“Community-based mental health centers … have become the public safety net,” Daly says. “We should be really funded and supported so people have access to us when they feel like they need access. That’s going to be severely restricted.”
The cuts that put Daly in this situation caught her and others in Montana’s health care industry largely off guard last month. State revenues for 2017 came in $75 million lower than projected, triggering reductions passed by the Legislature this spring in Senate Bill 261. To meet those reductions, the Department of Public Health and Human Services proposed a 3.47 percent decrease in Medicaid reimbursements, along with a 32 percent reduction to case management, effective Oct. 1. Missoula-based nonprofit Opportunity Resources announced last week that the change would result in annual reductions of more than $400,000 to the organization’s budget, affecting programs and services critical to clients with mental and physical disabilities. DPHHS did not respond to an email request for comment.
- Parker Seibold
- Jodi Daly, CEO of the Western Montana Mental Health Center, fears that recent state budget cuts will severly hinder her nonprofit and its mission.
“Of course, what they’re thinking about is, ‘What about me? What about my job?’” Daly says. “‘Is it going to be here? How stable are we?’”
Daly also fears that WMMHC’s services will take a hit, starting with case management for adults and children. She views case managers as the “glue” between therapists and physicians, reminding clients about upcoming appointments and encouraging them to complete their prescriptions. A therapist may see a client for “an hour a month,” Daly says, but case managers may interact with clients upward of 10 hours a month. Prioritization of third-party payers and increased scrutiny of WMMHC programs are also on Daly’s list of potential outcomes. Even before the cuts, she adds, waiting lists for substance-abuse services have sometimes reached 100.
“When you look at the drivers of health care costs, 40 percent are behavioral patterns. So we’re cutting what we need. Case managers help people in changing their behaviors. That relationship is really what engages people in recovery.”
Any large-scale reductions to case management will spiral out to the rest of the WMMHC budget. The organization operates on a Medicaid fee-for-service model, Daly explains, meaning the agency gets reimbursed only for face-to-face contacts or “a head in the bed” at one of its five crisis facilities in Helena, Butte, Missoula, Polson, Bozeman and Hamilton. Staff salaries have historically outpaced funding for programs, and money from the far-larger case management reimbursements have been “cost-shifted” to close the gap. Daly points to the Recovery Center Missoula—an inpatient facility for people suffering from substance addiction and co-occurring psychiatric disorders—as an example. Over its nearly four years of operation, she says, the facility has “never been in the black.”
“Frankly, third-party payers as well as Medicaid doesn’t cover the cost of running a unit such as that,” Daly says. “That’s OK. It’s our vision and mission. But I’ve been stealing from Peter to pay Paul. I’m not going to have any of that anymore.”
Daly’s biggest concern is crisis stabilization, and it’s there that she sees the state’s budget cuts spreading out into western Montana communities. If WMMHC and other Medicaid-centered behavioral health outfits scale back their services, they’ll be ill-equipped to intercept people bound for detention centers or the Montana State Hospital. Law enforcement will wind up shouldering much of the burden, Daly says, as will emergency rooms at area hospitals.
Despite the apparently daunting effects of SB 261’s implementation, Daly hopes state officials will respond to the opportunity to open a larger conversation about the statewide health-care system—a conversation she and other health care providers have complained did not take place when amendments to SB 261 were adopted in the final days of the session. Regardless, Daly isn’t giving up the fight. She’s a Butte girl, she says, and has seen the effects of substance abuse and suicide in her own family.
“I’m not ready to fold my cards yet,” she says.