Article from NAMI

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NAMI Statehouse Spotlight
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February 15, 2006

NAMI's Statehouse Spotlight is a biweekly electronic public policy news resource containing recaps of recent media coverage and useful grassroots tools gathered from across the country. NAMI leaders and advocates are encouraged to use this information to energize their thinking as they plan future advocacy efforts.

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News from the States
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To follow up on any of the items featured in this publication, please contact Steven Buck, director of state policy at sbuck@nami.org

**Federal Budget Reconciliation Means Changes for South Carolina Medicaid**

South Carolina Governor Mark Sanford believes the recently enacted federal budget reconciliation bill allows the state Medicaid program to implement personal health accounts for the state's 850,000 program participants. Previously, this proposal would have required state legislative approval, but now the change can be implemented administratively. The federal reconciliation bill allows ten states to pilot Medicaid programs similar to the one proposed for South Carolina. Sanford anticipates that the changes in the program will save the state $300 million over five years. (MyrtleBeachOnline.com, February 3, 2006).

**Georgia Delays Medicaid Reforms for at Least One Year**

In a move projected to save $478,000 in 2006 and $1.2 million in 2007, Ohio's Medicaid program implemented $3 co-pays for non-emergencies treated in hospital emergency departments. The collection will occur at the point of service if hospital staff determine that there is no urgent reason for the patient to be seeking emergency care. Hospitals are balking at the changes, noting that they would spend more on administrative activities related to collecting the $3 than they would on the actual lost recovery. (The Columbus Dispatch, February 12, 2006)

**Pennsylvania County to Seek Medicaid Reimbursements for Juvenile Detention Center**

Luzerne County's juvenile justice detention costs could diminish significantly if the detention center is successfully certified eligible for Medicaid funds. Currently, the state and county pick up 50 to 80 percent of the total cost for individuals receiving services in the detention center. However, if Medicaid eligibility is achieved, the state and county share would drop to 10 to 20 percent of the cost. Program administrators suggest that the transition will provide better care to persons served in the center. Statewide, similar certifications have been achieved at 50 centers. (TimesLeader.com, February 12, 2006)

**Initial Steps to Major Reform Taken in Virginia**

Virginia lawmakers have taken the first steps toward major Medicaid reform by proposing that the state move toward electronic records and disease-management strategies for chronic illnesses. Lawmakers also advanced a bill to create a commission to explore possible changes in the next legislative session, including the use of personal health accounts. Currently, Medicaid accounts for 16 percent of the Virginia state budget. (DailyPress.com, February 3, 2006)

**State Advances Plan to Take Responsibility for Medicaid Expenditures**

A proposal debated in North Carolina would require that the state take full responsibility for non-federal costs of Medicaid. Currently, counties contribute to the required Medicaid match. In exchange for the state's participation, the state government is asking North Carolina counties to surrender to the state a one cent local sales tax that generates about $1 billion annually. Some counties oppose the proposal as they currently take in more from the tax than they currently spend on Medicaid, providing important resources for other county services. (JournalNow.com, February 12, 2006)

**Funding Equalization Under Fire in Georgia**

Citing a need to equalize funding throughout the state, several Georgia providers of mental health services are experiencing significant cuts. Advocates express concern that the funding shifts will create homelessness and interaction with the criminal justice system. For one center, the cuts were initially 20 percent but an additional 30 percent cut is proposed. The Department of Human Resources contends that the equalization will promote a better statewide system of care and foster better approaches to providing services. (Rome News Tribune, February 13, 2006)

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NAMI Advocacy Tools & Resources
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Needs assessments from across the country point to affordable housing as being one of the greatest needs for people living with mental illness. NAMI state organizations and affiliates from across the country do an exemplary job of promoting affordable housing and seeking community solutions for this national need. NAMI Vermont, for example, participates in the Vermont Affordable Housing Coalition. To review the coalition's objectives for 2006, click here ( http://www.nami.org/Template.cfm?Sec...ontentID=30530 ) .

An excellent source on the price of housing in your state is Priced Out in 2004: The Housing Crisis for Persons with Disabilities. The report is co-published by the Technical Assistance Collaborative and Consortium for Citizens with Disabilities Housing Task Force. A summary and a link to the document are available by clicking here ( http://www.nami.org/Content/ContentG...ut_in_2004.htm ) .

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Washington Quick Glance
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**Medicare Drug Benefit Update: Consumer and Family Tip Sheet Available to Help Address Coverage Problems; Bills Introduced in Congress to Address Gaps**

The Medicare Part D drug benefit is now 45 days old and while many of the problems that plagued the early days of the benefit have been addressed, some problems persist. Of particular concern to NAMI are coverage gaps faced by low-income beneficiaries with severe mental illness who are concurrently (dually) eligible for both Medicare and Medicaid.

Perhaps the biggest challenge facing the new drug benefit in these early days is the persistent gap between the coverage and transition obligations imposed on drug plans by the Centers for Medicare and Medicaid Services (CMS, the federal agency that administers Medicare) and what drug plans and pharmacies are doing in the real world. It is no surprise to many NAMI members that the standards that CMS has required of drug plans and pharmacies with regard to coverage for dual eligibles is not always being followed where it really matters. (i.e. where a consumer is at a pharmacy counter being told "no.")

In order to help alleviate these problems and provide consumers and families with the tools they need to maintain continuity of care, NAMI has developed a simple one-page listing of the obligations required for all Medicare drug plans serving dual eligibles. This "tip sheet" also has FAQs explaining cost sharing requirements (including circumstances under which cost sharing can be waived) and the process for getting a drug that is not on a drug plan's preferred list or is subject to a restriction such as prior authorization. NAMI affiliate leaders are strongly encouraged to download this document ( http://www.nami.org/Template.cfm?Sec...ontentID=30580 ) and make it available to consumers and families.

NAMI National staff is willing and able to print and ship requested quantities of these guides to state and local NAMI affiliates at no cost. However, it is important to note that NAMI staff will periodically update this document since CMS is expected to issue new guidance in the coming weeks and months – in particular as March 31 expiration date of the current initial transition guidance draws closer. In other words, NAMI wants to be careful to ensure that information provided is timely and completely accurate.

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NAMI Statehouse Spotlight is an electronic newsletter provided free of charge as a public service. With more than 1,100 state and local affiliates, NAMI is the nation's largest grassroots organization dedicated to improving the lives of people with severe mental illnesses. Contributions to support our work can be made online at www.nami.org/donate. (http://www.nami.org/donate)

If you do not wish to receive further Statehouse Spotlight Alerts, please click here (http://www.nami.org/subscribe) , sign in and uncheck the box next to Statehouse Spotlight. Please do not reply to this email (it will go to an unattended mailbox.) If you have any questions, concerns, or comments, please send an email to sbuck@nami.org.
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