Board of Supes, April 23: Controversial fire fees; Medi-Cal’s Mental Health Coverage (Confused? Reporter invites questions)
The Board on this day made brief reference to the very controversial State Recovery Area fee to support Cal Fire.
The Board has taken positions opposing the fire fee, most recently objecting to the implementation of the state law requiring that the owners of every habitable structure in areas that are within the State Responsibility Area (SRA) pay a fee of $150, reduced by $35 for structures in areas that pay a local fire prevention and protection fee. A State Responsibility Area is land for which the state assumes primary financial responsibility for protecting natural resources from damages from fire.
Fees were assessed for the first time this past fall, and the law contains provisions that would permit raising the fee in July 2013. Among many objections to the fee, including by some who oppose any increase in taxes or fees, the Board argued in a November 12, 2012 letter that the fee unfairly targets rural residents; that Cal Fire commonly responds to fires in areas that aren’t within the State Responsibility Area; that fires in non-rural areas are more costly to contain; and that this new fee may limit the ability to pass local assessments for effective local fire response.
Supervisor Les Baugh reported on his recent attendance at a Regional Council of Rural Counties (RCRC) meeting. RCRC is an organization of 32 small and/or rural California counties that advocates at the state and federal levels for the unique interests of rural California and provides policy analysis and information representing those counties. RCRC believes that opposition to the SRA fire fee is growing, and that legislative action on the issue is possible. The preferred RCRC response is to support a tax or fee that is more broadly based across the state to support Cal Fire and other emergency response entities in their activities in State Responsibility Areas, Local Responsibility Areas, and on federal lands.
The Board also approved an agreement with the state Department of Health Care Services for the provision of Medi-Cal specialty mental health services in Shasta County by the county’s Health and Human Services Agency.
Public mental health funding is as complicated as any other part of the health care system. If this brief summary is not clear or not enough information, let me know in the comment section and I’ll try to provide more information.
The state contracts with counties to provide mental health services to Medi-Cal beneficiaries. This arrangement provides services that must be provided by a specialty provider, generally to persons with a serious mental illness. It does not include care that can be provided in the primary care or general medical system. The county must provide, or arrange and pay for, the specialty mental health services covered by Medi-Cal and must have a plan in place to ensure access and/or authorization for urgent conditions and to pay for emergency psychiatric services provided to Medi-Cal beneficiaries.
These services are paid for with a combination of federal Medicaid funds, state funds that are designated by law for mental health services (such as the special tax on millionaires), state General Funds, and a small amount of county funds. The contract approved this week with the Department of Health Care Services is good for five years, and will provide up to $37.7 million in federal Medicaid funds over that period to reimburse the county for eligible specialty mental health services provided to Medi-Cal beneficiaries. The contract is a statewide agreement that has been negotiated collectively by county representatives over the past year.
Donnell Ewert, Director of the county Health and Human Services Agency, reported that the contract reflected negotiated resolution of problems raised by counties in the past year. He also reported some challenges in providing adequate mental health services with the allocated amount. The county has had difficulty recruiting a sufficient number of psychiatrists, due to the county’s rural nature and its salary ranges.
Shasta County has seen increased psychiatric admissions into hospitals and nursing- home levels of care (called Institutes of Mental Disease, or IMDs). This is due in some part to the closure of several lower level board and care facilities, and the county is working on recruiting new board and care providers. The county has also seen an increase of people with eligible levels of medical necessity for treatment. The reasons for this aren’t entirely clear, although increased economic and housing instability due to the recession is a part of the picture.
Shasta County has not seen the shipping of mentally ill persons from Nevada that appears to have occurred in Sacramento. And finally, the economy has reduced the amount of some of the funds that are designated for mental health at the state level. It’s a story that is reflected in many government activities, isn’t it?
Catherine Camp is currently retired. She served as a Consultant to the California Senate Budget Committee in 2001-02, reviewing Social Services, Employment Development, Aging, Community Services, Alcohol and Drug Programs, Rehabilitation and Child Support budgets. From 1989-2000, Catherine was Executive Director for the California Mental Health Directors Association. During that period, Catherine staffed the county mental health system's restructuring of public mental health through Realignment of community and long term care programs from the state to the county, transfer of the management of specialty mental health Medi-Cal services to those counties that agreed to provide them, development of risk mechanisms for consortia of small counties, and advocacy and policy analysis for the operation of public mental health programs throughout the state. Her prior experience includes Executive Director to the California-Nevada Community Action Association, Principal Consultant to the Assembly Human Services Policy Committee, and Director of Community Action and Head Start programs in Shasta County.
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