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The budget cuts that had to be made are already causing pain, especially in the field of mental health. While the legislature and governor have done the best they could under the circumstances, the cuts in health care, especially mental health care, will have a huge effect on the people who need these services, their families and their communities.
Shira Schoenberg outlined some of these issues in an article in the Concord Monitor.
The cuts will affect the community mental health centers the most. These centers provide care to the most vulnerable people, helping them find places to live, access psychiatric care, and supporting them in daily life skills. According to the article, most of these services are mandated and include round the clock emergency services and case management, and serve the state's most severely mentally ill patients. Sixty to eighty percent of the centers' income is from Medicaid reimbursement, which is slated to be cut by 2 million dollars.
The state budget funds a predicted caseload increase of 1 percent when the Department of Behavioral Health estimates an actual increase of 3 to 4 percent. This means they will receive $181.6 million in funding when they need $191 million to keep services at their current level.
The choices of how to cut boil down to either the centers' being paid less for services or capping services they offer, such as limiting life skills support, such as shopping and household help to two hours a day.
Health and Human Services Commissioner Nick Toumpas is trying to figure out how to put more money into the community services aspect of care:
Toumpas talked about taking money meant for construction on the state hospital campus and moving it into homes in the communities. He talked about having the state contract with a single agency that would manage a person's care and hire the necessary services, rather than having the state contract with seven different agencies. Within his department, Toumpas said he is looking at savings like consolidating offices, or using technology to enable employees who are often on the road to work from home.
Staff has already been cut, as has overtime, and many fear more lay-offs on the way.
Riverbend CEO Louis Josephson
It's like telling Dunkin' Donuts you have to charge 50 cents for a cup of coffee, with the same coffee, the same staff," Josephson said. "Sooner or later you can't do it."
Concord state rep. candidate and tireless advocate for the mentally ill, Jim MacKay created a ten year plan that used community based rather than institutional based care as a model. This leads to better outcomes and saves money in the long run. McKay is understandably disappointed in the cuts.
Schoenberg gives him the last word:
"Caseloads, particularly that deal with poor people, get hit very hard, and they need these services more now than they ordinarily would."
Cutting reimbursement rates now, he said, creates more problems down the road when people end up back in the hospital or prison. "What it means is a significant part of the population who needs care is not going to get it," MacKay said.
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