Lawrence ? Against the backdrop of the state’s $700 million budget shortfall, a few million dollars’ worth of cuts here and there may appear insignificant.

But for Kansas’ 29 community mental health agencies and the citizens they serve, the prospect of a $3.1 million reduction in state grant money is a big deal. No matter how much the centers receive from the state, they must continue to provide services required by state and federal governments.

That means doing the same or more with less.

“You just don’t get paid,” said David Johnson, chief executive officer of the Bert Nash Community Mental Health Center in Lawrence, which serves about 4,000 people a year.

The $3.1 million reduction has been approved by the House and Senate in their respective versions of a state budget for the fiscal year that starts July 1. Negotiators are to start drafting a final version this week, for action when the Legislature begins its wrap-up session May 1.

But it’s not the funding cut alone that confronts community mental health agencies. Hundreds of clients’ ability to pay for some services is also likely to shrink.

Limiting assistance

For the first time, the state Department of Social and Rehabilitation Services is setting limits on how long Kansans can receive benefits under the MediKan and general assistance programs.

The department plans to limit the assistance to 24 months, which would save the state about $5.1 million in the upcoming fiscal year. Some legislators have suggested setting the eligibility period at just 18 months, which would save $750,000 more.

Some of those whose state benefits will be cut off while their Medicaid assistance is being arranged also are community mental health clients. Laura Howard, SRS assistant secretary for health-care policy, said there are about 900 such people, mostly in Sedgwick County.

“These are people who have some severe needs,” Howard said.

High demand for services

Meanwhile, according to the Association of Community Mental Health Centers, demand for services is outstripping funds because the agencies are required to serve all Kansans regardless of income.

At the Bert Nash center, about one-fourth of the clients are eligible for Medicaid and the rest pay fees on a sliding scale.

Johnson said the center, with 168 full-time staff positions, received nearly half its $7 million budget from state and federal grants and reimbursements, 8 percent from county sources and the rest from private sources. Its financial needs continue to grow, he said.

“It’s not just the cuts, it’s also the increase in costs,” Johnson said, noting recent increases in the cost of mental health malpractice insurance.

Last year, SRS began reimbursing the mental health centers for individual services they provided rather than giving them grants to spend as they saw fit. Howard said the change allowed the state to capture more than $25 million in federal Medicaid funds.

“Without the Medicaid changes a year ago I would be painting a gloomier picture,” Howard said. “I don’t think there will be dramatic reversal of progress, but this will slow progress.”

Howard said she was optimistic that legislators would still consider some additional revenue for mental health this session.

Prevention endangered

But officials at centers like Bert Nash still are worried about having to reduce some programs so that they can continue to serve those they are required to treat.

Prevention programs supported by grants, Johnson and Howard said, are likely to lapse.

In Lawrence, one potential casualty is WRAP (Working to Recognize Alternative Possibilities), a dispute resolution program that links Bert Nash staff with Douglas County schools.

WRAP’s possible disappearance is troubling to one Lawrence man whose daughter was referred to the program after being suspended for fighting at Lawrence High School. The father, a self-employed businessman, described his family’s experience on condition that his name not be used to keep his daughter’s counseling confidential.

A WRAP counselor met with his daughter and family after the incident. The family’s financial resources and insurance coverage were limited when it came to mental health services.

“It became an unbelievable blessing,” he said.

A few weeks later, two of his daughter’s classmates were killed in a traffic accident. The girl became withdrawn, her grades began to suffer and she fell into depression.

The WRAP counselor continued to meet with his daughter to treat her depression and improve her outlook on life.

“To have not had access to this, my daughter would have become one of those silent agonies that falls through the cracks and falls behind in school not knowing how to deal with those feelings,” he said.