Kansas’ system of addressing mental health issues continues to deal with funding problems and the state’s decision not to expand Medicaid, mental health advocates say.
But they also say there are bright spots on the horizon.
“We are taking some small steps forward,” said David Wiebe, president of the Kansas Mental Health Coalition.
“But like so many things in the public arena, it boils down to funding, and clearly there is not enough money to meet the needs,” Wiebe said.
The 27 Community Mental Health Centers treat about 120,000 people each year.
But most of those people, 85,000, have neither Medicaid nor other health insurance.
For years, under mental health reform, state funding was provided for low-income Kansans who didn’t qualify for Medicaid. But during the Great Recession, the grant funding to the community mental health centers was cut by 65 percent, or $20 million since 2008.
A recent report by Gov. Sam Brownback’s task force on mental health said that while the state must hold the mental health system accountable with specific performance measures, it also must “ensure adequate funding is present to carry out these key tasks.”
In response to the report, Brownback announced a $9.5 million initiative that he said would strengthen the delivery of mental health services in the state.
Wiebe and others in the mental health community applauded the initiative as a promising start.
“It’s very encouraging that the governor is placing a focus on mental health,” said Wiebe.
He was particularly pleased that the plan includes $1 million for the mental health centers to provide crisis services and programs to the uninsured.
But that is one-time funding and will be the subject of appropriations battles in years to come to continue it, he said.
The task force report, however, was silent on the political touchy subject of expanding Medicaid.
Currently in Kansas, parents cannot make more than $9,063 a year for a family of four to qualify for Medicaid, and in most cases, childless adults cannot qualify even if they have no income.
But under the Affordable Care Act, or Obamacare, states can expand Medicaid eligibility and the federal government will pay for it for three years, and pay no less than 90 percent of the cost after that.
Brownback, a Republican and ardent opponent of the ACA, and the Republican-dominated Legislature have rejected Medicaid expansion, saying they don’t trust the federal government to pay for the bulk of it. Kansas is one of 19 states not moving forward on expanding Medicaid under the ACA.
Recently, Brownback said more alternatives to the ACA are needed.
“I think there are going to be more options coming out. I think as this wears on, and people have difficulty with it, and the cost structure is so high, you’ll see more options open up,” Brownback said.
Asked if he was noting how some other states, including those led by Republican governors, were negotiating different ways to expand Medicaid, Brownback said, “We’re watching all of it, if there is a way to do it. I am more confident today than I’ve ever been that there will be other options out there by as malleable as the Obama administration has been on every other piece of Obamacare.”
But Brownback said his primary focus on health care has been the startup of KanCare, his privatization of the state’s Medicaid program.
Mental health advocates say failing to expand Medicaid under the ACA is a wasted opportunity.
“That (expansion of Medicaid) is probably the biggest single thing that would help the mental health system and go a long way to providing coverage to the bulk of low income Kansans,” Wiebe said.
Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas, said he recently went to a national conference and every person he spoke to from a state that had expanded Medicaid eligibility expressed no regrets. “It makes a lot of sense to have a payer source for every patient,” Kessler said.
Both Kessler and Wiebe, however, said they were pleased with other recent mental health developments, particularly the transformation of the Rainbow Mental Health Facility in Kansas City, Kan., from a more long-term inpatient facility to a crisis stabilization center, which started operating last month.
Officials say this will enable people who show excessive behaviors to receive quicker treatment and connect them faster to community services. The facility will be run by Wyandot Center, the community mental health center in Kansas City, Kan.
“It is a go-to place for law enforcement and people in the community,” said Amy Campbell, a lobbyist for the Kansas Mental Health Coalition. “You can get screened for what you need and hopefully they can get directly into the kinds of services that you need. The idea is that it will provide the right services for people at the right time. It gives law enforcement an option to take them there instead of jail,” she said,
Failing to provide care for people who need it will, in many cases, just leads to higher costs down the road in the criminal justice system.
Nearly one-third of inmates in the state prison system have been diagnosed with mental illness, and nearly one in five are being treated with psychotropic medications, according to state corrections officials.
One of the initiatives in Brownback’s plan includes $500,000 in community grants to help divert people with mental health problems from jails and prisons.
And another part of the plan will take $7 million from reserves in a program designed to provide temporary cash assistance to the needy and use those funds for programs aimed at helping families that are experiencing mental health problems, administration officials said.
Wiebe said helping families is crucial. “Working to help at-risk families, that is where it all begins,” he said.
Another area of hope in the mental health community is the proposal by KanCare, the state’s Medicaid program, to start providing “health homes” for people with mental illness. This will provide both mental and physical health care for people out of a central location. “This is to make sure you are getting served as a whole person,” Campbell said.
Campbell said she was optimistic about the future for mental health services in Kansas.
“I feel like we are right on the edge of something good. There are many evidence-based practices that we know that will work, and hopefully we can reverse this trend of contraction that started in 2008,” she said.