Wednesday, September 21, 2016

Caution: Mental health services on the chopping block

Posted By on Wed, Sep 21, 2016 at 8:36 AM

click to enlarge ARKANSAS STATE HOSPITAL: Alone it can't meet needs for care of people with mental illness.
  • ARKANSAS STATE HOSPITAL: Alone it can't meet needs for care of people with mental illness.

A legislative vote yesterday to cap Medicaid reimbursements for mental health care raises the question: Is it false economy?

There's a lot of bureaucratic chaff to handle in the Arkansas Democrat-Gazette's report this morning on a legislative subcommittee's vote to cap Medicaid reimbursement for group psychotherapy. On the surface, it looked like a no-brainer. Arkansas spent $147 million in that category over three years, more than eight southern states combined.

The money goes to regional mental health centers. They say the comparison is badly out of whack. The short version: The spending in other states is only for hourly billings for psychotherapy and doesn't include separate per diem rates charged by facilities in those other states for residential care of people with mental problems. The Arkansas centers say they'll be forced to close without the money.

This much we know is true: Arkansas's woeful history in caring for the mentally ill — a shameful story dating back decades — lands it in court repeatedly. The State Hospital can't handle the demand. The regional centers have become secondary placement for people who'd otherwise be wandering the streets or creating enormous problems for criminal lockups.

Any notion that there's $100 million to save by trimming maximum hours devoted to group therapy is, I'd suspect, illusory. Without that money — or without a mental health reimbursement formula rewritten to account for care of people now covered by the formula to be changed — I suspect the regional centers will, if not close, have a dramatically limited ability to serve as a safety valve for the State Hospital. If that doesn't lead us right back to federal court, it will lead society to an awful place in terms of meeting needs of the mentally ill. And it's an illness just as surely as cancer.

Legislators yesterday seemed anxious to cut spending and worry about consequences later. With leadership from Rep. Charlie Collins, who's never met a program he didn't think needed cutting in the name of freeing money for income tax cuts for the wealthy, you can understand my pessimism.

Also: Underlying this debate is on ongoing struggle on exactly what a constitutional amendment that gave the legislature absolute approval rights over executive agency rules means. Is it absolute? Can the executive branch claim the  amendment is overridden in certain cases? Is review and approval required on a Medicaid rule change such as this? More to come on this topic, too.

PS — Here's a report on the detrimental effects of mental health budget cuts.

We should be spending more on mental health, not less (even if the formula needs to be reworked on reimbursements.) The estimate is that every $1 spent on mental health saves $20 in the cost of criminal incarceration. 

Budgets indicate values. If the talk yesterday was mostly about cuts and not first about properly caring for people in need, our values are in need of adjustment.

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