Voices’ Blog

Building a Stronger Mental Health System for Virginia’s Kids: 2018 Budget Amendments

Posted:  -  By: Ashley Airington

The 2018 General Assembly session is well underway, and Voices is once again at the forefront, advocating for a stronger children’s mental health system in Virginia. Our mental health priorities this year are the following:

  1. STEP-Virginia: Continue implementation of STEP-VA, the plan for improving statewide community-based mental health services for all ages.
  2. Alternative Transportation for Children in Crisis:  Improve transportation of children in mental health crisis by supporting a non-law-enforcement transportation model.
  3. Medicaid Expansion 

Last week, policymakers submitted their proposed budget amendments for the 2019-2020 budget. A number of budget amendments impact behavioral services in Virginia. Here are some measures we will support this year:

Alternative Transportation for Children and Adults in Crisis

In Virginia, children and adults experiencing a mental health crisis are often transported to a mental health facility by law enforcement under a temporary detention order (TDO). During transport, children are frequently handcuffed in the back of a police car. This criminalization of children’s crises often results in traumatization and stigmatization. The Department of Behavioral Health and Developmental Services (DBHDS) implemented a pilot program in 2015 in Southwest Virginia that provided transportation by an alternative provider for individuals under a temporary detention order. The pilot produced positive patient outcomes and provided relief to law enforcement. Voices joins Legal Aid Justice Center in advocating for a budget package that includes funding to develop and implement a recovery-focused alternative transportation model for children and adults experiencing a mental health crisis. The following budget amendments have been proposed:

Delegate Watts (Item 311 #2h)  and Senator Hanger (Item 311 #1s) 

This amendment provides $10.2 million from the general fund each year for the DBHDS to implement an alternative transportation system for adults and children under a temporary detention order.  This amendment would implement a regionally based transportation service within each of the five primary DBHDS regions with state oversight and certification of providers. Statewide implementation is a recommendation of the Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century.

Delegate Garrett, member of the Deeds commission and chair of House Appropriations HHR Subcommittee, proposed the following budget amendment:

Garrett (Item 311 #3h) 

This amendment provides $1.7 million from the general fund each year for the DBHDS to begin to phase in alternative transportation system for adults and children under a temporary detention order. Instead of statewide implementation, this amendment would implement an alternative transportation model in two areas of the state: (1) Health Planning Region 3, served by the Mt. Rogers Community Services Board (CSB) and the five neighboring CSBs (New River Valley, Cumberland Mountain, Highlands, Dickenson County, and Planning District 1) and (2) Health Planning Region 1 served by the Region 10 CSB, serving the city of Charlottesville and the counties of Albemarle, Fluvanna, Greene, Louisa, and Nelson.)

Finally, Senator Dunnavant also submitted a budget amendment that addresses the alternative transportation needs of individuals in crisis.

Dunnavant (Item 303 #40s) 

The amendment creates the Priority Needs Access Program which modifies the existing GAP waiver to: (i) include individuals with income up to 138 percent of the federal poverty level; (ii) add inpatient and emergency room hospital benefits; (iii) add qualifying diagnoses of mental illness, substance use disorder, or life-threatening or complex medical conditions; and (iv) moves the waiver population into Medicaid managed care. In addition, funding of $37.7 million from the general fund and a like amount of federal Medicaid matching funds each year are provided to add an additional 2,296 Medicaid waiver slots to eliminate the Priority One waiting list for disabled individuals in need of services. Medicaid reimbursement to hospitals is increased to 80 percent of costs for private hospitals and to 100 percent of allowable costsfor for critical access hospitals. The amendment fully funds a statewide alternate transportation model for individuals under a temporary detention order. Lastly, language is included to ensure children in Medicaid and FAMIS are being screened for adverse childhood experiences. The funding for the items in this amendment is generated from a provider assessment on private acute hospitals.

STEP-Virginia: Same Day Access and Primary Care Screening and Monitoring 

Gov. McAuliffe’s proposed budget provides funding to continue the implementation of STEP-VA, Virginia’s plan for improving statewide community-based mental health services for all ages. Last year, Gov. McAuliffe and the General Assembly signaled their commitment to STEP-VA by providing $4.9 million in general fund dollars to implement same-day access to mental health services at 18 of the 40 community services boards (CSBs). In the proposed budget, $5.9 million GF in FY 2019 and $5.9 million GF in FY 2020 are recommended in order to implement same-day access to screening and assessment services for children and adults at the remaining 22 community services that were not funded last year. Additionally, the governor’s budget proposal includes $3.7 million GF in FY 2019 and $7.4 million GF in 2020 to implement primary screening and monitoring services at all 40 CSBs. Primary care screening and monitoring includes elements such as checking blood pressure, BMI, blood sugar, and other health risks.

Additionally, the following amendments have an impact on our behavioral health system: 

Dunnavant (Item 303 #16s) : This amendment directs the Department of Medical Assistance Services to transform the system of care of Medicaid-funded behavioral health services to emphasize community services that are evidence based and trauma informed.

Garrett (Item 307 #7h) and Dunnavant (Item 307 #2s): These amendments provide $150,000 from the general fund and a like amount of federal Medicaid matching funds the first year as one-time funding to contract with Virginia Commonwealth University to develop a comprehensive strategic plan to transform the Medicaid/FAMIS behavioral health system. This strategic plan will redesign Medicaid and FAMIS mental health services into a more complete continuum of care in which services are evidence based, trauma focused, clinically necessary, preventative focused, and cost effective, with positive health outcomes for Medicaid and FAMIS members and their families. This funding will support research of the evidence-based and trauma-focused practices for behavioral health services, focus groups with stakeholders, and the development of the strategic plan.



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