Politics of health care reform, cuts impact mental health, substance abuse treatment
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.
Barry Rose, crisis services manager for the University of Utah’s Neuropsychiatric Institute, said funding cuts and the uncertainty over ACA and Medicaid expansion present challenges, but he believes UNI’s community-based services are extending the reach of precious prevention and treatment dollars.
UNI is a contract provider for OptumHealth, which manages the county’s mental health treatment resources.
UNI’s crisis line handles some 3,400 calls a month, Rose said. Its mobile outreach team, which helps police handle calls that involve people with mental health issues and also makes house calls to assist people in crisis, averages 200 "outreaches" a month, he said.
UNI’s receiving center, meanwhile, offers 23-hour stays that give people time and services such as meeting with mental health professionals and prescribers who can help them to work through a crisis.
The center's overriding goal is to reduce numbers of hospital admissions. Only 5 percent-6 percent of people who receive care at the receiving center require hospitalization, he said.
While psychiatric hospital stays are sometimes needed to ensure the safety of the patient and the community, “people are much better served out in the community,” Rose said.
As elected officials quibble over the politics of the Affordable Care Act and Medicaid expansion, the best the mental health community can do is demonstrate that it is treating patients in a cost-effective manner, Rose said.
“There’s a lot up in air. We’re going to try to show people the value of doing it the right way,” he said.
After 25 years working as a mental health professional, Rose said people who lack access to treatment because of a lack of health care coverage suffer as individuals and impact other systems such as emergency rooms and jails.
“What happens is, we all pay for caring for those people one way or another,” he said.
Norman Longshaw, who is homeless and undergoing substance abuse treatment at St. Mary’s, agrees.
“Do they want to spend a little now or a lot later on prison or jail? What’s the most cost-effective?”
Longshaw said his substance abuse has reached the point that he is ready to do the hard work of committing to a treatment program.
“You have to be ready to do it. It gets to the point you’re just tired,” he said.
Longshaw is aware of the funding crunch that has made it more difficult for nonprofit organizations such as St. Mary's Center for Recovery to fill its available treatment beds. Because he has been turned down for Medicaid coverage in the past, he said he’s keeping a close eye on what the state decides on expansion.
For now, he’s simply grateful there was county funding available for his treatment bed at St. Mary’s.
“I just feel fortunate I got one,” he said.
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