Transcript Slide 1

Office of Mental Health and
Substance Abuse Services
FY 07-08 Budget Presentation
Stakeholder Briefing
March 1, 2007
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The Rendell Administration’s Major Budget Initiatives
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Increase in total state education funding for PreK–12 by 6%
Accelerate property tax relief
Address the transportation funding crisis for Pennsylvania’s roads,
bridges, and public transit systems
Continue investments to make appropriate options available for longterm living
Propose the Energy Independence Initiative to invest in alternative
energy production in Pennsylvania
Jonas Salk Legacy Fund ($500 M for bioscience research,
commercialization, and early-stage capital investments)
Additional funding to address the continuing offender population
growth and new resources to reduce the rate of prison re-entry
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Prescription for Pennsylvania
• Increases access to affordable health care coverage for all
Pennsylvanians, improves the quality of care delivered throughout the
Commonwealth, and helps bring health care costs under control for
employers and employees. FY 07-08 budget recommends a total of
$255.3 million in state and federal funds to implement this initiative.
• The Prescription for Pennsylvania initiatives are being paid for by
levying a tax on other tobacco products. Every other state except
Pennsylvania already taxes these products.
• Expands access in underserved rural areas ($5.4 M investment)
• Increases the number of health professionals equipped to address the
needs of racial and ethnic minorities ($1 M)
• Includes a Behavioral Health Services component
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Pennsylvania’s FY 2007-2008 General Fund Expenditures
All Other
14%
Debt Service
3%
Pre K-12
Education
34%
Spending on
Education, Medical
Assistance, other
Public Welfare
Programs,
Corrections, and
Debt Service
comprises 86% of
total General Fund
expenditures.
Corrections
6%
Higher Education
7%
Other Welfare
17%
$27.3 Billion
Medical
Assistance
19%
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National Medicaid Spending Growth
MA Spending Growth is Down from 2002 Peak but Costs are Still Rising
1996 – 2007
Economic Downturn,
Enrollment & Cost
Growth, 2000 - 2003
Health Care Cost
Growth, 1998 2000
Strong Economy, Welfare
Reform, Enrollment
Declines, Managed Care
1995 - 1998
12.4%
Start of Economic
Recovery, Slower
Enrollment Growth
2004 - 2006
10.3%
8.2%
8.3%
7.1%
7.4%
6.3%
5.0%
6.1%
2.7%
1996
3.0%
1997
2.8%
1998
1999
2000
2001
2002
Note: Estimates in State Fiscal Year. Preliminary estimate for 2007.
2003
2004
2005
2006
2007
Projected
SOURCE: Kaiser Commission on Medicaid and the Uninsured. “Results from a 50-State Medicaid Budget Survey, State
Fiscal Years 2006 and 2007” October 2006.
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Average Monthly Enrollment
2,200,000
Source: DPW Budget Office
+3.4%
+3.9%
+4.9%
+7.8%
+4.8%
+4.5%
+2.8%
+1.4%
-0.2%
-3.6%
-8.2%
-2.9%
1,600,000
+4.9%
+4.3%
2,000,000
-1.7%
1,800,000
+7.0%
MA Eligibles Expected to Increase by 64,000
1,400,000
1,200,000
1,000,000
800,000
*Projected
A common misconception
The claim that “Pennsylvania has 1.9 million welfare recipients” is
wrong and confuses health care and cash assistance
1,900,000
Medical Assistance
TANF Cash Grant
235,000
0
500,000
1,000,000
1,500,000
2,000,000
Children and Adults Enrolled
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Elderly & Disabled Are Driving Eligibility
Increase
Eligibility Category
Chronically Ill Adults
Dec-05
Dec-06
% Change
99,831
99,897
0.07
Elderly/Healthy Horizons
243,403
257,063
5.6
Disabled
376,428
383,769
2.0
Adults/Parents
281,532
265,497
(5.7)
Children
821,528
865,338
5.3
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Department of Public Welfare
• Provides for a $56.154 M increase for County Child Welfare needsbased budgets as mandated by Act 30 of 1991. BH transition fund for
ICSI (Integrated Children’s System Integration) maintained at $8M
• Deputy Secretary for Early Childhood; dual reporting structure to
Education and Department of Public Welfare; expansion of day care;
mental health consultation
• Office of Developmental Programs
– Office of Mental Retardation is now the Office of Developmental
Programs
– $28.902 M increase to expand community mental retardation and
autism services
– Will work to coordinate both autism services and community
mental retardation services
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Office of Medical Assistance Programs: FY 07/08 Budget Initiatives
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MCO Pay for Performance (P4P)
MCO Capitation Payment Change (PH Only)
Pharmacy Carve-Out
Transition Clients from Voluntary to ACCESS Plus
Hospital Pay for Performance
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Other Departments and Funds
• PA Dept of Corrections was provided an increase of $792,000 for
reintegration programs to enhance skills and treatment for inmates
to reduce recidivism rates
• Board of Probation and Parole was provided $3.167 M to provide
additional resources to enhance community re-entry preparation
and offender management
• Department of Health was provided a 3% COLA ($1.229 M) for
drug and alcohol abuse prevention and treatment services
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DPW: OMHSAS Administered Behavioral Health Funding
• Community Mental Health Services
– Base Funds
– CHIPPS
– BHSI- Mental Health
– MH Block Grant/SSBG/Other Federal
– Other Categoricals
– State Mental Hospitals
• DPW Administered Drug and Alcohol
– Act 152
– BHSI- Drug & Alcohol
• Medicaid
– BH FFS
– HealthChoices Behavioral Health
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OMHSAS: Administered Behavioral Health
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County government legislatively grounded and uniquely positioned to
manage local systems of care; primary objective to integrate program
and fiscal accountability
– 48 County MH/MR Programs
• 1966 MH/MR Act
– 49 Single County Authorities
• DOH Bureau of Drug & Alcohol Programs as Single State Agency
• DOH Primary Licensing entity for D&A
– 8 State Mental Hospitals; 1 Long Term Nursing Care Restoration Center
• Closed or Consolidated 5 (five) state hospitals since 1994-1995
• Eliminated State Hospital capacity for children & adolescents
• Discharged 2,539 individuals through the Community Hospital
Integration Projects Program (CHIPP)
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•
67 HealthChoices Counties
– 28 counties accepted right of first opportunity
– 1 direct state contract with BH-MCO (Greene County)
– Direct state contract with 23 counties
– 15 counties accepted right of first opportunity for 7/01/07 implementation
– Incorporates broad behavioral mandates
– Variety of models including full risk county contracts, subcontracts with
Administrative Services Organization and full risk subcontracts
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OMHSAS: Unified Systems Strategy
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County Based Medicaid state plan services utilizing county base funding for
state match: 1990-91
CHIPP dollars follow person from State Hospital to community: 1991
Streamline appropriation Community/Hospital Appropriation: 1993-94
Act 152 Dollars administered by OMHSAS: 1996-97
BHSI funds mental health and drug and alcohol established and administered
by OMHSAS: 1997
HealthChoices Behavioral Health Program Administered by OMHSAS:
1997(Southeast)
OMH changes name to OMHSAS: 1998
HealthChoices expansion to Southwest 1999; Lehigh/Capital 2001
Service Area Planning Initiatives; County Planning (2003-04)
Children’s Integrated Planning Initiative (ICSI) (2004-05)
Expansion of Health Choices: Northeast Counties (2005-06)
BH FFS Transfer (2006-07)
Health Choices Expansion–23 counties (2006-07)
HealthChoices Expansion to all 67 counties by 7/01/07
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Movement of Funding from State Administration to County
Administration
Percentage of OMHSAS
Funding Under County Admin.
28%
Com m unity Grant
Dollars Under
County Admin.
$354,355,067
66%
HealthChoices
16%
Com m unity Grant
18%
State
72%
State
Dollars Under
State Admin.
$914,662,672
1994-1995
Community Grant Program
Dollars Under
County Admin.
$2,906,576,139
Dollars Under
State Admin.
$626,228,510
Percentage of OMHSAS
Funding Under State Admin.
2007-2008
HealthChoices
Note: State Mental Hospital and Medicaid Fee-For-Service Funding are under
State Administration.
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OMHSAS: Guiding Principles
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The Mental Health and Substance Abuse Service system will provide
quality services that:
– Facilitate recovery and resiliency for adults and children
– Are responsive to individuals’ unique strengths and needs
throughout their lives
– Focus on prevention and early intervention
– Recognize, respect, and accommodate differences as they relate
to culture/ethnicity/race, religion, gender identity and sexual
orientation
– Ensure individual human rights and eliminate discrimination and
stigma
– Are provided in a comprehensive array by unifying programs and
funding building on natural and community supports unique to
each individual and family
– Are developed, monitored and evaluated in partnership with
consumers, families and advocates
– Represent true collaboration with other agencies & service
systems
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OMHSAS: Objectives
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Policy implementation of a “Call for Change” to recovery and
resiliency
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Transform the Children’s Behavioral Health System to a system that
is family driven and youth guided
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Assure that behavioral health services and supports recognize and
accommodate the unique needs of older adults
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Fiscal Year 2004-2005 Unified Mental Health and
Substance Abuse Services System
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County Allocations
– Persons Served:
– Expenditures:
– Ave. Expend.
MA FFS (03/04)
– Persons Served:
– Expenditures:
– Ave. Expend.
HealthChoices
– Persons Served:
– Expenditures;
– Ave. Expend.
200,004
$401,610,444*
$2,008
BHSI (D&A)
Persons Served:
Expenditures:
Ave. Expend.
39,325
$40,408,520
$1,028
88,141
$377,941,134
$4,288
Act 152 (D&A)
Persons Served:
Expenditures:
Ave. Expend.
5,690
$18,431,321
$3,239
State Mental Hospital
Persons Served:
Expenditures:
Ave. Expend.
3,582
$404,429,485
$112,906
227,087
$1,111,910,124
$4,896
* incomplete county data
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OMHSAS FY 2007-2008 BUDGET SUMMARY
Fiscal Year
2005-2006
Actual
APPROPRIATION
SOURCE
MH Services
State
Federal
Other
TOTAL
$
BHSI (State)
IGT (Other)
MAOP/Act 152 (State)
TOTAL
$
BHSI/Act 152
$
$
Fiscal Year
2006-2007
Available
676,961,000
273,682,000
20,008,000
970,651,000
$
43,981,000
15,107,000
18,175,065
77,263,065
$
$
$
Fiscal Year
2007-2008
Recommended
686,169,000
284,263,000
10,449,000
980,881,000
$
43,981,000
12,107,000
17,464,988
73,552,988
$
$
$
716,266,000
264,525,000
10,449,000
991,240,000
45,300,000
12,107,000
16,227,107
73,634,107
State funds for MH Services increased by 4.39% and State funds for BHSI increased by 3.00 %
from FY 2006-07 to FY 2007-08.
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Fiscal Year
2005-2006
Actual
Fiscal Year
2006-2007
Available
Fiscal Year
2007-2008
Recommended
APPROPRIATION
SOURCE
MH/D&A MA Capitation
State
Federal
TOTAL
$786,342,914
817,924,806
$1,604,267,720
$938,705,953
978,164,821
$1,916,870,774
$1,141,820,512
1,192,365,627
$2,334,186,139
MH/D&A MA Fee-ForService
State
Federal
TOTAL
$132,742,199
141,553,949
$274,296,148
$185,006,776
207,598,938
$392,605,714
$64,638,494
69,105,909
$133,744,403
State funds for MH/D&A MA Capitation increased by 21.64% from FY 2006-07 to FY 2007-08.
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APPROPRIATION
SOURCE
Fiscal Year
2005-2006
Actual
Grand Total
State
Federal
Other*
TOTAL
$ 1,658,202,178
1,233,160,755
35,115,000
$ 2,926,477,933
Fiscal Year
2006-2007
Available
Fiscal Year
2007-2008
Recommended
$ 1,871,327,717
1,470,026,759
22,556,000
$ 3,363,910,476
$ 1,984,252,113
1,525,996,536
22,556,000
$ 3,532,804,649
* Includes Other and IGT
Total State funds increased by 6.03% from FY 2006-07 to FY 2007-08.
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OMHSAS: FY 2007-2008 Budget Unified System Strategy
Community MH Services
• $991.24M total state and federal funds, net increase of $10.359M;
State funds increase $30.097
• $15.977 M provided for three (3) percent cost of living adjustment,
including Base, CHIPPS and BHSI
• CHIPP funding of $18.9M included for the discharge of 200
individuals from the State Hospitals
• $500,000 to support respite care services for 2,000 families
• Transfer of $12.7M for Behavioral Health HealthChoices Expansion
• Transfer of $8.7M matching funds for Structured Treatment Services
• Elimination of funding for Psychiatric Services in Eastern PA
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OMHSAS: FY 2007-2008 Budget Unified System Strategy
Presidents Proposed Budget Federal Funding Update
• Reflects a slight decrease in the Community Mental Health Services
Block Grant
• Reflects a $4.442 M decrease in the Social Services Block Grant; FY
2006-07 funding restored to prior year funding level of $14.808 M
• Changes to the Medicaid Rehabilitative Services Option are
projected to yield a federal savings of over $2.3 billion over the next
5 years
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OMHSAS: FY 2007-2008 Budget Unified System Strategy
Drug and Alcohol Services
•$1.238 M in Act 152 funding transferred to MA Capitation as a result of
HealthChoices expansion; FY 2007-08 Act 152 budget is $16.2 M
•BHSI IGT funding of $12.107* million
•BHSI funding is $45.300 million (MH: $20.130, D&A: $25.170), which
includes a 3% COLA
Sexual Responsibility and Treatment Program (Act 21)
•Implemented in April 2004 on the grounds of Torrance State Hospital
•Ten men are now being served
•SRTP program operation was transferred to the Commonwealth and
operated by Torrance State Hospital (July 1, 2006)
*$3 million in additional funding was provided in FY 06-07; additional
funding will not be available in FY 07-08
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OMHSAS: HealthChoices
• As of January 1, 2007, there are 1.375 M people enrolled in
HealthChoices. Projected enrollment for SFY 2007-08 is 1.74 M.
• Funding for Fiscal Year 2007-08 is projected to be $2.3 Billion in the
Southeast, Southwest, Lehigh/Capital, Northeast Zone, 23 county
expansion zone and 15 county expansion zone:
– Southeast Zone total
$939.7 million
– Southwest Zone total
$435.4 million
– Lehigh/Capital Zone total
$408.4 million
– Northeast Zone total
$119.5 million
– 23 county expansion zone
$186.4 million
– 15 county expansion zone
$244.5 million
– Mental Health portion*
$2,051.0 billion
– Substance Abuse portion*
$283.1 million
*(includes admin.)
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Erie
Warren
McKea
n
Bradford Susquehanna
Wayne
Wyoming
Forest
Elk Cameron
Sullivan
Lackawanna
Venango
Lycoming
Pike
Mercer
Luzerne
Clinton
Clarion
Jefferson
Columbia
Monroe
Montour
Clearfield
Lawrence
Union
Centre
Carbon
Butler
Northumberland
Armstrong
Snyder
Northampton
Beaver
Indiana
Mifflin
Schuylkill
Lehigh
Cambria
Juniata
Allegheny
Blair HuntingdonPerry Dauphin
Berks
Westmoreland
Lebanon
Bucks
Montgomery
Washington
Cumberland
Lancaster
Bedford
Chester Philadelphia
Franklin
Fayette Somerset
York
Fulton
Delaware
Adams
Greene
Crawford
Potter
Tioga
SOUTHEAST
Implemented
Feb. 1997
SOUTHWEST
Implemented Jan. 1999
LEHIGH/CAPITAL
Implemented Oct. 2001
NORTHEAST
BH Implementation
July 1, 2006
NORTH/CENTRAL
STATE OPTION
BH Implementation
January 1, 2007
NORTH CENTRAL
COUNTY OPTION
BH Implementation
July 1, 2007
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• Currently OMHSAS has 8 state hospitals and 1 long term nursing
care facility
• Since FY 1994-95 there has been a reduction of 60% in the census
of the individuals being served in our state hospitals through June
30, 2008
• During the same period, staff complement will have decreased by
48%
• Through the CHIPP funding opportunity, 2,539 individuals will have
been discharged and 12,387 individuals will have received
diversionary services as a result of these discharges through June
30, 2007, and supported in the community with funding of
$190,337,062
• Service area planning work will continue through Fiscal Year 20072008
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OMHSAS State Mental Health Facilities and Service Areas
ERIE
WARREN
McKEAN
WAYNE
Warren
CRAWFORD
SUSQUEHANNA
BRADFORD
TIOGA
POTTER
Clarks Summit
FOREST
ELK
VENANGO
WYOMING
CAMERON
SULLIVAN
LACKAWANNA
LYCOMING
MERCER
PIKE
CLINTON
CLARION
LUZERNE
JEFFERSON
LAWRENCE
CLEARFIELD
BUTLER
COLUMBIA
Danville
CENTRE
UNION
MONROE
MONTOUR
CARBON
ARMSTRONG
NORTHAMPTON
SNYDER
BEAVER
INDIANA
SCHUYLKILL
CAMBRIA
DAUPHIN
ALLEGHENY
Mayview
PERRY
WESTMORELAND
LEHIGH
Torrance
LEBANON
BERKS
Wernersville
HUNTINGDON
CUMBERLAND
WASHINGTON
SOMERSET
GREENE
BEDFORD
FULTON
FRANKLIN
BUCKS
MONTGOMERY
Norristown
LANCASTER
FAYETTE
Allentown
BLAIR
CHESTER
ADAMS
YORK
PHILADELPHIA
DELAWARE
South Mountain
Warren
Staff 494
Patients 180
Torrance
Staff 477
Patients 237
Clarks Summit
Staff 513
Patients 219
Wernersville
Staff 461
Patients 219
Mayview
Staff 677
Patients 303
Danville
Staff 405
Patients 182
Allentown
Staff 377
Patients 170
Norristown
Staff 793
Patients 403
As of February 09, 2007
South Mountain
serving all counties
Staff 311
Patients 130
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CHIPP FUNDING HISTORY (CUMULATIVE)
Fiscal Year
94-95
95-96
96-97
97-98
98-99
99-00
00-01
01-02
02-03
03-04
04-05
05-06
06-07**
Funding Level
$ 52,903,014
$ 60,627,725
$ 66,702,352
$ 83,801,837
$ 100,608,283
$ 114,593,261
$ 132,270,374
$ 155,651,196
$ 164,409,141
$ 166,997,141
$ 172,508,492
$ 194,690,118
$ 190,337,062
Beds Persons Served*
769
2,626
867
3,733
1,072
4,246
1,432
5,105
1,523
6,173
1,646
6,875
1,892
8,435
2,170
9,990
2,203
10,883
2,236
11,048
2,269
11,213
2,462
11,538
2,539
12,387
*Persons served include persons receiving CHIPP funds and others receiving
diversionary services.
**Transferred $10.076 M to support federal match for structured treatment services
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MENTAL HEALTH AND DRUG AND ALCOHOL SERVICE SYSTEM
FY 2007-2008
MH/D&A MA FFS
$133.7
4%
SM Hospitals
$418.9
12%
Com m Based
Grants
$572.4
16%
HealthChoices
$2,334.2
66%
BHSI/Act 152
$73.6
2%
Total Funding
$3,532,804,649
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Program Updates
OMHSAS Fee-For-Service Transfer
• Transfer of 41 staff from OMAP to OMHSAS on 8/15/06
• BH FFS Staff provide prior authorization for the following services:
–
–
–
–
Inpatient Psychiatric Services
Inpatient Drug and Alcohol Services
Residential Treatment for Children
Behavioral Health Rehabilitation Services (BHRS) for Children
• Working to replace outdated HUP manual for initial authorizations
• Reviewing cases individually to determine cases incorrectly identified
as FFS which should be HealthChoices
• Refined process for automated site to correct errors in eligibility
• Streamlined process to resolve eligibility issues through Field Office
contact with BHMCOs
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Program Updates
HealthChoices
• CMS approved waiver for the HC BH Expansion
• Implementation began on January 1, 2007
• County Human Services Staff including MH/MR/SCA’s will comonitor state contract
• HC County Option: 15 counties
– Technical and Cost Proposals finalized
• Recommendations made to the Secretary of Welfare to support all
of the proposals
– Final Rates have been issued; all but three counties have
accepted rates
• Readiness Review: Spring, 2007
• Implementation will begin on July 1, 2007
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Program Updates
Objectives
• State Plan Services approved by CMS
– Certified Peer Specialists
– Mobile Mental Health Treatment
• HC Expansion
• Older Adult Priorities and Supporting Projects
– MFP resubmission
– Regional Forums
• Adult Priorities and Supporting Projects
– Housing TA identified
– Integrated Treatment Standards Completed
• Children’s Priorities and Supporting Projects
– Response to the BH Taskforce Report
– School Based Intensive and Partial Hospital Bulletins/Subcomm
34
Program Measures:
Community Mental Health Services
Total persons provided mental health
services ..........................................................
Persons receiving mental health inpatient and
outpatient services from community mental
health funds (unduplicated)* ..........................
Persons receiving services through Medical
Assistance expenditures (fee for service
and HealthChoices) (unduplicated) ...............
Persons receiving services through BHSI
funds (unduplicated) .......................................
Average cost per person served ....................
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12
418,749 522,162 526,810 531,320 535,880 540,500 545,165
121,447 122,661 124,080 125,325 126,575 127,840 129,120
258,580 361,166 364,780 368,425 372,110 375,830 379,590
38,722
38,335
37,950
37,570
37,195
36,825
36,455
$3,684
$3,721
$3,758
$3,796
$3,834
$3,872
$3,911
State Mental Hospitals
Total persons served in State Mental
Hospitals ..........................................................
3,611
3,575
3,415
3,380
3,345
3,315
3,280
Total admissions to State Mental Hospitals ......
1,544
1,390
1,360
1,335
1,310
1,280
1,255
Cost per person in State Mental Hospital
population ..................................................... $113,165 $114,297 $115,440 $116,594 $117,760 $118,938 $120,127
Forensic admissions to State Mental
Hospitals .........................................................
519
514
510
505
500
495
490
Percentage of adults readmitted to State
Mental Hospitals within one year of last
discharge ..........................................................
11%
10%
9%
8%
7%
6%
5%
Percentage of persons in State Mental
Hospitals with stay longer than two years .....
37%
32%
27%
22%
17%
12%
7%
Total persons provided mental health services was revised to include individuals receiving services from
community mental health funds, Medical Assistance expenditures (both through the HealthChoices Behavioral
Health Program and the fee-for-service delivery system), and BHSI funds.
35
Program Measures:
Substance Abuse Services
Total persons receiving DPW administered
substance abuse services ............................
Persons receiving services through Medical
Assistance expenditures (fee-for-service
and HealthChoices) (unduplicated) ................
Persons receiving services through Act 152
funds (unduplicated) .......................................
Persons receiving services through BHSI
funds (unduplicated) ........................................
Average cost per person served ....................
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12
91,508
96,519
96,590
96,670
96,760
96,855
96,965
46,306
51,769
52,285
52,810
53,340
53,870
54,410
5,952
5,892
5,835
5,775
5,715
5,660
5,605
39,250
38,858
38,470
38,085
37,705
37,325 36,955
$1,954
$1,974
$1,994
$2,014
$2,034
$2,054 $2,075