06/07/09 — State budget threatens mental health

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State budget threatens mental health

By Matthew Whittle
Published in News on June 7, 2009 2:00 AM

In May, Eastpointe Director Ken Jones said he was confident state legislators would do their best to protect mental health funding.

Today, as House budget writers are discussing slashing funding to local management entities, phasing out funding for community support programs and eliminating level two and three group homes for children, he is concerned that many mentally ill patients might end up going unserved.

"The projected cuts are deep," he said. "As the budget deficit grew, the more concerned I became. But while I'm not surprised that we're being cut, I am surprised at how deep they're looking. I know we have to take some cuts, but these are too deep."

Currently, the state is looking at a $4.6 billion budget shortfall, and the possibility of slashing the state's spending from the $21.4 billion originally budgeted for the current fiscal year, to between $17 billion and $18 billion for 2009-10.

In terms of mental health, Jones explained that means House budget writers are looking at cuts of more than $50 million to consumer services, $50 million to LME fund balances, and $7 million in LME funding, as well as a two-year phase out of Medicaid payments to community support programs and the elimination of Medicaid payments to level one and two group homes for children.

And, Jones said, it's not just mental health that's being affected. Medicaid funding for traditional rest homes, as well as physical therapy, occupational therapy and speech therapy also is being threatened.

All total, Jones said, the cuts to Medicaid services are estimated to be about $1.4 billion -- a number that reaches $3 billion when the lost federal matches are included.

"These cuts are bad for the economy, and they're bad for the people relying on these services," he said. "This is going to affect us. This is a crisis.

"There's not going to be some shifting of money around and minor reduction of services to people. People will go unserved if these services are cut out of the system. People will not get the services they need to be contributing members of society.

"The whole idea of mental health reform was to serve clients in the community, in the least restrictive settings, and we're beginning to see that pay off."

But if those community support programs are cut, he continued, many of those clients are likely to end up back in crisis and back in state facilities, local hospitals and even local jails -- effectively spelling the end of mental health reform.

"It'll end up costing the system one way or another, and it could end up costing more money, because once a client is in a crisis situation, more intensive care is required. I don't think cutting community support is really going to save the state any money in the end," Jones said. "I think it would create a different type of reform of mental health. It would be a new system, and I don't think it will be one that will be well liked."

And while he acknowledged that the community support program has had some problems with poor service definitions and overpriced and unnecessary care, he also said he believes that with the steps that have been taken to fix those problems, along with LMEs like Eastpointe receiving permission to handle the Medicaid billing themselves, the system is improving.

And so he is hopeful the end result won't be what's being described.

"I really am hoping that the House budget is worst-case scenario," he said. "We know there will be some cuts and we're prepared to take those and meet that challenge.

"I don't want for consumers to be scared. I really do believe the legislators will do everything they can to make the budget cuts as minimal as possible."

And, said state Rep. Van Braxton, D-Lenoir, and member of the House Mental Health Reform Committee, that's his goal, too.

"Right now everything is on the table," he said. "Everything is being looked at."

He explained that because "there's not much of an appetite for raising taxes" cuts will be unavoidable, but that he, too, is hopeful they won't be as deep as advertised.

"I don't think (community support services) will be cut, but I think they'll be scaled back," he said. "This budget crisis, this economic crisis, is not the end of the world. We need to do away with programs we don't need, but others, if you completely eliminate them, when things turn around and you have to restart them, that just puts you further behind. I don't see how we can do away with any large-scale program like community support, especially when we've already been cutting back our state facilities."

Braxton also questioned whether cutting community support services would be entirely legal since the federal Supreme Court decision in 1999 Georgia case of Olmstead v. L.C. and E.W. found that states are required to provide for mental health care in community settings -- something Jones agreed with, saying that any new system would likely require the approval of the federal Centers for Medicare and Medicaid.