you you you you you you you you you you you you you you you you you you you you you you you you you you you Good morning, good people. We are here to discuss two items on the agenda before the Health and Human Services Committee. I am, course joined by my colleagues and friends, Council Member Sales and Lutki. And the first item we will be discussing this morning is Supplementary Appropriation 2533. On the fiscal year 2025 operating budget. And this is for the Department of Health and Human Services, State, opioid response, IV grant, for grant, $1,299,883. Source of funds is state grants. I will now turn it over to our incredible team to tee this up and walk us through this particular packet. Good morning, thank you and I'll invite our counterparts from DHHSN OMB to the table. And thank you for all of your time and help as we develop this Council staff report for today's session. As Chair Arbano has mentioned, we have a supplemental appropriation of the $1.3 million for the state opioid response for grants. And this is the fourth iteration of the SOAR grant, SOAR, SOR. And if you'd like to see the expenditure breakout of the previous three, you can find that on circle page four as well. As noted, this is a state grant. However, council staff wanted to bring some issues up to the committee before a review and to provide a recommendation to the council. In 2019, the Maryland General Assembly passed legislation requiring local correctional facilities to conduct mental health and substance use assessments of each and me to determine if medication assisted treatment or MAT was required. So this SOAR 4 grant aims to bring the county's MAT program up to the mandated MAT minimums in standards of care and licensing requirements. Specifically, the grant will be used for new positions and as well as service delivery operations. The positions include a new therapist, four new community health nurses, and one existing community services aid. The service delivery funds will be used for the MAT treatment including screenings, examinations, behavioral health treatment, and reentry plans for the eligible offenders with the diagnosis of the opioid use disorder. In the most recent full grant year, which was October 2023 to September 2024, the correctional facility-based map program, number of clients served doubled to 137 clients, and about three quarters of them were identified as male and the remaining female. We have a race breakout too by those clients with about 50% identifying as white and the 47% identifying as African American. While this appropriation is funded by state grant and should not have an impact on FY25 General Fund Reserves, we did wanna note that the state is the past due agency for what are actually federal funds. As we know, the federal fiscal climate is in a new environment and has threatened the reliability of federal funding. So we wanted to identify potential funding contingencies of that funding where to become unavailable. DHHUS noted that they would explore additional grant opportunities or a new allocation of state opioid abatement funds if the funding became unavailable. And you'll note that on February 7th, 2024, the committee, along with government operations, did recommend approval and the council approved $3.1 million and state opioid abatement funds. While the Office of Racial Equating Social Justice Impact Assessment is not available at this time. We do note that the council will have a public hearing on the supplemental on March 11th with action scheduled at a future date. And so council staff will be sure to include that assessment and identify any conclusive findings for the committee and council at that time. And council staff recommends approval of the supplemental. Thank you very much for that overview. Yeah, sadly this is probably going to be a recurring theme of us having to think through creatively what happens at the end of the funding cycle given all of the changes that we're seeing at the federal level. So Miss Barton just wanted to give you an opportunity to talk a little bit more about this particular grant and then some preliminary discussion about what we do once these funds have expired and what transition plan there may be out there. Thank you for that opportunity and consider the record Monica Martin Chief of Behavioral Health and Crisis Services. As stated in the packet, I just want to reiterate it, you know, at these time, these are mandated services, right? The state does require us through legislation to provide these services. And as you've heard, there's been different iterations in various years of grants that we've received, cycles we've received for these funds. And the reality is that they were initially stood up with our existing outpatient medication assistant treatment team and very quickly at least to get the medication, the assessments and medication available to our residents in the correctional facility. But with the contracted positions that have been in the prior iterations of these grants, it's been very difficult to recruit and retain some of those positions. So this particular request is particularly critical because these new positions, some of which are replacing contractual positions are needed to be able to recruit and retain some of those folks. This is a very important partnership with our Department of Corrections 40. We know that our inmates are at higher risk, much higher risk of opioid overdose and death due to overdose upon release from the correctional system at a rate of 40 to 129 times, more likely to experience death due overdose upon release. So, you know, we have the choice, but to move forward and to do this great work, understanding that, as you said, yes, there are funds here that are at risk. I will say that just yesterday our manager for these services did share that we did receive notice of funding for the first quarter of FY26, moving forward as well. So it's probably going to be a piecemeal as it is for a lot of these funds that we did receive notice of funding for the first quarter of FY 26 moving forward as well. So it's probably going to be piecemeal as it is for a lot of these funds that we rely on our federal government for but we do have some possible alternatives and of course we're exploring them as council staff mentioned. And so with this particular service again even of our funds where we do so we'd be able to maintain a basic level of care to provide those medications. We may not be able to maintain the gold standard of care for the full treatment protocol, because medication-assisted treatment is not just about providing medication. It's about a comprehensive assessment. It's about thorough treatment and follow-up care as well. Well, thank you for that overview. I didn't have any additional questions. I don't know if colleagues did. I think without objection then we will support this recommendation. Great. So that takes us to the second item which is supplemental appropriation 2523 to the fiscal year 2025 operating budget for the Department of Health and Human Services, behavioral health crisis stabilization center, and mobile crisis team pilot in the amount of little more than $2.9 million. Source of funds is state grants. Once again, turn it over to colleagues to talk about this one. All right, thank you. And this is our second state grant we are reviewing today. This is focused, this money is focused for behavioral health and crisis services and residential crisis services, which of course has the goal to stabilize individuals in the least restrictive community-based setting using services appropriate to the client situation, which can include telephone, walk-in, mobile crisis outreach, screenings, referrals, and the crisis residential services, experiencing situational, emotional, or mental health crises. Currently, the Montgomery County Crisis Center has four residential crisis service beds with a 72 hour maximum use period, but concordant hospitalization when needed. In addition, we are, DHS is opening a second center, which will serve and provide an alternative to incarceration for individuals ages 18 and older who have committed a minor nonviolent offense in our experiencing a behavioral related issue. The current crisis center on Pickard Drive will be available for youth as well as the only center for youth and for walk-ins. In addition, this funding will support the crisis center mobile crisis outreach team services, which as we know, to respond to community behavioral health emergency 24 hours a day, seven days a week, providing crisis evaluation and helping to stabilize the individuals and making referrals as needed. The committee has met several times on this topic, most recently on September 26, 2024, and where they received a very comprehensive update on the county's crisis services response. The executives requested $2.9 million appropriation will be used to increase the capacity in reach of services through additional staff and the development and implementation of the stabilization room and MCOTs within the crisis center services and preparation to become licensed programs eligible for reimbursement through Medicaid. Specifically, the grant funds will be used to support enhanced comprehensive and effective care operations at the Behavioral Health and Crisis Service Center facility on Pickard Drive to meet the new 2024 Code of Maryland regulations or KOMAR requirements. In addition, they note that the crisis stabilization room, which opened in in 2023, has served an admitted number of 409 individuals with about 60%, identifying as male and 38% identifying as female and 1.5% identifying as transgender. As well as the crisis services center facility, the crisis outreach teams will receive grant to enhance their service delivery of the existing seven operational services in teams. And the packet includes on page three identification of the number of residents receiving a completed MCOT or crisis outreach team comprehensive assessment with about 1,994 individuals in fiscal year 24. The supplemental appropriation also includes the addition of 25 new positions and the details of those positions in the component and role can be found on Circle Page 5, but they note these positions will help reduce the barriers to accessing care and increasing timely interventions to prevent crises from escalating. Finally, Council staff also wanted to note the fiscal impact of here of this appropriation as well. And while it is a state grant and should not have an impact on FI-25 general fund reserves, as noted, the funds will help support the program to become eligible for reimbursement through Maryland Medicaid. And as we know on February 28th, the U.S. House of Representatives passed a budgetary resolution which proposes over time a $880 billion cut in Medicaid. We know that we'll have a ripple effect through many, many programs, but to the timing we wanted to mention that specifically for this meeting as well. Maryland state lawmakers are already preliminarily discussing those fiscal impacts of the cost sharing agreement where to shift between federal and state and the potential eligibility restrictions that may have to occur on the state level for Medicaid as well. Thankfully Maryland does not have a trigger law that would automatically move to end. The expansion of coverage for Medicaid or takes steps to mitigate those increases in state costs. But we did want to note and DHS also explains that the statement of work and conditions of this award for this grant were written prior to the federal administration change and transition. However, if they were to be impacted by decreased Medicaid revenue projections, DHS believes these services are sustainable through fiscal year 26. In addition, the positions that were identified are funded by, will be funded as grant term funded or contractual only. And we are also waiting for the racial equity impact assessment on this. Supplemental and included in future packets and council staff recommends approval. Thank you. Great, thank you. So I know all three of us had the opportunity to tour the crisis center last year and each of us were really impressed and excited that this additional service and amenity would be available to our residents and it's heartening to hear that many of them are taking advantage of it. Obviously, it's a huge challenge in a number of different levels but having this tapestry of different programs and services is critical. Miss Martin, did you want to talk about this particular supplemental appropriationation at a high level or micro level however you'd like to approach it? Thank you for the opportunity I could talk about it at all levels all day. However, however I just want to thank you for coming to tour last year. Thank you for your support. As you know this is one of many components of our evolving coordinated system of care for behavioral health crisis supports across the county. It's a critical piece. Again, it's another must have. We're very excited to be looking forward to extending the service to youth specifically and to having a youth and family focus space that's centered on their needs. And to be able to, in the future, coordinate with law enforcement to be able to facilitate a diversion from the criminal justice system, even in advance of the diversion center facility opening up at 7 Locks Road. So, so just thank you for the opportunity. Again, I could say so much more, but I know that we have your support and we know that we have to to keep working on contingency planning. This is again an area that's a focus and party for HHS, for our director for the executive. So we will find a path forward one way or another. Yeah, and just at a high level, it's not a done deal. The house still has to go through the Senate and there will be a budget resolution. So I think we have to do a full-core press as best we can. We are fortunate to have our delegation who is very much behind us and extremely supportive national leaders on this and many other issues. But we have to encourage their colleagues on the other side of the aisle to understand the importance of this. This should be a bipartisan issue. It's crazy that this is being caught up on so many things as partisan, because it impacts every part of the country, every zip code, no matter what your socioeconomic status is. So it's infuriating that we're even having to consider the kinds of reductions that are going to have to be made. But here we are. So with that rosy outlook, I turn it over to Councilmember Sales, who had a question or a comment. Thank you so much for all the work that you're doing during these difficult times. We are calling on you more now than ever before. I don't want to think about worst case scenario, but I have to think about worst case scenario. So what would happen to a program like this if we weren't able to recoup the funding post fiscal year 26. So because this is a licenseable service and it's a billable service, the answer to that question is the same answer that you would probably hear from many of us around any licenseable and billable service, right? It's not unique to this specifically. So while there are certain, there've been certain grant opportunities available to federal and state level to get these services up and running, the intent is the original intent was of course that they would be sustained through Medicaid fee collections and other fee collections as needed. So we really don't know what that forecast looks like, right? We're all on the same boat and scrambling at what we could do, realistically here, because this particular stabilization unit is, I'm going to say relatively, it's not that the dollars and cents are our minimal but relatively small. We have four adult recliners at this moment. We are expanding to be able to have four youth recliners as well. We may have some other options through some other funding sources, through some foundation opportunities that we've been looking into as well, in the private sector potentially through hospital investments. You know, I don't want to get ahead of right? Anything that is set in stone or that is actually a plan from a fiscal forecast perspective, but sustaining this particular operation could be more feasible than the larger scale and entire project. Should we have to put the brakes on anything due to not being able to have providers or the county bill for the service? So that's what I can share in response. And I know that there was mention of creating maybe changing the criteria of who's eligible and making that shift to the state level. Is anyone in your department involved in any committees or advisory boards to the governor? Religate. I don't think I'm interested in the question changing the criteria for eligibility for Medicaid. Oh, for Medicaid and just to serve the greatest amount of folks. Excuse me. Yeah, absolutely. Certainly, our legislative analysts, we provide statements and all kinds of information and data, impact statements to them. So we work with our office of Intergovernmental Relations for those messages to be sent to the state level. Yeah. All right, thank you. Thank you. I just wanna highlight and elevate what you've said about trying to be able to, even if we don't have the Restoration Center online yet, being able to do our best to try to stabilize folks and why that's so important, right? Because for individuals who may be charged with a nonviolent misdemeanor offense, they can't actively participate in their defense and be part of their court process. If they require stabilization, that got to come first. And so thank you for that. And also, again, noting the ever shifting landscape in which we live. And we are all finding ourselves that I appreciate your attention to figuring out how we could be fluid or adaptable as things evolve. So, you know, certainly I support this and I hope we have more past through funds that will continue to be available to allow for us to do the work we do well here in Montgomery County. But know that we are always here to be partners to you in that work and in figuring out how to adapt in order to make the best of the hands we are dealt and move forward. So thank you. Thank you very much. All right so I think with that objection then we support disproportion, the recommendation for this appropriation as. Thank you, and I'll see you later, David Smartin. We're on a panel discussion together in DC. Thank you, so we are a little bit early because we next have a joint education and culture session. So why don't we just break for the next seven minutes or so and then come back when our colleagues from education and culture arrives? So this committee session is adjourned. Thank you.