Baker Act

1
Baker Act

• Ken DeCerchio
• Acting Deputy Secretary of Substance Abuse
• and Mental Health
• House Health Care Appropriations Committee
• February 24, 2005

2
Baker Act Funding History FISCAL YEARS 2002-2003
THRU 2004-2005
FY 02-03 54,749,763 8,908,208 FY
03-04 54,749,763 8,908,208 FY
04-05 57,945,135 12,107,021
3
Adult Baker Act Capacity/Need

• 1,250.2 Total beds/bed equivalents needed based
  on adult population.
• 1,041.4 - Current DCF and Medicaid total beds and
  bed equivalents available.
• 255.7 Unmet Baker Act Bed/Bed Equivalent Need
  at a cost of 20,436,251.

4
Adult Baker Act Bed SummaryFiscal Year
04-05
'(1) The remaining 25 is derived from local
match contributions. Note The cost of a Crisis
Stabilization Unit Bed or bed equivalent is 292
per day. The state share is 75 and the
remaining 25 comes from local match
contributions. The amounts in Column G above
reflect only the 75 state share needed.
5
Adult Baker Act Equity Funding Fiscal Year
2004-2005 by Districts/Region Based on 10 per
100,000 General PopulationAmount to bring to
equity 20,436,251
6
Childrens Mental HealthCapacity/Need

• Childrens Baker Act capacity is 142.4 beds.
  This, plus the 171 Medicaid crisis beds, meets
  current statewide need, based on 10 beds per
  100,000.
• Childrens Mental Health will use the increase in
  funding to divert children from multiple CSU
  admissions.
• Targeted services include mobile crisis, respite,
  in-home and school-based treatment, wrap-around
  mental health treatment services based on the
  individual needs of each child.

7
Childrens Baker Act Funding
8
Governors Recommended Budget

• 6,400,000 appropriated in Lump Sum - Adults with
  Mental Illness from General Revenue Funds in
  Specific Appropriation 325.
• Proviso Funds in Specific Appropriation 325
  shall be used to increase the capacity of adult
  and child crisis stabilization services in order
  to appropriately divert individuals with mental
  illness from civil and forensic state hospitals.
  Services provided in this funding include CSU
  beds and CSU bed equivalent services. Funds
  shall be targeted to districts with the highest
  level of unmet need.

9
Mental Health Funding History FISCAL YEARS
2002-2003 THRU 2004-2005
10
Adult Mental Health Equity

• Target Population Adults with severe and
  persistent mental illnesses who meet any of the
  following criteria
• Had documented evidence of long-term psychiatric
  disability
• Receives income due to psychiatric disability
• Is over 59 and demonstrates inability to perform
  independently in day-to-day living
• Per capita funding target 1,165.00
• Basis for Target Benchmark of 1,165 is based on
  weighted average of G. Pierce Wood districts 8,
  14, 15 and Suncoast Region

11
Adult Mental Health Equity
Amount to bring to equity 120,104,655
1,165
12
Childrens Mental Health

• Target population Children with serious
  emotional disturbance
• Equity Target 619
• Basis District 15 current per child funding is
  targeted benchmark
• Funding will meet 13 of equity need

13
Childrens Mental Health Equity
Amount to bring to equity 20,894,174
14
Community-Based CareImplementation

• Bob Fagin
• Deputy Secretary of Administration
• House Health Care Appropriations Committee
• February 24, 2005

15
Community-Based Care Current Status February
2005
16
Implementation Challenges

• Major conversion during last fiscal year
• 12 contracts signed in FY 03-04
• 13 CBCs are in their first full year of
  operations during 04-05
• 432.4 million in contracts with CBCs this year
• 1,252 FTEs transferred to CBCs or otherwise
  reduced from DCF since FY 03-04 to a delivery
  system UNIQUE across the country

17
Implementation Challenges

• Unique Delivery System
• Anticipated some agencies would struggle
• Recovery plans in place
• Another CBC (FCP, PFF)
• Cure Letter (PCBC, KCI)
• Recovery options not used to date
• Performance Bond
• Risk Pool
• Receivership
• Working on a federal waiver to gain increased
  flexibility of funding streams

18
Risk Factors and Solutions
Serious Performance Problems

• Recovery possible
• Cure letter

• Recovery unlikely
• Replace lead agency

19
Risk Factors and Solutions
Serious Eligibility Shortfalls

• Recovery possible
• Offset

• Recovery unlikely
• Reduce contract
• amount

20
Risk Factors and Solutions
Governing Board Dissolution

• Recovery possible
• Another CBC
• as receiver

• Recovery unlikely
• Re-procure

21
Risk Factors and Solutions
Significant Workload Increases

• Recovery possible
• Risk pool

• Recovery unlikely
• Risk Retention Group/
• LBR issue

22
Risk Factors and Solutions
Significant Imbalance of Case Mix to
Budget (Structural Deficit)

• Recovery possible
• Offset

• Recovery unlikely
• Adjust LBR

23
Community-Based CareEquity

• Bob Fagin
• Deputy Secretary of Administration
• House Health Care Appropriations Committee
• February 24, 2005

24
Governors Recommended BudgetFY 05/06

• 10.2 million in nonrecurring General Revenue
• 10.5 million recurring General Revenue for
  Shared Risk/Insurance Program
• 3 million to capitalize the risk retention group
• 7.5 million to fund a risk pool
• 10.5 million recurring General Revenue and
  Federal Grants Trust Fund for Community-Based
  Care Equity
• Funding to improve equity among the
  community-based care lead agencies.

25
Lead Agency Chronology
26
Equity Funding 3 year history
27
Equity Funding Current and Request
28
Shifting Populations Affect Funding

• State and federal policy has been more focused on
  keeping children in their families or, where that
  is not possible, achieving timely permanency for
  children.
• Particular focus has been on placing children
  with relatives, who often are not eligible to
  earn Title IV-E funding.
• This has caused a shift in the case mix,
  affecting the fund mix. Funding categories for
  out-of-home have different earning structure than
  those for TANF or in-home.

29
Funding Case Mix Changes
30
Actions Underway

• The department has formed a task force to address
  the case mix issue in relation to funding.
• Task force brings together budget, revenue, and
  program staff from central and local offices.
• Mid-year review will be basis for developing
  proposed FY 05/06 allocation model that can
  address case mix issues at the local level while
  staying within appropriation limits.
• Other effects of funding shift in relation to
  desired child outcomes and local capacity must be
  considered.