Minding Houston Episode III: The 1115 Medicaid Waiver in Houston

What if I told you the State of Texas and the federal government are working together, on an $11.4 billion partnership to help increase access to care for Texans? There are no lawsuits, political posturing, or name calling. The program is praised by Republicans, Democrats, and every healthcare organization across the state. Sound impossible? Well, let me tell you: it’s all true. And when it comes to increasing behavioral health services, it’s even better.

This is Minding Houston, I’m Bill Kelly. 

Today, we wanted to talk about the biggest expansion of behavioral health services in Texas. Ever heard of the 1115 Waiver? Well, if not, maybe it’s because it hasn’t generated the, let’s call it the “heat” that other federal initiatives have here in Texas.

So first things first, what is the 1115 Waiver? Simply put, it is a 5 year agreement between the federal Center for Medicare & Medicaid Services, or CMS, and the Texas Health and Human Services Commission, or HHSC. Together, CMS and HHSC have negotiated a plan to combine state dollars spent on healthcare to draw down matching federal funds all in an effort to expand the footprint of healthcare services in Texas.

       1115 Medicaid Waiver made easy

So what does this really mean for us in Greater Houston? As it turns out, quite a lot. Over our nine county Regional Health Partnership (one of 20 organized throughout the state), we stand to gain over $2.3 billion dollars in expanded healthcare services.

So, what do these programs look like? Well, let me introduce you to two programs funded
by the 1115 Waiver. First, in a report by Houston Public Media’s Carrie Feibel, is a look at Mental Health Crisis Clinics set up by Memorial Hermann.

Now, as we’ve noted before, the lack of access to mental healthcare leaves an increasing number of cases to be handled by law enforcement. That’s where our second example, the Crisis Intervention Response Team comes in. In this story by KHOU reporter Jeff McShan, you can see first hand the difference having both a mental health professional and law enforcement training has in dealing with a mental health crisis.

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Both the Memorial Hermann mental health crisis clinics and three CIRT details are funded by the 1115 Waiver using Delivery System Reform Incentive Payments, or DSRIP funds. In our area, there are 55 projects specifically for Behavioral Health totaling $457 million dollars. Now, remember from last week, our state spends just over 1 billion a year in mental health services through DSHS for the entire state, and DSIRP dollars put almost half a billion right here in our own backyard.

This badly needed expansion of access for mental healthcare represents a huge step forward for the State of Texas. But it also brings a number of challenges. Like, do we have enough of a workforce to staff this expansion? What is the mental health workforce shortage and what we can do about it? More on that, next time.

This is Bill Kelly for Minding Houston, a presentation of Mental Health America of Greater Houston.

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Music from this episode: “Rollin at 5 – 210” by Kevin MacLeod and “Sand Castle” by Pitx.

To hear Carrie Fiebel’s full report about the Humble Crisis Center, listen here at Houston Public Media. To hear more about the HPD Crisis Intervention & Response Team (CIRT), watch here at KHOU.com.

Minding Houston Episode II: Mental Health Money

As the 84th Legislative Session begins, our lawmakers are only constitutionally required to do one thing: pass a budget. While likely to pass over 1,000 other pieces of legislation, the Legislature is legally bound to determine the funding for state services for the next biennium. And that bill, the Appropriations Bill, is where questions about the financing for mental health services are answered.

Before looking at this biennium, it is worth looking at were we started. Historically, Texas has not funded services on the level with other states. The best study of this was done by the Kaiser Family Foundation in comparing per capita spending on mental health services.

From an interview I gave with Houston Public Media’s Craig Cohen on an episode of “Houston Matters” in June of 2014,

“For the Fiscal Year 2010, Texas ranked 49th in terms of per capita spending on mental health with right at $39. Keep that 39 dollar figure in mind for comparison sake. Our neighbors to the east in Louisiana spend $62 per capita, and further down the road, Alabama spends $78. Mississippi, who we are often compared to for social services, spends $114. The national average is $120.”

So with that historical under investment in mind, what does Texas spend on mental health now? To best show the answer, our friends at the Meadows Mental Health Policy Institute produce the following slide that breaks down the figures.

The vast majority of state spending on mental health comes from the $1.16 billion spent yearly by the Department of State Health Services. Roughly $160 million a year is spent on substance abuse.

Getting your head around those big numbers helps to show just how successful the last legislative session was for funding. A chart from the House Appropriations Committee hearing this summer outlines the additional $312 million in increased spending within DSHS. A breakdown of these additional expenditures is listed on the attached chart.

While badly needed, last session’s invest won’t solve the problem of serving Texans with mental health needs. Aside from continued investment from lawmakers, Texas needs to expand the footprint of services so more people can have access. Thanks to a partnership between Texas and the federal government, and yes you heard that right, we are doing just that. More on that next time.

This is Bill Kelly for Minding Houston, a presentation of Mental Health America of Greater Houston.

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We would like to thank both Houston Matters and the Meadows Mental Health Policy Institute. To hear the rest of the interview, listen here at the Houston Matters website.

This episodes music included “Never Let it Go” by Bluesraiders, “Strange Sensations” by Anitek and “Plethora” by Anitek.

Minding Houston Episode I: Moving Forward in 2015

Welcome to the 84^th Legislative Session! My name is Bill Kelly, the Director of Public Policy & Government Affairs here at Mental Health America of Greater Houston. With the start of new year comes 140 days of governing, and that means our advocacy will be kicking into high gear.

We invite you to keep up with our work by following our new Legislative Blog, “Minding Houston” where we will share the latest on issues and bill movement. 

I’ve been a Chief of Staff for a State Legislator and worked for the Mayor’s Office at the City of Houston. I’m very proud to work for the issues and policies that Mental Health America of Greater Houston has endorsed and look forward to using this blog to keep you updated on legislative progress.

To receive your free EMAIL SUBSCRIPTION to the blog visit mhahouston.wordpress.com

Enter your email address (see top right of page) to subscribe to this blog and receive notifications of new posts by email.  Then select, SIGN ME UP.

[Transcript below]

Since the last Legislative Session ended, there have been a number of press reports about the progress made in Texas in mental health funding. The purpose of this blog is to help keep you updated with what policies Mental Health America of Greater Houston will be working on during 2015 and the stories of real people that these policies impact.

Recently, the Mental Health America of Greater Houston Board has approved series of Legislative Priorities. It is our hope to help tell the stories of how and why policy changes have dramatic impacts for the quality of life for those with loved ones suffering from a mental illness or substance abuse problems. By highlighting our priorities in press stories, we hope to raise the attention of lawmakers and hope they continue their efforts to invest in mental health.

To help set the stage, check out this article from our friends at the Houston Chronicle on July 12th.

Advocates are urging Texas lawmakers to remember the problems in the state’s mental health system after a couple of hearings in which progress on mental health has been cast as one of the Legislature’s greatest recent accomplishments.

Last session’s roughly $350 million increase in funding for mental health and drug abuse services helped reduce the number of Texans on a waiting list for psychiatric treatment from 5,515 last February to 790 this February, including from 1,750 to zero in Harris County, and 194 to 11 among children. The reductions were hailed at a state House Appropriations Subcommittee meeting last month.

“That’s an extraordinary outcome,” said Rep. John Zerwas, R-Richmond, the panel’s chairman.

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Still, Zerwas said the waiting-list reductions represent a “very solid first step.”

“We have made steps forward in the past,” the lawmaker added. “But every time we would make a step forward, we would next time make a step backward. So, a real focus of mine is making sure that we take another major step forward next year.”

This is where we hope to help Rep. Zerwas and the strong bipartisan coalition that wants to reduce the expensive consequences of failing to invest in mental health services. We need to move forward, and we know that we can by showing the solid return on investment that come with funding.

This is Bill Kelly for Minding Houston, a presentation of Mental Health America of Greater Houston.

Music from this episode: “The 3rd” by Anitek and “Looping Guitar Improv in Em” by Steve Combs.