Spring 2008
Mental health and substance use services desperately need a 5% funding increase. Support services such as Peer Centers, Criminal Justice/Mental Health Liaisons and PATH homeless outreach have had NO increase since 1996. Service providers received one 2.5% increase in 2005 from TennCare to provide Mental Health Safety Net services to people disenrolled from TennCare. When you consider that the medical costs in general have increased by 44% in that time, you know that community service providers are stretched to the breaking point. Bravo to Commissioner Virginia Trotter Betts for who asked Governor Bredesen for a $3.65 million to keep services viable. The state’s budget for 2008/09 looks tight, so we need all of you contacting your state legislators to urge them to support more funding for community mental health and substance abuse providers. Contact the NAMI TN office for more information (800) 467-3589.
Please click on the following links for further information
on this issue and others
Issue: 5% Increase for Community Behavioral Health Providers
Issue: Report to General Assembly Supporting 5% Increase
Spring 2007
As the 2007 legislative session begins we have a great opportunity to help our representatives understand how things look for those of us affected by mental illness.
Good News
We eagerly anticipate the Middle Tennessee integrated TennCare pilot program in April. Linking primary care and behavioral health services consumers will hopefully get the primary health care they need and persons seeking treatment for physical health conditions can be screened and referred to mental health treatment when needed.
We applaud Commissioner Betts, her staff and the TennCare Bureau for the Crisis Stabilization Units to be established in Cookeville , Nashville & Columbia . These 72 hour facilities will offer psychiatric expertise to those in need, and will limit long waits associated with Emergency Rooms and crisis teams.
Praise to the Memphis Mental Health Summit, including NAMI Memphis, for their creative efforts to welcome diverse populations, making mental health services acceptable and useful to all. Many thanks to Magellan and the Department of Mental Health and Developmental Disabilities for funding the outreach initiative.
Concerns
We will hit the ground running this year with public policy issues.
All Tennesseans with severe mental illness must have access to services and supports to promote recovery and resiliency, regardless of health care coverage.
Decision-makers must put consumer well-being first and foremost in start-up procedures for CoverRx and other Cover Tennessee programs.
Tennessee consumer confidentiality procedures must allow families to provide vital information to providers. Consumers must have repeated opportunities to involve their families in treatment to varying degrees.
Tennessee must give educators the necessary training to help our children succeed in school. School-based mental health screening must continue because early identification is key to success for children with behavioral disorders
Youth in transition to adulthood must be supported with programs to help them achieve independence. We cannot allow our youth to lose health care coverage at this very vulnerable, but promising time in their lives.
We must develop feasible alternative transportation to emergency commitment. More humane transportation will decrease trauma, increase dignity and make wiser use of public resources.
Jails must develop consistent standards to provide adequate psychiatric medication to inmates with severe and persistent mental illness.
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Summer 2006 Update
Legislative Session 2006 provided many welcome policy changes for persons with SPMI. Just look at the bills below! Each is a clear victory, the result of many hours of work on the part of legislators, staff and advocates like you!
Passed: ASJR614
Suggested by NAMI Tennessee, this bill urges the governor to develop a comprehensive fiscal analysis of expenses relative to adults with SPMI and children with Severe Emotional Disturbance. Then decisions about programs and expenditures can be data-driven and effective. We hope that this effort will be adequately funded. It awaits the Governor’s signature.
Passed: SJR799
This bill directs the Select Committee on Children & Youth to study the state’s mental health system for children and develop recommendations.
Deferred: SB3692/HB3517
This bill dealt with mental health screening in public schools. The bill raised concerns and did not pass the House. It was deferred to a study committee.
Passed: SB2719/HB2744
This bill requires insurance coverage for autism disorders. It awaits the Governor’s signature.
Passed: SB3682/HB3562
This bill requires TDMHDD to recommend options for access to nonemergency behavioral health services for people who are uninsured by November 20, 2006. The bill awaits the Governor’s signature.
Passed: SB3424/HB3340
This bill directs the state administration to negotiate an insurance premium waiver for individuals under the 250% poverty level, potentially providing crucial relief to uninsurable people no longer covered by TennCare. The appropriations bill was amended to provide revenue for this effort. 20,000 to 25,000 uninsurable people may receive help.
Held: SB3528/HB3583
This bill directs Commerce & Insurance to work with a non-profit group to advise consumers on health care, assist with appeals, and advise about how various insurance coverages work together. The bill was held, but the administration was interested in providing sophisticated information, screening and referral for disenrollees.
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Spring 2005 Update
TennCare issues dominated NAMI Tennessee’s advocacy agenda this spring. Early this year, Governor Bredesen announced that, in an effort to balance the state budget, TennCare would revert to a basic Mediciad program. In the process, more than 300,000 people would lose coverage. Nearly 30,000 of those slated for disenrollment were persons with severe and persistent mental illness (SPMI).
The Mind of America Campaign in Tennessee
In response, NAMI launched the Mind of America Campaign in Tennessee, documenting the cost of untreated mental illness and suggesting measures to improve treatment and contain costs. NAMI’s efforts accelerated in March as we joined other organizations for Mental Health Day on the Hill. Hundreds of consumers, family members, providers and advocates visited legislators in Nashville, urging careful consideration of Tennesseans affected by SPMI. As the legislative session progressed, the needs of various groups were debated in the Assembly and in the press. The issue grew heated, and NAMI continued to push.
Teresa Godsey, Judge Dan Eisenstein, Dr. Ken Duckworth, Brian McQuire,
Jeff Blum, Donna Nichols and Sita Diehl launch the Campaign for the Mind
of America in Tennessee.
Thanks to the Legislators Who Championed SPMI Funding
Along the way, we found many champions in Tennessee’s 104th General Assembly. Representative Mark Maddox authored a letter from the Assembly urging the Governor not to abandon persons with SPMI. Senator John Ford proposed a resolution recognizing persons with SPMI as a vulnerable population. Senator Doug Henry supported SPMI funding. Senator Roy Herron advocated for increased services in rural areas. Senator Ron Ramsay stood strong for TennCare enrollees. Representatives Joe Armstrong and Craig Fitzhugh supported SPMI funding, and Senator Kathryn Bowers brought SPMI before the TennCare Oversight Committee.
Some Relief Funding Won for Mental Illness
Our advocacy brought some relief. Additional tax monies became available, and the overnor proposed keeping persons who were medically needy on TennCare roles, providing insurance for as many as 6,000 persons with SPMI. Near the end of the session, the Legislature passed what was called the “soft landing” amendment providing $38 million for psychiatric meds and roughly $10 million for mental health centers. A tobacco tax offered more relief, making $7 million available to help consumers sign on to patient assistance programs offered by drug companies. And, finally, about $8 million was designated to cover the gap in services for people cut from TennCare but eligible for Medicare coverage starting in January 2006.
Yes, services continue to be cut. Yet our voices were heard this spring. Together, we made a difference.
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Spring 2005
In testimony on Monday, April 25, NAMI will urge the TennCare Oversight Committee to protect Tennesseans with severe and persistent mental illness (SPMI) from impending disenrollment from TennCare.
Downstream Consequences
Katrina Gay of the NAMI National office points to the fact that many states have drastically cut massive Medicaid programs, yet none has disenrolled persons with SPMI. “State administrations and legislatures across the country are cognizant of the downstream consequences of leaving this vulnerable population without coverage,” says Gay. “Without services, people with SPMI will crowd Tennessee’s hospitals and jails. They will swell the numbers of the homeless. For every dollar the state spends now to keep people with SPMIs stable, it will save many dollars more in public costs a year from now. Helping a person with schizophrenia or a bipolar disorder buy his meds today is vastly more economical than paying for emergency procedures or hospitalization when his condition has become acute.”
All Other States Protect Persons with Severe and
Persistent Mental Illness (SPMI) from Medicaid Cuts
“We know that Governor Bredesen is concerned about the 30,000 people with severe mental illness who will be losing TennCare coverage,” says Sita Diehl, executive director of NAMI Tennessee. With the details of TennCare cuts still in the making, she says, “Whatever the Governor or the assembly does at this point to protect our most vulnerable citizens will be both humane and fiscally prudent.” Other states such as South Carolina, Washington, Oregon and New York have protected people with SPMI from disenrollment during drastic Medicaid cuts.
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TennCare Cuts Hit Mental Health Hard
NASHVILLE, TN – More than 320,000 adults will be cut from TennCare during 2005. Those who remain will have limited coverage on benefits, including prescription drugs.
The Newly Uninsured
Those among us who will lose TennCare benefits are mostly women (60%), white (83%) and the working poor. Many are uninsurable because of chronic health problems. Others have an income too large for Medicaid benefits, yet too small to pay for private insurance. The bottom line is that 30,000 Tennesseans with severe mental illness, people who need ongoing meds and therapy in order to remain productive and stable, will lose TennCare coverage. They are unlikely to be able to pay for their prescriptions.
Beginning in May, uninsured people and those on Medicare will receive letters about the cuts. Soon thereafter, they will lose all TennCare coverage. By fall, medically needy people who do not make enough to pay their medical bills and people who are uninsurable will learn their coverage is ending. Everyone who remains will have limited services: 4 prescriptions per month, 12 doctor visits, 20 inpatient and 8 outpatient visits annually.
What the Future Holds
Governor Bredesen has pledged aid to the places people go for low-cost care (county health departments, hospitals and faith-based clinics) but no one knows how much help will be provided. No other state has cut as many people from its public health insurance rolls as Tennessee plans to do in 2005, but several states have been down the road Tennessee is navigating. South Carolina, Oregon and Mississippi have dropped subscribers or imposed new limits. What’s happening there may offer a glimpse into our future in Tennessee. When Oregon monitored the effect of cuts, officials found that 60% of the newly uninsured reported skipping does of medicine and cutting back on food to cover the costs of meds. Fifty percent were given prescriptions they could not afford to fill. And one year after being cut, 72% of those losing coverage remain uninsured.
There were, and still are, many unknowns about how TennCare changes will affect families and communities. The burden is almost certain to fall heavily on local hospitals, sheriff’s departments and county governments. Right now, all of us in the NAMI family—board members, families, consumers and staff—are responding almost daily to announcements about TennCare changes. For more about NAMI’s position now and in the months to come, see the Exec’s Desk.
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February 10, 2005
NAMI National TO RESPOND TO TENNCARE CUTS
Policy Experts to Analyze Proposed
TennCare Cuts and Make Recommendations
NASHVILLE, TN – NAMI Tennessee's Executive Director, Stia Diehl, announced today that NAMI National will be analyzing the proposed TennCare cuts and making policy recommendations as part of its twelve-state Mind of American Campaign 2005. "We're delighted to have national expertise to help us with this very difficult situation," she said, noting that Tennessee is one of several states facing deep cuts in healthcare coverage. A press conference on the findings at the national level has been scheduled for March 3.
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January 2005
As TennCare Scales Down, State Economy Will Suffer
Cutting TennCare Rolls Will Cost State Twice What It Will Save.
NASHVILLE, TN – Governor Bredesen has announced plans to substantially scale back TennCare, removing 323,000 adults from the program for poor and uninsurable citizens. The Governor’s aim is to save the state treasury 488 million in direct costs annually. In reality, this move will deprive the state coffers of at least $875 million in matching federal funds annually. At the same time, 10,600 health care sector jobs will disappear, and hospitals will be forced to absorb an additional $230 million to $450 million in uncompensated charity care.* “Then there’s the human cost of severely ill people who can no longer get the care they need,” says Sita Diehl, executive director of NAMI Tennessee, the state’s advocacy group for the mentally ill. “On every level, the cost of these cuts is high indeed. We’ll feel ripple effects from this for a long time to come.” More. . . . .
A Perfect Storm:
Diminishing Services for Mentally Ill Tennesseans
NASHVILLE, TN – Changes are brewing that spell increasing troubles for the 285,000 Tennesseans with mental illnesses such as depression, schizophrenia and bipolar disorder. “Several factors are coming together at once, each exacerbating the effects of the other. It’s a perfect storm,” says Sita Diehl, executive director of NAMI Tennessee, the statewide advocacy group for mentally ill Tennesseans and their families.
She refers to three recent changes. First, Governor Bredesen is considering cutting TennCare, meaning that 400,000 Tennesseans will be completely uninsured. More . . .
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