The Department of Mental Health and Addiction Services budget before the Legislature takes a giant step backward. It cuts off state grant funding to community agencies for providing outpatient mental health and detox clinical services. The patients who will be denied are those who need these services the most. How can this be? In the light of the Sandy Hook disaster, how can this make sense?
I am a volunteer member of the board of directors of BHcare, the local mental health provider for the eastern Shoreline towns and the Naugatuck Valley. CMHC in New Haven and Bridges in Milford have similar missions. In our case, we have some 2,000 uninsured psychiatric clients receiving clinical outpatient services. About 200 new clients come in each month. These clients include those suffering from serious mental illness, such as schizophrenia and bipolar disorder, and those with drug and/or alcohol addictions. Some are very fragile; some desperate; some only tenuously holding their own. If the community agencies cannot provide clinical services, there is no option for them except hospital emergency rooms, many of which are already overcrowded, are two to three times more expensive, and are not really necessary in many cases.
That this state action comes on the heels of a broad and constructive post-Sandy Hook dialogue on the need to strengthen the mental health safety net is a cruel irony. The trigger was the Obamacare provision expanding Medicaid to cover some of the cost of these services as of Jan. 1, 2014. As a condition, the law also requires those eligible to take those active steps necessary to enroll in Medicaid and/or the insurance exchange and pay the necessary cost. The state has seized on the mere effective date of the law as sufficient to terminate grant funding for clinical services. This is wrong on two counts.
First, note that the Medicaid payment scheme does not automatically come into effect on Jan. 1, 2014. It is dependent on the enrollment of and payment by the intended patient. Experience in Massachusetts suggests that it may take several years to conclude the enrollment of (and payment by) a substantial number.
Moreover, Medicaid is no promised land for the community agencies. It appears that it will only pay about half of the costs. Clearly, something needs to be worked out on this a point alone.
The law is there, and BHcare knows that we will have to learn how to adapt to it. But it was never anticipated that State grant funding would be cut off long before the Medicaid substitute can even start to replace it. What is needed is time and study: a gradual process needs to be worked out to relate the Medicaid enrollment of the target population to the withdrawal of State grants for community-based clinical services. That would make sense. At the same time, it has to be recognized that the current Medicaid rate itself is inadequate for the purposes, and this needs to be addressed; it would leave too big a hole in the safety net.
Richard G. Bell
Hamden