"Welfare Options, Mental Health"
Welfare Reform Options
Set #7, Mental Health
WORKGROUP #3 SUPPORT SERVICES
ISSUE: Within the context of welfare reform, when a person
has a mental disorder which represents a barrier to self-
sufficiency, is it the responsibility of the State or the
County to provide treatment services?
OPTION TITLE: State responsibility for additional mental
health services needed to remove employment barriers.
OPTION DESCRIPTION: The state shall provide the funding
necessary to provide mental health services not currently
provided under state law which are needed to move TANF
recipients with a mental impairment from welfare to work or
self-sufficiency.
BACKGROUND: Under current law, and under severe funding
restraints, counties provide services to seriously mentally
ill adults and seriously emotionally disturbed children.
There are many individuals in the TANF population with
mental impairments which do not meet these definitions but
who will need mental health services if they are to find or
keep a job. If the state is to meet work participation
requirements most of these people will need to be moved into
the workforce or to work activities. Without state funding
the counties cannot meet the anticipated demand for
additional services.
WORKGROUP #3 SUPPORT SERVICES
ISSUE: Within the context of welfare reform, when a person
has a mental disorder which represents a barrier to self-
sufficiency, is the responsibility of the state of the
county to provide treatment services.
OPTION TITLE: Using monies block granted to the counties,
develop a sharing ratio between the state and counties to
cover the cost of needed services.
OPTION DESCRIPTION: A sharing ratio shall be developed
between the state and counties to cover the cost of
providing needed mental health services to TANF recipients
with a mental impairment which prevents their ability to
work or achieve self-sufficiency. This option shall only be
operative if county TANF funding is provided through block
grants which are not based on current caseloads.
BACKGROUND: The viability of this option depends on the
mechanism which is chosen to fund programs at the county
level. If the state transfers TANF funds to the counties
through a block grant, based on the formula used by the
federal government in determining California's block grant,
counties may have a small amount of discretionary funds to
apply to support services depending on legislative decisions
on work requirements and time limits, among other things.
In most cases, case loads currently are lower than in the
base years used in the federal/state block grant formula and
if this block grant approach was used most counties would
benefit from the federal block grant to the same extent that
the state has benefited. If, however, counties are funded
based on the grant amount of their current caseload there
would be no additional monies available to apply to support
services.
WORKGROUP #3 SUPPORT SERVICES
ISSUE: What financing mechanism should be developed at the
state level to facilitate the treatment of mentally impaired
TANF recipients in order that they may move from welfare to
work or self-sufficiency?
ISSUE TITLE: State allocation of funds to cover the costs
of additional mental health services using a mechanism
similar to that used in determining EPSDT funding.
ISSUE DESCRIPTION: If an assessment provided by the
County Mental Health Department determines that a person has
a mental disorder which meets the criteria for medical
necessity, and represents a barrier to employment, the
Mental Health Department will be required to provide
treatment and case management within the limits of Medicaid.
The state shall reimburse the county for the non-federal
cost associated with the screening, diagnosis and treatment
provided to this target population.
BACKGROUND: In California, the federally mandated
provision of Medicaid called "Early Periodic Screening,
Diagnosis, and Treatment" (EPSDT), has provided a
programmatic mechanism and financing strategy to access
federal financial participation for providing mental health
services to TANF children ages 0-21. Currently, all
children in TANF families (and adults under 21) have access
to EPSDT.
Financially, the federal government provides 51% of the
allowable cost for the direct and indirect expenses to
provide health and mental health services to Medi-Cal
eligible children. The state provides the other 49%.
Adults over 21 are not included in EPSDT. Under current
law, the non-federal cost of mental health services for
adults is paid by capped Realignment funds within county
budgets.
This proposal would expand the procedures and financial
provisions of EPSDT to a specific priority target population
of TANF adults who require medically necessary mental health
treatment that they are not receiving under realignment
funds in order to gain employment and self sufficiency. In
order to ensure that these are new services being provided
to members of the target population, prior to implementing
this mandate a baseline amount should be determined by each
county based on the amount currently being spent for these
services. The state would pay 49% share above this
baseline.
WORKGROUP #3 SUPPORT SERVICES
ISSUE: What financing mechanism should be developed at the
state level to facilitate the treatment of mentally impaired
TANF recipients in order that they may move from welfare to
work or self-sufficiency?
ISSUE OPTION: Create an assessment and treatment fund
allocation to each county
ISSUE DESCRIPTION: Create an assessment and treatment fund
allocation to each county which would be available to cover
the costs of screening, diagnosis and treatment not covered
by federal Medicaid dollars for those TANF recipients who do
not have a severe mental illness but who have a mental
disorder which is identified as a barrier to employment.
BACKGROUND: At this point it is difficult to estimate the
demand for these needed services.
The County mental health and welfare directors have formed a
collaborative with the California Institute for Mental
Health to develop more precise information on this question,
along with strategies to resolve behavioral health problems
that affect the employability of public assistance
recipients. A report is due in November 1997.
WORKGROUP #3 SUPPORT SERVICES
ISSUE: What exemptions, if any, should persons with
mental disabilities be given relative to time limits or work
participation requirements?
ISSUE OPTION: Give discretion to the counties, with
specified exceptions.
ISSUE DESCRIPTION: Counties shall be given the discretion
to exempt persons with mental disabilities from mandatory
time limits or work participation requirements on a case by
case basis.
BACKGROUND: There are many levels of mental impairment and
individuals will vary in their response to treatment and how
quickly they can move into the workforce. Stability is
also a factor which will vary. The counties, with access
to multidisciplinary professionals, is in the best
position to assess an individual's ability to participate in
TANF requirements.
WORKGROUP #3 SUPPORT SERVICES
ISSUE: What exemptions, if any, should persons with mental
disabilities be given relative to time limits or work
participation requirements?
OPTION TITLE: Exempt primary caretakers of seriously
emotionally disturbed children or mentally ill adults or
children.
OPTION DESCRIPTION: The following persons shall be
exempted from mandatory work requirements and time limits:
a) The primary caretaker in a TANF family with a
seriously emotionally disturbed or mentally ill child who
does not have medically appropriate child care. There must
be medical verification that the care provided is an
alternative to institutionalization.
b) The primary caretaker in a TANF family who is the caring
for a mentally ill adult family member. There must be
medical verification that the care provided is an
alternative to institutionalization.
BACKGROUND: Disabled children may be in school but subject
to frequent periods of intense care needs which would limit
stable employment for the caretaker. Child care for
emotionally disturbed children is almost impossible to find.