Bert Nash Community Mental Health Center

Topeka ? Officials at the Bert Nash Community Mental Health Center in Lawrence said they have already reduced their staff and discontinued some services after losing more than $1 million in state Medicaid funding, and they are now asking Douglas County to help fill in the gaps.

“We’ve eliminated some positions, and we’ve realigned other staff,” said Dave Johnson, CEO of Bert Nash. “This is a real penny-wise, pound-foolish situation.”

Bert Nash is one of more than two dozen community mental health centers around the state that have lost a combined $30 million a year in Medicaid funds to treat low-income individuals with serious mental health problems.

Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas, said the cuts fell into three categories:

• Elimination of a “health home” pilot program designed to coordinate care for people with both mental health illnesses and chronic medical conditions.

• Gov. Sam Brownback’s veto of funding for a mental health screening program aimed at diverting mental health patients, when appropriate, away from inpatient hospitals and into community-based treatment programs.

• And an across-the-board 4 percent cut in state Medicaid spending, which was part of a package of allotment cuts that Brownback ordered in May to balance the state budget.

Johnson said that for Bert Nash, the health home program was probably the most significant of the funding cuts, for the center and its patients.

“People who have serious mental illnesses, most primarily have other chronic illnesses,” he said. “People with serious mental illnesses have life a expectancy that’s 25 years shorter on average than the rest of us.”

Kansas launched the pilot program in 2014 with funding under the Affordable Care Act that paid 90 percent of the cost for the first two years. Starting July 1, 2016, the state’s share of the cost would have increased to the normal 56 percent, or an additional $13 million a year.

In January, though, Budget Director Shawn Sullivan recommended discontinuing the program, saying it had not produced the significant cost savings that were expected.

Kessler, however, argued the program was showing results, but it wasn’t given enough time to fully develop.

“We knew that if someone goes into emergency room with an anxiety attack, that person probably also has high blood pressure,” he said. “A person with diabetes is also likely to suffer from depression. We were able to reduce the number of emergency room visits and hospital admissions.”

The mental health screening program has been a point of contention between Kansas and federal Medicaid officials for months.

Under the program, people who showed up in emergency rooms or who were detained by law enforcement displaying mental problems or behavioral disorders were examined and screened before they were admitted to an inpatient psychiatric hospital.

But the Centers for Medicare and Medicaid Services, or CMS, the federal agency that administers Medicaid, told Kansas officials the way the program was administered ran afoul of federal mental health parity laws that prohibit insurers, including Medicaid, from imposing conditions on receiving mental health services that are not imposed for other kinds of physical health services.

The Kansas Department for Aging and Disability Services changed its policy last fall so mental health patients were no longer required to be screened before being admitted to a hospital.

Lawmakers responded by inserting provisions in two budget bills this year to reinstate the screening program, but Brownback used his line-item veto authority on both bills to strike those provisions.

Brownback has said earlier this year that his administration was negotiating with CMS to find an acceptable way of running the program.

Finally, Kessler said, the 4 percent cut to Medicaid will be translated into reduced reimbursements to Medicaid providers, including community mental health centers. He estimated that cut alone would cost mental heath centers statewide about $10 million this year.

On top of those cuts, Johnson said, the city of Lawrence has proposed reducing its subsidy for the Bert Nash center by about $37,000 next year.

“People think Bert Nash is a big agency that can take that kind of cut,” Johnson said. “Thank goodness we’ve got local support. The county and city have made a big difference for us. But we’ve been pummeled so hard this year, we’re hoping they’ll be able to help.”

The Lawrence City Commission and Douglas County Commission are expected to make final decisions about their 2017 budgets in early August.