State budget cuts announced Tuesday will hit particularly hard on services for the mentally ill, undermining local programming that’s vital to Montana’s system of care, providers told MTN News.
“With these rate cuts … I’m going to have make business decisions as to whether we can keep (some) services or not,” said Jodi Daly, CEO of Western Montana Mental Health Center. “If there is no crisis center to help people, they will go to the State Hospital.
“I feel like we’re going backwards instead of forwards.”
The Bullock administration said Tuesday that budget cuts outlined in a bill passed by the 2017 Legislature will occur, because state tax revenue didn’t hit expected targets at the end of June.
Among the mandated cuts are $3.85 million in state funds for case management for the mentally ill, over two years. Daly says it amounts to a 37 percent cut in case management, which helps mentally ill clients negotiate the services they need to stay in their communities.
The cuts also include reduced Medicaid payments to all health-care providers, including those who serve the mentally ill.
Medicaid is the state-federal program that pays medical bills for the poor, including mental-health services.
Health-care and other providers are expected to testify Thursday against the state’s proposed Medicaid rate reduction of 3.47 percent, saying it goes beyond what the law suggested.
“I’m one who thinks that … we could have absorbed a 1 percent cut,” Daly told MTN News this week. “I know everyone is getting cut, so we have to give. But I’m not willing to take it all on.”
Gov. Steve Bullock’s budget director, Dan Villa, said Tuesday he sympathizes with the problems facing mental health-care providers.
But he also said that community-based programs have been beefed up in recent years, and that the 2016 expansion of Medicaid coverage to nearly 80,000 low-income adults has greatly increased access to mental health care.
“The single best thing that we’ve done for mental health care in the state was expand Medicaid,” Villa told MTN News. “We’ve been able to draw nearly $300 million in additional investment in community care.”
Yet mental health-care providers said expansion of Medicaid has increased the need for case management, which is being sharply cut.
Case managers help the mentally ill navigate things like finding a job, or housing – or keeping up with their treatment.
“These cuts that the state is proposing will profoundly impact the quality of care that can be given to people who are dealing with the chaos of addiction and mental illness,” said Lenette Kosovich, CEO of Rimrock, which provides treatment programs in Billings. “When people don’t get those types of services, it is a ripple effect.”
Kosovich predicted that hospitals will face more drop-ins with mental health crises, crime will increase, and child-protective caseloads will go up.
Daly also said cutting case management will impact the entire mental health-care system, affecting clients who may see their services reduced, as well as other services offered to the mentally ill.
Money for case management sometimes is used to offset losses in other services, she said, and if the case-management funds are cut, those other services, such as crisis centers, may have to be cut back as well.
“It’s not just about case management; it’s about community-based mental health care,” she said.
Western Montana Mental Health Center is one of four nonprofit mental health centers across the state. It employs about 200 case managers and serves 15,000 clients across 14 counties.
Case managers also work for about 20 other smaller mental-health centers in Montana.
Mental-health services for children will be hit particularly hard, Daly added, if the rate cuts go through.
“One of the things we looked at – that particular rate, for the children’s services, is the rate we got in 1993,” she says. “That’s how far back they’re bringing us.”