california department of alcohol and drug programs

1State 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 2011-12

April 12, 2011

2

To develop and maintain a comprehensive, integrated statewide prevention and

treatment system.

Overall Strategic Goal

State of CaliforniaDepartment 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


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


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Alcohol abuse: $38.4 billion

Illicit Drug Abuse: $23.8 billion

Annual Fiscal Cost to CA


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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


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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


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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 21-25 exhibit greatest harm related to risky & excessive use

Between 750,000 and 1.3 million adults age 21-25 could benefit from early intervention services

(such as SBIRT)

Subpopulation AOD Treatment Need (continued)


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In SFY 2008-09 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


Treatment Admissions

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19%

12%

5%

7%

57%

ODF Non-NTP

ODF NTP

ODF Detox

RES Detox

RES

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Client Demographics – By Gender


64% Male

36% Female

Client Demographics – By Race/ Ethnicity

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42%

34%

17%

2% 1%4%

White Hispanic AfricanAmerican

Asian/PacificIslander

AmericanIndian/AK

Native

OtherRace/Multi-

Racial

Client Demographics – By Age

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12%

18%

24% 23%

18%

5%

0%

5%

10%

15%

20%

25%

30%

Under 18 18-25 26-35 36-45 46-55 56 +

Source of Client Referral

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43%

34%

13%

7% 3%

CriminalJustice

Individual Self Referral

Community/Health/Work

AODProgram

School

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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


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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


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ADP’s proposed budget for FY 2011-12 is $630.4 million

This is a total increase of $24.3 million

ADP FY 2011-12 Budget


ADP Budget by Fund Source

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Other Funds$28.14.5% General Fund

$222.135.2%

Federal Funds

$260.1

41.2%

DMC FFP$120.119.1%

ADP Budget by Category

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Local Assistance$587.993.3% State Support

$42.56.7%

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Governor’s Realignment Proposal


$184 million in General Fund is proposed to be realigned to the counties to fund the responsibilities of providing substance abuse disorder

treatment services

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Main Tenets of Realignment


Flexibility for decision making

Adhere to minimum federal requirements

Maximize federal resources Minimize adverse impacts

to clients and patients

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The Realignment Proposal


Non Drug Medi‑Cal Regular $ 5.2 mNon Drug Medi‑Cal Perinatal 20.5 mDrug Court Partnership Act 6.8 mComprehensive Drug Court Implementation Act 15.7 mDependency Drug Court Program 4.3 mDrug Medi‑Cal Program 130.7 mState Support 0.8 m

Total Realignment $184 m

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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.

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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

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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

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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

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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

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Phase 1 - FY 2011-12 The substance abuse treatment component of

realignment is planned for Phase I, beginning in FY 2011-12

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

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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

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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

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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

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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

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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


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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


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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)


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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


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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)


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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)


39


Thank You

www.adp.ca.gov

California Department of Alcohol & Drug Programs

california department of alcohol and drug programs

Documents

state of californiadepartment

ca homeless need aod

aod tx males

drug programschart10

aod arrests

ca alcohol abuse

aod tx adults age

drug programsaod treatment