Block Grants Respond to State Needs

By Kristin Engdahl

By 2014, 32 million more people will be eligible for health coverage through the Affordable Care Act, spelling big changes for the behavioral health field. Qualified providers will be in greater demand, while state budgets remain tight and decisionmakers will be pressed to allocate resources toward the most successful substance abuse and mental health services.

In this environment, SAMHSA's block grant program is providing a lifeline to states that are already planning ahead for this new reality. Recent changes to the applications for SAMHSA's Substance Abuse Prevention and Treatment Block Grant (SABG) and Community Mental Health Services Block Grant (MHBG) were rolled out earlier this year to address emerging needs.

These changes reflect the need to expand the block grants' reach to focus more heavily on low-income populations and the uninsured, including people and services not covered by health reform. They also streamline the application process so that states whose mental health and substance abuse offices overlap do not have to complete separate application forms. The new application process focuses on ensuring the sustainability of these successful behavioral health care programs, while ensuring that the needs of states are met by providing a flexible, biannual application system.

The block grants are designed to provide a safety net for people who do not have health insurance — even for short periods of time — by funding priority prevention, treatment and recovery support services specifically for those in need. They focus on services that will not be covered by Medicaid, Medicare, or private insurance through health exchanges. Future funds can be used for broader prevention and recovery support services as needs evolve. The new block grants are also designed to provide a reliable source of funding for primary substance abuse prevention activities.

"Changes in health care delivery structures, rapid adoption of health information technology, scientific advances in prevention and treatment services, growing understanding of recovery, and implementation of the Mental Health Parity and Addiction Equity Act and the Affordable Care Act will greatly enhance access to prevention, treatment, and recovery support services nationwide," said SAMHSA Administrator Pamela S. Hyde, J.D. "These changes also present opportunities to establish the role of the block grants as critical underpinnings of the public substance abuse and mental health service systems, drivers of quality and innovation, and essential resources for transforming health care in America, especially in difficult economic times."

In all, SAMHSA will provide nearly $1.9 billion in FY2012 to help states address behavioral health problems through its block grants. These significant resources are designed to give states the flexibility to design and implement behavioral health programs and fund targeted prevention activities that meet the needs of their communities. In alignment with the National Prevention Strategy (PDF 4.7 MB), the new block grants are designed to foster healthier, safer community environments; ensure the availability of community preventive services; empower individuals to make healthy choices; and eliminate health disparities.

The grants support best practices by going toward proven services that have demonstrated success in improving outcomes or supporting recovery. In addition to funding treatment and support services, they fund a range of prevention efforts and help states collect outcomes and performance data to determine which prevention, treatment, and recovery support services are most effective.

Implementing smart strategies for making the most of such vital behavioral health services is more important than ever, according to Administrator Hyde, particularly in this time of budget cutbacks. Reforming the block grants now to better empower states, positions these resources as a critical component of our future health system.

Streamlined Application

Until this year, states have had different structures for applying, accepting, planning, and accounting for the two block grants in their budgets. With SAMHSA's new streamlined application, which was issued in July following a public comment period, states and territories had the option to submit one coordinated plan for both block grants — covering both mental health and substance abuse services — by September 1, 2011. Alternatively, applicants could submit separate applications if preferred, with the final application for the SABG due by October 1, 2011 and the final application for the MHBG due by September 1, 2011. A total of 22 states and 2 territories took advantage of the opportunity to submit a combined application.

For the first time, this year's application enabled states and territories to apply for two-year grants (FY2012 and FY2013), eliminating the need to submit a new application each year. The new application process was largely well received during the public comment period, with more than 770 comments from 522 individuals and organizations.

Increased Planning and Performance Evaluation

The redesigned block grant application helped states explore how to adapt their behavioral health systems to best meet their needs over the next few years. The types and levels of behavioral health problems that states confront vary widely, according to SAMHSA's report, State Estimates of Substance Use and Mental Disorders from the 2008-2009 National Survey on Drug Use and Health. These differences mean it's critical for states to prioritize their needs to ensure that block grant funds are used where they are most needed.

To assist states in their planning, the block grant application included guidance on conducting a needs assessment and developing a plan to identify and analyze the strengths, needs, and priorities of their behavioral health systems. It also encouraged states to form strategic partnerships, develop collaborative plans for health information systems, increase their focus on recovery services, describe their work in consulting with tribal communities, and focus their block grant programs on improving accountability for the quality and performance of services they provide.

"No state is free from the unique impact of mental and substance use disorders," Administrator Hyde pointed out. For this reason, she noted that "data like these give states the information they can use to target their prevention and treatment activities for the greatest benefit to their residents."

Just as important as the planning phase is determining the results of federally funded programs and their outcomes in reducing the impact of substance abuse and mental illness on America's communities. SAMHSA's new grant process places a heavier emphasis on performance evaluation and monitoring, setting dashboard measures for grantees to show the effects of their programs. This focus on evaluation aligns with SAMHSA's Strategic Initiative 7 — Data, Outcomes, and Quality (PDF 82.5 KB) — which strives to realize an integrated data strategy and national framework for quality improvement in behavioral health care. This framework will inform policy, measure program impact, and lead to improved quality of services and outcomes for individuals, families, and communities.

Applications for FY2014-FY2015 block grants will be due April 1, 2013. For more information on SAMHSA Block Grants, visit: http://www.samhsa.gov/grants/blockgrant.