAT.
THOSE PEOPLE WOULD LITERALLY BE
HOMELESS OKAY SO WE NEED TO LOOK
AT THAT RIGHT WE NEED TO AND
ESPECIALLY WHEN YOU HAVE SOME
[inaudible]
VERY EXPENSIVE.
STAND EXACTLY HOW YOU KNOW HOW
WE A BUFFER AGAINST THAT
VARIATION ESPECIALLY THE SMALLER
COUNTY THE LESS LIKELY GIVE YOUR
AVERAGE THAT OUT.
I GUESS THE OTHER QUESTION IN
TERMS OF OVERSIGHT IS --
AND I APPRECIATE THAT --
THERE'S A LOT OF INNOVATION
GOING ON DIFFERENT COUNTIES BUT
ALSO YOU KNOW SOME DO BETTER
THAN OTHERS --
I APPRECIATE Là THE THINGS THAT
YOU MENTIONED BUT AT COUNTY IN
THE STATE OF CALIFORNIA.
NOT IN EVERY COUNTY BUT THERE'S
A LOT OF DIFFERENCES IN TERMS OF
WHAT THE COUNTY NEEDS ARE SO SO
I THINK WE NEED MORE
ACCOUNTABILITY RIGHT WE WE NEED
TO KNOW AT STATE WHAT IS GOING
ON IN EACH COUNTY.
AND ALSO WE NEED TO BE SURE THE
BEST PRACTICES ARE BEING
PRACTICED ACROSS THE STATE THAT
PEOPLE.
ACCESS TO MENTAL HEALTH AND THE
QUALITY TO CARE SHOULD NOT BE
DEPENDENT ON WHAT COUNTY DO YOU
LIVE IN.
NOW REALIZE DIFFERENT COUNTIES
ARE DIFFERENT YOU KNOW YOU HAVE
DIFFERENT YEAH THE DIFFERENT
CHARACTERISTICS BUT AT SOME
POINT AND I THINK THERE'S A
THAT'S A BIG FRUSTRATION IS IS
THAT WE HAVE A LOT OF PEOPLE
VERY CONCERNED ABOUT MENTAL
HEALTH.
DEMANDS NEEDS FOR MENTAL HEALTH
BUT WHAT WE CAN'T WE'RE HAVING
CHALLENGES IS THAT WE CAN'T --
MAKE SURE THAT PEOPLE.
IN YOU KNOW THAT THIS IS
HAPPENING ACROSS THE STATE WE
HAVE THINGS LIKE THE OPIOID OUT
NO PROBLEM.
RIGHT IT'S WE SHOULD BE ABLE TO
HAVE STATEWIDE.
WAYS OF ADDRESSING THIS RIGHT --
THERE ARE THINGS YOU KNOW SCHOOL
MENTAL HEALTH WE SHOULD THEIR
THIRD VARIETY OF DIFFERENT
THINGS THAT --
WELL CERTAINLY I THINK WE WANT
TO GIVE FLEXIBILITY TO COUNTIES
BE ABLE TO DO.
THINGS THAT ARE MORE TAILORED AT
SAME TIME THEY ALSO NEED BE HELD
ACCOUNTABLE THAT THEY'RE
DELIVERING A CERTAIN LEVEL OF
SERVICE AND THAT THERE ARE
CERTAIN LEVEL CONSISTENCY ACROSS
THE STATE.
THE ONE CHALLENGE WITH FUNDING
THOUGH IS THAT COUNTY IS --
A LOT OF THE BIGGER COUNTIES DO
COUNTY GENERAL FUND SO LIKE IN
MY COUNTY I GET WHAT'S CALLED
THE MAINTENANCE OF EFFORT WHICH
IS THE MINIMUM REQUIRED IN ORDER
TO HAVE A CONTRACT WITH THE
STATE.
OTHER COUNTIES HAVE DEVELOPED
LIKE SALES TAX --
SAN FRANCISCO SAN MATEO COUNTY
THEY'RE GETTING I THINK HUNDREDS
OF MILLIONS OF DOLLARS OF THAT
ARE ALSO ABLE TO LEVERAGE SOME
MORE FEDERAL DOLLARS AND REALLY
GROW TO MEET THE SYSTEMS NEEDS.
AND SO SORT OF A LOCAL
INVESTMENT MENTAL HEALTH VARIES
DRASTICALLY AND KIND OF CHANGES
I THINK I DID A PRESENTATION ON
SCHOOL BASED MENTAL HEALTH I'M
ABLE TO INNOVATE IN THE SCHOOL
BASED SETTING. FIVE SCHOOL
PARTNERS THAT HELP PAY FOR IT
ABSENT THAT WOULD REALLY BE
STRUGGLING AND SO MANY COUNTIES
COME TO ME AND SAY I WANT TO DO
WHAT YOU'RE DOING I WANT THEIR
PERCENT EVERY SCHOOL THAT'S THE
RIGHT THING TO DO.
I SIMPLY DON'T HAVE THE MONEY TO
DO IT.
SO I THINK YOU HAVE A LOT OF
EAGER PARTNERS THAT SEE WHERE
THEY WANT TO BE AND HAVE THAT
PASSION AND THAT THAT
UNDERSTANDING OF HOW TO BE
COMMUNITY BASED.
IT'S JUST A VERY CHALLENGING
FUNDING RUBRIC TO MAKE A LOT OF
THESE THINGS HAPPEN AND THEN YOU
KNOW THE WAY COUNTIES ARE.
WE ARE AUDITED SEVERAL YEARS
AFTER THE FACT IS OR FISCAL
LIABILITIES WE CAN LOSE MILLIONS
OF DOLLARS BASED ON THINGS THAT
HAPPENED FIVE YEARS AGO.
AND SO THAT ALSO PUTS MANY
COUNTIES IN A POSITION WHERE
THEY'RE AFRAID TO INNOVATE BASED
ON FISCAL RISK.
WELL.
I THINK --
ACTUALLY SINCE YOUR SETS SITTING
NEXT TO DIRECTOR CAT AND I KNOW
IN THE BUDGET WE YOU KNOW
THERE'S LIKE A HUNDRED AND WHAT
FORTY MILLION OR SOMETHING PANEL
FEDERAL PENALTIES.
AND WE NEED TO HAVE A BETTER.
FIGURE OUT HOW WE DON'T AND IF
IT.
FIRST IN TERMS OF OUR
COMMUNICATIONS I REALIZE THE CMS
IS CAN ALWAYS BE A BIT
CHALLENGING AND SO FORTH.
BUT I ALSO THINK THAT --
IT REALIZE THERE'S GONNA BE
VARIATIONS IN LOCALITIES --
BUT THE AND I THINK WE NEED TO
ALSO TALK ABOUT THE FACT THAT --
AT THERE'S ONLY THERE NEEDS TO
BE ACCOUNTABILITY FOR THAT --
WE SHOULD BE ESTABLISHING STATE
MENTAL HEALTH GOALS --
THAT --
COUNTIES ARE HELD ACCOUNTABLE
FOR AND THAT --
AND AND THAT OF COURSE THE
STATE'S RESPONSIBILITY IS TO
HELP OUT WITH --
FUNDING AS WELL AND TRYING TO
FIGURE OUT HOW HOW WE DO THIS
BECAUSE UNFORTUNATELY WE CAN'T
WE ALL RIGHT NOW.
A LOT OF TIMES WE DON'T KNOW
WHAT'S GOING ON IN PARTICULAR
COUNTIES WE HAVE A PATCHWORK AND
THAT MEANS THAT WHAT KIND OF
MENTAL HEALTH SERVICES YOU GET
DEPENDS ON WHICH COUNTY LIVE ON
HOW INNOVATIVE.
YOUR YOU KNOW YOUR YOUR BEHAVIOR
HEALTH DIRECTOR IS AND AND
VARIETY OF OTHER THINGS AND I'M
NOT SURE THAT DOES POLITICAL
BOUNDARIES OF THE BEST WAY TO BE
TRYING TO DETERMINE --
QUALITY OF CARE AND I REALIZED
WILL BE TALKING LATER ABOUT
QUALITY CARE.
A COUPLE.
OF I KNOW THE SENATE.
THE START DATE OKAY KNOWS WHAT
WELL AND I'M CONCERT YOU GUYS
HAVE A TIME CRUNCH SO OVER YOU.
OKAY WILL EVEN YOU GUYS ARE YOU
OKAY OKAY SENATOR LIMóN THANK
YOU MISTER CHAIR PRECIADO I
WOULD JUST SUBMIT TO ALL OF US
IN THIS ROOM THAT AND WE TILL WE
CHANGE THE MAIL SLIDE THERE.
UNTIL DAD OR BOYFRIEND CAN GET
HELP EASILY.
HOW DO WE SOLVE DOMESTIC
VIOLENCE BECAUSE WE ARE TAKING
CARE OF LOTS OF PEOPLE IN THIS
PICTURE BUT WE'RE NOT TAKING
CARE OF SOMEONE WHO COULD BE THE
PERPETRATOR SO JUST SUBMIT TO
ALL OF US THAT WE NEED TO FIGURE
OUT AN EASIER WAY TO MAKE SURE
DATA BOYS?
HAVE A HOUSE SYSTEMS TO MOVE
THINGS THAT WE MIGHT BE DOING
NOW AND UNFUNDED WAY TOO WHICH
IS SOMETHING THAT WE FEDERAL
WHILE AT LEAST HAVE SOME MORE
STATE DOLLARS ASSOCIATED WITH IT.
ASSEMBLYMEMBER ALMOST LOOK THANK
YOU AND THANK YOU FOR THAT AND I
WANT TO GET BACK --
TO THE SLIDE NUMBER SEVEN THAT
YOU -- WERE
PRESENTED TO US ON SOME OF THE
SPECIALLY MENTAL HEALTH SERVICES
PROVIDED.
AND IN PARTICULAR THE CRISIS
INTERVENTION --
COMPONENT THAT'S THERE.
I KNOW WE TALK ABOUT --
EMERGENCY ROOMS AND LAW
ENFORCEMENT BEING ENGAGED.
BUT AT MONTEREY COUNTY AND AND I
GUESS THE WHOLE GENERAL
DISCUSSION AS FAR AS CRISIS --
STABILIZATION AREAS --
WHERE WE CAN ACTUALLY START TO
SEE THOSE IN THE COMMUNITY HAS
TRIED TO BE MORE PROACTIVE IN
THAT APPROACH?
BEFORE IT GETS TO THE MERGER SEE
RUBY FORGET MONTEREY COUNTY OR
IS A BEEN A DIALOGUE ON MOVING
FORWARD ON THOSE TYPES OF CRISIS
STABILIZATION --
UNITS WELL AND SO PART OF IT IS
IT JUST THE FACILITIES CRISIS
STABILIZATION UNITS WHICH ARE
HOSPITAL LIKE IT'S COMMUNITY
BASED SETTINGS WHERE THIS CRISIS
RESPONSE SO MY CAN I HAVE A
MOBILE CRISIS TEAM ASSOCIATED
WITH LAW ENFORCEMENT MANY
COUNTIES HAVE THAT THERE'S A LOT
OF INNOVATION IN THAT.
SPACE I CAN TELL YOU WE LOSE SO
MUCH MONEY ON THOSE.
AND NOWHERE NEAR FISCALLY
SUSTAINABLE --
IN TERMS OF STAFF COVERING THEIR
COSTS THROUGH BILLING CRISIS
INTERVENTION IS KIND OF LIKE I
THINK MANY OF YOU ARE SO SAID
WITH HEALTH AND ON THE THE
AMBULANCE SYSTEM STRUGGLES IN
THE SAME WAY.
HEAR YOU NEED TO BE RESPONSIVE
AND TIMELY BUT THEN YOU'RE
PAYING PEOPLE WHO YOU CAN'T
REALLY OPTIMIZE ALL OF THEIR
TIME.
SO.
I THINK YOU'RE SEEING A LOT OF
COUNTIES MAKES MY VESTMENTS I
KNOW LA IS DOING SOME REALLY
INCREDIBLE THINGS AROUND MOBILE
UNITS THAT ARE FULLY STAFFED
INCLUDING CONSUMERS THAT ARE
TREMENDOUSLY INNOVATIVE --
SO I KNOW THAT THAT'S HAPPENING
A LOT OF PLACES IN THE STATE
WERE REALLY COMMITTED TO IT.
BUT IT'S A VERY CHALLENGING
THING TO SUSTAIN FISCALLY.
SO IF -- THE
COST UP FRONT IS SOMETHING
THAT'S OF CONCERN BUT IN THE
LONG TERM IS IT SOMETHING THAT
PHYSICALLY.
BABY SOUND IF WE LOOKED AT IN A
LONG TERM --
YEAH AS FAR AS IT SHORT OF
LOOKING AT THE DOLLARS TODAY BUT
LOOKING HOW.
TACKLING OF THE CRISIS
STABILIZATION AREAS NOW AND IN
THE LONG TERM WOULD HAVE A
BETTER --
OUTCOME CAN BE MORE PREVENTIVE
TO A LOT OF THESE DIFFERENT
SUBPOPULATIONS THAT ARE THERE.
YEAH SO LIKE I'M WORKING ON
TRYING TO EXPAND A CHILDREN'S
MOBILE CRISIS I WAS DOING THE
FISCAL ANALYSIS IT'LL COST AT
ONE POINT FIVE MILLION DOLLARS
PER YEAR ANTICIPATE FIVE HUNDRED
THOUSAND AND MEDI CAL POTENTIAL
REIMBURSEMENTS.
I'M LOOKING AT A MILLION DOLLAR
GAP.
RIGHT AND SO I'M GOING TO HEDGE
MY BETS CAN I REDUCE CHILD
HOSPITALIZATIONS.
OUT OF COUNTY PLACEMENTS IT'LL
BE AN EXPERIMENT TO SEE IF I CAN
SUSTAIN IT.
RIGHT.
BUT THAT'S A PRETTY BIG DOLLAR
AMOUNT TO HAVE IT AS OPERATING
LOSS FOR A LINE ITEM OF BUSINESS
IT'S A IT'S A LARGE DOLLAR
AMOUNT NOW BUT IF THERE'S A WAY
TO QUANTIFY IT.
IN THE FUTURE WITH LONG TERM
APPROACH TO BE INTERESTED TO SEE
SOME OF THAT THOSE --
HAD DATA COMING FORWARD NEXT
QUESTION I I HAVE IS --
YOU HAVE WALKING HOURS IN THOSE
THINGS AND SO TARGETING --
AND AROUND THE DISCUSSION AGAIN
I NOTICED MONTEREY COUNTY BUT
THIS IS THE LARGER DISCUSSION.
THROUGHOUT THE STATE THE
HOMELESS YOUTH --
BETWEEN THE AGES OF EIGHTEEN TO
TWENTY FIVE ARE WE STILL KEEPING
THAT INSIDE OF SOME OF THE
COMPONENT DIALOGUE IT'S THEIR
ALSO YES WE DO HAVE HOMELESS
OUTREACH PROGRAMS THE HOMELESS
YOUTH HAS BEEN PRETTY
CHALLENGING TO CAN BE VERY
TRANSIENT POPULATION AND THERE'S
SIGNIFICANT VARIATIONS BETWEEN
THE COUNTY IS.
ACTUALLY MONTEREY COUNTY HAS A
PRETTY SIZEABLE POPULATION OF
HOMELESS YOUTH SAN FRANCISCO BUT
SOME OF THEM WERE OR RURAL
COUNTIES ARE STRUGGLING WITH
THAT. TO THE SAME EXTENT THAT'S
VERY MUCH A SERVICE FOCUS AND
THEY'D BE ENTITLED TO A FULL
RANGE OF BENEFITS.
SO THOSE TWO ARE OR IS IT --
YOU KNOW SENATOR PAT WAS TALKING
ABOUT AS FAR AS FINANCIAL
RESOURCES AND LEVERAGING THE
MONEY FROM THE FEDERAL TO THE
STATE TO THE COUNTY --
BUT I JUST WANT TO OPEN UP THE
THE DIALOGUE ON ON THOSE TWO
SUBJECTS YEAH AND SO IT'S LIKE
WHEN YOU THINK ABOUT WORD MAKING
A HOMELESS YOUTH PROGRAM THAT
WE'RE OFTEN PAYING FOR THE FOOD
SHELTER CLOTHING AND MENTAL
HEALTH SERVICES SO EVEN THOUGH
WE'RE BEHAVIORAL HEALTH.
WE'RE MAKING PROGRAMS THAT ARE
PAYING FOR THAT FULL SPECTRUM
AND THAT THAT'S GOOD AND THAT'S
IT A FISCAL CHALLENGES WHILE.
IF CENTER MONITORING ANOTHER
QUESTION THANK UNITS KIND OF A
FOLLOW UP ON ASSEMBLYMEMBER
ALMOST AS QUESTION.
I KNOW MODERATES BEEN INNOVATIVE
IN EARLY WITH CRISIS
INTERVENTION TEAMS BEHAVIOR
HEALTH WORKING WITH LAW
ENFORCEMENT.
IN THE CHALLENGE HAS ALWAYS BEEN.
FUNDING --
WE HEAR FROM OUR SHERIFF'S THAT
ARE COUNTY JAIL SIR.
HOLDING PENS FOR PEOPLE WITH
MENTAL HEALTH DIAGNOSES --
DO YOU KNOW OFFHAND HOW MUCH OF
YOUR BUDGET OR PUT IT COSTS IS
TO MAINTAIN THE CRISIS
INTERVENTION TEAM FROM THE
BEHAVIORAL.
HEALTH SIGN IT I THINK THERE ARE
KIND OF ON CALL TWENTY FOUR
HOURS.
HOSPITAL BASED CRISIS TEAMS ON
CALL TWENTY FOUR HOURS SO
THERE'S TWENTY FOUR HOUR
SEGMENTS WITH AN EMERGENCY
DEPARTMENT.
OR MOBILE CRISIS HAS --
DIFFERENT STAFFING RIGHT NOW
LIKE A TWO TO TEN SCHEDULE BASED
ON PEAK HOURS I THINK THE OP THE
GAP LAST YEAR WAS ABOUT.
FOUR HUNDRED THOUSAND THAT
WASN'T COVERED BUT THAT --
IS A FRACTION OF WHAT'S NEEDED
IN TERMS OF MOBILE DIVERS SO WE
HAVE THREE THREE TEAMS AND WHAT
WE REALLY NEED IS QUITE A BIT
MORE TO RESPOND TO THE SCHOOL
BASED EMERGENCIES.
SO OUR ARMY OF SCHOOL BASED
CLINICIANS ARE DOING A REALLY
GOOD JOB BUT THEY'RE NOT ABLE TO
DO SOME OTHER DAY JOB BECAUSE
THERE'S SO MANY CRISIS IS
HAPPENING IN THE SCHOOLS NOT TO
WE WANT TO MAKE MORE OF A
STRATEGIC INVESTMENT.
IN USE CRISIS.
I APPRECIATE THAT AND I THINK
ONE THING THAT WE HELPFUL FOR US
WHETHER IT'S COUNTY BY COUNTY OR
STATE WIDE.
THERE'S SO MANY AREAS IN THE
MENTAL HEALTH BROAD CATEGORY.
BIT.
SOME IF YOU HAD A MAGIC WAND YOU
MENTIONED EARLIER.
A BUDGET SHORTFALL. FOR FOR
TEAMS FOR CHILDREN'S CRISIS
INTERVENTION.
AND BE HELPFUL FOR US EVEN JUST
TO GET.
SOME OF THOSE BALLPARK FIGURES --
THAT AND THEN HOW DO YOU
PRIORITIZE.
WHERE YOU PUT THE MONEY I KNOW
THE CRISIS INTERVENTION TEAMS --
NOT ONLY PROTECT.
INNOCENCE IN OUR COMMUNITY IT
ALSO PROTECTS ALONG FORSMAN
OFTEN TO HAVE ALLIES WHO MIGHT
HAVE A HISTORY.
WITH A PRIOR PATIENT OR A
PATIENT WHO'S IN CRISIS --
THAT INTERFACE CAN OFTEN --
AND OTHERWISE MINA SITUATION
THAT HAS A BAD ENDING EITHER FOR
THE PATIENT OR FOR LAW
ENFORCEMENT OFFICER.
SO ANY INFORMATION YOU CAN SHARE
WITH US THAT'S EITHER MONTEREY
COUNTY BASED OR STATE WIDE --
JUST SO WE KIND OF KNOW WHERE
THESE CATEGORIES ARE AND WHAT
THE SHORTFALL SUMMER WOULD BE
HELPFUL THANK YOU MISTER CHAIR
[inaudible]
ANYONE ELSE.
THE COUPLE QUESTIONS --
FIRST WELL DIRECTOR CAN'T JUST A
QUESTION FOR YOU.
YOU HOW MANY PEOPLE MOVE UP AND
DOWN THE CONTINUING CARE FROM
MILD TO MODERATE TO SEVERE AND
BACK DO WE HAVE ANY.
YOU KNOW I I THINK WE THE DATA
THAT I SHARED --
IN THE CHARTS THAT I HAVE IS
KIND OF THE BEST WAY THAT WE
HAVE IT WITH THAT'S THE KIND OF
OUR ATTEMPTED A PROXY.
BECAUSE WHAT YOU'RE REALLY
TRYING TO DO --
IS WE KNOW THE ADULTS AND
PEDIATRIC POPULATIONS THAT ARE
USING EXCLUSIVELY SHORT OIL
SERVICES MEANING THERE'S THERE
SOLELY IN THE SPECIAL TO MENTAL
HEALTH SERVICES.
AND THEN WE HAVE INDIVIDUALS
THAT ARE SOLELY USING THE MILD
TO MODERATE BENEFIT IN THE
MANAGED CARE PLAN AND THEN I
SAID THERE'S A GAP.
THAT THEY'RE USING AND
STRADDLING BOTH --
SYSTEMS AND WITHIN THAT WE PULL
THE DATA OUT TO SEE HOW MUCH OF
THE SHORT OIL SERVICES ARE USING
VERSUS HOW MUCH OF THE MANAGED
CARE AND THAT OVERLAP.
AND THAT'S KIND OF OUR BEST
CLOSEST --
WAY OF TRYING TO APPROX ME INTO
IN BETWEEN THE TWO DELIVERY
SYSTEMS BUT WE DON'T HAVE LIKE A
HARD AND FAST KIND OF DATA POINT
THAT WE CAN JUST PULL OT OF OUR
DATA WAREHOUSE TO SAY OH YEAH
THESE INDIVIDUALS.
YOU KNOW LAST YEAR WERE YOU KNOW
SEVERELY MENTALLY ILL AND THIS
YEAR THEY'RE EXCLUSIVELY MILD
YOU KNOW IT DOESN'T EXIST AND
NOT KIND OF A NEAT OF A FORMAT
BUT I'M HAPPY --
TO SURE THAT DATA IF YOU DON'T
HAVE IT.
THANK YOU --%
SO WHAT HAPPENS LOCALLY WHEN
THIS WHEN PEOPLE SLIDE AROUND IN
THE IN THE CONTINUUM OF CARE --
SO WE WORK VERY CLOSELY WITH A
MANAGED CARE PLAN TO WORK ON
TRANSITIONS IN CARE SO SAY A
PERSON WAS SEVERELY MENTALLY ILL
OR TRYING TO STEP THEM DOWN SO
WE TRY TO DO A WARM HAND OFF --
TO THE EXTENT RESOURCES ARE
AVAILABLE IN THE MILD NETWORK
AND WE KNOW THAT WE MONITOR
QUITE CLOSELY THAT BENEFICIARIES
ARE NOT RECEIVING BOTH SERVICES
AT THE SAME TIME BECAUSE WE'VE
SEEN THE MANAGED CARE WHEN A
PERSON.
ON THEIR OWN VOLITION TRIES TO
DO THAT WE'VE SEEN AND PRODUCED
IN NILES AND AND MOVE A PERSON
BACK OVER.
SO WE WORK PRETTY CLOSELY TO TRY
TO MANAGE THAT BUT IT'S COMPLEX
BECAUSE PEOPLE'S NEEDS CHANGE
DAY TO DAY THESE ARE HUMANS NOT
YOU KNOW QUANTIFIABLE.
RIGHT ENTITIES SO THERE'S A LOT
OF CHALLENGE BETWEEN THAT MILD
MODERATE DISTINCTION.
GRAY --
CONSIDERING --
THE AND THIS BACK TO YOU
DIRECTOR CAN'T OF CONSIDERING
THAT DIVERSITY OF THE STATE AND
THE CHALLENGES WE HAVE GETTING
ACCESS TO CARE OR GETTING CARE
TO SOME PEOPLE.
HOW MUCH OR OR OR OR WHERE WERE
YOU WITH THE TELEHEALTH AS FAR
AS --
TELEHEALTH THROUGH --
CHAVIS EVEN EVEN EVEN
POTENTIALLY THROUGH A DEVICE
LIKE THIS.
SO WE ISSUED --
CLARIFYING TELEHEALTH POLICY
ACROSS ALL THE DELIVERY SYSTEMS
MAYBE A MONTH OR TWO AGO SO WE
REVIEWED AND ACTUALLY IT WAS
DRIVEN BY THE MENTAL HEALTH --
SIDE OF OUR DEPARTMENT AND THAT
THEY HAD A PER HELLO HEALTH --
BOTH POLICY AND REIMBURSEMENT --
SCHEME AND WE KIND OF WE LOOKED
AT OUR PRIMARY --
ROLE INDIAN HEALTH DIVISION WE
LOOKED AT THE MANAGED CARE
DIVISION WE LOOK TO FEE FOR
SERVICE WE LOOKED AT DENTAL WE
LOOKED AT A CD AND WE SAID YOU
KNOW WHAT IS EVERYBODY'S
TELEHEALTH POLICY AND HOW DO WE
DO THAT AND SO WE ISSUED
GUIDANCE. TO EVERY SINGLE PART
OF OUR PROGRAM AND SAID THIS IS
WHAT THE TELEHEALTH POLICY IS IN
TERMS OF THESE ARE THE CODES
THAT ARE REIMBURSABLE UNDER
THESE -- YOU
KNOW BY THESE PROVIDERS I THINK --
IT'S NOT ONLY FROM A MENTAL
HEALTH STANDPOINT BUT ALSO
ACCESS TO SPECIALTY CARE RIGHT
SO IF YOU ARE A AN INDIVIDUAL
WITH A CHRONIC CONDITION AND YOU
LIVE IN A RURAL AREA.
AND HEMATOLOGIST IS DOWN IN
SACRAMENTO BUT CAN CONSULT VIA
TELEHEALTH THAT SOMETHING THAT
WE'RE LOOKING TO FACILITATE --
SO WE HAVE A PRETTY I THINK --
BOTH BROAD AND OPEN ACCEPTANCE
OF THE TELEHEALTH POLICY TO THE
EXTENT THAT IT WORKS FOR BOTH
THE PROVIDER AND THE PATIENT --
IT IS BEEN EXTREMELY SUCCESSFUL
I THINK IN THE MENTAL HEALTH
AREA BECAUSE OF THE NATURE OF
VIDEO CONFERENCE SEEN YOU KNOW
I'VE I'VE SHASTA FOR EXAMPLE
WHERE --
THEY HAVE A PRETTY --
AMAZING SET AS INFRASTRUCTURE I
TS TYPES OF DEVICES --
WHERE YOU THEY LINK DOWN HERE TO
UC DAVIS FOR PSYCHIATRIC
CONSULTATIONS AND OTHER TYPES OF
THINGS --
THOSE ARE BOTH PRACTICES AND
INNOVATIVE WAYS OF DELIVERING
CARE THAT WERE WERE SUPPORT OF
US [inaudible]
THANK YOU.
ANY OTHER QUESTIONS [inaudible]
OKAY.
SO WE'LL PUT YOU'LL BE BACK IN A
FEW MINUTES FOR ANOTHER PANEL SO
AT THIS POINT WE WILL THANK YOU
VERY MUCH BOTH OF YOU AND WE'LL
BRING UP --
OUR NEXT PANELIST --
RYAN MELENDEZ.
SEC BROTHER RYAN RYAN AND RYAN
AND GUEST SO --
SO SO WE RHYME MELENDEZ IS A
FISCAL POLICY ANALYST WITH THE
LEGISLATIVE ANALYST'S OFFICE --
MISTER MELENDEZ WILL DESCRIBE
FINANCING IN SPENDING ON PUBLIC.
A MENTAL A MIDDLE SERVICES TO
THE MEDICARE PROGRAM.
MISTER MELINDA'S PLEASE.
GOOD AFTERNOON CHAIRMAN WOULDN'T
MEMBERS OF THE HEALTH COMMITTEE --
BRUNDTLAND.
WITH THE LEGISLATIVE ANALYST'S
OFFICE SOME WITH.
THE DEPUTY ANALYST FOR HEALTH
AND HUMAN SERVICES MARK NEWTON
SAID ON THE FINANCING STRUCTURE
FOR MEDI CAL MENTAL HEALTH
SERVICES --
I HAVE A HANDOUT THAT.
SHOULD BE IN YOUR PACKAGE TO GO
OFF OF SO --
BEGINNING ON PAGE ONE I WANTED
TO START OFF --
TALKING ABOUT THE LARGER FUNDING
STRUCTURE FOR PUBLIC.
COMMUNITY MENTAL HEALTH SERVICES --
I WANT TO DO THIS UP.
BECAUSE ESPECIALLY FOR COUNTY
BASED OF MEDI CAL MENTAL HEALTH --
THE FUNDING IS DEEPLY INTEGRATED%
WITH THE BROADER PUBLIC
COMMUNITY MENTAL HEALTH OF
FUNDING SYSTEM AND BY --
JUST WANNA CLARIFY BY PUBLIC
COMMUNITY MENTAL HEALTH --
WHAT I'M TALKING ABOUT IS --
BOTH INPATIENT AND OUTPATIENT
MENTAL HEALTH SERVICES AT A
PUBLIC PLEA PROVIDED PRIMARILY
IN COMMUNITY SETTINGS --
BUT WHICH DOES ALSO DOES NOT MRS
STATE HOSPITALS PRISONS --
AND SERVICES FROM MEDICARE --
PRIVATE INSURANCE OR THE K.
THROUGH TWELVE EDUCATION SYSTEM.
IF YOU LOOK AT PAGE THREE OF THE
FIGURE.
WHAT WE CAN SEE IS A? FOR THE
OVERALL PUBLIC COMMUNITY MENTAL
HEALTH --
SERVICE SYSTEM IT'S ABOUT A TEN
BILLION ALMOST TEN BILLION
DOLLARS --
WITH THE FUNDING AND TWENTY
SEVENTEEN EIGHTEEN AT WITS
BREAKS DOWN --
LARGELY BY COUNTY AND NON COUNTY
BASED SERVICES --
FOR THE NON CAN BE SERVICES THIS
IS ENTIRELY A MEDI CAL MENTAL
HEALTH SERVICE --
PROVIDED THROUGH THE TRADITIONAL --
MEDI CAL MANAGED CARE PLANS AND
STATE FEE FOR SERVICE.
WHICH PROVIDE THE SO CALLED MILD
TO MODERATE SERVICES --
FUNDED THROUGH STATE JOURNAL FOR
DOLLARS.
THIS TOTALS ABOUT TWO BILLION
DOLLARS --
FOR THESE OUTPACING A MULTI
MODERATE SERVICES.
THE BULK OF THE FUNDING HOWEVER
GOES TO YOU COUNTY BASED MENTAL
HEALTH SERVICES.
SO IN TERMS OF MEDI CAL THAT
WOULD BE.
THE COUNTY MENTAL HEALTH PLANS
THE PRIDE THE SPELLS FLUTIE
MENTAL HEALTH SERVICES THE AT
THE MORE INTENSIVE SEVERE --
INPATIENT SERVICES FOR SEVERE
MENTAL HEALTH ISSUES BUT THIS
ALSO AGAIN PAYS --
FOR OTHER COUNTY BASED ON A
WHOLE SERVICES THROUGH THE
PROPOSITION SIXTY THREE MENTAL
HEALTH SERVICES ACT.
AS WELL AS VARIOUS OTHER KINDS
OF SAFETY NET MENTAL HEALTH
SERVICES --
SO THIS TOTALED ABOUT SEVEN
POINT NINE BILLION DOLLARS WORTH
OF FUNDING IN.
TWENTY SEVENTEEN EIGHTEEN OUT
ESTIMATED ABOUT FOUR POINT NINE
BILLION MEDI CAL --
METAL SERVICES OF THE MENTAL
HEALTH PLANS --
AND THE SO THE FUNDING FOR THIS
COMES FROM OF AS HAS BEEN
PREVIOUSLY DESCRIBED A WIDE
VARIETY OF DIFFERENT FUNDING
STREAM CERTAINLY --
FEDERAL FUND FEDERAL MEDICAID
MEDICAID DOLLARS AND SOME G.
STATE GENERAL FUND.
BUT ALSO SUBSTANTIAL LOCAL MATCH --
AND THIS --
LOOK MATCH FOR A TWENTY
SEVENTEEN EIGHTEEN WAS --
ABOUT ONE POINT SEVEN BILLION
DOLLARS TOTAL WE ESTIMATE --
AND THAT COMES FROM A WIDE
VARIETY OF FUNDING STREAMS
ITSELF --
INCLUDING IN TWENTY ELEVEN
REALIZE --
THE MENTAL HEALTH SERVICES ACT
AND COUNTY GENERAL FUND AS WELL --
WE'RE NOT ENTIRELY SURE --
WHAT THE?
POR **** WHAT PROPORTIONS OF
THIS ONE POINT SEVEN BILLION
DOLLARS OF TOTAL.
FOR LOCAL MATCH COMES FROM EACH
OF THE INDIVIDUAL --
FUNDING SOURCES AND THIS IS DUE --
IN LARGE PART BECAUSE EACH OF
THE FUNDING SOURCES --
SUPPORTS BOTH UP MEDI CAL AT THE
SPORTS BOTH MEDICAL AND AUTOMATE
MEDI CAL.
US MENTAL HEALTH SERVICES OR
SUPPORTS --
MEDI CAL MENTAL HEALTH SERVICES
BUT HAS ALSO --
SUBSTANCE USE DISORDER SERVICES
AND COUNTIES HAVE --
DISCRETION ON HOW THEY ALLOCATE
THE DIFFERENT LOVE PORTIONS OF
EACH OF THOSE FUNDING STREAMS TO
THEIR VARIOUS.
OF OVERALL BEHAVIORAL HEALTH
SERVICES THEY'RE RESPONSIBLE FOR
FUNDING.
IF YOU LOOK ON GOING BACK ON ITS --
FOR I'LL GO MORE INTO MORE
DETAIL ON THE DIFFERENT --
AT FEET INTO YOU --
MEDI CAL MENTAL HEALTH SERVICES
STARTING WITH THE FINAL FUND
PARTICIPATION FROM --
MEDI CAL THIS CONSTITUTES MORE
THAN HALF OF THE OVERALL MEDI
CAL MENTAL HEALTH FUNDING.
OF FEDERAL GOVERNMENT --
TYPICALLY PAYS FOR ABOUT 50% OF
COSTS FOR IT FROM MOST MEDI CAL
MENTAL HEALTH SERVICES.
HOWEVER --
YOU KNOW THERE ARE EXCEPTIONS
NOTABLY --
ONE MAJOR EXCEPTION IS THE THE
FEDERAL GOVERNMENT PAYS FOR NOT
YOU KNOW OVER 90% OF THE COST
FOR ENROLLEES WERE MADE ELIGIBLE
THROUGH --
THE AFFORDABLE CARE ACT MEDICAID
EXPANSION.
SO WE ESTIMATES IN TWENTY
SEVENTEEN EIGHTEEN THAT --
THE FEDERAL FRONT PARTICIPATION
FOR MEDI CAL MENTAL HEALTH
SERVICES WAS ABOUT.
A FOUR POINT TWO BILLION DOLLARS
WHICH WOULD MAKE THIS --
FUNDING SOURCE --
BUT OVERALL OF FUNDING SOURCE
PUSH FOR MEDI CAL MENTAL HEALTH
FUNDING BUT AS AS WELL AS THE
BILL FOR ALL PUBLIC COMMUNITY
MENTAL HEALTH SERVICE SYSTEM.
MOVING ON TO A LOCAL REALIGNMENT
A REVENUES SO BOTH NINETEEN
NINETY ONE IN --
TWENTY ELEVEN REALIGNMENT.
A DEDICATE --
SALES TAX IN VEHICLE LICENSE FEE
REVENUE TO COUNTIES TO PAY FOR
THEIR VARIOUS --
BEHAVIOR HEALTH SERVICE
RESPONSIBILITIES AND THIS IS THE
LARGEST --
NON FEDERAL --
FUNDING SOURCE FOR BEHAVIORAL
HEALTH SERVICES --
IN THE PUBLIC IMMUNITY MENTAL
HEALTH SYSTEM --
IN TOTAL --
WE ESTIMATE ABOUT TWO POINT
SEVEN BILLION DOLLARS OF TOTAL
REALIGNMENT FUNDING WITH THE
COUNTIES --
FOR THEIR MEDICAL AND NOT
SERVICES. FOR NINETEEN NINETY
ONE REALIGNMENT --
SPECIFICALLY THIS.
REALIGNMENT SHIFTED FUNDING
RESPONSIBILITIES TO COUNTIES --
FOR NOT A DONNELLY MEDI CAL
MENTAL.
HEALTH SERVICES A COMMUNITY
BASED MENTAL HEALTH SERVICES BUT
ALSO --
SAFETY NET MENTAL HEALTH
SERVICES AND NOT FEDERALLY
REIMBURSABLE INSTITUTIONS FOR
MENTAL DISEASE --
THE SALUDABLES THE DISTRIBUTION
FOR THE COUNTIES --
FROM THE STATE FOR THIS
PARTICULAR FUNDING.
IS THROUGH A SERIES OF FORMULAS
THAT ARE BASED PRIMARILY ON HOW
MUCH COUNTY SPENT.
ON THEIR MENTAL HEALTH
RESPONSIBILITIES IN THE EARLY
NINETEEN NINETIES --
UP FOR TWENTY SEVENTEEN EIGHTEEN
WE ESTIMATE THE TOTAL --
NINETEEN ANYONE REALIGNMENT
REVENUES TO COUNTIES AT ONE
POINT THREE BILLION DOLLARS.
TWENTY ELEVEN REALIGNMENT --
TRANSFERRED --
FUND RESPONSIBILITIES TO
COUNTIES FOR THE REMAINING MEDI
CAL SPECIAL MENTALLY MENTAL
HEALTH SERVICES INCLUDING --
CHILDREN'S EARLY --
PERIODIC SCREENING DIAGNOSIS AND
TREATMENT THREE PST T. SERVICES --
HAVE IT ALSO --
REALIGNED SUBSTANCE USE DISORDER
IS A TO THE COUNTIES.
AND STE UNDER THE SAME --
SHARED BEHAVIOR HEALTH ACCOUNTS --
SO WHILE TWENTY ELEVEN
REALIGNMENT --
FUNDING A DISTANT TO BE MORE --
WELL ALIGNED WITH A MORE UPDATED --
DATA ON COUNTY SPENDING A IN
THIS AREA --
COUNTY IS STILL DO HAVE --
TO PARSE BETWEEN FUNDING FOR
MENTAL HEALTH SERVICES AND FOR
THEIR SUBSTANCE USE DISORDER
SERVICES WITHIN THIS FIND AND
IT'S NOT IT'S THEIR DISCRETION
HOW THEY DECIDE --
TO TO ALLOCATE THOSE FUNDS
BETWEEN THE TWO SERVICES AND SO
WE ESTIMATES --
THE TOTAL FUNDING FOR TWENTY
ELEVEN REALIGNMENT AT ONE POINT
FOUR BILLION DOLLARS. FOR
PROPOSITION SIXTY THREE MIDDLE
OF THE MENTAL HEALTH SERVICES
ACT.
OF TWO THOUSAND FOR THIS --
YOU KNOW IT'S FUNDING IS IS ON
HIGHER INCOME EARNERS IN THE
STATE -- AND
IS MEANT LARGELY FOR SERVICES
THAT KIND OF GO BEYOND --
THOSE TRADITIONALLY PROVIDED BY
MEDI CAL --
INTENSIVE UP PREVENTATIVE AND
WRAPAROUND SERVICES THINGS LIKE
WORKFORCE --
TRAINING AND A DEVELOPMENTS --
DEVELOPING INNOVATIVE DELIVERY
SYSTEMS FOR MENTAL HEALTH
SERVICES --
BUT WE DON'T THAT --
COUNTIES ARE ABLE TO USE SOME OF
THEIR FUNDING --
FOR L. LOCAL MATCH FOR MEDI CAL
MENTAL HEALTH SERVICES EVEN AS
THE MAJORITY OF THEIR THERE
FUNDING GOES TO OTHER KINDS OF
MENTAL HEALTH SERVICES OUTSIDE
OF MEDI CAL.
AND SO TOTAL MINUTE --
AND ME TO SAY FUNDING TO COUNTY
IS WAS SOMEWHERE AROUND TWO
BILLION DOLLARS IN
TWENTY SEVENTEEN EIGHTEEN
FINALLY --
WITH THE STATE GENERAL FUND.
THIS TENDS TO BE A A MORE
LIMITED A SOURCE OF FUNDING FOR
MEDI CAL MENTAL HEALTH SERVICES
COMPARED TO SOME OF THE OTHER
FUNDS.
AGAIN LARGELY AS A RESULT OF THE
THE FACT THAT TWENTY ELEVEN AND
NINETEEN NINETY ONE REALIGNMENT
A SHIFTED --
LOTS OF THE FUNDING
RESPONSIBILITY ESPECIALLY FOR
SPECIALTY MENTAL HEALTH SERVICES
IT'S WHERE --
ONE OF THE LARGEST COSTS FROM
MENTAL AN ACCOUNT OF THE HEALTH
LAW -- THE
THE THE STATE THOUGH STILL
PROVIDE SOME GENERAL FUND TO
COUNTIES FOR THEIR MENTAL HEALTH
SERVICES ABOUT ONE HUNDRED
SEVENTY MILLION DOLLARS IN --
TWENTY SEVENTEEN EIGHTEEN THIS
IS.
THE STILL TO BE --
FOR SERVICES THAT ARE --
POST TWENTY ELEVEN AS A RESULT
OF PROP PROPOSITION THIRTY WHERE --
THIS MIGHT HAVE TO PROVIDE
ADDITIONAL OR ENHANCED SERVICES
FROM STATE FEDERAL OR
TRADITIONAL --
MANDATES --
AT FOR EXAMPLE THE ACA EXPANSION
WHICH EXPANDED ELIGIBILITY --
THE THE THE AMOUNT OF A
SPECIALTY MENTAL HEALTH SERVICES
THAT ARE PROVIDED. TO YOU --
THIS ELIGIBLE POPULATIONS WILL
BE COVERED BY THE AND AGAIN
LASTED GOLF AND PROVIDES THE THE
NON FEDERAL UP PORTION OF THE
MEDICARE FEE FOR SERVICE AKA
MULTI MODERATE SERVICES IN
TRADITIONAL MEDICARE AL --
ESTIMATE ABOUT SIX HUNDRED
MILLION DOLLARS IN --
TWENTY SEVENTEEN EIGHTEEN
STARTING ON PAGE --
SEVEN I'LL PROVIDE SOME MORE
INFORMATION ON THE OVERALL LEVEL
OF FUNDING FOR MEDI CAL --
MENTAL HEALTH SERVICES AS YOU
CAN SEE THE FIGURE --
BELOW THE BETWEEN FEDERAL FUNDS
STATE JOURNAL FUND AND THE LOCAL
MATS WHICH AGAIN.
INCLUDES OF BOTH REALIGNMENT
FUNDS -- AND
IT'S A SAY AND COUNTY GENERAL
FUND --
TOTAL MEDICAL MENTAL HEALTH
FUNDING CONSTITUTE CONSTITUTED
ABOUT SIX POINT EIGHT BILLION
DOLLARS IN TWENTY SEVENTEEN
EIGHTEEN WHICH IS MORE THAN TWO
THIRDS.
OF TOTAL FUNDING FOR THE PUBLIC
COMMUNITY MENTAL HEALTH SYSTEM.
A ON PAGES. EIGHT YOU CAN SEE
HERE IS THAT OF THAT --
BUT ACCOUNT MENTAL HEALTH
FUNDING MORE THAN 70% OF IT GOES
TO COUNTY MENTAL HEALTH PLANS --
ABOUT FOUR POINT EIGHT BILLION
DOLLARS COMPARED TO ABOUT ONE
POINT NINE BILLION DOLLARS TO
YOU ON THAT ACCOUNT --
MINUTES CARE PLANS.
AND UP LESS THE ON PAGE --
NINE WITH FIGURES SHOWS BLOWS --
THE SOME OF THE FUNDING A MORE
RECENT FUNDING GROWTH OVER TIME
FOR COUNTY BASED --
MEDI CAL MENTAL HEALTH RISING
FROM ABOUT THREE POINT NINE
BILLION DOLLARS IN TOTAL FUNDS
IN. TWENTY SIXTEEN SEVENTEEN TO
NEARLY FIVE BILLION DOLLARS
ESTIMATED IN.
TWENTY EIGHTEEN NINETEEN WHICH
HAS BEEN LARGELY ATTRIBUTED TO
COVERING COSTS ASSOCIATED WITH
HIGHER --
SERVICE UTILIZATION RATES.
BOB THIS CONCLUDES MY BRIEF I'M
HAPPY TO TAKE ANY QUESTIONS FROM
HERE.
WE QUESTIONS WITH THE YOU YOU
JUST YOU ANSWERED MY QUESTION
JUST A SECOND AGO THANK YOU
[inaudible]
ANYONE ELSE.
OKAY NO GREAT OKAY THANK YOU
VERY MUCH APPRECIATE.
WE GO BACK TO A BRING BACK OF
ITS COUPLE FAMILIAR FACES --
I HEAR THE GO WE HEARD THAT --
IS OUR FOURTH FENNEL I WAS
QUALITY MEASURED INSURED FOR
MENTAL HEALTH SERVICES IN MEDI
CAL.
SO ONCE AGAIN IT WILL BE --
DIRECTOR CAN'T AND DIRECTOR
MILLER --
WILL PRIDE RIGHT AN OVERVIEW OF
MEDI CAL --
MENTAL HEALTH CARE DELIVERY
SYSTEM THE BENEFITS THAT ARE
PROVIDED HOW CARE IS DELIVERED
SO.
THANK YOU TO SEEMS LIKE MOMENTS
AGO YOU WERE HERE.
IT WAS IT WAS THE BUT THE BRUTE
STRENGTH OF TIME --
SO THANK YOU SO I WOULD SAY THAT --
IN -- TWENTY
SIXTEEN THE FEDERAL ALL THAT
REALLY DID SUBSTANTIVELY CHANGE
THE NATURE OF THE WORK THAT WE
DO BETWEEN.
OVERSIGHT OF THE COUNTY MENTAL
HEALTH PLANS --
AS HAD PREVIOUSLY --
BEEN VERY VERY DIFFERENT AND
IT'S NOT TO SAY THAT THERE
WASN'T OVERSIGHT BUT THE MANAGED
CARE RULE PUT IN SUCH --
GRANULAR DETAIL AROUND NETWORK
ADEQUACY TIME AND DISTANCE
STANDARDS AND I KNOW THAT THE
LEGISLATURE --
PASS LEGISLATION AROUND HOW WE
WERE GOING TO SET THOSE TIME
DISTANCE STANDARDS AND SO FOR
THE FIRST TIME LAST JULY --
ALL OF THE COUNTY MENTAL HEALTH
PLANS --
FILED NETWORK AS NETWORK FILINGS
WITH US AS A DEPARTMENT IT WAS
AN INCREDIBLE AMOUNT OF WORK ON
THEIR PART IT WAS AN INCREDIBLE
AMOUNT OF WORK ON OUR PART --
AND I THINK YOU KNOW AS WE GET
BETTER AT THIS IN TERMS OF WE
HAVE GONE BACK AND WORKED WITH
THE COUNTIES TO REFINE --
YOU KNOW ACTUAL F. T. E.'S AND
HOW WE COUNT THOSE PROVIDERS AND
HOW DO YOU --
ACCOUNT FOR GEOGRAPHIC
DISTRIBUTION AND LOTS OF OTHER
BOTH ADULT AND PEDIATRIC
POPULATION AND AS A CAT
PSYCHIATRIST DOING.
YOU KNOW PRESCRIPTION MANAGEMENT
VERSES AND DIFFERENT KIND OF
PROVIDER --
I THINK WHAT THE MANAGED CARE
RULE REALLY DID WAS HIGH LATE
BOTH THE IMPORTANCE --
FOR US AS A STATE AS WELL AS FOR
SIMMERS THAT --
WE CAN'T--
WE CAN'T IMPROVE WHA WE CAN'T
MEASURE AND SO FOR THE FIRST
TIME WE AS A STATE ARE WORKING
WITH THE COUNTIES TO MEASURE --
THE NUMBER OF PROVIDERS THAT ARE
IN A GIVEN --
NETWORK WE'RE LOOKING AT
UTILIZATION DATA WE'RE LOOKING
AT TIME AND DISTANCE STANDARDS
AND APPEALS AND GRIEVANCES AND
LANGUAGE COMPETENCY AND A LOT OF
REALLY.
IMPORTANT UNDER PENDING --
DETAIL AND ADMINISTRATIVE
OVERSIGHT OF HOW WE DELIVER
SERVICES IN THE STATE AND SO.
THROUGH THAT --
WE HAVE.
BEEN WORKING PRETTY DILIGENTLY
WITH THE COW --
CLOSE ACTION PLANS THAT WERE
ISSUED AS A PART OF THE NETWORK
FILINGS FOR THE FIRST TIME
OBVIOUSLY WE WILL BE ANNUALLY
CERTIFY IN THESE NETWORKS.
AND SO TO THE EXTENT THAT
COUNTIES ARE NOT IN COMPLIANCE
THAN WE WOULD BE EITHER PUTTING
THEM UNDER CORRECTIVE ACTION
PLANS OR IN THE CASE OF EITHER
PERSISTENT OUR ON GOING --
FAILURE WE WOULD BE LOOKING AT
OTHER FINANCIAL --
SANCTIONS ARE PENALTIES THEM FOR
THESE FOR THESE AND ALL OF OUR
MANAGED CARE PLANS THAT HAVE TO
FILE THESE THIS IS NOT JUST
ISOLATED TO THE COUNTY MENTAL
HEALTH PLANS.
I THINK WHEN YOU LOOK AT QUALITY
MONEY IN OVERSIGHT AND I KNOW
THAT WE SHARED A LOT OF DETAIL --
WITH THIS COMMITTEE IN TERMS OF
BACKGROUND DATA --
WE HAVE A BOTH A GROWING AND A
MORE ADVANCED SCENE SET OF DATA
METRICS --
BROKEN DOWN BY POPULATION BROKEN
DOWN BY AGE BROKEN DOWN BY
SERVICE CATEGORY AND REALLY WHAT
I THINK WE ARE TRYING TO DO
COLLECTIVELY IS TO LOOK AND SAY
YOU KNOW ARE THERE COUNTIES --
SUCH AS THE CONVERSATION THAT WE
HAD ON THE PANEL BEFORE WHERE
THEIR OUTCOMES APPEAR TO BE
SIGNIFICANTLY BETTER THAN
DIFFERENT COUNTY AND WHAT'S THAT
RELATED TO AND I THINK THAT IT'S
ONLY THROUGH.
KIND OF THIS ADVANCEMENT AND THE
DATA ANALYTICS --
AND THE MONITORING AND OVERSIGHT
AS MUCH AND AS HARD AS IT IS TO
DO IS THAT'S REALLY WHERE WE'RE
GOING TO START TO SEE KIND OF
SUBSTANTIVE CHANGE I THINK AND
THAT'S THE BOTH ARE --
INTENSE IN TERMS OF COMPLYING
WITH THE FEDERAL RULES AND BUT
ALSO WHEN WE THINK ABOUT WAIVER
RENEWAL AND WHAT WE WANT TO DO
AS A STATE GOING FORWARD WE
CAN'T CREDIBLY COME UP WITH A
PLAN FOR HOW WE WANT TO GET
THERE IN THE FUTURE IF WE DON'T
ACTUALLY.
KNOW WHERE WHERE THE GAPS ARE
NOW AND SO I WOULD SAY THAT ALL
OF THE WORK THAT WE'VE DONE WITH
THE COUNTIES --
SO FAR HAS BEEN.
DONE WITH THE INTEREST OF MAKING
SURE THAT WE KNOW WHAT WE KNOW
AND HOW CAN WE MEASURE WHAT WE
WANT TO IMPROVE AND SO.
THE QUALITY MONITORING AND THAT
WE HAVE AND AGAIN LIKE I SAID WE
WE CERTAINLY ARE HAPPY TO
PROVIDE THE DETAILS THE
COMMITTEE MEMBERS AS WELL AS
WELL -- WE
LOOK AT PENETRATION RATES WE
LOOK AT APPEALS AND GRIEVANCES
WE LOOK AT ACCESS --
THOSE ARE ALL INTENDED TO HELP
BOTH DR --
QUALITY NOT ONLY FOR THE COUNTY
THAT'S ADMINISTERING THE PROGRAM
BUT ALSO DRIVE AN OVERALL
QUALITY STRATEGY THAT WE HAVE --
HELD OURSELVES AND THE AND THE
COUNTIES ARE ACCOUNTABLE FOR SO
YOU HAVE TO ANSWER QUESTIONS AT
THE END OF THIS BUT IT IS A IT
IS A HEARING TOPIC WORTHY OF A
GREAT DEAL OF PAPER AND AND DATA
THAT WE WILL PROBABLY AND SO
[inaudible]
SO -- SO.
WE HAVE A FEW DIFFERENT LAYERS
OF LOOKING AT QUALITY WITHIN THE
MENTAL HEALTH PLANS IS IMPORTANT
REMEMBER THAT IS A MENTAL HEALTH
PLAN WE OPERATE LIKE.
DIRECTOR CAN'T SAID WE OVERSEE
ALL THE SAME MANAGED CARE RULES
PLUS WE DIRECTLY PROVIDE
SERVICES TO CLIENTS AND THEN
OVERSEE IT UP ROBUST NETWORK OF
CONTRACT FOR WRITERS THAT
ADDITIONALLY PROVIDE SERVICES.
SO WE DO TRY ANNUAL REVIEWS
PERFORMED BY DH CS WE ALSO HAVE
AN ANNUAL EXTERNAL QUALITY
REVIEW.
AUDITS --
AND THEN WE WORK ON OUR NETWORK
ADEQUACY --
STANDARDS OVERALL AND ALL THAT'S
PUBLICLY AVAILABLE SO THE
TEACHER --
AUDIT IS PRETTY ROBUST IN TERMS
OF LOOKING AT OUR SYSTEM REVIEW
THEY INTERVIEW CONSUMERS TALK
ABOUT TIMELINESS OF ACCESS
MEASURE INDICATORS LIKE OUR
BENEFICIARIES SERVICE PERFORMED.
THE COST PER BENEFICIARY AND
THEN HOW WE'RE SERVING SPECIFIC
POPULATIONS LIKE THE FOSTER CARE
POPULATION.
WE ALSO HAVE TO DO --
PERFORMANCE IMPROVEMENT PROJECTS
AT LEAST TWO PER YEAR TO
INNOVATE AND AND ADMINISTRATIVE
AND CLINICAL DOMAIN.
SO THAT'S ANOTHER WAY THAT WERE
CONTINUALLY WERE OUR SYSTEM --
THEY ALSO LOOK AT TIMELINESS TO
ACCESS AND TREATMENT POST
HOSPITALIZATION TIMELINESS AND
TIMELINESS --
TO FIRST APPOINTMENTS THIS IS AN
EXAMPLE OF ONE OF THE CHARTS
THAT EACH ROW PROVIDED JUST HAD
MY COUNTY SWEET COMPARED TO
OTHER MEDIUM SIZED COUNTY IS.
THE STATE AND WE LOOK AT OUR OUR
OWN DATA SOMETHING WE ARE
CONSTANTLY WORKING ON IS OUR
PENETRATION RATES.
SPECIFICALLY WHAT I'M WORKING ON
MY COUNTY IS THE INCREASING
SERVICES PATINO POPULATIONS OF
THIS IS A METRIC BUT I'M.
I'M ALWAYS LOOKING AT YOU KNOW
WE'RE STARTING TO DO BETTER
BETTER THAN STATEWIDE AVERAGES
BUT WE LOOK AT THE PREVALENCE
RATE A MENTAL ILLNESS WE KNOW
THAT THERE'S THERE'S SO MUCH
MORE NEED AND SO MUCH MORE.
AREAS OF GROWTH --
WE ALSO TWICE A YEAR ON THE
MENTAL HEALTH SIDE AND ONCE
YOU'RE ON ALCOHOL AND DRUGS I DO
CONSUMER SATISFACTION SURVEYS SO
WE SURVEY PEOPLE AT OUR CLINICS
AND IN OUR CONTRACTED PROVIDERS
YOU'LL SEE THAT THE MOST RECENT
RIVER.
RESULTS STATEWIDE PUBLISHED BY
DH CS SHOW.
THAT WERE SORT OF HIGH STRENGTH
AND GENERAL SATISFACTION WHERE
OUR LOWEST RANKING OVERALL AREA
IS LAW ON HELPING OUR CONSUMERS
FEEL SENSE OF CONNECTEDNESS
WHICH IS JUST A REALLY IMPORTANT
DOMAIN IN TERMS OF PEOPLE
ACHIEVING THEIR LIFE GOALS AND
OUTCOMES.
THE EACH SPECIAL THE MENTAL
HEALTH PLAN HAS A PERFORMANCE
DASHBOARD DIRECTOR CAN'T LARGELY
ALREADY WENT OVER THAT THAT'S
BOTH A COUNTY IN OVERALL
AGGREGATE LEVEL FOR THE STATE.
SO LOOKING AT STEP DOWNS IN CARE
NEW PEOPLE HOW QUICKLY WERE
RESPONDING TO SERVICE.
THIS IS WHAT A NETWORK ADEQUACY
MAP LOOKS LIKE IN MY COUNTY SO
IT'S ENSURING OUR TIME AND
DISTANCE STANDARDS WERE
PRODUCING THESE ANNUALLY IN
GETTING RECERTIFIED --
AND IT'S A DIFFERENT LAYERS THIS
WAS JUST MY PSYCHIATRY MAP BUT
THERE'S A LAYER SPECIFICALLY FOR
CHILDREN FOR ADULTS LOOKING AT
MAKING SURE THAT IT'S IT
ACCESSIBLE FOR THE ENTIRE
COMMUNITY.
AND CERTAINLY TELL HEALTH HELPED
US TO EXPAND THIS NETWORK EVEN
MORE SO WE USE TELL HAVE QUITE
EXTENSIVELY IN RURAL AREAS
REFUNDED TO REALLY SUCCESSFUL.
IN PARTICULAR THE LATINO
POPULATION COMING IN FROM THE
FIELDS THEY REALLY LIKED THAT --
MORE SO THAN WE ANTICIPATED.
AND THE BIG QUESTION BECAUSE WE
COULD LOOK AT DASH WAS FOR
AWHILE I THINK EVEN DIRECTOR
CAN'T SAYS OUR DASHBOARD OR
SLIGHTLY OVERWHELMING. FOR THE
QUESTION IS WHAT DOES THIS DO
FOR THE CLIENTS THAT WE SERVE.
YOU KNOW ULTIMATELY WHAT WE'RE
DOING THE BEHAVIOR HALL SYSTEM
IS ARE WE INSURING THAT PEOPLE
HAVE YOU KNOW A PLACE TO LIVE A
PLACE TO HEAL AND PEOPLE AT
THEIR CONNECTED.
TO AND SO I THINK WE'VE
DEMONSTRATED TODAY THAT THERE'S
QUITE A BIT OF DIVERSITY IN THE
TYPE OF SERVICES WERE PROVIDING
IN BEHAVIORAL HEALTH SO WHEN I
THINK OF IN MY CHAIR.
YOU KNOW WHAT AM I DOING FOR MY
COMMUNITY I'M MORE THINKING
ABOUT AND MY INSPIRING CULT BY
MAKING SURE THAT CONSUMERS SEE
THE POTENTIAL NEW LOOK AT THE
SUICIDE RATES ARE SO ALARMING.
YEAH THAT'S A DEATH OF DESPAIR
SO HOW DO I MAKE SURE PEOPLE ARE
CONNECTED IN THE COMMUNITY AND I
CLINICS ARE OPEN AND ACCESSIBLE
THERE WERE INCREASING SAFETY BY
BEING IN THE RIGHT PLACE MALL
RIGHT TIME TALKED A COUPLE WEEKS
AGO ABOUT OUR SCHOOL BASED
SERVICES I THINK ARE.
DEFINITELY SAVING LIVES BY BEING
IN THE SCHOOLS AND BEING PRESENT
YOU KNOW WE'RE ADDRESSING PEOPLE
THAT WOULD HAVE NEVER GOTTEN
INTO BEHAVIORAL HEALTH CARE AND
WE'RE REDUCING YOU KNOW ALL
SORTS OF NEGATIVE INCIDENTS THAT
WILL NEVER MAKE IT TO A
DASHBOARD.
THANKFULLY RIGHT --
AND THEN A BIG PIECE FOR COUNTY
MENTAL HEALTH PLANS ARE WE DOING
ALL WE CAN TO REDUCE INEQUITIES
SO THERE'S A LOT OF HISTORICAL
INEQUITY AND WE HAVE A LOT TO DO
IN TERMS OF MAKING SURE THAT
WE'RE MEETING THE NEEDS OF
DIVERSE POPULATIONS --
A BIG QUESTION FOR ME IS A
DIRECTOR'S HAVE I JOINED WITH AN
EMPOWERED FAMILIES SO MUCH OF
OUR WORK YOU KNOW IN OUR MENTAL
HEALTH SYSTEM WE'VE DONE SOME OF
THE OTHER PANELS PEOPLE ARE
ASKING ABOUT.
THEIR LOVED ONES STRUGGLING A
WHAT DO THEY DO WHEN THEY'RE
FALLING BETWEEN THE CRACKS IN
BETWEEN A HOSPITALIZATION OR
GOING TO JAIL ARE WE DOING
ENOUGH TO TRAIN FAMILIES AND BE
ACCESSIBLE IN THE COMMUNITY --
AND THEN.
MOST IMPORTANTLY I'D SAY ARE ARE
WE LEADING FOR THAT FROM THE
TRENCHES SO AS I BEHAVIORAL
HEALTH SYSTEM WE REPRESENT SOME
OF THE MOST VULNERABLE PEOPLE IN
CALIFORNIA.
AND SORRY MAKING SURE THAT
PEOPLE LIKE YOU ARE HEARING
THEIR VOICE HELPING THEM TO GET
THEIR NEEDS MET AND DEVELOPING A
SYSTEM THAT REALLY RESPONSE TO
THEM TO ME THAT SORT OF OUR OUR
NUMBER ONE PERFORMANCE INDICATOR
[inaudible]
QUESTIONS.
OKAY I HAVE SOME --
A DIRECTOR MILLER SO WHEN YOU
PERFORM THESE BENEFITS SHERRY
SATISFACTION --
SURVEYS OR FOCUS GROUPS OR
WHATEVER.
WHAT ARE THE ISSUES THAT COME UP
[inaudible]
TRANSPORTATION --
SO EAGER --
DOES --
SATISFACTION GROUPS THAT WERE
NOT ALLOWED TO PARTICIPATE IN
THEIR SORT OF LINE WHERE THEY
TALK ABOUT CONSUMER SATISFACTION
THERE'S NOT A LOT OF TRENDING
DOWN ON THAT IT'S MORE FEEDBACK
ABOUT ON IMPROVING TIMELINESS TO
SERVICES AT TIMES --
BUT WHEN WE DO OUR LONG CONSUMER
PERCEPTION SERVICES LIKE THIRTY
FIVE QUESTIONS --
ITS A LOT AROUND TRANSPORTATION
AND THEN YOU KNOW HELPING PEOPLE
AGAIN WITH THEIR SOCIAL
CONNECTEDNESS WHEN I WAS LOOKING
OUR MOST RECENT RESULTS WE
PERFORMED REALLY WELL ON YOUR
FAMILY SAYING MY CHILD GOT ALL
THE SERVICES THEY NEEDED WHEN
THEY NEEDED THEM --
BUT THOSE ARE SOME OF THE
FINDINGS THAT WE SEE.
SO THESE OF THE ISSUES THAT ARE.
OKAY OKAY THERE MY JUST ANSWER
MY OWN QUESTION HERE SORRY IT
HAPPENED.
DOCTOR DIRECTOR CAN --
SO NGUYEN IMAGE WHEN MHP SUBMIT
BEEN BENEFICIARY STE
SATISFACTION SURVEY AND WHEN WE
DID GO OUT TO THE COUNTIES FOR
THE TRI IN DEALS --
WE LOOK AT A COMBINATION OF BOTH
ADMINISTRATIVE DATA AS WELL AS
KIND OF SOME OF THE QUALITATIVE
DATA I THINK THAT --
THE CONSUMER --
RESPONSES AND FEEDBACK ARE PART
OF AN OVERALL --
YOU KNOW A WE MAKE SURE THAT
THEY'RE DOING THE SURVEYS YOU
KNOW JUST FROM THAT YOU KNOW
CHECK IN THE BOX MAKE SURE THAT
IT'S BEING DONE.
BUT I THINK WHAT WE LOOK FOR IN
THE DOCUMENTATION WITH THE
COUNTIES IS THE IS THE FEEDBACK
THAT THEY'RE GETTING SOMEHOW
EITHER INCORPORATED --
I KNOW THAT WE HAVE HAD COUNTIES
WHERE THEY HAVE IDENTIFIED
THROUGH THEIR SURVEYS --
GAPS -- FOR
MAYBE L. G. B. T. POPULATIONS
FEELING THAT THEY DON'T HAVE YOU
KNOW THE RIGHT TYPE OF PROVIDER
IN THAT COUNTY OR SOMETHING AND
THEN WHEN WE DO THE TRIENNIAL WE
WOULD BOTH KNOW THAT AS A SURVEY
RESPONSE BUT THEN ALSO NOTE THAT
THE COUNTY HAD DONE SOMETHING TO
EFFECTUATE.
A CHANGE IN THAT AREA SO
SOMETIMES IT'S NOT NECESSARILY
REACTING TO THE SURVEY ITSELF IS
IS IT'S LOOKING INTO THE
COUNTIES PROCESS THAT THEY
INCORPORATED IT AND SOMEHOW
ADDRESS IT IN A WAY THAT.
IF IT COULD BE MEANINGFULLY
ADDRESS THEN THAT WOULD
CERTAINLY BE SOMETHING THAT WE
WOULD TAKE INTO ACCOUNT AND AND
IT WOULDN'T BE A SIGNIFICANT
FINDING SO WHEN WE DO --
KIND OF SYSTEM --
REVIEWS WE NOT ONLY GO IN AND
LOOK AT LIKE DID YOU FILL THE
CHART OUT DOES IT HAVE THE
PATIENCE SIGNATURE DO YOU HAVE
THE RIGHT CODE YOU KNOW DID YOU
MAKE THE RIGHT NOTE FOR THAT
PARTICULAR DAY BUT WHEN WE LOOK
AT THE OVERALL SYSTEM.
WE'RE LOOKING AT A KIND OF A
BROAD PERSPECTIVE AS BOTH.
BENEFICIARY FEEDBACK --
YOU KNOW OVERALL COMPLIANCE YOUR
APPEALS AND GRIEVANCES SO
SOMETIMES IF THE COUNTY HAD FOR
EXAMPLE A LOT OF APPEALS AND
GRIEVANCES THAT WOULD INDICATE
TO US THAT BENEFITS YEARS I'M
HAPPY BECAUSE FOR THEM TO
ACTUALLY GET INTO AN APPEAL
GRIEVANCE PERIOD THAT WOULD SEE
THAT.
YOU WOULD SEE THAT THERE'S
SOMETHING WRONG THERE SO THEN WE
WOULD GO BACK TO THE SURVEY DATA
AND SAY WHAT'S THE PROBLEM AND
IF YOU SAW THE SURVEY DATA THAT
THE PATIENT WAS SAYING.
YOU KNOW THERE'S NOT ENOUGH
CLINICS AVAILABLE AND THE TIME
THEY WILL THAT SOMETHING THAT
WOULD OBVIOUSLY LEAD THEM TO
HAVE SO THOSE ARE THE WAYS IN
WHICH WE WOULD USE THE DATA --
AND THE RESPONSES THAT KIND OF
LEADS US TO OTHER PARTS OF THEIR
OVERALL OPERATION TO SAY IS THIS
BROKEN OR CAN IT BE IMPROVED.
SO YOU USING THE INFORMATION
THAT'S GENERATED BY THE COUNTIES
AND EVALUATING THAT YEAH ARCHERY
AND YELLS WE'RE ON SITE.
FOR THREE TO SO YOU HAVE FIVE
THREE TO FIVE DAYS DEPENDING ON
THE SIZE OF THE COUNTY WITH THE
TEAM SO WE ACTUALLY ARE IN THE
COUNTY LOOKING AND TALKING AND
GOING OUT TO PROVIDERS OFFICES
AND DOING SHARPLES AND THINGS
LIKE THAT SO IT'S A PRETTY
EXTENSIVE REVIEW WHICH IS.
WHY THEY'RE TRY ANY ELSE WHICH
IS WE DO A THIRD OF THE COUNTIES
IN ONE YEAR A THIRD OF THE
COUNTIES THE NEXT YEAR AND A
THIRD OF THE COUNTIES?
SO WE'VE GOT ROTATING BECAUSE IT
IS -- LABOR
INTENSIVE TYPE BEFORE CLASS.
IS OVER THERE TOP LIKE A TOP THE
TOP THREE STATEWIDE.
OR OR WHAT THE TOP IT FROM YOUR
PERSPECTIVE ONE OF THE TOP
ISSUES THAT YOU SEE CONSISTENTLY --
I WOULD.
I WOULD SAY AND PSYCHIATRY
SERVICES IN GENERAL CHILD
PSYCHIATRISTS MOST ACUTELY --
IF YOU TALK TO ANYONE --
ANYWHERE THEY WILL SAY CHILD
PSYCHIATRISTS ARE ONE OF HE
MOST DIFFICULT PROVIDERS --
TO ATTAIN --
THEY ARE NOT --
NECESSARILY DEEPLY AN HEALTH
CARE DELIVERY SYSTEMS NOR THEY
ACTUALLY INVOLVED AND PRIVATE
COMMERCIAL INSURANCE --
THAT MUCH SO THERE IT
EXCESSIVELY HARD TO GET --
AND THAT'S CONCERNING OBVIOUSLY
FROM A FROM A ADMINISTRATORS
PERSPECTIVE WHICH IS IF YOU WANT
TO TALK ABOUT CHILDREN AND HOW
DO YOU TRY TO PREVENT --
MENTAL ILLNESS FROM PROGRESSING --
PROGRESSING TO A MORE SEVERE
FORM -- THE
FACT THAT WE DO NOT HAVE ENOUGH
CHILD PSYCHIATRIST IN THE STATE --
IS A IS A DEEPLY CONCERNING AN
ISSUE FOR US --
I THINK TRANSPORTATION WAS
CERTAINLY SOMETHING THAT HAS
ALWAYS CONSISTENTLY COME UP --
WHICH IN SOME CASES WE ARE
HOPING WE SOFTEN WE DIRECTED
THAT MANAGED CARE PLANS TO PAY
FOR TRANSPORTATION FOR MEDI CAL
BENEFICIARIES REGARDLESS OF
WHETHER THE PLAN IS PAYING FOR
THE SERVICE OR NOT.
SO -- ARE
MANAGED CARE PLANS ARE TWENTY
FOUR CONTRACTING MEDICAL MANAGED
CARE PLANS HAVE TO PAY FOR
TRANSPORTATION FOR MEDI CAL
BENEFICIARIES FOR THEIR COVERED
ENROLLEES. TO SERVICES WHETHER
OR NOT THE PLAN IS ACTUALLY PAID
FOR THOSE SO.
SPECIAL TO MENTAL HEALTH CARE
DENTAL CCS --
YOU KNOW ANY OF THOSE THE PLANTS
ARE NOT RESPONSIBLE AND THAT WAS
OUR WAY OF TRYING TO ADDRESS
SOMETHING THAT WE THOUGHT WAS A
GAP -- I
THINK OTHER THAN THAT I THINK --
CRISIS STABILIZATION CRISIS AND
HAS CONTINUE TO BE AN AREA IN
WHICH MORE CAN BE DONE --
PRIMARILY BECAUSE IT COMES IN A
TIME IN WHICH THE HEALTHCARE
DELIVERY SYSTEM IS NOT ALWAYS
KNOWN FOR BEING AVAILABLE YOU
KNOW ON A ON A TIME IN WHICH
THAT SYNCS UP NATURALLY WITH
WHEN YOU'RE PEAK CRISIS SEES
USUALLY INVOLVE WHICH IS.
TYPICALLY AT NIGHT --
TYPICALLY ON THE WEEKENDS AND SO --
COUNTIES ARE REQUIRED TO HAVE
CRISIS SERVICES BUT NOT
NECESSARILY THEY'RE NOT REQUIRED
TO HAVE MOBILE CRISIS SERVICES
THAT'S UP TO THE COUNTY TO
DECIDE.
AND THEN OBVIOUSLY GIVEN THE
RURAL OR URBAN NATURE OF A
COUNTY THAT CAN BE --
MORE DIFFICULT AND I KNOW THAT
SHASTA HAS CERTAINLY BEEN
PILOTING A NEW MOBILE CRISIS --
UNIT THAT HAS A SEEM TO GO VERY
WELL BUT THOSE ARE SOME OF THE
THREE THAT IF I HAD A NAME THREE
THOSE WOULD BE THE TOP THREE
THAT WERE MOST AWARE OF AND AND
SENSITIVE.
TO OTHER TYPES OR I MEAN --
HOW MANY HOW MANY OR WHAT TYPES
OF ISSUES AND A LEADING CALLS TO
THE OMBUDSMAN FOR EXAMPLE --
IT USUALLY IS --
AROUND.
ALL OF THE CALLS TO THE
OMBUDSMAN CAN BE --
YES CAN BE CERTAINLY DIVERT
STANDING OF WHAT --
THE BENEFIT IS --
SOMETIMES THEY DON'T LIKE THE
PROVIDER --
SO THEY HAVE A COMPLAINT ABOUT
THE SPECIFIC PROVIDER LIKE THEY
WERE RUDE TO ME OR THE OFFICE
STAFF WOULDN'T RETURNMY CALLS --
SOMETIMES THEY DON'T LIKE THE
NATURE OF THE SERVICE THAT HAS
BEEN --
DETERMINED APPROPRIATE FOR THEM
SO IF THEY SOMETIMES IF IT'S A A
PARENT THAT THINKS THEIR CHILD
NEEDS A RESIDENTIAL PLACEMENT
AND THE ASSESSMENT IS DONE AT
THE COUNTY LEVEL IN THE COUNTY
SAYS THIS IS NOT A THIS IS NOT
AN INDIVIDUAL THAT IS NEEDING.
A RESIDENTIAL PLACEMENT --
YOU'LL HEAR FROM THE ON YOU KNOW
YOU'LL GET A CALL IN TO THE
OMBUDSMAN SAYING I DISAGREE --
MORE OFTEN THAN THAT IS A
USUALLY A LACK OF UNDERSTANDING
IN TERMS OF WHERE DO I GO AND
HOW DO I GET SERVICES WHICH YOU
KNOW AS I SAID AT THE BEGINNING
OF MY REMARKS TODAY WE RUN SIX
DELIVERY [inaudible]
EVERYONE I THINK WE ARE DEEPLY --
COMMITTED TO TRYING TO MAKE THAT
MORE --
SEAMLESS FOR INDIVIDUALS
ESPECIALLY THOSE THAT HAVE --
MENTAL HEALTH OR SUBSTANCE USE
DISORDER I MEAN THAT IS A REALLY
DIFFICULT THING TO TRY TO
NAVIGATE ON THEIR OWN AND SO --
THAT'S USUALLY WHAT THE
OMBUDSMAN IS DEALING WITH THIS
PEOPLE THAT THEY'RE JUST SIMPLY
ACTION NOT UNDERSTANDING WHAT IS
AVAILABLE TO THEM AND BY WHICH
SYSTEM --
HOW HOW TO HOW TO OUR
PENETRATION RATES MATCH UP WITH
PREVALENCE AND?
HAS A VERY BY COUNTY OBVIOUSLY --
I WILL HAVE TO TAKE A LIFELINE
ON THAT ONE BECAUSE OUR
PENETRATION RATES I KNOW FROM A
STATEWIDE --
PERSPECTIVE BUT I DON'T KNOW
FROM MY COUNTY PERSPECTIVE WHAT
ARE THEY STATEWIDE --
THEY'RE ABOUT THE SAME FOR BOTH
PEDIATRIC AND ADULT THE
PENETRATION RATES ABOUT 4% GIVE
OR TAKE.
POINT -- ONE
POINT TWO ONE ON EITHER SIDE --
I KNOW THAT --
THE PENETRATION RATE FOR
CHILDREN HAS BEEN A CONCERN --
FROM THE ADVOCATE CERTAINLY OVER
THE LAST FEW YEARS AND THAT THEY
FELT LIKE THE PENETRATION RATE
SHOULD BE HIGHER --
BUT JUST FROM THE STAND LATER
AND OUR DENOMINATOR HAVE GROWN
BOTH YOU KNOW WE'VE WE'VE GOT A
SIGNIFICANT NUMBER OF CHILDREN
IN THE MEDICAL PROGRAM THAT WORD
NOT PREVIOUSLY AND SO --
I TEND TO THINK THAT IT'S
ACTUALLY PROBABLY REFLECTIVE OF
THAT YOU KNOW IT'S BEEN A VERY
KIND OF STABLE NUMBER BOTH PRE
AND POST ACA BUT IT'S ALSO
REFLECTIVE OF WHAT THE
PENETRATION RATE IS ON THE ADULT
SIDE WHICH YOU KNOW TO THE
PRESENTATION BY C. H. C. F..
WE KNOW KIND OF THE GENERAL
POPULATION HAS THIS PERCENTAGE
OF SERIOUS MENTAL ILLNESS AND
BECAUSE IT'S A CHRONIC DISEASE
AND SO THEREFORE WE WOULDN'T
NECESSARILY EXPECT THERE TO BE A
HUGE SPIKE IN PENETRATION.
BASED ON SPECIALTY MENTAL HEALTH
SERVICES DUE TO A SERIOUS MENTAL
ILLNESS JUST BECAUSE THAT IS NOT
NECESSARILY A GROWING --
A GROWING --
DIAGNOSIS OR DISEASE STATE I
THINK WHAT HAS BEEN GROWING AS
AN INTEREST IN IDENTIFYING
CHILDREN WITH BEHAVIORAL ISSUES
EARLIER AND DOING AN
INTERVENTION EARLIER AND SAID
THAT IS CERTAINLY AND BUT THAT'S
DIFFERENT THAN A DIAGNOSIS WITH
THE SERIOUS MENTAL ILLNESS AND
SO.
THAT'S REALLY WHERE A LOT OF
ATTENTION HAS BEEN PAID BOTH ON
THE COUNTY SIDE AS WELL AS ON
THE ADVOCATE SIDE WHICH IS HOW
DO WE GET TO KIDS.
AND TRY TO PROVIDE THEM WITH
SERVICES PRIOR TO THEM BEING
DIAGNOSED WITH A SERIOUS MENTAL
ILLNESS IF IF AT ALL POSSIBLE SO.
IT'S JUST SO IMPORTANT TO
REMEMBER HOW MUCH OF A CHANGE IT
WAS WITH A CA RIGHT THE
POPULATION JUST ONE UP SO MUCH
MORE THAN WE ANTICIPATED SO I
THINK THAT'S YOU KNOW WE'VE DONE
A GOOD JOB IN COLLABORATION WITH
DH CS YOU KNOW KEEPING THE
PENETRATION RATE.
STABLE AND NOT NOT LOSING GROUND
BECAUSE FUNDING HASN'T
SIGNIFICANTLY INCREASED.
THANK YOU FOR MY THANK YOU.
ANY ANY OTHER QUESTIONS ANYTHING
[inaudible]
OKAY.
SCENE NINE THANK YOU VERY MUCH
ONCE AGAIN.
AND WILL HAVE NO GO AHEAD --
TO PUBLIC COMMENT --
ARE THERE THERE WAS THE PUBLIC
WOULD LIKE TO SPEAK WITH LIKE TO
LIMIT THE COMMENTS TO TWO
MINUTES APIECE.
SO PLEASE COME ON UP TO THE
MICROPHONE AND PLEASE.
IDENTIFY YOURSELF IN YOUR
ORGANIZATION OR FOR AN
INDIVIDUAL AND TO PLEASE.
GOOD AFTERNOON THANK YOU SO MUCH
FOR THIS HEARING --
MY NAME IS PARTIALLY WALKER I'M
WITH NOR CAL --
MENTAL HEALTH AMERICA AND A CO
DIRECTOR ABOUT FOR MENTAL HEALTH.
AND WE REPRESENT TO LGBT Q.
POPULATIONS I'M HOPING THAT IN
FUTURE HEARINGS WILL GET TO HEAR
STATISTICS ABOUT.
LGBT Q. FOLK --
AROUND THE STATE WE HEARD AROUND
THE STATE THAT MANY TRANSGENDER
FOLKS HAVE TO TRAVEL GREAT
DISTANCES AND SPEND A LOT OF
TIME. TO GET THEIR CARE --
EVIDENCE INDICATES THAT LGBT Q.
PEOPLE ARE OVER REPRESENTED IN
SUICIDE RATES DEPRESSION ANXIETY
TRAUMA.
AND OTHER MENTAL HEALTH
CHALLENGES AS WELL AS
HOMELESSNESS AND OTHER
DISPARITIES AND YET WE WE DON'T
SEE THAT REPRESENTED OF COURSE
IN ANY OF THE STATISTICS.
THAT WE SAW TODAY SO I JUST WANT
TO BRING THAT TO EVERYONE'S
ATTENTION --
WHAT WE HEARD TODAY IS VERY
IMPORTANT FOR ALL THE
POPULATIONS THAT WERE
REPRESENTED?
AND THAT WERE MISSING SOME VERY
VALUABLE DATA --
AND I HOPE TO HEAR THAT SOON NOW
THAT --
CERTAIN LEGISLATION HAS COME
INTO EFFECT THANK YOU VERY MUCH
THANK YOU.
GOOD AFTERNOON ON A HOUSE OF
LEAD WITH UNITED WAYS OF
CALIFORNIA ALSO SPEAKING ON
BEHALF OF CHILDREN'S DEFENSE
FUND OF CALIFORNIA JUST WHEN I
THINK THIS BODY --
FOR YOU'RE COMING TOGETHER IN A
JOINT HEARING TO ADDRESS THESE
COMPLEX ISSUES --
AND CERTAINLY WE KNOW --
THAT OUR DELIVERY SYSTEM AROUND
MENTAL HEALTH IS IS HIGHLY
VARIABLE ACROSS OUR STATE --
AND SO ANY SOLUTION AND SYSTEMS
REFER A GREAT KIND OF FROM JUMP --
AND AT ALL LEVELS --
MENTAL HEALTH DOES NOT EXIST IN
SILOS BUT OUR STATE IS NOTORIOUS --
NOTORIOUSLY KNOWN FOR SEILING
OUT CARE --
BE AT AGE --
TO BASED INCOME BASED ETCETERA --
WE ARE VERY ENCOURAGED OF COURSE
BY THE ATTENTION BEING PAID TO
THESE ISSUES DISCUSSED TODAY --
BY THIS BODY --
AND URGE THAT WE COLLECTIVELY
EXPLORE HOW WE EXPAND PREVENTION
AND EARLY INTERVENTION SERVICES
IN PARTICULAR --
INTEGRATING THOSE INTO TRUSTED
COMMUNITY BASED SETTINGS --
ESPECIALLY FOR OUR CHILDREN --
THEIR MENTAL HEALTH AND AND
FUTURE DEPEND ON THAT --
AND WE STAND AS READY AN ACTIVE
THANK YOU.
LINDA WAY WITH WITH ON POVERTY
WE APPRECIATE THE THE CHAIR AND
AND THE COMEDIAN HOLDING THIS
SIZE HEARING IT'S IT'S BEEN VERY
INFORMATIVE --
I THINK ONE THING THAT THAT HAS
BEEN HIGHLIGHTED IS --
THAT THE FRAGMENTED SYSTEM
BETWEEN --
IN THE DELIVERY OF MENTAL HEALTH
SERVICES WITH THE MEDIC HOW
MANAGED CARE PLANS PROVIDING
MILD TO MODERATE SERVICES AND I
THE COUNTY PROVIDING MORE
SPECIALTY MENTAL HEALTH SERVICES --
WHICH IS FURTHER COMPLICATED AS
THE LA --
POINTED OUT IN THERE THE
FINANCING OF OF OF THE DIFFERENT
STRUCTURES AND SO WHEN WHEN
CHALLENGE THAT WE'VE EARD FROM
OUR LEGAL AID ADVOCATES IS IS
THAT THE DIFFICULTY IN
NAVIGATING THATTHE DIFFERENT
SYSTEMS --
AND WHICH IS PARTICULARLY WHEN
I'M THERE THERE IS AN AGREEMENT
WHETHER THE SERVICE IS MILD TO
MODERATE OR A SPECIALTY MENTAL
HEALTH SERVICES SO THERE CAN BE
A LOT OF BOUNCING BACK ON JUST
TO GET THE SERVICE AND SO --
THE ROLES I CARE COORDINATION IS
NEEDED AT THE AND THE DATA THAT
WAS PROVIDED ON THE THE COUNTY
MENTAL HEALTH SIDE IS IS
CERTAINLY --
UP PAINS --
AS I HAVE A PICTURE WE'D LIKE TO
SEE.
MORE OF THAT ON THAT MEDI CAL
MANAGED CARE SIDE THAT THAT DATE
IS --
REFLECTED ON THE FOURTH MILD TO
MODERATE AS WELL THANK YOU.
GIVE.
THANK YOU SO MUCH --
SHOCK OF IT I WITH THE SERVICE
EMPLOYEES INTERNATIONAL UNION
SEIU CALIFORNIA AND JUST WANT TO
COMMEND --
THEIR COMMITTEE AND ON YOUR
EXCELLENT BACKGROUND PAPER I
THINK IT PROVIDES A LOT OF
IMPORTANT FOUNDATIONAL DETAILS
ABOUT HOW TO UNDERSTAND OUR
MENTAL HEALTH SYSTEM IN
CALIFORNIA AND I JUST WANT TO
POINT OUT.
THAT -- WELL
WE DID A AN A PRO.
WHEN WE TALK ABOUT INTEGRATION
WHETHER IT'S WITH THE PHYSICAL
HEALTH OR WITH SUBSTANCE USE
DISORDER SERVICES --
WE REALLY DO NEED TO PULL OUT A
FEW DIFFERENT LEVELS --
AND THINK ABOUT IT BEYOND JUST
THE FINANCING AND THE CONTRACTS
RIGHT BECAUSE EVEN WITHIN THE
MEDICAL MANAGE CARE SYSTEM AS
YOU SEE FROM YOUR APPENDICES
WE'RE TALKING ABOUT THE MANAGED
CARE PLAN THEN TURNING AROUND
AND SUBCONTRACTING TO ANOTHER
AND EIGHTY AND WE'RE REALLY
INTERESTED IN A CONVERSATION
ABOUT WHAT.
DOES THAT UNDERLYING DELIVERY
SYSTEM LOOK LIKE FOR
BENEFICIARIES SO DOES THE
SUBSTANCE USE PROVIDER KNOW
ABOUT MENTAL HEALTH AND PHYSICAL
HEALTH DOES THEM THE MENTAL
HEALTH PROVIDER UNDERSTAND
ADDICTION.
AND YOU KNOW I THINK THE
CONTINUE IN LOOKS REALLY
DIFFERENT DEPENDING ON IT DOES
WHETHER YOU'RE ON THE MILD TO
MODERATE OR THIS SPECIALTY
MENTAL HEALTH SIDE OF THINGS.
I ONE MORE NOTE COUNTIES DO MUCH
MORE THAN THE MEDIC HOW --
SMI DELIVERY THEY ALSO EXTEND
INTO NON MEDICAL POPULATIONS
WHETHER THREE PST T. OR AT A
SPECIALTY MENTAL HEALTH.
AND SO WE WOULD URGE THAT WE
HAVE A CONVERSATION AGAIN THAT
GOES BEYOND --
JUST SORT OF HOW THE MONEY FLOWS
AND WE LOOK AT THIS OPPORTUNITY
OF THE INTEREST IN OUR MENTAL
HEALTH SYSTEM TO TRULY TRANSFORM
IT. TO MEET THE NEEDS OF TWENTY
FIRST CENTURY CALIFORNIA --
SO THANK YOU SO MUCH AND WE LOOK
FORWARD [inaudible]
THANKS [inaudible]
GOOD AFTERNOON MEMBERS AYE AYE
OLLIE UNFAIR BUT THEY TING WITH
THE CALIFORNIA STATE ASSOCIATION
OF COUNTIES I ALSO WANT TO
COMMEND THAT BOTH COMMITTEES FOR
CONVENING THIS HEARING AND THE
MATERIALS WERE VERY VERY --
INFORMATIVE INFORMATIVE AND
CLEAR WHICH WE DON'T USUALLY SEE
IN THE SPECIALLY MENTAL HEALTH
SYSTEM AS YOU SEE.
I DO ONE ECHO THE PREVIOUS
SPEAKER'S COMMENTS ABOUT
COUNTIES DON'T JUST DO SPECIALLY
MENTAL HEALTH SERVICES WE HAVE
OTHER FUNDING STREAMS AND
PROVIDE OTHER SERVICES --
AND ALSO WE THINK THE BEHAVIOR
HEALTH SYSTEM IS RIPE FOR
COLLABORATIONS AND PARTNERSHIPS
INCLUDING WITH THE STATE AND
LOCAL ENTITIES LIKE SCHOOLS
LOCAL COMMUNITY BASED
ORGANIZATIONS AND OTHERS TO
IMPROVE THE MENTAL HEALTH OF
EVERYBODY.
THANK YOU.
GREAT THANK YOU VERY MUCH ANY
ANYONE ELSE.
I WOULD JUST LIKE TO SAY --
OUR NEXT HEARING --
WHICH WILL --
FOCUS ON HOW MENTAL HEALTH TO
HAVE HELP MENTAL HEALTH.
DELIVERY SYSTEM ACTUALLY WORKS
TODAY WAS MEANT TO BE
FOUNDATIONAL TALK ABOUT THE
MONEY TALK ABOUT --
HOW IT'S FINANCED BUT NOW WE'RE
GONNA TALK NEXT WEEK ABOUT HOW%
IT ACTUALLY WORKS SO THAT IS
ACTUALLY ON MARCH FIFTH --
WHICH IS A WEEK FROM TODAY --
WE HEAR A COLDER'S AFTER AN
OVERVIEW BY DH CS AND C. B. HDA.
WHICH MEANS WE MIGHT SEE SOME
FAMILIAR FACES AGAIN AT SOME
POINT YES --
ON THEIR VISION FOR THE MEDI CAL
MEDICARE MENTAL HEALTH DELIVERY
SYSTEM GOING FORWARD.
AND WITH THAT --
WE ARE ADJOURNED SO THANK YOU
VERY MUCH FOR EVERY FOR OUR
PANELISTS AND THANK EVERYONE FOR
BEING HERE