1 State of California Department of Alcohol and Drug Programs California Department of Alcohol and Drug Programs Coalition of Alcohol & Drug Associations Annual Public Policy Conference CSAC Conference Center ADP Planning & Budget for FY April 12, 2011

2 To develop and maintain a comprehensive, integrated statewide prevention and treatment system. Overall Strategic Goal State of California Department of Alcohol and Drug Programs

3 The Statewide Needs Assessment and Planning (SNAP) process has been established within ADP business operations to develop a data informed planning and decision making process. Statewide Needs Assessment & Planning State of California Department of Alcohol and Drug Programs

4 Over 20,000 alcohol involved fatal & injury collisions Over 287,000 AOD related hospitilazations Over 279,000 AOD related emergency visits Over 636,000 AOD arrests Consequences of AOD Abuse State of California Department of Alcohol and Drug Programs

5 Alcohol abuse: $38.4 billion Illicit Drug Abuse: $23.8 billion Annual Fiscal Cost to CA State of California Department of Alcohol and Drug Programs

6 Approximately 3.3 million age 12 & older need, but are not receiving AOD Tx Of 18 – 25 year olds 24% (over 1 million) need, but do not receive AOD Tx Nearly 2 million 26 and older need, but do not receive AOD Tx Males have higher percentage than females of need but are not receiving AOD Tx AOD Treatment Need State of California Department of Alcohol and Drug Programs

7 10% American Indian & 9% Hispanics need, but are not receiving AOD Tx Over 1 million Hispanics & Whites need, but are not receiving AOD Tx Approximately 107,000 pregnant women in CA used AOD during pregnancy in 2008 Over 1 million adults 60 and older need treatment for alcohol & prescription drug misuse Subpopulation AOD Treatment Need State of California Department of Alcohol and Drug Programs

8 Over 100,000 CA homeless need AOD Tx on any given day Approximately 416,000 CA veterans need AOD Tx Approximately 275,000 CA adults with serious mental illnesses also need AOD Tx Adults age exhibit greatest harm related to risky & excessive use Between 750,000 and 1.3 million adults age could benefit from early intervention services (such as SBIRT) Subpopulation AOD Treatment Need (continued) State of California Department of Alcohol and Drug Programs

9 In SFY there were approximately 262,000 unique clients served in: 833 licensed residential facilities 842 certified outpatient facilities 222 licensed detox facilities 145 licensed NTP facilities System Performance State of California Department of Alcohol and Drug Programs

Treatment Admissions 10 State of California Department of Alcohol and Drug Programs

11 Client Demographics – By Gender State of California Department of Alcohol and Drug Programs 64% Male 36% Female

Client Demographics – By Race/ Ethnicity 12 State of California Department of Alcohol and Drug Programs

Client Demographics – By Age 13 State of California Department of Alcohol and Drug Programs

Source of Client Referral 14 State of California Department of Alcohol and Drug Programs

15 87% increase in job training 65% increase in abstinence from AOD use 58% increase in recovery activities 33% increase in employment 12% increase in number of no arrests 10% increase in independent living 8% reported no health problems Treatment Outcomes State of California Department of Alcohol and Drug Programs

16 Employ more science-based, population level prevention strategies and identify new funding or resource strategies to expand evidence-based prevention activities in California Build the AOD System capacity for early intervention strategies, such as SBIRT Planning for Health Care Reform activities Statewide Needs Assessment & Planning Priorities State of California Department of Alcohol and Drug Programs

17 ADP’s proposed budget for FY is $630.4 million This is a total increase of $24.3 million ADP FY Budget State of California Department of Alcohol and Drug Programs

ADP Budget by Fund Source 18 State of California Department of Alcohol and Drug Programs Other Funds $ % General Fund $ % Federal Funds $ % DMC FFP $ %

ADP Budget by Category 19 State of California Department of Alcohol and Drug Programs Local Assistance $ % State Support $ %

20 Governor’s Realignment Proposal State of California Department of Alcohol and Drug Programs $184 million in General Fund is proposed to be realigned to the counties to fund the responsibilities of providing substance abuse disorder treatment services

21 Main Tenets of Realignment State of California Department of Alcohol and Drug Programs Flexibility for decision making Adhere to minimum federal requirements Maximize federal resources Minimize adverse impacts to clients and patients

22 The Realignment Proposal State of California Department of Alcohol and Drug Programs Non Drug Medi ‑ Cal Regular$ 5.2 m Non Drug Medi ‑ Cal Perinatal 20.5 m Drug Court Partnership Act 6.8 m Comprehensive Drug Court Implementation Act 15.7 m Dependency Drug Court Program 4.3 m Drug Medi ‑ Cal Program m State Support 0.8 m Total Realignment $184 m

23 State of California Department of Alcohol and Drug Programs Drug Medi-Cal (DMC) $130.7 Million The DMC funding for realignment includes the funding for NTPs. Twenty nine counties currently operate or contract for NTP services ADP currently contracts directly with providers in 8 counties that choose not to provide the services under their county contract with ADP.

24 State of California Department of Alcohol and Drug Programs Non-DMC – Regular & Perinatal $25.7 Million Funding for the Women and Children’s program is included in the realignment proposal For the perinatal program, there is a federal perinatal MOE requirement being factored in

25 State of California Department of Alcohol and Drug Programs Drug Courts - $26.8 Million Counties may have flexibility to determine if they choose to operate Drug Courts If they choose to do so, they are expected to adhere the Drug Court best practices

26 State of California Department of Alcohol and Drug Programs Impact on Clients No immediate impact to the individuals served by the treatment programs is anticipated Counties are better able to tie local needs and priorities The effectiveness and efficiency of treatment programs will increase with the control of fiscal and programmatic decision making

27 State of California Department of Alcohol and Drug Programs Maintenance of Effort (MOE) The federal SAPT Block grant MOE requirements are being included in determining the processes and procedures for realignment in order to ensure that the expenditures and services funded can continue to be counted toward the MOE requirement

28 State of California Department of Alcohol and Drug Programs Phase 1 - FY The substance abuse treatment component of realignment is planned for Phase I, beginning in FY One step is to solicit the input of our stakeholders to identify the issues, questions and concerns Use stakeholder input to establish processes and procedures that work for both counties and providers and minimize burdens Clarify the expected roles and functions of the State and counties

29 State of California Department of Alcohol and Drug Programs Roles & Functions of ADP Serve as SSA for AOD, SAPT Block Grant, and other discretionary grants Delegated administration of DMC Licensure and certification for programs and counselors Data collection, reporting, and analysis

30 State of California Department of Alcohol and Drug Programs Roles & Functions of ADP (CONTINUED) Establish AOD Prevention & Treatment standards Statewide needs assessment and planning TA - Translating research into practice Auditing and fiscal oversight Public education and information dissemination

31 State of California Department of Alcohol and Drug Programs Benefits & Risks - Benefits Increased flexibility and local control Promotes local decision making for fiscal and programmatic decisions Flexibility to establish priorities and tie program and fiscal together Transfers program oversight and provider selection to the local level

32 State of California Department of Alcohol and Drug Programs Benefits & Risks - Risks Funding source does not take caseload growth into account Negatively effects the MOE Potential litigation AOD services become low priority for funding

33 The Patient Protection and Affordable Care Act (ACA), as amended by the Health Care and Education Reconciliation Act of 2010, has one major goal: To transform the way health care is provided and paid for in the United States in order to provide quality and affordable health care for all Americans ACA Overarching Goal State of California Department of Alcohol and Drug Programs

34 Greater access to treatment by Medicaid expansion New marketplaces to purchase health plans Inclusion of SUD providers & individuals with SUD conditions in Medicaid; medical homes as a state option for chronic conditions SUDs listed as a national priority ACA Requirements for SUD Services State of California Department of Alcohol and Drug Programs

35 The minimum essential health benefits include substance abuse and mental health services Health plans must cover SUDs as essential health benefit &include evidence based preventive health services such as SBIRT Parity coverage of SUDs ACA Requirements for SUD Services (continued) State of California Department of Alcohol and Drug Programs

36 Determine SUD basic benefits Determine Medi-Cal SUD services & delivery system changes Determine population to be served by public programs Determine populations and services to be covered by SAPT Block Grant Major ACA SUD Related Tasks State of California Department of Alcohol and Drug Programs

37 Develop & implement plan to integrate with primary care Prepare SUD workforce Facilitate interagency collaboration and planning Facilitate SBIRT adoption as a standard of care Plan & implement preventive services Major ACA SUD Related Tasks (continued) State of California Department of Alcohol and Drug Programs

38 Provide TA on ACA Make necessary statutory & regulatory changes Redesign HIT system data collection, reporting & sharing processes Redesign SUD financing & administrative systems Develop & implement quality improvement processes & measures Major ACA SUD Related Tasks (continued) State of California Department of Alcohol and Drug Programs

39 State of California Department of Alcohol and Drug Programs Thank You California Department of Alcohol & Drug Programs