Mentally ill would be wait-listed

Last modified: 3/23/2011 12:00:00 AM
The House Finance Committee will recommend creating a waiting list for mentally ill patients.

Current law requires the state's community mental health centers to serve everyone who needs help. Language approved by the division of the committee dealing with health and human services would allow mental health centers to triage patients.

"We're changing the mandate that says the agency must care for all to one that says the agency can triage," said division Chairman Neal Kurk, a Weare Republican who proposed the language.

The new language states that if a person does not have the ability to pay for mental health services, the responsible agency "may conduct a clinical assessment and may prioritize services based on clinical needs. Emergency services may be provided as appropriate." The amendment would also add language stating that admission to the state's mental health services system and access to treatment "shall be contingent upon the availability of appropriations."

Kurk said the change is necessary because the state is cutting mental health services so deeply that centers may not be able to survive if they have to treat all patients.

"We're taking such significant funds away that they will not be able to meet the mandate," Kurk said. "We suspended the mandate for the biennium and said to centers, 'Provide services within the limit of your appropriation on a triage basis, to provide services to folks who need them.' "

According to an analysis by the New Hampshire Community Behavioral Health Association, the proposed House Finance Committee budget would reduce state reimbursements to services for people with mental illness by $68.1 million over two years, and nearly 8,000 people would be removed from state services.

The changes would come from several places. According to the Finance Committee, the state would save $6.7 million a year by reducing the number of adults eligible for services. It would save an additional $5.8 million a year by reducing the number of children eligible for services.

Kurk said 670 adults with low levels of assistance would lose services, as would 3,540 adults with severe mental disabilities. About 3,400 children - or 46 percent of the current population getting services - would lose their assistance.

The Behavioral Health Association warned that the cuts could put children and adults with severe mental illness at risk of harming themselves or others and of ending up in hospitals or tangling with law enforcement. The burden of caring for them would be shifted to family members and hospitals, including New Hampshire Hospital. Adults with lower levels of mental illness could become sicker if they are denied treatment.

Other cuts would add some service limits and reduce Community Mental Health Centers's case management payments by $4 million.

Representatives of Community Mental Health Centers said they were upset at the notion of a waiting list. Louis Josephson, CEO of Riverbend Community Mental Health in Concord, said the change gives the centers some flexibility but also poses dangers.

"You can make the argument someone who's suicidal or homicidal is more urgent, but for the person having a panic attack, it's equally debilitating," Josephson said.

Josephson said with the proposed cuts, mental health centers will only serve the sickest of the sick.

"I could imagine a scenario where we got a lot of acute people - suicidal, homicidal - and are triaging among the really acute people," he said.

Josephson said he was not relieved that mental health centers would be spared some responsibility.

"Maybe it makes everyone sleep better at night that we are having a waiting list, but it will be cold comfort for the people we serve," Josephson said. "Technically, we're off the hook, but we know demands are there, and we know we'll see people in the emergency room."

Jay Couture, president of the Community Behavioral Health Association said in a statement, "The impact of these cuts, the license and authorization to ration care and the disregard for harm found in this budget are awful and to pass it as written calls into question the judgment of our Representatives in Concord."

 Cutting Health and Human Services

The creation of a mental health waiting list was one of dozens of cuts totaling $207 million that the House Finance Committee division dealing with the Health and Human Services Department suggested, beyond what the governor already proposed. That amount represents a 6 percent cut in the amount of general fund money going to the department, compared with 2011. But the department also benefited from federal stimulus money this year. Counting that money, the cut represents a 17 percent loss to the department's general fund budget compared with 2011.

The full House Finance Committee recommended passing the Health and Human Services cuts, along with the rest of the two bills that make up the state budget, almost entirely along party lines. Republicans supported the bills, and Democrats opposed them.

"They're devastating the state safety net for people who need services," said House Deputy Democratic Leader Mary Jane Wallner.

Rep. John Reagan, a Deerfield Republican and chairman of the House Health and Human Services and Elderly Affairs Committee, wrote on behalf of the committee that the reductions suggested to the Department of Health and Human Services "border on irresponsible." Reagan requested the Finance Committee "clearly prioritize the elimination of services to vulnerable New Hampshire people with careful consideration and placement lower on the list than other state services."

Kurk acknowledged the pain that could be caused by the proposed cuts.

"I've been doing budgeting for 20 years, and this was the most difficult," Kurk said.

The biggest single cut is the $115 million that was given to hospitals to cover the costs of uncompensated care. Leslie Melby of the New Hampshire Hospital Association warned that free programs to the community, such as dental clinics and cancer screenings, could be eliminated, and hospitals would have to lay off employees. The state would continue to fund critical access hospitals, which are smaller, rural hospitals.

Funding would be eliminated or cut for child care, adoption subsidies, foster care payments, domestic violence programs, Head Start, assistance for unemployed parents and other programs.

Services that help people with developmental disabilities remain in the community would be cut in half.

"These are difficult decisions and . . . will make it much more difficult for these families to function," Kurk said. "But of all the choices available I can assure you the others were worse."

The committee also agreed to eliminate "children in need of services," a category of children ordered by the court to get treatment or counseling before they become delinquent.

The committee agreed with the governor's plan to eliminate the nonprofit organization that operates the Healthy Kids program, which provides insurance to low-income children. The state would continue to run the insurance program for children who are eligible or nearly eligible for Medicaid. The children would be moved to a Medicaid managed care program, which the state plans to implement. But children whose families are at 300 to 400 percent of the poverty level, whose families are allowed to buy into the program, would likely not continue.

"The program is probably not viable, because most of those children have significant medical issues such that their rates of a standalone program would have to be so high none of the families could afford them," Kurk said.

While the governor proposed taking $8 million away from nursing homes, the House Finance Committee voted to return $2.6 million to county nursing homes to avoid downshifting costs to county property taxpayers. Private nursing homes will still be cut.

Despite some concern by Planned Parenthood, family planning money will still be distributed by an open bid process, giving Planned Parenthood a chance to compete. An amendment makes clear that no public money can be used for abortion, in accordance with existing law.

The Senate is expected to estimate the state's revenue at a figure higher than the House's revenue estimates. Kurk said if the Senate does find additional money, he would recommend increasing funding for a diversion program to help at-risk children and giving more money to Community Health Centers, which provides primary care services for low-income individuals and faces $4.5 million in cuts.

(Shira Schoenberg can be reached at 369-3319 or sschoenberg@cmonitor.com.)


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