Update on 2017 Behavioral Health Division Proposed Budget

The Mental Health Board Finance Committee met last Thursday, May 26. The primary agenda item was a high level overview of the 2017 BHD budget and the budget timeline, including public comment. Here is a link to the meeting packet and budget overview: http://county.milwaukee.gov/ImageLibrary/Public/BHD/Mental-Health-Board/MHBFinance05-26-16MeetingPacket.pdf

We have listed below some key points regarding the 2017 BHD budget based on what we know to date. A line item budget is not yet available. It is our understanding that this will be available at the 6/16 Finance Committee meeting (scheduled for 1;30, location not yet posted) and there may be another opportunity for public comment at that time. The table below include a listing of the budget highlights from the overview, broken out by program area, and a second table listing each Mental Health Task Force budget recommendation with any related information from the 2017 budget overview.

As noted in the Mental Health Task Force testimony which was shared with you last week, it was very gratifying to see a number of items in the budget overview that the MHTF had identified as priorities. These include: creation of an additional CART team, expanding 24/7 coverage to the Southside Crisis Resource Center, adding AODA residential beds, enhancing Opioid Epidemic Strategies (no funds specified), and partnering with Housing Division on the Initiative to end Chronic Homelessness, as well as support for Wraparound. It’s important to express appreciation to the Board and administration for these positive investments, so please consider reaching out to share your thanks.

The overall budget message was concerning. The Finance Committee was told there is a $2.7 million hole for 2017 which limits the ability to expand community services and maintain current services. The Finance Committee was also given the directive to keep tax levy at or below last year’s tax levy of $58.8M. Note that Act 203 gives the Mental Health Board the option to budget for up to $65M in tax levy, so the Board does have the authority to recommend an increase in tax levy to the County Executive.

The next step in the budget process is for Mental Health Board members to advance budget recommendations to the Finance Committee Chair by June 6. Mary Neubauer represents the Mental Health Task Force on the Mental Health Board and will be advancing several recommendations to the Finance Committee. These are items which were included in the MHTF 2017 budget recommendations but did not appear to be included and/or fully funded in the Budget overview. The Steering Committee has recommended that these include the following: A Research and Policy Analyst to staff the Mental Health Board; 2 additional CART team positions (1 position was included in the budget); an AODA services investment (not specified in the budget overview); and support for Warmline.

It is still timely for members of the public to contact the Board to share your priorities for the 2017 budget, including expressing support for the recommendations advanced by the Mental Health Task Force.
Board members may be contacted via email at: mhb@milwaukeecountywi.gov

We hope this overview is helpful and will continue to keep you posted as additional information is available.

REMINDER:

We hope to see you Tuesday June 7th at 3 PM for a special June Mental Health Task Force meeting where we will welcome new BHD Administrator Michael Lappen. Please bring information about your agency and programs to add to the resource bag we are preparing for Mike. Note the change from our usual meeting date and location.

Meeting Location
700 W. Virginia St. (lower level), Tannery Building- Next Door to MHA’s Office
Take elevator to the lower level, after exiting the elevator, conference room is to the right

Parking: The adjacent lot is usually full. Please use the lot across the street behind Lutheran Social Services (south of the location). There is also free street parking in front.

2017 BHD Budget Highlights: Based on 5/26 MH Board Finance Committee meeting & Packet
Note: Cost to continue for 2017 BHD budget is $3.4 million
ProgramProposed for 2017 in Budget Overview
Inpatient adult54 beds (Adult inpatient bed capacity of 60 beds with a 90% occupancy factor)
Inpatient Child and adolescent12 beds (CAIS average census of 12)
Comprehensive Community Services (CCS)Add 340 clients. (increase by 85 clients per quarter to at least 800 clients by year end)
Community Service Program (CSP)No increase
Community Recovery Services (CRS)No increase
Targeted Case Management (TCM)Increase of $.3 million ($300,000). Increase enrollment by 110
Southside Community Access Hub$1.2 million to establish and open
Northside Community Access Hub$.5 million to operate. It is supposed to open in 2016
2 additional Cart Teams$.1 million ($100,000)
Expand Southside CRC to 24/7$.33 million ($333,333) (we are verifying whether this includes Certified Peer Specialists)
Full Year intensive Outpatient Program$.5 million ($500,000)
Initiative to End Chronic Homelessness$.25 million ($250,000)
Electronic Medical Records Solution$3 million ($300,000)
Telehealth$7,000
Wraparound Clinic$ .4 million ($400,000)
AODA Residential CapacityAdd 16 beds
Enhance Opioid Epidemic StrategiesListed but not specified


MHTF 2017 Budget RecommendationsProposed in 5/26 Finance Co. Budget Overview
1. CART: Fund at least four additional clinicians from BHD’s budget to fund an additional CART team w/MPD to cover all shifts and creation of additional CART teams with the Milwaukee County Sheriff’s. Cost: $400,000 - $100,000 per clinician$1 $100,000 Per BHD: This amount will cover for one clinician for one team. The other clinician cost will be covered by the Macarthur grant funds. Implementation will be early 2017.
2. Third Shift Crisis Resource Center Coverage. Add 3rd shift coverage at South side with clinician and peer. Add peer to 3rd shift at north side CRC$.33 million allocated Will expand 3rd shift coverage to south side CRC. . Follow up w/staff to clarify if this includes Certified Peer Specialist at both CRCs.
3. Crisis Respite and CRC for People with Developmental DisabilitiesNot included in BHD budget. Could be in Disability Services/ DHHS budget.
4. CCS: Create a CCS Provider Relations/Network Development position to assist in the CCS expansionThis position is not mentioned in budget overview – need to check. Budget expands enrollment by 340 clients in 2017 (85 per quarter). Should we recommend a higher goal?
5. Change BHD Access Clinic to serve individuals insured by Medicaid and bill MedicaidNot mentioned in budget overview, follow-up with staff
6. Warmline–$50,000 for Warmline to return to employing staff and a part time Director, with a charge for the Director to secure other funding over time, and reduce reliance on county fundingNot mentioned in budget overview, follow-up with staff. Warmline did receive a contract for $15,000 for 2016
7. AODA treatment including medication assisted treatmentEnhance Opioid Epidemic Strategies is listed, no funding specified. BHD is reviewing both federal and state funding sources instead of tax levy if at all possible.
8. AODA residential services. Increase capacity and rates16 beds added. No rate increase mentioned.
9. Housing$.25 million added to support Initiative to end Chronic Homelessness
10. Youth mental health services$.4 million for Wraparound Clinic
11. Research Analyst for the Board – estimated cost = $90,000Not included
12. Impatient Services54 beds (Adult inpatient bed capacity of 60 beds with a 90% occupancy factor); 12 Child & Adolescent beds
13. Divert People with Mental Illness from Jail/ MacArthur grantInc Increased CART teams, TCM capacity, and AODA residential capacity.
14. Accelerate implementation of Community HubsSouthside Access Hub: $1.2 million to open and operate\\ Northside Access Hub: $.5 million to operate. It is supposed to open in 2016
15. Other expansion of core community servicesCSP – no increase in number served \\ CRS – no increase in number served \\ TCM – Increase of $.3 million. Increase enrollment by 110\\ New full year intensive outpatient program: $.5 million

BACKGROUND INFORMATION FOR 2017 BUDGET

Data from 2015 CARS Annual Report

Individuals Served by Level of Care (Source: CARS report in 04282016 MH Board Packet)
 20142015 
Level of CareTotalTotal2Goal
Community Based Residential Facilities (CBRF)159173162
Day Treatment545955
Community Support Program (CSP)139212901419
Comprehensive Community Services (CCS)23233236
Community Recovery Services (CRS)1406261
Targeted Case Management (TCM)150517381535
Community Linkages and Stabilization (CLASP)243165247
AODA-Detox189618541858
AODA-Clinical547444005583


Time (in Days) from Request to Admission, by Level of Care
 20142015
Level of CareMeanQ1Q2Q3*Q4**Mean2
CBRF113.382.576 52.770.4
Day Treatment38.872.667.4 43.361.1
CSP87.4107.981.9 54.981.6
CCS1948.58158.951.459.9
TCM72.478.164.8 2756.6

Barbara Beckert, Milwaukee Office Director: DISABILITY RIGHTS WISCONSIN
6737 W. Washington St., Suite 3230 Milwaukee, WI 53214
414–773–4646 Ext 15 Voice
414–773–4647 Fax
barbara.beckert@drwi.org

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Last edited by Tyler Schuster.   Page last modified on June 02, 2016

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