California
Association of Alcohol and Drug Program Executives, Inc
CAADPE
The
California Association of Alcohol and Drug Program Executives, Inc. (CAADPE)
opposes Governor Davis’ proposal to realign alcohol and other drug abuse (AOD)
treatment services to counties. CAADPE’s opposition is based on the absolute
necessity to protect a vastly under funded critical system of specialty care and
to protect the state’s investment in an existing system of treatment that is
high quality and cost effective.
The
assumption that realignment of AOD services is a logical choice is misleading.
Instead, realignment would be a complicated and dangerous direction jeopardizing
the stability of critical services that are currently interdependent with public
safety and almost all other systems of healthcare, social services and criminal
justice. CAADPE’s reasons for opposition include:
§
Federal Funds Jeopardized
Federal funds constitute approximately two-thirds of
the state’s funding for alcohol and other drug abuse treatment services. The
federal government requires the state to maintain (match) specific levels of
funding in order to qualify for federal funds.
The state’s Maintenance of Effort (MOE) requirements for federal
funding would be placed in jeopardy. The state is now funding alcohol and other
drug abuse treatment at the minimum level needed to qualify for federal funds.
Any further reduction to state share would result in the loss of federal funds.
Under the realignment plan, 1) there is no state share to meet the federal MOE
requirement; 2) there is no requirement that counties must seek federal
substance abuse treatment funds with realignment allocations; 3) there are no
provisions assigning to the state the responsibility for coordinating/assuring
funds for the MOE requirement. Without state oversight and control, it will be
impossible to ensure that each of the 58 counties will collectively provide real
and effective alcohol and drug abuse treatment services required by MOE
requirements.
§
Realignment creates a split system
The realignment proposal only “realigns” the State
General Fund (SGF) and leaves the federal block grant dollars at the state
level. The State Department of Alcohol and Drug Programs would continue to
administer all federal block grant funds thereby setting up a split system. SGF
funded services are not typically stand alone funded programs. The funds are
more often than not combined with federal dollars to provide full funding to
various services, adding yet another level of complication. The substance abuse
prevention and treatment (SAPT) block grant is set to become a performance based
grant in the next fiscal year and will be tied to effective outcomes. Creating
the split system will jeopardize the field’s ability to successfully meet the
performance measurers and to sustain California’s share of federal dollars.
§
Realignment of Prop 36 is a mistake.
The realignment proposal dedicates $227
million of the proposed tax increases to counties for substance abuse services.
However, $120 million of that amount is tied to the voter-approved initiative
mandating substance abuse treatment, (the Crime Prevention and Substance Abuse
Treatment Act of 2000 - Proposition 36). The initiative requires cross
collaboration between criminal justice, probation, parole and other systems of
care. The initiative further assigns to the state, the responsibility for
oversight, fund management and evaluation to assure that the initiative is
implemented according to voter intent. The intent cannot be effectively assured
at the county level. Even under the current system that allows counties a
certain amount of discretion, critical treatment funds have been diverted into
non-treatment costs, probation, and courts. This diversion of funds is not
isolated to one or two counties; rather it occurred in county after county with
many counties charging 25 to 50 % or more of their Proposition 36 allocations on
non-treatment related costs. This is a clear indication what would happen under
a realignment plan that calls for no state involvement after the first year of
the realignment. Realignment of
Proposition 36 funds may also be unconstitutional and violate state law.
§
Merging of AOD and Mental Health funds is a
mistake
The realignment proposal pools AOD with Mental
Health funds. This mixing of funds further places the limited AOD funds at risk.
AOD services are a specialty service not always identified as a priority in
county funding allocation decisions. AOD services are typically overshadowed and
under recognized as a critical system of care by larger Mental Health Services
and certainly are very much different then mental health care. The success
gained in AOD care in recent years is in large part a direct result of the
growing recognition at the federal and state level that AOD treatment services
constitute a system of specialty care and the integrity of the system must be
independently maintained. Pooling of AOD and Mental Health funds will
undoubtedly result in lost funding to the AOD field and a breakdown of the
system’s integrity. The end result will be a further hampering of the ability
of the AOD treatment field to demonstrate effective outcomes.
§
Realignment Undermines Existing System.
The system of providing drug and alcohol
services, which is currently collaboration between four stakeholders: federal,
state, local governments and providers, has proven to be both cost and
programmatically effective. Why
risk the dismantling of these critical services? Due to zoning restrictions and
NIMBY (not in my backyard) any loss of AOD services in the community would be
extremely difficult to replace, if replaceable at all.
§
Direct State Contracts Negatively Impacted
Many counties currently refuse to contract for
certain Drug Medi-Cal services. The responsibility for providing the services
falls to the state through direct state/provider contracts. Under realignment,
this gap is likely to increase and this issue further complicates the matter.
§
CALWORKs funding reductions a mistake.
The proposed cut of 50% of the CALWORKs
supportive services substance abuse treatment allocation is a mistake. The
positive benefits of providing AOD treatment to this population has proven
extremely cost effective, and has significantly aided families in returning to
productive, drug free life styles without the need for continued welfare
support. Reduction of AOD services in CALWORKs would be counter to national
trends. At the federal level, the value and benefits of substance abuse service
for TANF recipients is being emphasized as a critical supportive service in the
welfare reauthorization. The proposed reductions are counter-productive to this
effort.
§
State Cost Savings/offset at Risk
The cross systems benefits to the effective delivery
of AOD services are in the people and state of California’s best interest.
Numerous scientific research studies, including California’s own CALDATA
study, have documented the cost saving benefits of AOD treatment to criminal
justice, welfare, hospitalization, other medical care, child protective services
and more. The CALDATA study made clear on average for every dollar spent on AOD
treatment there is an average saving to other systems of $7. In the first year
of Prop 36, the Legislative Analyst recorded over $60 million dollars in direct
saving in prison costs alone as a result of AOD treatment. The
state can ill afford to put such savings at risk by relinquishing state control
of these vital services.
While CAADPE is opposed to the Realignment proposal, it recognizes the possibility that policy makers could reach consensus and enact a realignment plan. In the event that a realignment plan does advance, CAADPE has identified a number of components that must be included in any realignment plan. Inclusion of these components will assure protection of crucial services that are in best interests of the prevention and treatment service community and will not compromise AOD treatment and prevention services to residents of California. .
1.
Funding
Levels: Counties must have sufficient revenue to support alcohol and
other drug treatment (AOD) services. A
full continuum of quality services in every California County is necessary to
help ensure public health and public safety. AOD funds must be clearly
identified to assure stable funding and to meet federal MOE requirements.
2.
Funding
Methodology: Fiscal Year 2002-03 funding levels should be used to
establish the base for allocations to counties. Counties, in turn, must maintain
the same levels of service at the county level at no less than the current FY
2002/03 level. Any growth at the county level shall also be allocated to the
treatment services according to the counties’ FY 2002/03 formula allocation.
3.
Maintenance
of Effort (MOE): The State Department of Alcohol and Drug Programs (ADP) shall
maintain its legal responsibility to meet the MOE. Counties will be responsible for meeting their share of the
MOE. Counties must be directed to maintain the MOE at the county level.
4.
Trust
Fund: A percentage no less than FY 2002-03 funding level shall be a
separate dedicated Trust Fund for AOD treatment services and not pooled with
mental health. Both the base and future growth will be used for AOD prevention
and treatment services, administered by the specific county entity responsible
for the delivery of AOD services. Allocations to counties will be bases on
current FY 02/03 methodology.
5.
Drug/Medi-Cal
(DMC): Counties will maintain the current State bifurcation system
for DMC services using Fiscal Year 2002-03 funding levels. The maintenance of
this system is essential in protecting non-drug Medi-Cal AOD services.
Future growth will be funded with additional State funds.
County Boards of Supervisors shall have the authority and responsibility
to contract with DMC providers.
6.
Substance
Abuse and Crime Prevention Act (Prop 36): Counties shall establish a
set- aside within their AOD trust funds to ensure current funding levels for
treatment for Prop 36. In addition,
ADP and the counties will comply with all provisions of the Act. Prop 36
funds must be included in calculation of MOE at both the state and county level.
State shall retain statewide performance and evaluation responsibilities as
outlined in the initiative.
7.
Corrections
Funding: The Corrections funding ($8.9 million) specified in the State
MOE for Fiscal Year 2002-03 will be administered directly by counties to provide
parolees with AOD treatment services. Funding for community aftercare and
services provided under the Parole Network Initiative (PNI) need to be assured.
Such funds shall be allocated to counties based on FY 02/03 AOD funding
methodology for new funds.
8.
State
Responsibilities: ADP should retain responsibility for various administrative
activities, but not limited to, the following:
·
Allocation
of Federal funds
· Compliance with Federal Performance Partnership Grant (PPG) requirements
·
Drug
Medi-Cal contract monitoring and claiming
·
Data
collection and reporting
·
Licensing
and Certification of treatment programs
·
Standards,
Testing, Registration and Fee collected for Counselor Certification
·
Involvement
in Criminal Justice programs, including evaluation and oversight activities for
Prop 36
·
Operating
the State-wide Resource Center
·
The State
administration overhead cost should be limited to 5%
Additional CAADPE recommendations for maintaining/strengthening the AOD field.
IMD
Exclusion
The federal Health Care Financing Agency (HCFA)
classifies all addictive disorders as mental disorders and it denies Medicaid
eligibility to the clients of residential drug treatment centers. Current HCFA
interpretation of the IMD exclusion policy prohibits Medicaid payment for
patients in substance abuse treatment facilities as well as those in psychiatric
facilities. Payment is prohibited not only for services provided within the
treatment center, but also for any services provided to these individuals
outside of the treatment center (e.g., tests or treatment for tuberculosis, HIV,
or sexually transmitted diseases; medical or surgical services in a general
hospital). The state should use all
avenues available to secure a federal waiver of the IMD (institutions for mental
disease) exclusion to expand drug abuse treatment services in the state.
CALWORKs
CALWORKs
substance abuse treatment funding shall be maintained at no less then the
current
FY 2002/03 levels and shall be allocated to counties based on current year
methodology.
Crime
Prevention and Substance Abuse Treatment Act of 2000
Maintain
Crime and Prevention Act funding at no less than the current FY 02/03 levels and
allocate based on current methodology