August 1, 2014

Mental Health Director talks budget withholds, Medicaid expansion

The Department of Mental Health could take a $68 million hit to its budget if money withheld by Governor Jay Nixon is not released at some point.

Mental Health Department Director Keith Schafer (photo courtesy; Missouri Department of Mental Health)

Mental Health Department Director Keith Schafer (photo courtesy; Missouri Department of Mental Health)

Director Keith Schafer says $28 million of General Revenue was withheld. That money and the programs it supports draw down federal dollars, which account for the other $40 million. He says that’s how much the Department stands to lose if the legislature votes in September to overturn the Governor’s veto of House Bill 253. If that veto stands, he is hopeful that money will be released.

Of that $28 million, $20 million would go to mental health provider rate increases.

Schafer explains, “Our mental health providers are pretty significantly behind in terms of keeping up with inflation with their rates.”

$2 million was withheld that would go to services for non-Medicaid eligible individuals. Schafer says that includes, “about 500 adults in need of things like alcohol and drug abuse treatment, about 90 kids in need of a whole range of mental health services.”

$4 million was withheld for the Department in the state employee pay plan and $2 million for expenses and equipment.

Schafer says some important money was left in the budget, though. A $10 million increase proposed by the Governor in January remains in place to train professionals how to recognize early warnings signs of mental illness, to train law enforcement in mental health crisis intervention, to increase services at community health centers and to teach families how to care for loved ones with mental illness.

Also supported is a program called Disease Management 3700 that deals with people with serious, persistent mental illness and chronic, serious health conditions that are on the Medicaid rolls.

“What you’ll find is those people cost the state a lot of money and their outcomes are not very strong … we have begun to track them and provide better care coordination for those folks.”

The Governor also withheld $13 million in a supplemental budget bill for capital improvements that would pay for the design of a new State Mental Hospital at Fulton.

Many lawmakers echoed discussions taking place nationally about improving mental health care in light of incidence such as the shootings in Sandy Hook, Connecticut that left 20 children at a school and 8 others dead. Those discussions often focus on a need for earlier diagnosis and treatment of mental illness in young people.

Schafer says that $10 million dollar increase will help, but says the best way for the Department to reach young people earlier will be for Missouri to adopt Medicaid expansion.

“Had the state extended Medicaid to individuals up to 138 percent of the poverty level an awful lot of young people we’re talking about would have become immediately eligible for those services just based on income. We could have intervened much, much quicker and much earlier, so I’m still hopeful that will happen.”

Schafer estimates if Medicaid expansion is adopted in Missouri, at least 50,000 more people could benefit from greater mental health treatment.

“Because the issue is so large, it would be very difficult for the legislature to make a dramatic impact outside of the Medicaid extension program.”

So far, three legislative committees are going to study Medicaid reform and expansion during the legislative interim. Schafer says his Department expects to be very engaged in the work of those committees, beginning this afternoon when the Senate Interim Committee on Medicaid Transformation and Reform meets.