Mental health: OBRA funding and more — despite vetoes

It was a good budget year for the Department of Mental Health and Developmental Disabilities. Lawmakers boosted funding to the department by $102 million and even gubernatorial vetoes of $8.96 million left the department with a 12 percent increase in funding. There will be more employees at state facilities. There is more money for community mental health agencies. And there is the funding to begin compliance with the federal nursing home reform regulations.

At center stage this year was the Omnibus Budget Reconciliation Act (OBRA) of 1987, a federal law that has forced change in the way that Illinois goes about caring for the mentally ill and retarded. No longer can the state place those clients in nursing homes, unless there is a medical need for a nursinghome's services. As a result, Illinois must change the way it goes about serving the estimated 12,000 mentally ill and retarded clients now in nursing homes. The federal government wielded the threat to cut off all $2 billion in federal Medicaid funding for Illinois.

Illinois' plan to respond to OBRA won all financing sought from lawmakers for the first year. In the fiscal year that began July 1 the department will:

• Screen all clients at nursing homes along with the 7,500 who will seek admission to nursing homes to insure that all need nursing home services. Total cost will be $11.2 million this year.
• Place 500 retarded nursing home clients in community settings, the first of 2,400 placements over a three-year period. Total cost will be $6.75 million this year.
• Place 600 mentally ill nursing home clients in community settings, the first of 3,200 placements over a five-year period. Total cost will be $4.5 million this year.
• Place in community settings another 1,800 mentally ill and retarded clients seeking admission to nursing homes but identified through the screening process as not needing the medical-based services. Total cost will be $14.3 million this year.
• Put in place staff to monitor screenings and to do random checks on community-placed clients to ensure they are getting needed services. Total cost will be $1.5 million this year.

The final piece of the OBRA plan no longer falls to the mental health department. The state will convert 35 nursing homes to care for 5,000 mentally ill or retarded clients. Those homes will receive an extra $10 per day per client to provide specialized treatment. Total cost will be $29.8 million this year.

Colette Croze, the deputy director for community programing with the department, said that implementation of the OBRA response was "on track" through mid-August. Initial screening had turned up 12,100 persons in nursing homes with diagnoses of mental illness or retardation, close to the department's 12,000 estimate. Agencies began to screen new nursing home admissions on August 15. And 160 community agencies expressed interest in creating 5,000 beds in communities.

There is still work to be done. While backing the state's OBRA efforts, the agencies that provide community mental health services and the advocacy groups for the mentally ill and retarded both see problems. David L. Stover, executive director of the Illinois Association of Rehabilitation Facilities, told the House Appropriations II Committee on June 13 that he believes the numbers to be served and the costs of that service have been underestimated. And Ann Boisclair, director of public policy for the Mental Health Association of Greater Chicago, told the same committee that there were other needs. "OBRA compliance demands services for only a few of the mentally ill, and it only demands some of the services they need," she said.

The effort that won initial funding for the OBRA plan must continue in future years. Over the next four years the mental health department will have to come up with another $130 million in new funding to continue with its plan to place clients in the community. Those funds will have to be won when there will be considerably fewer new dollars than there were this year.

But the OBRA intitiative was not the only new funding for the department this year. Lawmakers added $5,875 million in new funding to add 264 new staff members to 21 state residential facilities for both the mentally ill and developmentally disabled. The new jobs represent a 2 percent increase in positions and will bring the staff to patient ratios to 1.6 to 1. "This will eliminate many of the problems at our facilities regarding overtime and understaffing," said Ann Kiley, director of the Department of Mental Health and Developmental Disabilities. The new positions were to have been filled by October 1, but a Thompson veto trimmed the budget item by $2.4 million, delaying the new staff until spring. Lawmakers also gave the department $1 million to purchase new equipment at state facilities, an extra not vetoed by the governor.

Community agencies won extra funding from lawmakers to provide salary increases for their workers, but lost the money to a gubernatorial veto. Lawmakers had added a 2.5 percent salary hike on top of the 5 percent adjustment that the governor had recommended for community agency workers. Lawmakers, who had been convinced by the community agencies' argument that they were unable to pay salaries needed to attract and retain qualified workers, must decide whether to sustain or overrule the vote in the fall session.

Lawmakers also added money for two programs for which the administration had sought no new funding: $2 million in new funds for children and adolescent services and $1 million for teen suicide prevention programs. Thompson vetoed the money for the teen suicide programs.

The mental health budget received a substantial boost from lawmakers; it also received a relatively high proportion of the governor's budget vetoes. Nearly 20 percent of Thompson's budget vetoes came out of the mental health budget. Next month lawmakers have the opportunity to reassert their budget priorities.□

August & September 1989 | Illinois Issues | 51