Access to care for low income individuals with mental illness to stable housing and stable services is one step closer to a crisis. The Optional State Supplementation Program which helps fund access to state funded ALF care in Florida is collapsing. Recent numbers show that in 2001 there were 10,272 and in 2008 according to the Department of Children and Families which runs the OSS program there were only 7935 funded OSS slots.
The legislature over the last 10 years would hold funding for this program at $26 million. The last two years saw significant "raids" on the limited funds in this vulnerable program by lawmakers. The program was reduced in 2008 to $18 million and in 2009 it is projected to drop to $15 million.
The last time there was any increase in Florida was in response to the 1999 OSS workgroup that was authorized by the legislature. This workgroup recommended a $100 increase in OSS funding and what was funded in 2000 was an increase of $35/month for room and board and they moved the personal needs allowance from $43/month to $54/month.
The need for an increase in the rate for care for the state funded ALF residents has been a constant need for years. There have been numerous attempts to increase the OSS rate of funding only to be vetoed by then Gov Jeb Bush.
In Florida the OSS funding is used to as a state match to pull down medicaid resources under the state plan amendment called the medicaid assistive care services program. The rate of reimbursement for a low income individual is $9.28/day a rate that has not been adjusted since 2001.
The decreasing number of beds in Florida is a critical concern for persons with serious mental illness. We know that of the 7935 beds for OSS residents that 5379 are occuippied by persons with mental illness, the vast majority of these located in Miami Dade County. The major diagnosis associated with this population is schizophrenia.
Florida lawmakers should discontinue the practice of holding the rate of funding for care at the 2001 rate and "raiding" this fund for surplus funds to use in other programs. These funds should be utilized if surplus to increase the rate. The low rate of reimbursement has led to the closure of many facilities in Florida eliminating access to housing that offers some supervision and assistance with medications.
The decline of state funded ALF beds in Florida only spells that Florida taxpayers will pay an increased cost associated with greater demand and use of institutions; whether they are jails, nursing homes or state mental health treatment facilities.
The ALF model is a low cost and effective system of care for many people with chronic long term needs like those with schizophrenia. The absence of quality and available supply of beds will only lead to an expanding crisis that will drive up health care costs.
Even if lawmalkers started now to address the emerging policy and budget crisis facing state funded ALFs, there would be several years to correct the many issues that years of neglect have brought.
Saturday, April 18, 2009
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