| Feb. 20, 2005
Thousands could lose mental health services By REBECCA COOK
Associated Press Writer
OLYMPIA, Wash. (AP) _ Thousands of people across the state will
lose mental health services on July 1, unless the state Legislature
comes up with $82 million to restore federal Medicaid cuts.
Already, hundreds of mentally ill people have been turned away from
community services. Experts say many of them will end up in jail, on the
streets or in emergency rooms if they can't get help anywhere else.
"It's
ultimately a life and death issue," said Rick Weaver, president of
Central Washington Comprehensive Mental Health in Yakima. "These folks
are very ill."
The
state might not ride to their rescue. The Legislature and the governor
are facing a $2.2 billion shortfall over the next two-year budget cycle.
Even lawmakers sympathetic to the mentally ill say restoring the full
$82 million is unlikely.
"I
don't see the whole amount just because of the budget situation," said
House Speaker Frank Chopp, D-Seattle. Still, he said, "We ought to
provide a lifeline for these folks."
The
federal cut will vaporize 20 percent of the state's community mental
health budget.
For
years, Washington state exploited an ambiguity in federal law that
allowed the state to use the savings from its Medicaid managed care
program to pay for non-Medicaid people and services.
Other
states did the same, but Washington did it particularly well. Medicaid,
the joint federal and state health program for poor children and adults,
accounts for 89 percent of the state's community mental health budget.
The national average is 38 percent.
A
1997 federal law says states can use Medicaid money only for Medicaid
patients and services. The federal government let the states slide for a
while, but cracked down last year.
"It's
partially budget-driven, but it's also out of a commitment to more
strictly adhering to what Congress intended," said Rod Haynes, spokesman
for the Centers for Medicare and Medicaid Services' regional office in
Seattle.
The
federal cut will take effect in July. In the meantime, the state
Legislature could provide extra money in the two-year budget to fill the
hole. But mental health providers aren't counting on that.
Instead, most community programs are preparing for a bleak future by
starting cuts now. Many aren't taking new, non-Medicaid clients unless
they're in the throes of a crisis.
"We're having to turn away about 80 clients a month who are seeking
outpatient services," said Jess Jamieson, president and CEO of Compass
Health in Everett. The public mental health system in Washington is
administered by 14 Regional Support Networks, which contract out
services to local organizations such as Compass Health.
Last
month, Compass Health closed a homeless drop-in center in Everett that
offered mental health services and served about 500 people a year.
"We
just didn't have enough dollars to keep that facility open," Jamieson
said.
One-third of the people who use community mental health services are not
on Medicaid - that's about 43,000 statewide. Most are poor, but don't
qualify for Medicaid for other reasons. They don't have a lot of options
for treating their mental illnesses.
"The
places people go when they get cut off are the streets, the hospitals
and the jails," said Cathy Gaylord, CEO of the Washington Community
Mental Health Council.
Law
enforcement officials have complained frequently to the Legislature that
jails have become de facto state mental institutions. They're worried
budget cuts will make things worse.
"It's
left upon us to provide the treatment with no funding," said Karen
Daniels, chief deputy for corrections with the Thurston County Sheriff's
Office. About 30 percent of the Thurston County jail inmates suffer from
some sort of mental illness, Daniels said.
Two
jail employees work with mentally ill inmates, basically trying to get
them stable so they don't wind up back in jail again. Daniels said those
positions will go away unless the Legislature restores mental health
funding.
One
big problem is that inmates lose their Medicaid eligibility if they're
in jail for more than 30 days, even if they're not ultimately convicted
of any crime. They have to reapply for Medicaid when they get out of
jail. That can take up to two months, and that's a long time for a sick
person to go without treatment.
A
bill before the Legislature now would allow the state to suspend
Medicaid, rather than terminate it, for people in jail.
Sen.
Jim Hargrove, D-Hoquiam, has taken the lead on mental health issues this
year. He wants the Legislature to restore the $82 million Medicaid cut,
but first he wants to reform the system so it works better.
"It's
totally dysfunctional," Hargrove said of the current system. "It wastes
piles of money, and I mean piles - like billions - because we don't
provide a cohesive and coordinated system for mental health and alcohol
and drug dependency."
Hargrove's bill would integrate those two treatment tracks - mental
illness and chemical dependency - because they so often occur together.
It would also streamline and consolidate the process for involuntary
treatment; expand alcohol and drug treatment services; require the state
to create and use a consistent screening process for mental illness and
chemical dependency; and it allows counties to levy a local-option sales
tax to pay for expanding treatment.
It's
an ambitious bill and it will have a hefty price tag. Hargrove, however,
is concentrating on the prospect of future savings.
"I'm
not a trigger happy, tax-and-spend kind of person," said Hargrove, who
hails from a conservative district in southwest Washington. But he said
his past experience with reforming the juvenile justice system has shown
that prevention pays off.
"If
we can deliver the treatment they need in a timely fashions, not only is
it better for them, it saves taxpayers hundreds of billions of dollars,"
Hargrove said. |
