State urged to replace funds
A state task force recommended on Wednesday that Washington taxpayers pick up a mental health tab once paid by the federal government.
After hearing testimony from law enforcement, families and advocates, the task force urged the state to replace federal funding lost because of stricter new Medicaid guidelines.
“It’s a priority for everyone who sat on that task force,” said Sen. Linda Parlette, R-Wenatchee, a task force co-chair.
Under new enforcement guidelines from the Bush administration, Washington’s public mental health system will lose at least $41 million annually in federal money, according to state estimates.
That money has historically been provided by Medicaid, the state-federal program that pays nearly 90 percent of Washington’s outpatient mental health costs. But in the last year, federal officials have cracked down on Medicaid spending, potentially saving millions but ending public mental health care for thousands – including several hundred low-income people in Spokane County.
The task force unanimously recommended the increase in funding, even though Washington faces an estimated $1.7 billion shortfall, immediately raising questions about the viability of the proposal.
“We have a huge deficit to deal with,” said House Appropriations Chairwoman Helen Sommers, D-Seattle. “Obviously, it’s going to be very difficult because of what we face.”
The federal government argues that the state should only spend Medicaid money on patients who are enrolled in the program. But historically it allowed discretionary spending on patients who refused to fill out paperwork or made too much money to qualify for the program. A state report on the population said that 73 percent of those who reported income fell below the poverty level.
The effect has been felt in Spokane.
Last month, Spokane County commissioners approved more than $180,000 in emergency money to maintain a program that helps hundreds of elderly mentally ill residents in their homes. Under new guidelines, the program no longer qualifies for Medicaid money, according to mental health officials.
Commissioner Kate McCaslin warily agreed to the emergency funding but complained the cost of care was being shifted to local government.
Program advocates say they spend about $4 per day on each client, compared with $42 a day in nursing homes and $58 a day to jail a psychiatric patient.
Last year, Spokane County’s public health system stopped treating about 400 mentally ill people, according to mental health providers. County officials said they could face fines for continuing to serve patients who were not enrolled.
Both community health clinics and the county jail have complained that they now bear higher costs for serving the mentally ill. At Wednesday’s hearing, Sheriff Mark Sterk testified about rising jail costs because of psychiatric inmates.
“The task force recognized the real importance of mental health services for our communities,” said David Panken, CEO of Spokane Mental Health, who attended the hearing. “Hearing from law enforcement and corrections people today was very powerful. People are saying, ‘You have to fund this adequately to maintain the health and safety of the community.’ “
The task force met several times during the past six months before issuing the recommendations to the governor’s office and state Legislature.
“We have to be realistic,” said Cathy Gaylord, CEO of the Washington Community Mental Health Council, a nonprofit association of mental health centers. “It’s a bad budget year following a bad budget year. But many legislators recognize that this is one of the top issues for the next session and a must-do.”
The task force also recommended that the state’s Department of Health and Human Services not close any more psychiatric beds at state hospitals until it has provided adequate places for the mentally ill to live in the community.
It also urged DSHS to end the practice of terminating Medicaid eligibility when a person is jailed. Law enforcement officers and mental health advocates say that creates obstacles to receiving medications when the mentally ill are released back into society.
The Legislature should also authorize mental health courts across the state to handle the growing number of mentally ill offenders, the task force said.
The task force also recommended that state and county public mental health groups develop contingency plans for the potential loss of some or all of the $41 million.