Florida commission urges comprehensive mental health reform

A state commission is urging Florida to overhaul its patchwork system of mental health care.

Recommendations come from Committee on Mental Health and Substance Abusewhich was created in 2021 after a Parkland grand jury called Florida’s mental health system a “mess.”

The state’s Department of Children and Families presented the panel’s interim findings to the Tampa Bay Times. The group must submit a final report to Gov. Ron DeSantis and state legislative leaders by Sept. 1.

The initial report criticizes the Florida system as complex and unfair.

“Deinstitutionalization has led to a fragmented continuum of care that fails to appropriately integrate services, providers and systems,” says the 35-page report, “leaving massive treatment gaps and access disparities.”

Nearly 3 million adults in Florida suffer from a mental illness, according to the national advocacy group Mental Health America. This represents 14% of the state’s population. An estimated 225,000 young people have experienced at least one major depressive episode in the past year.

The Times reported last month on Several committee proposals expectedincluding a call for more pre- and post-incarceration prison diversion programs and a recommendation to limit the use of Florida for efficiency recovery.

The interim report, dated January 1, includes those and other insights The Times has not written about before.

The following are three main recommendations from the committee.

Youth Medicaid Expansion Study

The committee urged state officials to study the “potential impact” of expanding Medicaid eligibility for young people age 26 and younger who are in the so-called coverage gap and whose parents are uninsured.

Medicaid It is a joint federal and state program that provides medical coverage to individuals with disabilities and families and children with very low incomes. It can cover the costs of mental health care.

Before the pandemic, he estimated 415,000 people In the Sunshine State, he earned too much to qualify for Medicaid but not enough Tax credits To help them purchase private health insurance through Affordable Care Act Market.

“Modifying the income eligibility criteria (for Medicaid) for “young adults in the coverage gap whose parents do not have health insurance” would improve access to behavioral health care and primary and preventive care that can promote better long-term physical health outcomes,” the report says.

Individuals ages 19 to 26 account for just over 8% of Florida’s population but nearly 14% of the uninsured, according to the report.

More than 390,000 adults with mental illness in Florida are uninsured, according to a Report From Mental Health America. Only 11 countries have worse rates.

At a committee meeting last month, Simon Marsteller, former secretary of Medicaid in Florida, argued against the idea of ​​a study.

“I’m not sure this committee should address, propose, or even conduct a study that would lead to a recommendation to expand Medicaid,” said Marsteller, who resigned as DeSantis moved into his second term.

But most members voted in support of the idea. Commission chair and Charlotte County Sheriff William Brummel said at the meeting that Florida lawmakers will decide whether to start the study.

Florida is just one 11 states That did not expand Medicaid under the Affordable Care Act, which became law in 2010.

the Republican state representatives refused Expanding the program has long frustrated healthcare advocates.

The non-profit organization Florida Institute of Policywho supports expanding Medicaid, applauded the committee’s recommendation for a study.

“This really encouraged us,” said Holly Pollard. Chief Strategy and Development Officer for the nonprofit.

Pollard said the institute also wants the study to be broader.

She said Florida should study the impact of expanding eligibility to all adults age 64 or younger who earn incomes up to 138% of the federal poverty level.

the Healthcare Administration Agency Oversees the state’s Medicaid program. the Department of Children and Families Responsible for safety net behavioral health services for the uninsured.

Track how people navigate through the system

Those diagnosed with a mental illness such as major depression or schizophrenia bounce between caregivers when their treatment needs are not being met, which can lead to dual or conflicting care.

They cycle through community mental health centers, the criminal justice system, private facilities, emergency rooms and schools, receiving diagnoses and medication at each “without anyone being the wiser,” the report says.

This is due in part to the failure of state agencies to share information about who receives care in their publicly funded programs, according to the report.

The panel recommended that agencies upload patient information into a central database so they can track how people move through the system.

The report says this could lead to better treatment and reduce duplication of mental health services.

“We must connect the dots between all service providers, both public and private, to ensure that everyone shares information about a single customer,” the report says.

Focus on patients’ needs

number one budget Mental health funding exists in Florida. Funds for behavioral health programs are intended for many state agencies And it flows into local organizations.

The report says this makes the mental health system fragmented and disconnected. Patients’ treatment “often depends on how their services are funded” rather than their own needs.

“In the Florida system of care, money follows individual programs, not the individual,” the report says.

That’s why the commission is recommending Florida launch a three-year pilot program in which one agency manages all public behavioral health funding in a geographic area, including state and local dollars from counties, cities and school boards.

Clara Reynolds, a panelist and executive director of the nonprofit, said the model would “blend and braid” funding to create “consistency in contracting for services” across the system. Crisis Center Tampa Bayat the October meeting.

Providers will have more flexibility in treating patients based on their specific needs and will be able to focus less on complex billing processes and More on care, according to the report.