Congress Adjourns For The Year After Reaching Agreement On Budget; Family Opportunity Act Set Aside Until Next Year
In recent weeks, HR 4577 was held up because of issues unrelated to either NIMH or CMHS - school construction funds and OSHA regulations. This impasse continued as a result of the uncertainty and legal battles over the presidential race. In the end, both sides compromised on critical issues and the result is important increases for both NIMH and CMHS. The result is that funding for these agencies has finally been resolved, even though we are nearly three months into FY 2001.
The final version of the Labor-HHS-Education Appropriations bill includes $1.107 billion for the NIMH. This is $133 million above NIMH's FY 2000 level, or a 14% increase. This is slightly below the average increase for the entire National Institutes of Health (NIH) budget - a total increase of $2.5 billion, up to $20.5 billion. Earlier versions of a proposed House-Senate agreement on HR 4577 had included slightly higher increases for both NIH and NIMH. However, at the last minute the White House and GOP congressional leaders agreed to a very modest decrease as part of an overall effort to trim all programs covered under the Labor-HHS bill. Even with this late minor downward adjustment, Congress remains on track to double the NIH budget (including NIMH) by 2003.
The final agreement on the FY 2001 Labor-HHS bill also includes important increases for services programs at CMHS. The most important of these is the Mental Health Block Grant, which will be receiving a $64 million increase - up to $420 million. In fact, this final number was $4 million above the President's original request and amounts to a 31% increase over the past two years. The PATH program (services for homeless individuals with mental illness) will be getting a $6 million increase (up to $36.9 million). The Children's Mental Health program will be getting a $9 million boost in FY 2001 (up to $91.8 million).
The final Labor-HHS bill boosts the protection and advocacy (PAIMI) program by $5.1 million, up to $30 million. This increase will allow protection and advocacy agencies funded by the PAIMI program to expand their authority into the community under the new Substance Abuse and Mental Health Services Administration (SAMHSA) authorization law (P.L. 106-310) passed by Congress in October. This new law continued the existing limitation on the scope of clients that protection and advocacy programs could serve until funding for the federal PAIMI program rises to $30 million. This limitation, which has existed in federal law for years, restricts protection and advocacy services to individuals with mental illnesses residing in institutions (including hospitals, nursing homes, jails and prisons) or within 90 days after discharge from these facilities.
Passage of this new budget means that protection and advocacy agencies will be able to serve consumers in the community. This expansion was justified on the basis of the U.S. Supreme Court's Olmstead decision which places new duties on states to transition people with severe disabilities into the community from institutional settings. While NAMI supports this expansion of authority for protection and advocacy agencies, there is significant concern that the PAIMI program is now vastly under-funded given the massive number of consumers in the community who are now eligible to receive P&A services. In particular, NAMI is concerned that this modest boost in funding, coupled with massive expansion of scope of authority will make it more difficult for vulnerable consumers in institutional settings to obtain the assistance of a protection and advocacy agency regarding a case of abuse or neglect.
The Olmstead decision requires states to provide services to individuals who are institutionalized in the most integrated setting appropriate to their needs. NAMI advocates are urged to work closely with their state protection and advocacy program to ensure that they target their expanded resources on helping people at risk of institutionalization to access necessary treatment and services. NAMI advocates should also ensure that PAIMI programs continue to focus efforts on preventing abuse and neglect of individuals within and outside of institutional environments (e.g. inappropriate use of restraints and seclusion). Protection and advocacy agencies should not focus their expanded jurisdiction and resources on civil commitment or right to refuse treatment cases. This was not the intent of Congress in expanding the jurisdiction of the PAIMI program. Moreover, other legal advocates are already available in the community to represent people at civil commitment hearings.
Finally, CMHS' discretionary program (known as "Knowledge Development and Application" or KDA) will be receiving a substantial increase of $67 million for FY 2001, up from $137 million to $204 million. While final details are not available yet, it appears that most of this increase is directed to an existing CMHS program aimed at reducing and preventing violence in schools. However, there are indications that Congress has directed several specific set asides as part of this increase including as much as $10 million for youth suicide prevention and $10 million for services for persons diagnosed with post-traumatic stress disorder (PTSD).
FAMILY OPPORTUNITY ACT
Despite the aggressive efforts of its congressional sponsors - particularly Senators Charles Grassley (R-IA) and Edward M. Kennedy (D-MA) and Representatives Pete Sessions (R-TX) and Henry Waxman (D-CA) - the Family Opportunity Act (S 2274/HR 4825) was not included in the final budget agreement. As part of final budget negotiations, President Clinton joined with FOA's sponsors in supporting the bill. Unfortunately, key GOP leaders - including Senate Majority Leader Trent Lott (R-MS) and Don Nickles (D-OK) - refused to support the bill.
As NAMI E-News readers know, the Family Opportunity Act is intended to restore hope for children with severe mental illnesses and their families. Under the bill, states would be able to offer Medicaid coverage to children with severe disabilities living in middle income families through a buy-in program. Cost sharing on a sliding scale up to the full premium cost would be required within certain guidelines that protect lower income families. Currently, families must stay impoverished, place their child in an out of home placement or simply give up custody in order to secure the health care services their child needs under Medicaid.
One the key arguments that FOA's opponents made was that Medicaid eligibility should not be extended to "middle class" families that are above the program's strict standards governing income and assets. Instead, they argued for allowing states to expand eligibility for the Children's Health Insurance Program (SCHIP). Unfortunately, few states allow SCHIP policies to cover the types of services (e.g., long-term residential treatment) that children with severe disabilities need. More importantly, NAMI believes that this expansion of Medicaid eligibility is critically important to preventing families from having to quit jobs, spend themselves into poverty, and in extreme cases, relinquish custody to get a child with a severe mental illness the services they need (as opposed to the limited services their health plan is willing to pay for).
In 2001, NAMI will press hard for passage of the FOA. The bill's prospects will be enhanced next year, as lead sponsor Senator Grassley becomes Chairman of the Finance Committee. Efforts are already underway to ensure that President-Elect Bush will support the bill.
Finally, a number of other health-related bills were added to the final budget agreement, including $35 billion for a range of health care providers (hospitals, home health agencies and managed care plans serving Medicare patients). This final total is $2.7 billion above what House and Senate negotiators had previously agreed to (more than the $2 billion the projected 5-year cost of FOA). Most of these funds are intended to make up for larger than anticipated cuts made as part of the 1997 Balanced Budget Act. In addition, $1 billion was included to allow states to expand Medicaid eligibility to women transitioning from welfare to work, as well as to seek out eligible children in schools and public housing.