Politics of health care reform, cuts impact mental health, substance abuse treatment

Published: Friday, Sept. 20 2013 6:30 p.m. MDT

Wendy Stilson, program director at St. Marys Center for Recovery, walks through a bedroom at the center in Salt Lake City on Friday, Sept. 20, 2013. There are six empty beds that cannot be filled due to lack of funding. St. Marys Center for Recovery is a residential substance abuse treatment facility designed to help clients overcome addictions and transition to independence, security and good health.

Laura Seitz, Deseret News

SALT LAKE CITY — There are six empty treatment beds at St. Mary’s Center for Recovery, something treatment services director Wendy Stilson doesn’t like to see.

It means someone is lingering on a waiting list for the 40-bed facility but there is no available funding to fill the slots.

“It’s very unusual to have even one empty bed,” Stilson said. “The need is huge, but there’s just a lack of funding right now.”

For substance abuse and mental health treatment providers in Utah, the funding landscape has become increasingly uncertain in recent months. The recession took its toll on state resources. The federal budget cuts known as sequestration have also reduced available dollars. More cuts may be in the offing.

On top of that, there are many unknowns tied to the planned rollout of the Affordable Care Act and Medicaid expansion. On Friday, the House voted to keep the federal government going but only if the ACA was defunded, which further muddied the water, Stilson said.

“Now what?” she said.

Prior to the House vote, Salt Lake County human services officials had informed contract providers such as St. Mary’s that it plans to extend current contracts through June 30, 2015.

“The uncertainty means that Salt Lake County lacks the necessary information about available funding or client eligibility to construct a competitive and comprehensive request for proposal process,” Mayor Ben McAdams and Human Services Department director Lori Bays wrote in a letter to contract providers.

In August, Gov. Gary Herbert announced his office will make a decision on Medicaid expansion in conjunction with the Utah Legislature’s general session, which begins in January.

“Therefore, a final decision could come as late as early March, when the Legislature adjourns. If Medicaid expansion does not occur, significant cuts to services will be unavoidable,” McAdams' letter states.

Salt Lake County funds prevention and treatment services for more than 58,000 people, said Patrick Fleming, director of substance abuse services in the Division of Behavioral Health Services.

Dr. Bill McMahon, chairman of the University of Utah’s Department of Psychiatry, said the county is taking a sensible course given the uncertainty surrounding the Affordable Care Act and Medicaid expansion.

“I think Mayor Ben McAdams and his staff have been wise in preparing for a worst-case scenario,” McMahon said.

The Affordable Care Act gives the states the option of expanding eligibility for their Medicaid programs to cover more low-income people. While there is no set deadline for states to decide on Medicaid expansion, they risk the loss of millions of dollars of funding if the decision lingers.

“I think our state should step up and provide better mental health and substance abuse services. The ACA is a clear opportunity to do that,” he said.

Mike Morgan, a client of St. Mary’s, said his bed at the Catholic Community Services facility is funded by the Veterans Administration.

VA-funded clients are allowed longer stays, Stilson said, and the funding stream fluctuates less than other government programs.

Even so, Morgan said the House vote to defund the ACA has real-world consequences for people not covered by veterans services. “They play their games and we suffer for it,” he said.

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