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State lawmakers hope that spiraling costs of treating the state's mentally ill won't be like another Felix consent decree. Health Department:
Double budget to help
mentally illBy Lisa Asato
Star-BulletinThe state Department of Health wants to double the budget of the Adult Mental Health Division from $61 million to $122 million over four years, state lawmakers were told yesterday.
Part of the budget request is needed to comply with a 1991 federal settlement agreement between the U.S. Department of Justice and the state. It requires the state to develop an appropriate array of community services for patients discharged from the State Hospital.
But concerns over the escalating costs of the Felix decree has some lawmakers worried about manageability. The consent decree is a 1994 federal mandate to improve special-education services to public-school students.
House Health Chairman Dennis Arakaki (D, Kalihi) said the department is starting from the ground up, sparking concerns over the time frame.
"Felix is a good example of how long it's taken to provide those services across the board. It's also an illustration of how expensive these programs are," he said.
But he also said emphasizing services now will save costs down the road and lawmakers should "demonstrate a commitment (to fund) at least the first two fiscal years."
The budget request -- of an additional $8 million for the year beginning July 1, 2001, and $24 million the year after -- would address the needs of those affected by the lawsuit, namely state hospital patients and patients being discharged or diverted to other programs, said Health Department Director Bruce Anderson.
He said the $50 million balance would go toward quality control of contracted services and meeting other needs of the seriously mentally ill, who need persistent, lifelong care to function in the community.
The state budget approved by the House includes the first $8 million in addition to the $61 million, said House Speaker Calvin Say (D, Palolo). At this time, however, the House would not be willing to approve anything beyond that, he said.
"We will probably continue on the appropriation for the second year, but we're going with zero right now to see how the $8 million will be used," he said.
"The impact may be minimal, but we are trying to address the compliance," he said. "It's just another consent that we have on the Hawaii State Hospital. We're trying to do our best with the limited resources also."
Among other things, he suggested the department "get creative" and seek the $50 million balance in federal programs such as Medicare and Medicaid.
But Anderson of the health department said Medicaid usually supports mature programs, and wouldn't really kick in for five or six years.
Department officials met with House and Senate leaders yesterday to discuss a study defining the needs of the state's seriously mentally ill as well as a comprehensive plan to meet those needs with a new emphasis on community-based services.
Also yesterday, the Hawaii State Hospital special monitor, Leland Chang, briefed the House Health Committee on the status of the court-ordered monitoring.
Chang told lawmakers the judge charged him with observing and monitoring legislative support. "You are the ones who will enable this process to go further," he said.
The department's largest funding changes call for increasing funding for community-living resources from $7.5 million to $45 million -- or a jump from 12 percent to 37 percent of the budget . It also proposes increasing rehabilitation and vocational training funds from $2.9 million to $17 million -- a jump from 5 percent to 14 percent of the budget.
Senate Majority Leader Jonathan Chun (D, S. Kauai-Niihau) said the Felix case raises issues about "spending money with no end in sight," but added that funding the Health Department's four-year plan is necessary.
"We cannot just stop providing services without care or consideration to where (the State Hospital patients) will be going," he said.
The question on lawmakers minds, he said, is not whether to fund the request, but whether the department will use the money in the most cost-effective way.
Arakaki said the $122 million represents a "double funding of the system" necessary for the state to move toward more community-based services while continuing to fund the state hospital.
"It's a big challenge, especially this year because of collective bargaining and Felix," he said. "To have to come up with that amount of money is staggering but it's something we have to do."
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