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Editorial: A mental health program worth preserving

New Hampshire’s transition to Medicaid managed care from the old fee-for-service model of health care for low-income residents has been delayed, but change is coming. Weeks or months from now, Medicaid recipients will have to choose which of three managed care companies offers the plan that best meets their needs. Uncertainty, however, particularly for Medicaid recipients with a disability or a mental illness, remains.

Does the managed-care model, in which a company is paid a flat fee to try to keep a person healthy and treat them when ill, work for patients with complex and chronic needs? Will the 20-percent savings the state hopes to achieve come from a reduction in services and at the expense of care for fragile populations? Will managed-care companies consider some existing services medically unnecessary and refuse to pay for them? That fear was expressed around the table during a meeting that included the Monitor editorial board and clients and staff of Step Up, a therapeutic day program run by Riverbend, the community mental health center that serves Merrimack County.

It would be not just costly but cruel to kill a program that one person after another credited with preventing their return to the state psychiatric hospital and even keeping them alive. In two three-hour sessions each weekday, Step Up provides a meal, counseling, peer support and a non-judgmental place to go where people are accepted for who they are. With astounding openness, clients described their illness, how it affected them, and how Step Up helped them get by. They described their fellow Riverbend clients as “family,” in some cases as the only family they have.

Step Up, which for now operates out of the old gas station on South Main Street that was once home to the Penny Pitou Travel Agency, helps people remain in the community. Its small trained staff helps clients manage their illness and remain out of jail or the state hospital. The activities, which go far beyond the arts and crafts activities associated with similar day programs, teach techniques that help people control their temper, climb out of depression and reinforce positive behavior patterns.

Step Up has an annual budget of $532,000. The program, which next year will move to a building Riverbend owns on the Heights, serves clients for an average cost of $72.19 per day. That’s a bargain compared to the $200 per day it costs to care for someone in a residential outpatient setting or the roughly $1,000 per-day cost of the state hospital. It’s a bargain that increases the confidence of people with a mental illness, preserves their independence and allows them to live happier lives.

We don’t know the fine points of the state’s contract with the for-profit managed care companies, or how they will view programs like Step Up. Since taking a short-term view of such services will cost them economically in the long run, we’re optimistic that the companies will contract with Riverbend to continue to provide them. But if they don’t, the state will have to find bridge funding to keep Step Up running until the contracts can be revised.

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