Mental health advocates and county officials say Gov. Jerry Brown's (D) proposal to shift authority and funding for mental health services from Sacramento to the 58 counties could be a good thing -- as long as the new responsibilities come with enough money to keep programs afloat.
There appears to be some doubt about that.
"The difficulty in this realignment proposal is going to be determining how to keep revenues and expenses in balance in the long term," said Kelly Brooks, legislative representative for health and human services at the California State Association of Counties.
"We need to figure out how to put some protections around the money so that revenues and service levels are somewhat aligned so that we don't see revenues decline and caseloads grow. We need to build in some protections, and we need to do it fairly quickly."
Rusty Selix, executive director and legislative advocate of the Mental Health Association in California and the California Council of Community Mental Health Agencies, said there's a lot to like about Brown's proposal, but only if financial details can be ironed out.
"Conceptually, we like it," Selix said. "It fixes problems in the old realignment of 1991, and those fixes will be welcome in the counties. But you don't get something for nothing and there are some potential problems. There are a whole bunch of moving parts that have to get nailed down."
Realignment, and Who Pays for It
One of the cornerstones of Brown's budget proposal is a multipronged realignment that would move authority, responsibility and funding for several services from the state level to the county level. Fire protection services, court security, parole programs and other services would move from state to county jurisdiction. Part of the proposal includes turning responsibility for several mental health services over to the counties. Brown proposes to shift $861 million in Proposition 63 funds from the state general fund to counties to pay for the new responsibilities -- but only for one year. Prop. 63 -- written by then Assembly member Darrell Steinberg (now president pro tempore of the California Senate) and Selix -- levied an additional 1% tax on incomes of $1 million or more to provide money for mental health programs.
Under Brown's proposal, after the one-time use of Prop. 63 money, funding for these programs would come from ... well, that's part of the problem.
Brown's proposal says: "beginning in 2012-13, these programs, as well as community mental health services currently funded with 1991 realignment funds, will be funded through the proposed revenue source."
The proposed revenue source is Brown's plan to raise about $12 billion a year over the next five years by convincing voters to extend current temporary tax rates approved in 2009 and due to expire in July. Brown's budget plan depends on voters approving a five-year extension of the higher rates in June. But first he has to convince Republican legislators to put the issue on the ballot. Both are "iffy" propositions, and county officials are wary.
"In a normal year, I'm fairly sure we would be hesitant to take on federal entitlement programs that come with all the requirements and little flexibility," Brooks said. "But because this is such a dire budget situation, we have to wonder how these programs would fare if they remain in the general fund. That's a bleak alternative," Brooks said.
Services Shifting Away From General Fund
Most of California's government-connected mental health services already are administered by counties as a result of a 1991 shift of responsibilities and funding from Prop. 63. The state kept oversight of three programs and paid for them out of the general fund:
- The Early and Periodic Screening, Diagnosis and Treatment Program, a mandated Medicaid offering designed to improve the health of low-income children younger than age 21;
- Managed care mental health services, including psychiatric inpatient and outpatient services, through county mental health plans; and
- State-mandated mental health services for special education students provided in individual education plans through county mental health services.
Brown's proposal says: "Beginning in 2011-12, these three programs would be funded with Mental Health Services Act (Proposition 63) funds rather than General Fund, resulting in savings of $861 million."
In addition to mental health programs, the governor proposes to transfer Adult Protective Services to counties. The APS program, currently overseen by the state Department of Social Services, provides services to functionally impaired Californians ages 65 and older who are victims of abuse, neglect or exploitation.
'Structurally Sound, but ...'
In a California Council of Community Mental Health Agencies position paper, Selix said:
"The realignment proposal is structurally sound, but without several essential modifications, it is financially inadequate to meet the standard set forth in Proposition 63 of being consistent with the measure and furthering its intent and purposes. Without several changes, the proposal will have an additional adverse mental health funding impact which would violate Proposition 63 (besides diverting $861 million in funds)."
Neither Selix nor Brooks said the problems in Brown's proposal are insurmountable, but the timing may be tricky. In order to get the tax rate language on the ballot, the details of the governor's budget plans need to be spelled out by the end of February.
"The timeline is very aggressive," Brooks said. "There's a lot to do in a short period of time. We are not going to be at a level of detail to know what an individual county is going to get for a particular program. We need to work on the big picture first," Brooks said.
"All the problems don't need to be fixed by March 1, so that isn't a hard and fast deadline," Selix said. "But the more details we can work out in the next three weeks, the better."