"This is taking away the most valuable service of keeping people in their communities."This blog is the second in a series to bring to light the impacts that state budget cuts have on the lives of everyday Montanans. We began this series with a post about cuts within the Department of Health and Human Services (DPHHS), which resulted in the closure of more than half of the state’s outreach offices. Today our focus will be cuts to targeted case management and mental health services. In subsequent blogs we will cover cuts to developmental disability services, substance use disorder treatment, and the unintended consequences of eliminating such services. Prior to the special session, cuts made by the legislature has resulted in about $14 million in cuts to the rates paid to health care providers who accept Medicaid patients. These cuts have taken a toll on service providers’ ability to accept and provide care for Medicaid patients, including adults and children suffering from mental illness. On top of cuts made during the regular session, the special session resulted in an additional $18 million cut from targeted case management for children and adults with mental health needs, substance use disorders, and developmental disabilities. As of February 21, 2018, despite the nearly 100 people who opposed the proposed DPHHS rule changes, DPHHS will implement the changes to reduce rate payments for targeted case management services that help struggling families who need mental health support and substance use treatment services. What is targeted case management? Targeted case management has meant all the difference for people who need health services to remain in their communities. For children and adults with mental health needs, targeted case management is a relatively inexpensive service that helps them navigate between doctor and therapy visits. Case managers often assist clients with finding stable housing, trouble-shooting benefits paperwork, and checking on prescriptions. Basically, good case management makes all treatment more effective and allows more Montanans to live in their community instead of often expensive and isolating institutional settings. According to Barb Mettler, with South Central Montana Regional Mental Health Center, “case management is one of the things that keeps people in the community and out of the hospital. This is taking away the most valuable service of keeping people in their communities. They will end up in hospitals and those are the most expensive places for care." A ripple effect in the loss of services for Montana children An often-overlooked population served by mental health care is kids. When untreated, mental health disorders can lead to school failure, family conflicts, drug abuse, violence, and even suicide. The Western Montana Mental Health Center (WMMHC) has partnered with Head Start programs to offer therapy and mental health support services for young kids and family members for low-income families. In Butte, for example, WMMHC and Head Start used to partner to serve low-income families with kids with social, emotional, and behavioral concerns. The state budget cuts ended this partnership, and the lack of these therapeutic services will have a harmful ripple effect through the school environment, the community, and for these children’s lives as they grow up. Budget cuts also result in layoffs and lost jobs Western Montana Mental Health Center serves 15 counties and is one of the largest mental health care providers in the state. The South Central Montana Regional Mental Health Center offers mental health and chemical dependency treatment in an 11-county area. Both centers are Medicaid providers and the provider rate cuts have forced them to cut hours, reduce salaries, or lay off staff. To date, more than 70 case managers have lost their jobs and relationships with clients. This number does not include case managers for people with developmental disabilities. As MTPR reported, about 50 people at WMMHC lost their jobs in December and more case managers could be laid off this year. About 200 clients will lose their support system because of these layoffs. Similarly, the South Central Mental Health Center was forced to close its case management unit, affecting their clients and laying off 20 employees. Winds of Change, based in Bozeman, had to close their doors because of cuts, and more providers across the state may have to do the same. Patients of these organizations will add to the waitlist at other centers, but there are more people who need help than resources available. These are just a few of the layoffs we know about so far. It is likely that we will continue to see stories across the state of people losing their jobs. While the total impact of these cuts is yet unknown, we know from providers who directly serve people in need of mental health support that the budget cuts to health and human services will have dire consequences for Montana families. Cuts fall hardest on the most vulnerable, reimbursements are reduced below the cost of providing service, and community care is slashed, leaving nothing but the most expensive and limited inpatient treatment in place. The legislature could have supported common-sense revenue measures. But instead the state opted to create more hardship for Montanans who struggle day in and day out with mental health needs. At MBPC we know that Montana can choose another path; we can decide to adequately invest in the public services that educate our children, keep our communities safe, and provide much-needed health care to our neighbors.
MBPC is a nonprofit organization focused on providing credible and timely research and analysis on budget, tax, and economic issues that impact low- and moderate-income Montana families.