Winter 2004

• Highlights of the Mental Health/Aging Advocacy Project, 2003
• Comprehensive Plan Moves Toward Commitments
• Medicare Bill Is Adopted, Budget Is Passed, PACE Is Expanded
• State Matters: Expanded PACE
• Rally Succeeds/Budget Passed
• Passing the Torch
• Thanks for 2003
• Announcements

Winter 2004

Highlights of the Mental Health/Aging Advocacy Project, 2003

2003 has been an eventful year, with many events to improve behavioral health care for older adults. Some of the results:

• Launched "Don't Leave Me Out," which raises awareness of the mental health needs of older adults in long-term care facilities. In the past year, it has reached hundreds of such residents.
• In a year with tremendous pressure to cut budgets, successfully advocated to maintain current levels of funding for mental health programs for older adults.
• Successfully advocated to have Philadelphia City Council conduct a public hearing to address the lack of mental health services for older adults in Philadelphia; and worked with Council Member Blondell Reynolds Brown to organize the hearing.
• As a result of the hearing, participated in a workgroup to plan for the expansion of mental health services to the whole city and the integration of mental health services, aging services and health services.
• Held successful events, such as a Public Awareness Day and a Rally for Older Adults.
• Successfully advocated to have Community Behavioral Health (CBH) purchase and distribute 25,000 copies of the Mental Health and Aging Resource guide.
• In collaboration with the Pennsylvania Mental Health and Aging Coalition, succeeded in getting the Pennsylvania Office of Mental Health and Substance Abuse Services to revise its guidelines to require counties to report how they will identify and provide services to older adults.
• Began a collaborative project with the Positive Aging Resource Center at Brigham and Women's Hospital in Boston to provide consumer input on the development of educational materials for older adults
• The Mental Health and Long-Term Care Task Force of the Delaware Valley Mental Health and Aging Advocacy Committee held four trainings in spring and fall to teach direct-care staff how to work with older adults with mental health problems.
• Conducted mental health education/ advocacy training sessions at 25 senior centers/residences throughout Southeastern Pennsylvania.
• Trained over 230 older adults through mental health education/advocacy trainings.
• Held a successful conference on Mental Health and Long-Term Care for over 125 participants.
• Sent out a quarterly newsletter to over 700 older adults and advocates.

We expect more in 2004!

Comprehensive Plan Moves Toward Commitments

The efforts of older adults and advocates to improve access to appropriate geriatric mental health services for older adults in Philadelphia could take a big step soon.

A plan to expand mental health in-home services and to integrate mental health, health and aging services is near completion after much work that included representation from providers, consumers, HMOs, the Office of Behavioral Health (now the Office of Behavioral Health and Mental Retardation Services), Community Behavioral Health (CBH), and the Philadelphia Corporation for Aging (PCA). The committee received its instructions from the Health and Human Services Committee of the Philadelphia City Council after a public hearing on May 12 at which many testified on the need to improve access to geriatric behavioral health services in the city of Philadelphia.

The plan proposes, in part, to expand mental health services to homebound older adults. The public hearing highlighted the fact that mental health mobile programs for older adults currently cover only half of the city.

The program will also initiate a pilot project in South, West and Southwest Philadelphia. The pilot will begin by developing a broad-based coalition of stakeholders - including consumers, community groups, senior organizations, senior centers, health organizations, mental health services, primary care physicians, and faith communities - that will reach out to older adults and collaborate on caring for them. A call center will be established that will screen older adult referrals, help older adults navigate multiple service systems, and follow up to insure they are getting the help they need. A team of caseworkers will be available to help those who need more intensive help.

If the pilot proves effective, it will be expanded to other areas of the city. It will use modern technology, including telemedicine, for the many homebound older adults who have multiple problems.

The next move is to get the support of all the leaders of the systems, including the aging, health, insurance, and behavioral health systems.

Medicare Bill Is Adopted, Budget Is Passed, PACE Is Expanded

The Prescription Drug and Medicare Modernization Act of 2003 was signed on November 25, 2003. This controversial bill offers some relief from high prescription drug costs and makes some significant changes in Medicare. Unfortunately, it still hasn't changed one of the most discriminatory aspects of Medicare: the 50 percent co-payment for outpatient mental health services.

Most changes don't go into effect until 2006. However, the most immediate change will be the Medicare-approved drug discount card that will be coming out in the next few months. Here are some important facts:

• Discount cards will be available to individuals entitled to Medicare benefits or enrolled under Part A or B, and not entitled to any Medical Assistance (Medicaid) for outpatient-prescribed drugs or for discount cards due to enrollment under Title XIX or under an 1115 waiver.
• The cards will sell for up to $30 per year. Each beneficiary may have only one card per year. The cards will be issued by regional and national pharmacy chains, insurance companies and pharmacy benefit managers. (There will be an exception for someone who moves to a different service area.)
• If individuals are enrolled in an HMO and that HMO offers an endorsed discount program, then those individuals may only enroll in that particular plan.
• Persons whose income is not more than 100 percent of poverty and who don't have coverage or assistance for covered discount card drugs under a group health plan, health insurance coverage, insurance related to uniformed service or the Federal employees' health benefits program will be able to get a card for free, and 95 percent of their drug costs will be covered. Such individuals are termed special transitional assistance-eligible individuals.
• Persons whose income is not more than 135% of poverty who don't have coverage or assistance for covered discount card drugs under a group health plan, health insurance coverage, insurance related to uniformed service or the Federal employees' health benefits program are called transitional assistance-eligible individuals. They will be able to get a card for free, will get 90 percent of their drug costs covered, up to $600 for costs in 2004 and up to $600 for costs in 2005, including the leftover from 2004.
• Cards will offer a discount on the purchase of prescription drugs. This may or may not be better than provided by the current cards. In addition, the coverage could change throughout the year.

Suggestions:

• Don't immediately give up your current benefits since the Medicare program won't begin until 2006. If you have employer-sponsored health care coverage, hold on to it; this is the gold standard of coverage for seniors. If you have PACE, keep it; it is probably better than the Medicare prescription benefit. With regard to the discount card, keep and use your current discount cards. They may be better than the Medicare Card.
• Don't be confused by fake cards or "Medicare endorsed" cards: the real cards are scheduled to be issued in June. Also, this benefit is not insurance; it is just until the new program begins in 2006.
• You will need to make a list of all the drugs you take, and then see the price each card offers for those drugs. All providers and their prices will be listed at www.medicare.gov.
• Take advantage of organizations that provide counseling and information if you have questions. See the Mental Health and Aging Resource Guide.

State Matters: Expanded PACE

On November 26, Governor Rendell signed a bill that will expand the Pharmaceutical Assistance Contract for the Elderly (PACE) program for some 115,000 older adults in Pennsylvania by raising the income limits to $14,500 for individuals and $17,700 for married couples. It will also boost the income cap for PACENET to $23,500 for individuals and $31,500 for couples. Persons in PACENET will be able to get benefits after the first $40 a month of prescription costs. Previously, benefits began only after a participant spent $500 in a given year. About 225,000 people are currently enrolled in the PACE and PACENET programs.

Rally Succeeds/Budget Passed

On November 19, about 3,000 people, including many from the Senior Advocacy Team, gathered on the steps of the Capitol building in Harrisburg to demand that cuts in funding for mental health and substance abuse treatment be restored. After the rally, which was spearheaded by the Mental Health Association of Southeastern Pennsylvania (MHASP), they visited their state representatives, telling them that money for these human needs is well spent. As one leader pointed out, every dollar spent on treatment saves $7 in other costs such as health care, employment losses, children and youth services and the criminal justice system.

Hikmah Gardiner reminded legislators to live up to the promises they made when they took their oath of office. She challenged them not to betray the people they promised to serve for "30 pieces of silver."

The pressure led to the legislators passing a budget in December that restored most of the cuts, although it was six months overdue. However, don't throw away those signs yet: predictions are that this year's budget may be tougher than last year's.

Passing the Torch

Hikmah Gardiner is stepping down as president of MHASP's Senior Advocacy Team (SAT) for Mental Health and Aging after serving for a year.

Gardiner, considered by many to be an institution, has been involved in the mental health arena for over 45 years and is a staunch advocate for the rights of older adults. As the first president of a newly formed advocacy group, she was in many ways charting new territory. Under her leadership, the SAT had a productive 2003.

As a member of a coalition to provide better mental health services for older adults, Gardiner represented SAT at the City Council budget hearings (see Page 1) with such notables as Geneva Black, executive director of Haddington Multi-Services Center. SAT was a leading force in the City Council hearing on the lack of mental health services for many homebound older adults. In addition, Team members helped organize Public Awareness days at City Hall. Their participation has taken them from the state Capitol in Harrisburg to the halls of Congress in an effort to improve the lives of seniors. They have also taken a stand against the high cost of prescription drugs and supported raising the Medicare co-payment for outpatient mental health services to 80 percent.

We acknowledge Gardiner's fine leadership as she passes the presidency to another capable SAT member, Nickey Donlen. Gardiner will remain on the Board and is part of the work group that is developing a comprehensive plan for mental health services for older adults.

Thank you, Hikmah Gardiner: Rock on!

Thanks for 2003

We are most grateful to the following groups for financial and technical assistance support this year: Philadelphia Office of Mental Health, The Catholic Campaign for Human Development, Eli Lilly and Company, National Mental Health Association, Bread and Roses, Pfizer, Scolnick Family Foundation and the Mental Health Association of Southeastern Pennsylvania.

Announcements

Geriatric Counseling program is looking for people to fill two positions in Philadelphia. Contact Misa Romasco at 215-487-1990.

Senior Advocacy Team Meeting, February 3, 2004, 1PM-3PM, at MHASP, 1211 Chestnut Street, Philadelphia, 12th floor.

Delaware Valley Mental Health/Aging Advocacy Committee Meeting, February 12, 2004, 2PM-4PM, at MHASP, 1211 Chestnut Street, Philadelphia, 12th floor.

Mental Health Email Service: Provides email contact among advocates, providers and consumers around the country on mental health and aging issues. To join email: tvolkert@mhasp.org.