Update on the Choice Resolution

Last May, the Michigan Association of Community Mental Health Boards (MACMHB) Executive Board considered and then tabled for further consideration the Choice Resolution, a statement confirming the right of consumers of Mental Health services to choose from an array of services and supports based on their needs and preferences. Over the summer, the statement was revised and approved by the MACMHB Executive Board. It recognizes differences in philosophy and service needs in this diverse population of mental health consumers. The policy applies to members of the Association - all CMH Boards in Michigan.

The Choice Resolution was a response to issues raised in recent months regarding services for people with developmental disabilities. Administrators from the Michigan Department of Community Health had stated their intent to eventually eliminate specialized programs for people with Developmental Disabilities that are provided in group settings such as day programs, sheltered workshops, and group homes. They claimed they only wanted the best for our family members, but they also recognized that with the state in financial distress, this was an opportune time to begin slashing funding for programs they claimed were discriminatory and isolating. In addition, a draft policy from the Standards Group of the MACMHB, called the Vision for all People with Developmental Disabilities, was being distributed and talked about at meetings between the state and Community Mental Health agencies as if it were already approved policy .

The draft policy statement was especially disturbing because it explicitly stated that the "Vision" should apply to everyone with a developmental disability, regardless of the severity of the person's disabilities, cognitive abilities, or medical or other issues affecting the individual. It was also incredibly silly in its attempt to apply a detailed list of acceptable and unacceptable activities for all people with DD (joining Neighborhood watch is OK, but don't do it with a bunch of other people who are developmentally disabled; a little bit of Special Olympics may be OK, but too much is not acceptable; etc.). Behind the Vision statement is an ideology that some advocacy groups support, but it lacks a basis in law and policy regulating services to people with developmental disabilities.

At the May MACMHB Executive Board meeting there was some backtracking on the Standard's Group "Vision" with promises to take out value judgments on placements and programs that some people need and want in their communities. The Executive Board finally came up with this:

RESOLUTION REGARDING CHOICE
Adopted by the MACMHB Executive Board August 6, 2010

The Michigan Association of Community Mental Health Boards (MACMHB), Prepaid Inpatient Health Plans (PIHPs), and Community Mental Health Services Programs (CMHSPs) recognize there are differences in service preference among the individuals they serve and shall honor Choice for all consumers regardless of the individual’s service delivery site philosophy.

MACMHB, PIHPs, and CMHSPs shall support taking all necessary steps to ensure that individuals with mental Illness, developmental disabilities, or substance use disorders and children with serious emotional disturbances have the opportunity to live in the least restrictive setting that is appropriate to the needs of the individual and is the individual’s personal Choice.

MACMHB, PIHPs AND CMHSPs shall support a person centered planning process that honors the individual’s true Choice.

Our vision embraces programs or services that enable the persons that we serve to be full and participating members in their community.

This can include the continuation of existing services, the improvement of existing services, and the development of new opportunities, all driven by ongoing and informed consumer Choice.

This may do little to squelch the zealots who want to eliminate programs that don't measure up to their views on what our family members should want and need, but it is a beginning. The interest and participation of families and consumers from all over the state were a hopeful sign that the mental health system will respect the differing philosophy's of consumers and continue to take that into account in the programs and services they offer.

Health Care Reform Benefits

Family Voices, an organization devoted to family-centered care for all children and youth with special health care needs, including children with disabilities, has written a statement on the Patient Protection and Affordable Care Act (federal health care reform legislation) summarizing benefits. They give some useful examples of situations in which the benefits will be of particular interest to parents of children with disabilities.

A document on the immediate benefits available is found here. Major portions of the act do not go into effect until 2014, but in the mean time, there are many benefits that are already in place or will be soon:

• Elimination of lifetime benefits caps (beginning September 23, 2010)
• Prohibition against rescinding coverage when someone gets sick (beginning September 23, 2010)
• Prohibition against denying children coverage for pre-existing conditions (July 1, 2010)
• Requirement that young adults be permitted to stay on their parents' insurance policies until age 26 (beginning September 23, 2010)

One section of the law of importance to states is a provision that allows states new options to cover parents and childless adults up to 133 percent of the Federal Poverty Level (FPL) and receive current law Federal Medical Assistance Percentage (FMAP). Effective April 1, 2010, this expansion of Medicaid could help states like Michigan to bring in more money for mental health specialty services. This would be felt especially in the areas of services for mental illness and substance abuse (the vast majority of people with developmental disabilities already qualify for Medicaid). People with these problems who do not now qualify for Medicaid because of their status as single adults or who are just over the poverty line, could qualify in the future and also receive services that are dependent on Medicaid eligibility.

In the long run, this would probably save money for the mental health system by bringing people in early for services and avoiding expensive hospitalizations. Every $1 the state spends on Medicaid will bring in about $3 of federal matching funds and could keep the system from collapsing under the burden of huge state deficits. Not only does money spent on health care expand jobs and improve the economy, but it relieves the pressure on the mental health system and frees up money for other much-needed services.

Check out these important resources to see if you or your family member can benefit from health care reform now.

We're not in Kansas anymore!

We have returned from a 3,000 mile road trip to Colorado and back. Before the trip, I had many second and third thoughts about leaving the boys in their group home, the grandparents in their advanced state of age, and the dog and two cats at the mercy of relatives who agreed to live in our house for a week and watch over the whole mess.

It all turned out OK. The dog Lucy was especially happy to have two young kids at her beck and call who had the energy to take her for walks every day.