Legislature acted against mental health programs

(Opinion) — Have you ever noticed that the state of Wyoming often fails to recognize a crisis until there’s no money left to fix the problem?

Here’s the latest example: Wyoming is one of only three states that decreased mental health funding every year from 2013 to 2015. It’s not because the state didn’t have the money; Wyoming lawmakers had an $87 million surplus before the 2013 session.

Wyoming, Alaska and North Carolina bucked the national trend that year. In the wake of the 20 children and six adults killed by a mentally ill gunman at Sandy Hook School in Connecticut in December 2012, 36 states decided to appropriate more money for mental health services. Wyoming reduced its funding and cut even more the next two years.

Now, faced with declining energy prices that have created a huge budget deficit for the 2017-18 biennium, Gov. Matt Mead has recommended a $248 million reduction in state spending. The Department of Health was directed to cut its budget by $90 million, on top of a $10 million hit it took earlier this year. Combined with the loss of matching federal funds, health spending in the state will decrease by an estimated $143 million compared to the current biennium.

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Beginning July 1, community mental health and substance abuse treatment centers statewide lost more than $11 million in grants. Another $2.1 million for the state’s suicide prevention program was cut, despite the fact that Wyoming has had one of the highest rates of suicide in the nation for more than two decades.

Here are just a few examples of the impact the funding losses will have on mental health services in Wyoming:

— Peak Wellness Center in Cheyenne will lose 10 percent of its budget, about $1 million. The nonprofit agency offers counseling, substance abuse and mental illness treatment in Laramie, Albany, Goshen and Platte counties. Sixteen staff members are expected to lose their jobs and branch offices in Guernsey and Pine Bluffs will close.

— Peak Wellness will also eliminate two residential treatment programs and a peer specialist program.

— At the Volunteers of America Northern Rockies substance abuse treatment center in Sheridan, six people will be laid off and benefits for remaining staff members will be reduced. Patient wait times will increase to at least seven months.

— In the Bighorn Basin, money for transitional housing for people receiving mental health and substance abuse treatment will be eliminated. Meanwhile, Southwest Counseling Services in Uinta, Sweetwater and Sublette counties will lose seven substance abuse transitional living beds.

— High Country Behavioral Health, which has offices in Afton, Evanston, Kemmerer and Pinedale, has cut staff positions and will increase wait times for about 160 clients.

The budget for Central Wyoming Counseling Center in Casper has been reduced by nearly $700,000. It has lost 11 of its 86 beds in the substance abuse residential unit, and moved another seven beds from the facility to a new crisis stabilization unit for people who are in critical need of care.

“The wait times will increase,” said the center’s CEO, Brandon Wardell. “It takes 45 to 50 days now for someone to get in our residential substance abuse treatment.”

Wardell said the center had to be creative to cut the budget without reducing staff or services. He noted some employees will work with a wider variety of clients.

If the state’s economic downturn lasts for several years, Wardell said CWCC will be hard-pressed to absorb more cuts. “Our obligation to the state and community as a safety net is going to be difficult to continue at [a lower] level than we are now,” he said.

Other state budget cuts will also impact mental health services. The Department of Health’s Division of Healthcare Financing, which administers Medicaid in Wyoming, has been directed by the governor to reduce its budget by more than $54 million. DOH Director Tom Forslund said it will be necessary to reduce Medicaid provider reimbursements by 3.3 percent.

That move will result in fewer health care providers willing to accept Medicaid patients because it will reduce their profit margins. The majority of people who seek mental health and/or substance abuse treatment today do so through Medicaid.

In fact, the federal Center for Medicaid and Medicare Services estimates that 6,000 uninsured Wyoming residents with mental illness or substance abuse disorders would qualify for expanded Medicaid if state legislators would approve it.

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About 90 percent of the DOH’s budget is awarded in contracts to health-care providers, including hospitals and pharmacies. Forslund estimated the loss of state contracts could mean up to 700 private health-care workers will lose their jobs in the next year. Many of those taking up the slack will be mental health professionals who already have caseloads that are too big.

Another major impact of the health budget cuts will be paying for the state’s Title 25 program for those who may harm themselves or others. If a court decides a person needs to be hospitalized, the state requires the patient to be taken to the State Hospital in Evanston. But the facility is overcrowded, so patients are transferred to more expensive community mental health programs throughout the state. The Title 25 program has a budget of only $4.4 million, but its accumulated deficit totals $17 million.

Hospitals that take patients who are waiting for beds in Evanston must take a 14 percent reduction in their reimbursement rates. Many of these hospitals are already facing staff layoffs and other budget cuts, as well as an expected increase in uncompensated care.

Wyoming has a mental health-care crisis that it can’t simply put on the back burner during the Legislature’s 2017 general session. With the downturn in fossil fuel prices expected to continue, the lack of mental health funding is a problem that will get worse if we ignore it. By providing adequate mental health services, the state would see corresponding decreases in other societal costs, including lost productivity, emergency room visits, homelessness and incarceration. Mental health, substance abuse and suicide prevention programs should not fall victim to across-the-board budget cuts. Mental health funding needs to be a top priority.

At one time in Wyoming mental health was given the fiscal attention it deserves. In 2005 the Legislature — led by future Republican House Speaker Colin Simpson of Cody — created the Select Committee on Mental Health and Substance Abuse Services, and the state began increasing mental health funding. But when the national recession hit Wyoming a few years later, the money dried up. State lawmakers turned their attention to savings, putting money away in a rainy day fund the Republican majority never wanted to tap. Now, this account should be used to shore up a community mental health system that desperately needs a quick infusion of cash.

Conservative legislative leaders won’t like that proposal, but they had their chance to greatly improve health care in Wyoming by expanding Medicaid and they blew it for four consecutive years. Unbelievably, when the governor and DOH Director Forslund presented the massive health budget cuts to the Joint Appropriations Committee, several members had the audacity to ask if approving Medicaid expansion would have helped the state.

You tell me — would providing 20,000 low-income residents health insurance, receiving $120 million a year in federal funds and reducing the state’s financial Medicaid burden have improved our healthcare system while taking care of a huge chunk of today’s budget nightmare?

After he spent the last four years telling legislators why it was necessary to expand Medicaid, I give Forslund a lot of credit for not simply walking out of the room. Instead, he explained why they wasted their chance to have the feds pick up 100 percent of Medicaid expansion for the first three years, and always pay at least 90 percent after that.

“The money I would have used to pay for the [state’s 10 percent] match is gone,” Forslund said. “If we did expansion today it would have benefit. It would benefit the 20,000 plus or minus individuals who would have healthcare coverage. It would help healthcare providers who are getting hit with rate reductions as a result of these budget cuts. In terms of money to move over for the match, that money is going to be gone because I have to cut $75 million out of my budget.”

Republican leaders had a chance to improve our mental health and other health-care services, but they made Obamacare’s failure their real goal. Ours should be to throw them out of office for legislative malpractice.

These conservative lawmakers had money available in 2013 to improve Wyoming’s critical treatment of residents with mental illnesses, substance abuse problems and suicidal thoughts.

Even with the current downturn in mineral tax revenues, budget reductions in all health services and nearly every state agency would have been much smaller if the Legislature had passed Medicaid expansion. Hundreds of millions of dollars would have been pumped into the Wyoming economy and 20,000 of the working poor would have health insurance. Instead, lawmakers treated our fellow citizens as less than human and shamelessly played games with their mental and physical health while throwing away taxpayers’ money.

Don’t reward these mean-spirited fools.

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