In This Issue

ACA 2 and 0

Long-standing Crisis at ASH

Meet a Board Member

Donate

Upcoming Events

* Arizona Chapter of NASW has joined forces with the ASU School of Social Work to create workshops at locations around the state. Friday, July 17th from 9:00 AM - 12:00 PM. Register for, "Factitious Disorder Imposed on Another (FDIA) AKA Munchausen by Proxy, Medical Child Abuse" 3CEU's. Flagstaff Medical Center Education Complex 1000 N. Humphreys St. Ste. #210 (Piñon Room) Flagstaff. Register at here.

* July 17th & 18th Neonatal Abstinence Syndrome Conference, Topics include: The Finnegan Scoring Tool, The effects of NAS, addiction treatment, DCS reporting processes, educating families, local prevention & treatment efforts. Desert Willow Conference Center 4340 E. Cotton Center Blvd. Phoenix.

For more information contact danielle.dandreaux@azdhs.gov

* 2015 Eric Gilbertson Advocacy Institute for Behavioral Health is now accepting applications for future advocates. The Institute provides information, training, and resources to participants on behavioral health issues at the individual, provider, and system level. Please contact Mike Mayhew at 602-712-9200, ext. 204 or e-mail mikem@azabc.org. Applications are due August 10th.

* Get ready to Strike Down Stigma! August 20th from 11:00 am to 2:00 pm at Let It Roll Bowling, 8925 N 12th St, Phoenix. To participate it'll cost $20 per person which includes shoe rental & refreshments (popcorn, pizza and soda). A portion of the proceeds will go to MHAC. Call 602-712-9200 x205 or email info@azmhac.org for more information.

* The 2015 Southwestern School for Behavioral Health Studies August 23-27 at Loews Ventana Canyon 7000 N. Resort Drive, Tucson. The theme for this 5-day Conference is "Strengthening Communities through Innovation and Excellence". Click our the brochure here.

* Arizona's Fifteenth Annual Transition Conference, Connecting for Success: Shared Expectations, Responsibilities, and Outcomes is a collaborative, cross-stakeholder professional development event aimed at providing meaningful and pertinent information needed in the transition planning process for youth and young adults with disabilities, August 24-26 at Talking Stick Resort , 9800 East Indian Bend Road Scottsdale. Click here. Scholarships are still available.

Check out the Regional Behavioral Health Authority Calendars:

Mercy Maricopa Community Events Calendar,

NARBHA Community Events Calendar

Cenpatico Community Events Calendar

CPSA Community Events Calendar.

Board of Directors

Michael Shafer, Chair

Joshua Mozell, Vice Chair

Kristina Sabetta, Secretary

Jason Bernstein, Treasurer

Jack Beveridge

Max Dine, M.D.

Sheri George

Emily Jenkins

Marcus Johnson

Barbara Lang

Karen Pitico

Clarke Romans

July 15, 2015

Mother May I?

Remember this game as a kid where we asked permission to take a step towards "mother" and win? Over the next few months, Arizona's Medicaid program (AHCCCS) will be engaged in an endeavor very similar to this childhood game as proposed changes to the program are submitted to the Center for Medicaid and Medicare (CMS) in the U.S. Department of Health and Human Services (HHS). Recall that the Medicaid program provides federal funds to assist states in funding medical and health-related services for low-income people in Arizona. Each state has relatively broad leeway to determine who is eligible for its program, as well as having some discretion in which benefits the program provides.

Arizona was the last state in the country to sign onto the Medicaid program, and has operated under what is called a Section 1115 waiver that allows the Secretary of HHS to waive some of the requirements of the Medicaid law if it's viewed as a way improve the program. Arizona has operated under an 1115 waiver since its inception since it has been a statewide managed care program and during the initial years not all services, such as long-term care, were provided.

The Arizona Legislature has mandated that waivers be sought that:
1. Institute a work requirement for all able-bodied adults receiving Medicaid services.
2. Restrict benefits for able-bodied adults to a lifetime limit of five years that begins on the effective date of the waiver or amendment to the current Section 1115 Waiver. The limit does not include any previous time a person received benefits.
3. Develop and impose meaningful cost-sharing requirements to deter non-emergency use of emergency departments and the use of ambulance services for non-emergency transportation, with differing levels based on whether the patient was part of the expansion population or below 100% of poverty.
4. Discontinue non-emergency medical transportation services.

That's a lot of change! We have found that CMS has approved some form of these waivers in other states, except for the lifetime limitation listed above. AHCCCS is developing the waiver language this month and will hold hearings around the state in August as required by federal law. Modifications may be made prior to AHCCCS submitting the waiver request to CMS in September (their "Mother May I?" request). In the past, CMS has been in discussions and negotiations with the state for weeks or months. Interested community partners may also submit comments to CMS based upon their remaining concerns over what is finally submitted by AHCCCS.

The waiver request is not yet public, and the dates and locations of the hearings have not been revealed. MHA-AZ will be posting those dates and locations on our website as well as links to the AHCCCS proposal. It is important that you share your concerns and ideas. We want to be assured the program remains viable and responsive to the needs of enrolled individuals and families. It's another great summer advocacy opportunity for you!!.

ACA 2 and 0

Many of us took a huge sigh of relief when the U.S. Supreme Court ruled 6-3 in the King v. Burwell case on June 25th. The decision means that participants in the ACA (Obamacare) can continue to receive tax credits when purchasing health insurance off the Federal Marketplace if they are eligible by income for the subsidy. Kaiser Family Foundation reports that 126,506 people in Arizona will continue to receive the subsidy with this decision, which translates to an average benefit of $152 per enrollee. An estimated 132% increase in premiums had been projected in Arizona if the subsidy been removed, making insurance unaffordable for many.

Chief Justice John Roberts in writing for the Majority said the subsidies "are necessary for the federal exchanges to function like their state exchange counterparts, and to avoid the type of calamitous result that Congress plainly meant to avoid." Those who wanted to erode the subsidy and the ACA claim that unelected judges have once again acted as legislators.

This is the second major decision in the history of the ACA. In 2014, the U.S. Supreme Court upheld the constitutionality of the ACA's individual mandate, which requires most people to maintain a minimum level of health insurance coverage, but the Court then found that requiring expansion of the Medicaid program was unconstitutionally coercive upon the states. To date we still have 22 states that have not expanded their state's Medicaid program.

Just a quick side note here, Arizona did expand the AHCCCS program which became effective on January 1, 2014. You do remember that expansion is being challenged and we'll have updates on that debate in next month's newsletter. Keep your fingers crossed yet again.

Are we out of the woods yet on the public debate about the ACA? That's truly doubtful. These outcomes could still be in the cards:

1) Repeal. There have already been over 50 attempts to repeal the act thus far and all have been unsuccessful. Many believe Republicans are hoping that a new President of their party would assume the White House after 2016 election making it easier to repeal the act.

2) Marketplaces failing. Some of the 13 states that opted to set up state-run marketplaces are encountering problems due financial and technical problems. New Mexico, Nevada, and Oregon have already handed over the toughest aspects of their operations to the federal IT system. Hawaii decided earlier this year to follow suit, and other states, including Vermont and Minnesota, are considering this option.

3) Rising costs. There are concerns that 2016 premium increases of as much as 30 percent in some states blamed on ACA could undermine the program. States are likely to block any premium increases of that size, and the average premium increase appears to be trending at somewhere between 4 percent and 6 percent. Perhaps a bigger problem for the law is the cost of deductibles - the amount patients have to pay before insurance kicks in. A study from the Commonwealth Fund finds that 31 million people are "underinsured" because they face such high deductibles and out-of-pocket costs.

4) Enrollment challenges. Expanding coverage is the main goal of the ACA and the administration faces a daunting goal, set by the Congressional Budget Office, of 20 million sign-ups by 2016, up from 10.2 million currently. Robust enrollment is important for creating the mix of healthy and sick that is needed to limit increases in premiums.

5) Another lawsuit. The legal challenges to the law are not over. Lawsuits are brewing in various lower level federal courts that may impact the law.

While this latest U.S. Supreme Court decision didn't necessarily drive a stake through the heart of anti-Obamacare litigation, according to the media, legal experts agree that it wasn't a great day for the law's legal foes.

But, today it's important to know that the tax subsidy enables over 126,000 of our fellow Arizona residents to purchase affordable health insurance on the Federal Marketplace and not be denied coverage.

Long-standing Crisis at ASH

Since 2013 KNXV (Channel 15) has been reporting on problems at the Arizona State Hospital (ASH). The litany of concerns that have surfaced include: inadequate security at ASH resulting in patients escaping and causing injuries to members of the public; failure of the staff to intervene when a patient engages in a physical attack on another patient; staffing shortages resulting in patients carrying out self-harm activities; failure to meet federal certification standards; ongoing concerns about staffing shortage and oversight; lack of adequate documentation of patient medical conditions; lack of cooperation with the Human Rights Committee assigned to work at ASH; alteration of records; failure of Adult Protective Services under the Department of Economic Security to respond to allegations of abuse or neglect at ASH; and concerns about abuse and neglect of patients. In June these issues resulted in the dismissal of three top staff from the Department of Health Services. You can view the

series here.

Governor Doug Ducey appointed retired Chief Justice of the Arizona Supreme Court Ruth McGregor to head a special investigation into the issues and problems at ASH. A date for the report has not been announced. Additionally, the Center for Medicare and Medicaid is also back at ASH conducting a review of the certification of the hospital.

ASH is Arizona's only publicly owned and operated mental health hospital. The monthly census for both civil and forensic patients was 232 in February this year.

As this story enfolds, MHA-AZ will report progress and actions that will be taken to resolve the issues described above. "We want individuals to be safe and receive needed services while at ASH," said MHA-AZ Board Chair Michael Shafer.

Meet a Board Member

My name is Kristina Sabetta. I'm a CEO, Licensed Masters of Social Work, advocate, volunteer, athlete, wife, mom, step-mom, home owner, landlord - and I live with a mental illness. I was diagnosed with depression at the age of 15 and diagnosed with bulimia at the age of 20, both had threatened my life. It was during my darkest days that I turned to God and found the strength to seek a new, healthy way of coping with my depression. At age 23, I obtained treatment and started my journey of recovery. My mental illness is just one part of who I am. It doesn't define me or consume me. I refuse to let it.

I have decided to dedicate my time, energy, and talents to what matters most to me: inspiring hope and saving lives. I am an advocate for change on many different levels: local, state, and federal. I empower members of our community to have a voice, and lend my voice to those who go unheard.

I am a nonprofit CEO with the skills, experience and passion to lead agencies looking to make an impact in their community. I have talent in steering agencies to a level of financial stability while maintaining a focus on their mission and purpose.

Prior to moving back to Arizona, I was the CEO of Mental Health America of Wisconsin (MHA). MHA is the state affiliate for the National Mental Health America, a large national advocacy organization. The organization is dedicated to improving the mental health of all individuals through advocacy, education and service. Under my leadership, MHA grew enormously and became a leader in mental health advocacy and suicide prevention.

Currently I serve as President and CEO of CHEEERS Recovery Center in Phoenix. CHEEERS serves members of our community who are struggling with behavioral health issues, including mental illness and substance abuse. Since I came on board in May of 2014, we have achieved great things. We've obtained additional funds, brought on 8 new programs, rebranded the agency, expanded our Center, increased our enrollment and increased our presence in the greater Phoenix community. Under my leadership, we will become a leader in the peer-run, peer-driven behavioral health care system.

As a volunteer, I serve on the following Board of Directors:

* American Occupational Therapy Association (AOTA), Board Member from October 2013 - present. AOTA is the national professional association established in 1917 that works to advance the quality, availability, use, and support of occupational therapy through standard-setting, advocacy, education, and research on behalf of its members and the public.

* Southwest Network, Board Member from January 2014 - present. Southwest Network is a 501(c)(3) nonprofit charitable organization that provides behavioral health services to infants, children, adolescents and adults, partnering with them, their caregivers and families to help them overcome the obstacles they face to live their best lives possible.

* Mental Health America of Arizona (MHA-AZ), Board Member from May 2014 - present

MHA AZ is the state's oldest organization dedicated to all aspects of mental health, mental illness and behavioral health disorders. MHA AZ's mission is "To promote the mental health and well-being of all Arizonans through education, advocacy, and the shaping of public policy".

Mental Health America of Arizona wants to again acknowledge the support of Janssen Pharmeutical Company for our activities. Corporate support is key to assuring there's a voice in the community.

We invite your participation and sharing of this newsletter by forwarding to your friends and colleagues. If they wish to receive the newsletter, encourage them to simply click on the link here. Let's share the word. Time to get involved.

Eddie L. Sissons

Executive Consultant

Mental Health America of Arizona | | sissons8@cox.net |

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