Mental health takes hard hit

Johnson County’s Mental Health and Developmental Supports services took a hard hit from the most recent state budget cuts.

Gov. Mark Parkinson last week announced cuts and adjustments of $258 million in an effort to balance the 2010 fiscal budget.

The cuts mean a $1.35 million funding loss for Mental Health and a $352,000 loss for Developmental Supports, making the two county agencies the hardest hit by the governor’s cuts.

Those losses come in the form of grants to agencies and Medicaid reimbursements.

The 10 percent Medicaid reduction is going to cost the state even more in matching federal dollars, said David Wiebe, executive director for Johnson County Mental Health.

“The issue with Medicaid, … there’s like a 69 percent plus federal matching rate,” Wiebe said. “So when they try to hit some targets in the state budget cuts and they take it out of Medicaid, they give up all that federal matching money as well.

“Historically, states have been reluctant, including Kansas, to make those cuts to Medicaid for those very reasons.”

The cut in Medicaid reimbursements will be passed on to people and businesses that provide services to Mental Health and Developmental Disabilities, which some might not accept, said Maury Thompson, Johnson County Developmental Supports executive director.

 “I have the fear that we have some small providers in Johnson County that are struggling to try and make it on an inadequate reimbursement rate to begin with,” Thompson said. “Some might say they can’t keep their doors open with a 10 percent loss in revenue, which in turn is going to put more of a strain on the county to step in and figure out how these people are going to be provided services.”

The waiting list for Developmental Supports services in Johnson County is between 650 and 700 people – and growing, Thompson said.

Why Parkinson chose to lose federal matching funds has Thompson scratching his head.

“He chose that action over eliminating all of the unmatched funds in our system, which does not make fiscal sense to me,” Thompson said. “If you totally eliminated all of the SGF (State General Funded) grants in the DD system you could reduce the needed reduction in the Medicaid provider to 5 percent. If you want to eliminate a big portion of what we call state aid, which would be the very last unmatched funds, you could totally eliminate the need to reduce the Medicaid rate.”

Thompson asked county commissioners to write a letter to Parkinson urging him to take that course of action.

“Either way, people are going to get hurt but less people will be hurt by the reduction in eliminating the unmatched funds,” he said.

Regardless of the funding issues, Thompson and Wiebe said Johnson Countians still have to be served.

“By statute we cannot turn anybody away,” Wiebe said. “So as we lose resources, what (the cuts do) is degrades the level and quality of care that we can provide … we may end up in a situation where all we can provide is emergency crisis care.”

Wiebe said Mental Health would defer filling vacant positions pending a review of the need for specific services and the impact on clients.

“It also depends on how much money those positions bring in,” he said. “If we have a position that’s bringing in 70 or 80 percent of its cost in fees are we going to save $10,000 by eliminating a $50,000 position at the expense of losing the $40,000 in fee revenues that position generates?

“We really have to be judicious when we look at positions that we’re going to hold vacant and you have to look at positions that tend not to be revenue generators. I think the Legislature is going to have to probably respond (to the governor’s) cuts; I know there’s going to be a great deal of discussion when they convene next month.”

If the cuts stand, the cost could be much more than monetary, he said.

“The long-term issue is: what is the cost to our community of untreated mental illness?” Wiebe asked. “When you think about what the cost is of untreated mental illness, it plays itself out in the criminal justice system, people get caught up in law enforcement; it plays itself out in poor school performance; it plays itself out in difficulties and problems at work; it plays itself out in terms of family relationships and we could see an increase in domestic violence.

“These are all kind of the attendant consequences when you have mental illness and emotional stress that is not addressed and responded to.”

The 2011 fiscal budget is expected to have a $500 million shortfall that likely will lead to even more cuts.

“It just keeps going from bad to worse,” Thompson said. “There’s little likelihood that (the governor’s cuts) will be a six-month rate reduction; they will continue on into 2011.

“We’ve been cut into the bone now. Next year we could lose an arm. We’re to the point in the state of Kansas that people who meet the eligibility requirements due to their developmental disability are no longer going to be receiving any service. There will be nothing for them.”

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