The Governor’s Budget Dropped Today!

December 20, 2023

When you look at a budget document, you look for a couple of things:

  • What is included that is funding either to do something new, bigger or better OR to funding to maintain the status quo?
  • What items (frequently just language) are no longer included so the “protection” they offered is gone!
  • And when it is all put together, will the budget fit within what the Money Committees think are both the priorities and the available dollars to spend?
The answer to the last is TBD, but from the conversation in the halls of the General Assembly Building recently, I suspect that the answer is “No!” and the Governor’s proposal will be trimmed back (plus, this document does not reflect the priorities of the Democratic majorities. 

The answer to the second is that I did not, in my first read, find any hidden issues, except the wording to an item in the Medicaid Item (#288 XX) that says:
Effective July 1, 2024, the Department of Medical Assistance Services (DMAS) shall have the authority to modify Medicaid behavioral health services such that: (1) legacy services that predate the current service delivery system, including Mental Health Skill Building, Psychosocial Rehabilitation, Intensive In Home Services, and Therapeutic Day Treatment are phased out; (2) legacy youth services are replaced with the implementation of tiered community based supports for youth and families with and at-risk for behavioral health disorders appropriate for delivery in homes and schools, (3) legacy services for adults are replaced with a comprehensive array of psychiatric rehabilitative services for adults with Serious Mental Illness (SMI), including community-based and center-based services such as independent living and resiliency supports, community support teams, and psychosocial rehabilitation services, (4) legacy Targeted Case Management- SMI and Targeted Case Management- Serious Emotional Disturbance (SED) are replaced with Tiered Case Management Services. All new and modified services shall be evidence based and trauma informed. To facilitate this transition, DMAS shall have the authority to implement programmatic changes to service definitions, prior authorization and utilization review criteria, provider qualifications, and reimbursement rates for the legacy and redesigned services identified in this paragraph. DMAS shall only proceed with the provisions of this paragraph if the authorized Medicaid behavioral health modifications and programmatic changes can be implemented in a budget neutral manner within appropriation provided in this Act for the identified legacy services. Moreover, any new or modified services shall be designed such that out-year costs are in line with the current legacy service spending projections. No new Medicaid behavioral health services or rates shall be implemented until corresponding legacy services have ended. Implementation of the redesigned services authorized in this paragraph shall be completed no later than June 30, 2026″.

This is, as near as I can tell, BRAVO Phase II – but it is both an aggressive time line and another rather significant overhaul to the system.   It is another step on the way to qualifying for the BH 1115 Waiver.   Stay tuned for more definition as we move closer to the Session.

And, finally, the answer to the first item above:

  • The slots, as predicted last week – 172 CL each year and 1,548 FIS each year 
  • There are provisions for making Peer Support a bit more “user friendly”
  • $500K to conduct a state-wide evaluation of school-based mental health services
  • Funding to contract with a vendor for the establishment and maintenance of a public-facing online registry that identifies and verifies providers and practices with youth mental health services
  • Funding increases for veteran’s and behavioral health court dockets
  • Continuation of funding for many of the behavioral Health initiatives from the last budget