The state provides counties and Behavioral Health Administrative Service Organizations (BHASOs) non-Medicaid funds to be used for behavioral health programs and services, including crisis services, diversion, and Involuntary Treatment Act (ITA) court costs and services. These funds have decreased because the state shifted 30% away from BHASOs to the Managed Care Organizations (MCOs). Yet, the number of ITA courts and ITA cases has significantly increased, which results in a decrease in funds available for other crucial behavioral health services.
We asked the state to create a separate account for ITA court costs to allow for better accounting and budgeting. We also asked the state to convene a workgroup to examine current methods by which counties are reimbursed for judicial costs associated with county civil commitment cases. The study would also direct the workgroup to consider the findings in the Joint Legislative Audit & Review Committee report entitled Involuntary Treatment Judicial Costs, published on July 18, 2012.
The Governor’s budget provided an additional $6 million of non-Medicaid funds that could be flexibly spent on behavioral health purposes. However, the House and Senate took very different approaches.
The Senate budget did not provide an increase in non-Medicaid funds. Rather, it merely directed the Health Care Authority (HCA) to review and update the non-Medicaid funds disbursement between BHASOs and MCOs (currently 70/30). Any adjustments are required to be made by HCA by July 1, 2020. The Senate’s proposal does not require HCA to adjust the non-Medicaid fund disbursement. It also does not create a separate account for ITA court costs, nor does it study ITA court costs. While we do believe the current split should be reviewed, we also need to have a better accounting of those costs.
The House budget took a slightly different tactic. It, like the Governor’s budget, provided additional non-Medicaid funds – $2 million in 2020 and $4 million in 2021 – to go directly to the BHASOs. The remaining amounts of funds are distributed 70/30 in 2020 and 80/20 in 2021 to the BHASOs and MCOs. This is a better solution than the Senate budget. However, the House budget also fails to create a separate account for ITA court and does not study ITA court costs. Again, it is important for the state to have a grasp on the total price tag for ITA court costs.
There is a growing statewide need for increased non-Medicaid funding as a result of the state moving to integrated managed care. The outcome is that ITA court costs are being paid for, but to the detriment of other essential non-Medicaid services, which end up getting reduced or eliminated. At the very least, we need a proper accounting of all ITA court costs so the state and local governments can adequately budget going forward.