Optimizing Substance Abuse Funding from Federal Sources

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Optimizing Substance Abuse Funding from Federal
Sources

• Sources, Flow of Funds, Distribution of Funds
• Suzanne Gelber, MSW, Ph.D.
• The Avisa Group, Berkeley, CA

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Possibilities Public Funds Flow for Substance
Abuse Treatment in California
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Types of Federal Funding Block Grants and
Discretionary Grants/Major Agencies

• Block grants such as the Substance Abuse
  Prevention and Treatment Block Grant, are
  allocations to the states Single State Agencies
  for Substance Abuse (SSAs). Block grants are
  continuous, based on an acceptable state plan.
  The SAPTBG covers both prevention and treatment
  expenditures and is continuous/recurrent as long
  as requirements are met.
• Discretionary grants are actually special purpose
  grants based on solicited applications from the
  states/counties/providers, focused on emerging
  needs or special priorities. They generally run
  from 3-5 years, require proposals that are
  reviewed externally and usually require a
  Governors signature.
• Other Federal funding comes through non-substance
  abuse Federal agencies such as CMS or HRSA. This
  funding may or may not require state matching
  funds. Medicaid/CMS funding requires a state
  match that varies from state to state. Dollars
  flow from CMS to the state Medicaid agencies, who
  may allocate it to the counties. Drug Medi-Cal
  is a special type of Medicaid arrangement, where
  the CA Department of Health Care Services and ADP
  have a memorandum of agreement for ADP to
  administer substance abuse treatment-related
  Medi-Cal funds for specified categories of
  services.

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Sources of Funds for California Department of
Alcohol and Drug Programs2007 - 2008
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SOURCES AND USES OF FUNDS Substance Abuse
Prevention and Treatment Block Grant

• The Substance Abuse Prevention and Treatment
  (SAPT) Block Grant is awarded to the California
  State Department of Alcohol and Drug Programs by
  the Substance Abuse and Mental Health Services
  Administration (SAMHSA). The amount awarded is
  based on a long-standing Federal allocation
  formula and varies little from one year to the
  next.
• States are required to maintain their own prior
  level of state funding for substance abuse in
  order to continue receiving the SAPT Block Grant
  at the same level from one year to the next
  (Maintenance of Effort requirement) and the
  States are required to submit State Alcohol and
  Drug Abuse Plans to SAMHSA before receiving their
  block grants some auditing of the plans is
  done.
• The SAPT Block Grant is the largest single source
  of funds provided to ADP, amounting to
  258,218,000 in 2007-2008. Of this, ADP retains
  18.8 million for its own administration and
  distributes 239.4 million to the 58 California
  Counties. About 70 of the funds spent by the
  Counties are for substance abuse treatment
  services the remainder are for prevention and
  HIV-related services.

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SOURCES AND USES OF FUNDS Substance Abuse
Prevention and Treatment Block Grant

• Treatment services are provided to low-income
  individuals who are not eligible for Medi-Cal and
  who do not have commercial insurance coverage.
  Services are provided primarily by
  County-operated or County-contracted treatment
  clinics the latter are often not-for-profit
  community-based organizations.
• The predominant mode of treatment provided under
  the SAPT Block Grant is drug-free outpatient
  counseling. Annual funding is fixed (except for
  changes in the annual SAPT Block Grant award)
  Counties either use the block grant funds to pay
  salaries for their own employees or to provide
  pre-determined annual fixed amounts to contracted
  organizations.
• Currently, funds are not used for
  medication-assisted treatment of substance abuse.

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SOURCES AND USES OF FUNDS Drug Medi-Cal (Short
Doyle)

• Drug Medi-Cal is the county-based implementation
  of the Short-Doyle program in the arena of
  substance abuse treatment.
• Funds are provided by the State General Fund to
  match the Federal Government Centers for Medicare
  and Medicaid Services (CMS) funds.
• Total funding from both Federal and State sources
  for Drug Medi-Cal amounted to 174,384,000 in
  2007-2008. Of this, ADP itself retains only 8.2
  million for administration the remainder is
  allocated to Counties and it funds both
  residential treatment and outpatient therapy
  programs.
• Treatment services are provided to individuals
  who are enrolled in Medi-Cal and are typically
  delivered by a specialized system of safety net
  public providers certified by the State rather
  than through health plans.
• A provider must be State-certified to be eligible
  to participate in the Drug Medi-Cal program.

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SOURCES AND USES OF FUNDS Drug Medi-Cal (Short
Doyle)

• Drug Medi-Cal provides reimbursement on a
  fee-for-service basis, with the payment rate
  calculated according to the lowest of a
  providers usual and customary charge to the
  general public, the allowable cost of services,
  or the maximum allowance (rate cap) established
  in regulation for five statutorily defined modes
  of treatment service
• Narcotic Treatment Program (Methadone)
• Naltrexone (For treatment of opiate abuse only
  frozen since 1999-2000)
• Outpatient drug free programs
• Day care rehabilitative
• Perinatal residential
• A little over 50 of Drug Medi-Cal funds are
  provided for Narcotic Treatment Programs
  (methadone clinics). Narcotic Treatment Programs
  have special status within Drug Medi-Cal as a
  result of a federal court order in a case known
  as Sobky v. Smoley as a result of that case the
  State (ADP) must contract directly with any
  willing certified provider of the service in a
  County if the County is unwilling to do so.
  Consequently, Counties have little or no
  influence over the funding for Narcotic Treatment
  Programs due to this lawsuit.

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SOURCES AND USES OF FUNDS Other

• The Department of Alcohol and Drug Programs
  receives 78,438,000 in Other State Funds for a
  multitude of specific programs. Of this amount,
  30.9 million is for Drug Courts, 10.0 million
  is for a methamphetamine initiative, 20.1
  million for parolee services and the remainder is
  for other programs and administrative support.
  Some of these funds complement Federal
  discretionary grants.
• ADP also receives CSAT Discretionary Grants for
  very specific initiatives and high priority
  programs such as Screening, Brief Intervention
  and Referral to Treatment (SBIRT) and Access to
  Recovery (ATR), amounting to a total of 22.2
  million for 2007-2008.
• Medication costs are not explicitly or separately
  covered in any of these programs. However, with
  an approved Treatment Authorization Request (TAR)
  FFS Medi-Cal covers certain substance abuse
  medications that can be prescribed by outpatient
  physicians, such as buprenorphine.

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Additional Possible Sources of Federal Funds to
Support Additional Substance Abuse Treatment

• Department of Justice/Drug Courts and Other
  Funding for SA Treatment, including Juvenile
  Justice
• CSAT Treatment Drug Courts
• Department of Education/Vocational Rehabilitation
• HRSA (Human Resources Services Administration)
• CMHS (Center for Mental Health Services)
• Child Welfare Foster Care/Residential Treatment
  Funding
• TANF Funding
• Department of Housing and Urban Development
  (Supportive Housing) with CMHS

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Keys to Additional Federal Funding

• Doing a good job with current funding, watching
  Maintenance of Effort requirements on the block
  grant
• Continuously scanning for Federal and other
  funding to meet the States constant and emerging
  needs
• Pursuing a cross-systems funding approach such as
  the NM Collaborative (currently via a waiver from
  CMS but waivers may be phased out)
• Developing an entrepreneurial, customer-driven,
  recovery-oriented and data-based approach to
  funding adopting an aggressive new partnership
  strategy with funders
• ADP needs more resources to identify and attract
  Federal and other grants and identify and to
  satisfy new funding sources
• Pursuing, updating and annually publishing a
  vision of the future of substance abuse treatment
  and prevention in CA and sharing it with a
  portfolio of funders with whom to partner to
  achieve these goals within the State and with
  Federal agencies with evidence-based programming
  and continuous quality improvement techniques.