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President's Budget for FY 2015

The President’s FY 2015 budget is creating and expanding initiatives The National Technical Assistance Center for Children’s Mental Health (TA Center) has been supporting through training and technical assistance in states across the nation for many years. The budget components mirroring the TA Center's work include: Expansion of the Community Alternatives to Psychiatric Residential Treatment Facility Waiver initiative nationwide at a savings of 1.9 billion over 10 years; Expansion of the Healthy Transition Initiative by 20 million to support youth and young adults in accessing behavioral health services; Establishment of a new demonstration program for children in foster care to receive evidence based services and reduce the overreliance upon psychotropic medication; and Expansion of Money Follows the Person to prevent individuals from entering an institution and shortens the time for transition out of institutions. The proposed budget will help thousands of youth and young adults access quality mental health services and remain in their community. The following summarizes each of these sections in the President’s FY 2015 budget.

Alternatives to Psychiatric Residential Treatment

Provide Home and Community-Based Waiver Services to Children and Youth Eligible for Psychiatric Residential Treatment Facilities: This proposal would provide states with additional tools to manage their children’s mental health care service delivery systems by expanding the non-institutional options available to these Medicaid beneficiaries. By adding psychiatric residential treatment facilities to the list of qualified inpatient facilities, this proposal provides access to home and community-based waiver services for children and youth in Medicaid who are currently institutionalized and/or meet the institutional level of care. Without this change to provisions in the Social Security Act, children and youth who meet this institutional level of care do not have the choice to receive home and community-based waiver services and can only receive care in an institutional setting where residents are eligible for Medicaid. This proposal builds upon findings from the five-year Community Alternatives to Psychiatric Residential Treatment Facilities Demonstration Grant Program authorized in the Deficit Reduction Act of 2005 that showed improved overall outcomes in mental health and social support for participants with average cost savings of $36,500–$40,000 per year per participant.

Healthy Transitions Initiative

The Budget includes $130 million within the Substance Abuse and Mental Health Services Administration (SAMHSA) for the President’s Now is the Time initiative. This investment provides $20 million to continue the Healthy Transitions program, which will assist 16 to 25 year-olds with mental illnesses and their families in accessing and navigating behavioral health treatment systems to ensure their vulnerability does not hinder their treatment. Youths with mental health conditions are less likely than similar adults to receive care. It is important to ensure these vulnerable youth do not fall through the cracks during this period because having an untreated mental health condition makes young adults more likely to experience homelessness, be arrested, drop out of school, or experience underemployment.

Psychotropic Medications for Children in Foster Care

Demonstration to Address the Over-Prescription of Psychotropic Medications for Children in Foster Care. The Budget includes $500 million for a new Medicaid demonstration in partnership with ACF to provide performance-based incentive payments to states through Medicaid, coupled with $250 million in mandatory child welfare funding to support state infrastructure and capacity building. This transformational approach will encourage the use of evidence-based screening, assessment, and treatment of trauma and mental health disorders among children and youth in foster care in order to reduce the over-prescription of psychotropic medications. This new investment and continued collaboration will improve the social and emotional outcomes for some of America’s most vulnerable children.

Money Follows the Person Demonstration expansion

Extend and Improve the Money Follows the Person Demonstration: This proposal would extend the demonstration period through FY 2020 to enable states to continue to rebalance their long-term care systems and transition individuals to home and community-based services within the existing appropriation. Currently, individuals must enter institutions to qualify for covered home and community-based services in the Money Follows the Person Demonstration. To support individuals remaining in the community, this proposal would modify the demonstration to allow funds to be used to prevent individuals from entering an institution in the first place, as well as transition services. This proposal would also reduce the institutional requirement from 90 to 60 days and allow skilled nursing facility days to be counted towards the institutional requirement. Lastly, this proposal would allow individuals in certain mental health facilities to transition to home and community-based services under the demonstration.

Click here for the complete budget!