FY 2010 Preliminary Operating Budget & Program Plan September 2, 2009

1. SAGINAW COUNTY TREATMENT AND PREVENTION SERVICES FY 2010 Preliminary Operating Budget & Program Plan September 2, 2009

2. Mission and Vision Statements • SCCMHA Mission Statement As the public manager of supports and services for citizens with mental illness, developmental disabilities and chemical dependency and their families, SCCMHA actively strives to develop a system of care and a community that values and embraces the potential and contributions of all individuals with disabilities. • SCCMHA Vision Statement A belief in potential A right to dream An opportunity to achieve

3. Populations Served • Saginaw County Residents: • Children with Serious Emotional Disturbance • Adults with Serious Mental Illness • Adults and Children with Intellectual and Developmental Disabilities • Adults and Children with Substance Use Disorders

4. Philip Grimaldi, Chairman Evelyn Wolfgram, Vice Chair Lisa Kleekamp, Secretary Raymond Albert Steve Fresorger Robin Humble Chuck Howley Andy Johnson, Jr. Patricia Murray-Steding John Pugh Leola Wilson Robert M. Woods, Jr. Vicki Mikolajski, Chairman Mike Cierzniewski, Vice Chair Lynn Bradfield Sarina Brown Maggie Davis Ann Finta Susan Furlo Cheryl Nelson Merilee Perez Dalia Smith Eileen Vescio Sally Weber Joan Williams Citizens Advisory Committee Board of Directors Sandra M. Lindsey, CEO

5. 2009

6. 2009 Accomplishments Evidence-Based Practices (EBP) • SA Licensure for Community Support Services • Dialectical Behavior Therapy (DBT) Certification • MiFAST Reviews (Community Support Services, Saginaw Psychological Services & Assertive Community Treatment • Implementation of multi-stage Integrated Dual Disorder Treatment (IDDT) Groups • Kid’s Trauma-Focused Cognitive Behavioral (CBT) Therapy commences for network • Peer Support Services (Crisis Residential, County Jail, Housing Resource Center) • Picture Exchange Communication System (PECS) implemented at Skill Building • Evidenced-Based Practice Guide for individuals with Developmental Disabilities was Published

7. 2009 AccomplishmentsHousing Resource Center (HRC) • Housing Grants direct to SCCMHA • Salter Place Housing Resource Center Opens • Shelter Plus Care Tenant Based Rental Assistance (41) • Shelter Plus Care Sponsor Based Rental Assistance (25) • MI State Housing Development Authority (MSHDA) Chronic Homeless Tenant Based Assistance (12) • Daily shelter outreach • Peer Support Services through Housing Resource Center

8. 2009 AccomplishmentsSkill Building Transformation • New building for Community Ties North (Lamson) • Major modifications to Community Ties South • Completed stakeholder meetings and developed and implemented plan • Implementation of new program celebrated

9. 2009 Accomplishments Children’s Service • Creation of new Family Service Unit (FSU) team to address increased demand for services • Achieved children’s Medicaid expanded service targets (456 to 580 kids served) • Chosen for SED Waiver Expansion pilot • Completed study and issued report on mental health needs of children in foster care • Commencement of Mobile Crisis Team planning and staff training • Continued development of a System of Care (SOC) for children and families in Saginaw • youth group • family advisory committee • SOC newsletter • development of universal consent form

10. 2009 AccomplishmentsSelf-Determination • Supporting 36 persons living self determined lives including one of the last Saginaw consumers leaving Mt. Pleasant Center (MPC) • Micro-enterprises continue to grow with 14 separate businesses

11. 2009 Accomplishments Managed Care Administration (PIHP) • Implementation of new Crisis / Access Guidelines & Operational Integration • Application for Renewal & Recommitment (ARR) submission • Finalized and disseminated Pandemic Emergency Response Plan • Improved performance continues on both federal and state external quality reviews • Utilization Management enhanced by electronic medical record and data warehouse • Established independent relationship with PCE for software • Implementation of new claims payment software and development of auditing module in software

12. 2009 AccomplishmentsProgram Service Administration (CMHSP) • Successful first Serious Emotional Disturbance (SED) Waiver Audit • Annual Office of Recipient Rights report revealed significant reduction in substantiated recipient rights complaints • Continued improvement in Provider Network audit performance • Upgrades to Technology to enhance productivity and efficiency • Completed Transition to iPAY (paperless payroll & direct deposit) • Facilities upgrades at Towerline & Hancock sites • Expansion of Patient Assistance Program (PAP) • Improved Medicaid Spend Down management to maximize Medicaid benefit for consumers of SCCMHA • Successfully implemented numerous MDCH Federal Block Grants

13. 2010

14. State FY 2010 Budget Crisis • 2010 State Budget Leaves CMH financing unknown • No balanced budget from State of Michigan • No appropriations for MDCH line item for General Fund (GF funding unknown) • Medicaid Rebasing for FY10 not yet finalized (Medicaid funding unknown) • Legislative proposals indicate reductions to CMH GF financing statewide. Proposed cuts could be as high as $61 million (Saginaw = $1.2-1.8 million reduction) • Discontinuation of Adult Benefit Waiver program as of Dec. 31st (9 months of FY09 Authorization) = $759,000 • No new MDCH Adult Block Grants for FY10 • State Facility rates unknown for FY10 August 26, 2009 Projection of expenditure reduction needed to balance FY10 Budget (Saginaw = approximately $3 million)

15. 2010 Budget Crisis Unprecedented State Crisis Leaves CMH Financing Unknown • Legislative Proposals suggest: • General Fund Reduction to CMH Statewide of between $40–61 million • Recently announced Medicaid rate rebasing leaves Medicaid funding uncertain • Impact on SCCMHA is: • Reduction to GF is estimated to be between $1.2–1.8 million • Unable to project impact of Medicaid funding changes • Adult Benefit Waiver program ending (replacement program uncertain as of Dec. 31 program ends This uncertainty demands immediate strategic action to mitigate the harm of an even larger mid-year cut

16. Values & Approaches to the 2010 Budget Crisis • Protect as many consumers as possible • Medicaid beneficiaries • Persons with the most serious disabilities who are uninsured • MDCH defined priority populations • Protect community safety • Ensure an adequate service array and choice • Preserve an adequate workforce to meet need • Continue to meet obligations to regulatory compliance • Maintain status as PIHP and avoid financial insolvency • Continue to meet MDCH contract and mental health code requirements

17. MDCH Requirements for FY 2010 • Voluminous (75+) new or expanded Application for Renewal & Recommitment (ARR) expectations • Additional Training to support a “Culture of Gentleness” / Positive Behavioral Supports and development of alternatives to state institutionalization • Demonstrating Meaningful Life Activities • Enhancement of Consumer Leadership Opportunities • Implementation of Recovery Enhancing Environment (REE) tool • Expand System of Care (SOC) to include children with Developmental Disability • Implementation of Trauma Informed Practice • Evidenced-Based Practices (EBP) sustainability • Infant Mental Health Endorsement required • Expanded Financial / Compliance Audit

18. FY09 Ten Months Comparison Report Actual to Budget

19. FY 2010 Preliminary Operating Budget August 26, 2009 DRAFT

20. FY 2010 General Fund Reality as a result of projected state funding reductions – August 26, 2009 DRAFT

21. GF supports services to the following Saginaw citizens: • Uninsured persons • Persons requiring specialty mental health services receiving Social Security Disability, insured by Medicare only • Persons requiring specialty mental health services with commercial insurance: • Insurance does not cover full cost of these services • Insurance does not cover CMH deep end services, at all • Insurance benefit for mental health services has been exhausted by either annual or lifetime benefits • Insurance has co-pays or deductibles that are beyond the consumers “Ability to Pay” • Persons with a Medicaid Spend down until Spend down is met

22. Persons Supported by General Fund in 2009 • 2,586 persons had all or part of their service costs covered by general fund • 2,043 adults with mental illness • 367 children with serious emotional disturbance • 176 persons with developmental disabilities

23. State Rules for General Fund • Medicaid funds cannot be used for anything except services to Medicaid beneficiaries • We must serve the most disabled first, all others may wait • Eligibility is determined locally and based on available funding • Based on the Michigan Mental Health Code the following must be provided: • 24 / 7 crisis screening / eligibility determination • Payment for all state inpatient hospital care regardless of any other insurance, including Medicaid • Payment for inpatient psychiatric care at local hospitals for uninsured / underinsured persons for whom we’ve authorized admission

24. Permissible Uses of General Fund • If funding is available: • Access to all other CMH specialty services for uninsured & underinsured persons with serious and persistent mental illness (SPMI), developmental disabilities (DD), serious emotional disturbance (SED) • Jail Diversion / Juvenile Detention • Psychotropic medications for uninsured / underinsured persons • Homeless and special populations outreach • Inmate services • Guardianship • Other community benefit / collaborative efforts

25. Steps Taken in 2009 to Reduce Expenditures / Increase Revenue • Staff vacancies left unfilled • GF benefits cut (Respite per Governor’s Executive Order) • Delayed capitol improvements • Expansion of patient assistance program for pharmacy needs • Training & conferences restrictions • Operational efficiencies • Delayed technology upgrades • Review of entitlement history and improved status by DHS entitlement staff • Maximize grant opportunities • Layoff / Furlough days

26. Strategies to Reduce Expenditures / Increase Revenues in 2010 • Continue 2009 Strategies • Intensified utilization review in all service areas (what kind of service? How long? How much? - scope/duration/intensity of service plans) • Develop tools to better tie specialized residential contract rates to consumer level of care • Centralizing residential rate negotiations • Review admission risks and recidivism for inpatient care • Gathering data in order to make cut to General Fund package • Identifying consumers to be eliminated from services • Reduce length of authorizations for person receiving services supported by General Fund • Continue to work with DHS on behalf of consumers with Medicaid Spend down • Denying services for person receiving services supported by General Fund unwilling to complete a Medicaid application • Evaluating the cost savings of directing all eligible consumers receiving services supported by General Fund to contracted network providers

27. Saginaw County Substance Abuse Treatment and Prevention Services

28. TAPS Mission & Vision • To support and advise substance abuse treatment and prevention program through leadership, expertise, and funding in a integrated collaborative equitable effort. • To educate community stakeholders including families schools service providers community leaders, faith-based organizations, law enforcement and consumers.

29. Saginaw County Substance Abuse Treatment and Prevention Services • Public manager for Substance Abuse Treatment and Prevention Services (TAPS) for Saginaw County • TAPS is a program of the Saginaw County Department of Public Health

30. Douglas Carter Cheryl Hadsall Russell Howell Eddie Foxx Dennis Morrison Arthur O’Neal Georgia Reyes James Threws Tavey Zio Zois TAPS Advisory Board / Leadership Natasha Coulouris, Public Health Officer Bryant J. Wilke, Interim Director Amy Murawski, Treatment Coordinator

31. TAPS Budget FY 2009 • Total Budget $3,183,954.00 • Medicaid $1,208,893.00 • Block $1,821,963.00 • SPF/SIG $ 153,098.00 • Saginaw County contracts with MDCH for Block Grant Funds • TAPS contracts with SCCMHA for Medicaid Substance Abuse Services

32. 2009 TAPS Targets & Accomplishments • Co-Occurring Disorders (COD) Collaboration with SCCMHA • Community Collaboration & Evidence-based Practices • State Prevention Framework (SPF) / State Incentive Grant (SIG) • Methadone / Suboxone Clinic Victory Clinical Services • Family Dependency Treatment Court

33. Admissions

34. Admissions by funding source

35. Primary drug at admission

36. Age at admission

37. Invitation for Public Comment SAGINAW COUNTY TREATMENT AND PREVENTION SERVICES