BILL ANALYSIS
AB 1571
Page 1
Date of Hearing: April 21, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 1571 (Committee on Veterans Affairs) - As Introduced: March
16, 2009
SUBJECT : Veterans mental health: county plans.
SUMMARY : Prohibits the Department of Mental Health (DMH) from
approving a county's plan for the expenditure of funds from the
Mental Health Services Act (MHSA), as specified, unless it
includes verifiable representation from a legitimate veterans
group in the stakeholder planning process and includes a
separate section that specifically addresses how the mental
health needs of veterans are, or are not, being met.
Specifically, this bill :
1)Prohibits DMH from approving a county's plan for the
expenditure of MHSA funds for prevention and early
intervention and innovation programs unless it includes
verifiable representation from a legitimate veterans group in
the required stakeholder planning process and includes a
section that addresses the specific mental health issues of
veterans and how the plan will, or will not, address those
issues.
2)Requires each county's expenditure update report for MHSA
funds allocated to services for children, adults, and seniors
to include the number of veterans to be served.
3)Revises the list of local stakeholders required to be
consulted in the development and update of each county's MHSA
plan to include representatives from a legitimate veterans
organization.
4)Specifies that the reports of achievement outcomes that are
required to be included in each county's MHSA plan must
specifically include recognition of the mental health needs of
veterans and how those needs are, or are not, being met.
EXISTING LAW :
1)Establishes DMH to direct and coordinate statewide efforts for
the treatment of mental disabilities.
AB 1571
Page 2
2)Establishes the MHSA, enacted by voters in 2004 as Proposition
63, to provide funds to counties to expand services and
develop innovative programs and integrated service plans for
mentally ill children, adults, and seniors through a 1% tax on
personal income above $1 million.
3)Requires the State Controller to transfer specified amounts of
state funding into the Mental Health Services Fund,
administered by DMH. Requires revenues deposited into the
fund to be used to create new county mental health programs
and expand existing programs.
4)Requires each county mental health department to prepare and
submit to DMH a three-year program and expenditure plan for
MHSA funding that addresses the following five major
components: a) community services and supports; b) workforce
education and training; c) capital facilities and
technological needs; d) prevention and early intervention;
and, e) innovation. Requires DMH to establish guidelines for
the content of each of the five components and approval of
county plans.
5)Requires each county plan and update to be developed with
local stakeholders, including adults and seniors with severe
mental illness, families of children, adults, and seniors with
severe mental illness, providers of services, law enforcement
agencies, educators, social services agencies, and other
important interests.
6)Specifies that the MHSA may only be amended by a two-thirds
vote of both houses of the Legislature and only so long as the
amendment is consistent with and furthers the intent of the
MHSA. Permits provisions clarifying the procedures and terms
of the MHSA to be added by majority vote of the Legislature.
7)Establishes, under federal law, the Veterans Health
Administration (VA) within the U.S. Department of Veterans
Affairs, to provide health care and other benefits to veterans
and their families and administer VA medical centers and
outpatient clinics.
8)Establishes the Bronzan-McCorquodale Act, also known as
"Realignment," which shifted responsibility for the provision
of mental health services from the state to counties.
AB 1571
Page 3
Provides funding for local programs with revenues from
increased vehicle licensing fees and sales taxes.
9)Requires counties to provide mental health services to target
populations to the extent resources are available. Includes
in the target populations California veterans in need of
mental health services who are not eligible for care by the VA
or other federal health care provider. Specifies the minimum
array of services that must be provided to target populations.
10)Includes within the definition of a serious mental disorder
post-traumatic stress disorder (PTSD) and bipolar disorder for
purposes of qualifying target populations for county mental
health services.
11)Clarifies that counties are required to provide mental health
services to California veterans in need of services and who
meet existing eligibility requirements, to the extent services
are available to other adults.
12)Requires counties to provide mental health services to
California veterans in need of services and who meet existing
eligibility requirements, to the extent resources are
available. Requires counties to advise veterans who may be
eligible for mental health services through USDVA of these
services.
13)Requires counties to refer a veteran to the county veterans
service officer to determine the veteran's eligibility for,
and the availability of, mental health services provided by
the USDVA or other federal health care provider.
14)Prohibits an eligible veteran from being denied county mental
health services based solely on his or her status as a
veteran.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . The author states that this bill is
AB 1571
Page 4
needed to ensure that veterans receive their fair share of
state and county mental health resources. California is home
to the third largest population of veterans in the nation and
is third in the nation in residents who have been deployed in
the Global War on Terror. The author points out that there
has been a longstanding gap in mental health services for
California's veterans who have been referred to the VA for
services without regard to their actual eligibility for VA
services and the VA's actual capacity to deliver those
services. The author notes that veterans are
disproportionately represented among the homeless and mentally
ill populations and the VA lacks the capacity to meet the
needs of all of California's veterans, including the 45% of
all forces deployed in Iraq and Afghanistan from the Reserve
and the State National Guard. The author believes targeting
veterans in the provision of county mental health services
will help to reduce the overall burden mental health need
places on our state and our communities.
2)FEDERAL BENEFITS . According to the VA website, one of the
more important USDVA benefits is health care. It specifies
that VA has about 1,300 care facilities, including 163
hospitals, 850 ambulatory care and community-based outpatient
clinics, 206 counseling centers, 137 nursing homes, and 43
domiciliary facilities. The website also indicates that the
Veterans' Health Care Eligibility Reform Act of 1996 created
the Medical Benefits Package which is a standardized, enhanced
health benefits plan available to all enrolled veterans. The
Medical Benefits Package includes preventive services,
including: immunizations; screening tests; health education
and training classes; primary health care; diagnosis and
treatment; mental health and substance abuse treatment; and,
drugs and pharmaceuticals. To receive VA health care
benefits, most veterans must enroll. Veterans can apply for
enrollment at any VA health care facility or veterans'
benefits office. According to the website, more than six
million veterans are enrolled in the VA health care system as
of October 2001 and that a quarter of the nation's population,
approximately 70 million people, are potentially eligible for
benefits and services because they are veterans, family
members, or survivors of veterans.
3)STATISTICS FROM THE VA . According to an August 2007 research
brief by the VA's Office of Research and Development, from the
start of the conflicts in Iraq and Afghanistan in 2003, and
AB 1571
Page 5
through 2006, more than 631,000 soldiers have been discharged.
Approximately 32.5% have sought VA health care and, of these,
35.7% have had a mental health condition or concern. In 2008,
VA expects to treat 5.8 million veterans, an increase of 2.4%
over 2007. Of these 5.8 million, VA expects to see 263,000
Iraq and Afghanistan war veterans, or 25.8% more than in 2007.
The VA notes that many of these veterans have experienced
multiple injuries including injuries to several organs, limb
loss, sensory loss, burns, and chronic pain. Moreover, combat
veterans of the Iraq and Afghanistan wars are at higher risk
for PTSD and other mental health disorders, such as adjustment
disorder, anxiety, depression, and substance abuse. The VA
notes that war veterans are eligible for two years of free
health care from the USDVA for any condition that may be
related to combat, and USDVA clinicians are informed to
evaluate veterans for war-related mental disorders.
4)PROPOSITION 63 . In November 2004, voters passed Proposition
63 or MHSA. MHSA imposes a 1% state income surtax on incomes
exceeding $1 million. MHSA requires the State Controller to
transfer specified amounts of state funding into the Mental
Health Services Fund. Revenues deposited into the fund must
be used to create new county mental health programs and to
expand existing programs. Adult systems of care, children's
services, preventive measures, workforce and training, and
technology improvements are all programs that may receive
Proposition 63 funds.
MHSA requires each county mental health program to prepare and
submit a three-year plan to DMH that must be updated each year
and approved by DMH after review and comment by the Mental
Health Services Oversight and Accountability Commission. In
their three-year plans, counties are required to submit a
listing of all work plans for which MHSA funding is being
requested that identifies how the funds will be spent and
which populations will be served. This bill requires counties
to include in their revenue and expenditure reports the number
of veterans being served.
5)OPPOSITION . The California Mental Health Directors
Association (CMHDA) and the California State Association of
Counties (CSAC) object to this bill. They note that veterans
are and should remain an identified part of the target
population for MHSA programs but they point out that veterans
should qualify for enrollment based on community-identified
AB 1571
Page 6
priority and need, not solely on their status as a veteran.
They contend this bill singles out veterans for special
attention, which, they assert, could be very divisive at the
local level. Specifically, they are concerned that the
provision in this bill that includes veterans among the groups
of local stakeholders that counties must consult when
developing and updating their MHSA plans will set a precedent
that will open the floodgates to other populations seeking
similar status.
CMHDA and CSAC also take issue with the provision in this bill
that requires the updates on MHSA expenditures that counties
must provide to DMH to include the number of veterans served.
They argue that counties do not have a way to accurately
identify the number and costs of veterans served and this
requirement singles out veterans over other segments of the
population. Furthermore, they add that, in many cases,
veterans come to county mental health departments and choose
not to self-identify as a veteran or as having been in the
military. They point out that many veterans are in fact being
served through adult mental health service programs, but are
not specifically identified as veterans, and may not want to
be.
6)PRIOR LEGISLATION .
a) AB 3083 (Committee on Veterans Affairs), Chapter 591,
Statutes of 2008, requires counties to provide mental
health services to California veterans in need of services
and who meet existing eligibility requirements, to the
extent services are available to other adults, and expands
the definition of a serious mental disorder to include PTSD
and bipolar disorder for purposes of qualifying target
populations for county mental health services.
b) AB 2844 (Nation), Chapter 618, Statutes of 2006,
requires counties to provide mental health services to
California veterans in need of services and who meet
existing eligibility requirements to the extent resources
are available, and prohibits eligible veterans from being
denied county mental health services based solely on their
status as a veteran.
c) AB 599 (Gordon), Chapter 221, Statutes of 2005, adds
California veterans in need of mental health services who
AB 1571
Page 7
are not eligible for care by the USDVA or other federal
health care provider and who meet existing eligibility
requirements, to the existing target populations that
counties are required to serve, to the extent resources are
available.
7)SUGGESTED TECHNICAL AMENDMENTS . On page 2, lines 19 and 22,
delete "Include," and insert "Includes".
8)DOUBLE-REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to
the Assembly Veterans Affairs Committee.
9)POLICY COMMENT . This bill prohibits DMH from approving a
county's plan for the prevention and early intervention and
innovation components of MHSA funding unless certain criteria
have been met, including that the plan involves verifiable
representation from a legitimate veterans group in the
stakeholder planning process. Given that this bill does not
specify how the verification of representation would be
determined and there are many veterans' organizations at the
local level with various priorities, the author may wish to
clarify this provision.
REGISTERED SUPPORT / OPPOSITION :
Support
None on file.
Opposition
California Mental Health Directors Association
California State Association of Counties
Analysis Prepared by : Cassie Rafanan / HEALTH / (916)
319-2097