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May 26, 2009Honorable Noreen EvansChair, Assembly Budget Committee – Assembly Budget ConferenceCapitol Building, Room 6026Sacramento, CA 95814

RE: May Budget Revision Reductions to Mental Health Managed CareServices, Early and Periodic Screening, Diagnosis and TreatmentServices (EPSDT) and Institutes for Mental Diseases AncillaryServices - OPPOSE

Dear Assembly Member Noreen Evans:Disability Rights California, a non-profit advocacy organization mandated toadvance the human and legal rights of people with disabilities, is opposedto the proposed reductions to Mental Health Managed Care Services, Earlyand Periodic Screening, Diagnosis and Treatment Services (EPSDT) andancillary service payments for residents of Institutes for Mental Diseases.The Governor’s May Revision proposes to reduce Mental Health ManagedCare Services and Early and Periodic Screening, Diagnosis, and TreatmentServices (EPSDT). Mental Health Managed Care services retained includeacute inpatient services and prescription drugs for Medi-Cal enrollees only.EPSDT savings result from eliminating General Fund support for countyprograms identified as new programs in 2007-08 and 2008-09. Thesereductions will mean a loss of significant federal matching funds. Furtherthe reductions will result in increases in acute hospitalizations,homelessness and people with untreated mental health disabilities. TheGovernor also proposes to reduce ancillary service payments for residentsof Institutes for Mental Diseases. This would deprive individuals of medical

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services necessary for treatment and recovery.

Managed care mental health services:

The counties provide what arecalled “specialty mental health services, through managed care.” Theseare mental health services that are not provided by physical health careproviders or by Medi-Cal fee-for-service providers. These include inpatienthospital services, outpatient mental health services including residentialservices, and targeted case management. Outpatient services can beprovided by psychiatrists, psychologists, licensed clinical social workers,marriage and family therapists, and peer counselors. Eliminating theseservices will mean that people with mental health disabilities will not haveneeded services resulting in more acute care hospitalization andhomelessness. Further eliminating these services will mean California andits counties will not get federal matching dollars.

EPSDT:

EPSDT stands for “Early and Periodic Screening, Diagnosis andTreatment. It is a Medi-Cal benefit for people under age 21.EPSDT requires states to provide children with all services listed in theMedi-Cal schedule of benefits that are appropriate for children, as well asall other medical services that are eligible for federal matching funds.These services include Therapeutic Behavioral Services (TBS) andTherapeutic Foster Care.These programs resulted in an increase in children’s mental health servicesunder EPSDT. EPSDT, like most other Medi-Cal services, is anentitlement, so state General Fund expenditures for EPSDT have beendriven by the increases in entitlement for these services that are mandatedby federal law. The state cannot eliminate the federal entitlement to EPSDTservices unless it gives up all of its federal Medi-Cal matching funds - soessentially this will result in an unfunded mandate to the counties. Furtherif Therapeutic Behavioral Services and Therapeutic Foster Care areeliminated as a result of these reductions – the State could be in violationof the Emily Q. and Katie A. lawsuits, which resulted in the establishment ofthose required services.

Institutes for Mental Diseases (IMD)

: The reduction in ancillary servicessuch as physical health care, pharmacy and laboratory services, will meanpeople will not receive the services they need to maintain their physicalhealth while in IMDs.