Header, the Administration of the Honorable Lincoln C. Almond
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July 20, 1998


In accordance with the provisions of R.I. Gen. Laws § 43-1-4, I am transmitting herewith, with my disapproval, 98-S 2935, "An Act Relating to Mental Health, Retardation and Hospitals - Developmentally Disabled Adults."

This Act would create a new class of persons entitled to services from the Department of Mental Health, Retardation and Hospitals (MHRH) based solely on the fact that an individual has received "developmental, supportive, ancillary, or residential services for three (3) or more years immediately prior to referral to the department," excluding certain services provided to juvenile offenders. Under the Act, such individuals would be presumed to be both a "developmentally disabled adult" and an "adult with serious mental illness" for purposes of qualifying for entitlement to MHRH services. This presumption would be rebuttable under the Act only "by clear and convincing evidence to the contrary." This Act is essentially the same legislation that I have vetoed in previous legislative sessions.

This Act attempts to address difficulties that have arisen when children under the care of the Department of Children, Youth and Families (DCYF) become 21 years of age and must qualify under different criteria applicable to the adult system. In some instances, an individual who has received intensive treatment through DCYF as a child has been found ineligible for MHRH services by failing to satisfy eligibility requirements for such services. These circumstances can produce a harsh result in which an individual dependent on the State for treatment becomes ineligible for further services solely by reason of reaching adulthood.

Unfortunately, the solution prescribed by the Act goes much too far. For those individuals qualifying under the Act, federal eligibility criteria governing MHRH services would be tossed aside and replaced with presumptive eligibility which could be disproved only upon clear and convincing evidence. Such presumptive eligibility is provided under the Act not only to those persons in intensive, residential DCYF care, but also to those receiving "developmental, supportive, [and] ancillary" services for three years immediately prior to referral to the adult system. This leads to an incongruous result: individuals who have received counseling or other non-intensive services for three years would be "presumed" to be both "developmentally disabled" and "seriously mentally ill" irrespective of the individual's actual clinical condition.

In early 1997,1 established a Study Group to address this issue of the transition of services between DCYF and MHRH. The Study Group recommended that DCYF, with assistance from MHRH, should continue its practice of identifying individuals who will need services as adults but are not eligible for MHRH services and orient their cases towards rehabilitation and transition into the community. The Study Group also recommended that a pilot program should be established for a duration of three years in order to purchase additional services to respond to the most critical needs of this population after age 21, with services approved by both DCYF and MHRH, subject to appropriation. This pilot program, however, would have been costly: the Study Group recommended $225,000 for the first year and indicated that funding would need to be increased significantly each year as new individuals age out the DCYF system and join those already under the program.

The presumptive eligibility provided under the Act is far more expansive than the limited pilot program recommended by the Study Group. Unlike the proposed pilot program, individuals deemed eligible under the Act apparently would be entitled to services. Since the threshold for eligibility under the Act is relatively low, a large number of individuals could be deemed eligible for services, and the fiscal impact of this legislation could reach into the millions of dollars within a relatively short period of time. Moreover, the cost of services likely would be entirely state-funded since the individuals presumed eligible would not meet federal eligibility criteria and, therefore, would not qualify for Medicaid reimbursement. Importantly, the General Assembly failed to include any funding for the services required to be provided by MHRH under this Act. If this Act becomes law, I fear a diminution of services to persons who actually meet MHRH's traditional eligibility criteria, since there could be new persons eligible for services but no new funding.

Furthermore, MHRH currently provides programs and services only to those clinically determined to be developmentally disabled or seriously mentally ill. The Department does not currently offer services to individuals who may have some other condition and would now need to develop new programs to serve this new population.

For the foregoing reasons, I disapprove of this legislation and respectfully urge your support of this veto.


Lincoln Almond