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Some “Nuts and Bolts” of Financing for Systems of Care

Some “Nuts and Bolts” of Financing for Systems of Care. Technical Assistance Partnership for Child and Family Mental Health August 10, 2011. Welcome to Today’s Webinar. Audio Information: Dial Into: 800-503-2899 Conference ID: 1384349 For Technical Assistance: Dial: 1-866-493-2825

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Some “Nuts and Bolts” of Financing for Systems of Care

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  1. Some “Nuts and Bolts” of Financing for Systems of Care • Technical Assistance • Partnership for Child and • Family Mental Health August 10, 2011

  2. Welcome to Today’s Webinar Audio Information: Dial Into: 800-503-2899 Conference ID: 1384349 For Technical Assistance: Dial: 1-866-493-2825 To Submit Questions: Use the Q&A button at the top of your screen

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  8. Some “Nuts and Bolts” of Financing for Systems of Care Presenter: Frank Rider- Technical Assistance Coordinator, Technical Assistance Partnership for Child and Family Mental Health

  9. Do You Have the Tools You Need?

  10. Context/Overview The Economics of Systems of Care: • Macro-Economics • Micro-Economics • The Pursuit of A Unified Theory?

  11. Polling Question #1 At what stage of financial development is your SOC initiative? • Graduated site – federal funding already ended • Graduating in just 50 days/funded October 2005 • In 5th Year of 6/funded October 2006 • In 3rd Year of 6/funded October 2008 • In 2nd Year of 6/funded October 2009 • In 1st Year of 6/funded October 2010 • Forging ahead without any federal grant funding.

  12. Strategic Financing Approach: A Few Key Questions • Clarify “Financing for What?” • Estimate Your Fiscal Needs • Map Current Relevant Funding • Assess Gaps • Identify Financing Strategies and Funding Sources

  13. 1. Clarify “Financing for What?” • Scope of Supports and Services • Scale of Supports and Services • Other Relevant Factors and Cost Assumptions

  14. Financing for What?Worksheet

  15. Questions? Please press *7 on your phone to unmute your line. When you are finished, please press *6 to remute.

  16. 2. Estimating Fiscal Needs Develop Information to Support: • Program costs • Start-up costs • Operating costs • Infrastructure costs • Ramp-up Strategy/Going to Scale • Assumptions

  17. Sample Cost Estimates Worksheet

  18. 3. Map Current Spending Know What You Have to Work with Today: • What are your current sources of funding • Cash • In-Kind • Are they restricted? • Over what timeframe are they available? • How stable and reliable is each source?

  19. Kaiser Commission on Medicaid and the Uninsured (April 2011), MENTAL HEALTH FINANCING IN THE UNITED STATES: A PRIMER

  20. Resource Mapping Worksheet

  21. Show Me the Money! • Cooperative agreement funds • Other grants • Federal, state and local service programs • Partnering agencies: private providers, community organizations , universities (e.g. in-kind services) • Private insurance claiming • Redeployed funds into lower cost services • And leverage natural and other informal supports!

  22. 4. Assessing the Spending Gap What is the gap between our current spending and our projected fiscal needs? • by strategy/activity • by fiscal year

  23. Funding Gap Analysis Worksheet

  24. Questions? Please press *7 on your phone to unmute your line. When you are finished, please press *6 to remute.

  25. Micro-Economics of Systems of Care (CMHI Cooperative Agreements) • “Venture Capital” • Annual Budgeting and Accountability: • Required Reports • Continuing Application • Carryforward and No-Cost Extensions • Matching Funds • The Rules

  26. What Are the Rules? Cooperative Agreement Requirements: • Semi-annual progress reports • Annual reapplication (continuing application) • Annual Financial Status Reports (SF-425) • Matching Funds requirements Secure approval by CMHS for: • Change in scope of cooperative agreement • Change in contractor or subcontractors • Major budget modifications • Carryover funds/no-cost extension

  27. Cooperative Agreement Funds: Information References • SAMHSA Request for Applications (RFA) • US DHHS Grants Policy Statement (2007) • CMHS/Bazelon Center (2008): Building Sustainable Systems Change: A Guide to Non-Federal Match Funding

  28. Shifting Gears Now…

  29. Macro-Economics of Systems of Care Cost of Providing BH Treatment and Support: • MH Service Delivery • Maintaining “Ready” Capacity • Lost Opportunity Costs Cost of Not Providing Effective Treatment and Support : • Costs of Providing Ineffective MH Services • Immediate Related Costs • Long-term/Societal Costs • Intergenerational Costs

  30. Review Strategic Financing Steps • Clarify what you need and when • Review current funding mix • Analyze promising options to pursue as additional funding sources • Determine most appropriate funding sources to support your goals.

  31. Four Potential Financing Strategies • Redeploy Existing Resources • Refinance to Maximizing Public Funds • Raise New Revenues • Create New (Boundary-Crossing) Funding Structures Pires, S.A. (Second edition, 2010), Building Systems of Care: A Primer

  32. 1. Redeploy Existing Resources …from service areas that are producing high costs and/or poor outcomes (e.g. out of home placements), to invest in promising new approaches. Example: Maine – July 2011 QI Data Snapshot: “The (Wraparound) results showed a 28% reduction in overall average per child MH expenditures in 12-month period and significant reductions in crisis intervention, residential treatment and in-patient hospital services.”

  33. 2. Refinance to Maximize Public Funds (e.g. Medicaid) • Multi-systemic therapy • Wraparound process • Facilitation • Team Member Participation • Intensive in-home services • Family psycho-educational services • Integrated MH-SA treatment • Assertive Community Treatment (ACT) teams • Therapeutic foster care • Respite care • Family Peer Support • Youth Peer Support • Illness/Disability Self- Management • Telemedicine-Delivered BH Services • Traditional Healing Modalities

  34. Polling Question #2 Of the 15 services listed on the previous slide, how many are covered services in your state’s Medicaid program? ___ None ___ Some, but fewer than 5 ___ About half of them/6 to 10 ___ All 15, or nearly all ___ I don’t know enough about the services in my state’s Medicaid program to answer this

  35. 3. Raise New Revenues • Fees, third party billing (e.g. ACA affordable benefits exchanges) • Grants • United Way • Sponsorships • Trust funds • Special taxes: • California - Proposition 63 • Missouri, Illinois - County Tax Levies • Fundraising

  36. 4. Create New Funding Structures • Blended Funding Pools (e.g. flex funds) • Case Rates (examples: Wraparound Milwaukee, Impact SOC, MI) • Braided Funding (example: Arizona ‘s Therapeutic Foster Care)

  37. Look to the Future Use the opportunity of federal cooperative agreement funding to lay a strong foundation for the future: • Develop, test, demonstrate better approaches • Leverage cross-system investments, and secure commitments now for later years’ funding • Build strategies to modify what permanent funding streams will pay for later. • Provide services now to avoid costly high-end placements, and secure commitments for reinvestment of saved funds to increase capacity for cost-effective supports and services that work!

  38. And Remember… Not ALL Worthwhile Sustainability Depends of Financing!

  39. Questions? Please press *7 on your phone to unmute your line. When you are finished, please press *6 to remute.

  40. Polling Question #3 Financing is a difficult area to master. Which of the following dimensions do you feel the strongest need to learn more about? ___ Medicaid ___ Non-Federal Matching Funds ___ Flexible Funds (“Flex Funds”) ___ Private Health Insurance ___ Primary Funding Streams of Non-Mental Health Child Service Systems (Child Welfare, Education, Juvenile Justice, etc.)

  41. Presenter Contact Information Frank Rider frider@ffcmh.org 919-896-8309

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