Are Utah's mentally ill getting short shrift?

Advocates say Utah lawmakers lit the fuse on a time bomb and planted it at the doorstep of families, hospital emergency rooms and the correctional system in their refusal so far to fund a $3 million shortfall affecting community mental-health centers.

"I don't know whether to laugh or cry," said Vicki Cottrell, head of the National Alliance for the Mentally Ill, Utah. "I'm just amazed."

Cottrell's reaction comes after the House and Senate released lists of their funding priorities. Each chamber had $2 million to divvy up among various needs, including $1 million in ongoing money and $1 million in one-time funds, for a total of $4 million to satisfy requests not yet approved in a draft of the 2006 fiscal year budget.

The hope was for $3 million to partially plug a shortfall in Medicaid dollars directed to community mental-health centers. The Senate approved $500,000, while in the House, the request didn't even make the cut.

"I guess we should say we are grateful," Cottrell said. "But it is like leaving a nickel as a tip for the waitress."

The federal shortfall comes as a result of a rule change, which essentially eliminated much of the wiggle room for community health centers to deliver services to people who are not Medicaid-eligible but lack insurance or can't afford the high price of private care for mental illness.

Previously, the centers could collect one Medicaid dollar for services to Medicaid patients, even though the actual costs were only 93 cents. The remaining 7 cents of "profit" could then be used to expand services in the community, including offering help to those who are not Medicaid-eligible.

As a result of the funding change, advocates predict 4,300 Utahns will be cut off from community mental health services, including 800 children.

"They say it is a problem for the federal government or the counties, but because they are in a tug of war, does that mean 4,300 people have to suffer?" Cottrell said.

What particularly stings this session for advocates is the $120 million in new money directed to roads, which they concede are an important need.

"But is it 40 times more important than the needs of people getting cut off from services?" said Judi Hilman, health policy analyst for Utah Issues, a human services research and advocacy center.

Warnings about the mental-health funding crisis emerged in the 2004 session, and the rallying cry has gained momentum this session, eliciting support from the counties, the Utah Hospital Association and the Department of Corrections.