The legislature is far beyond the point where it’s easy to make budget cuts. For the state Department of Mental Health, it means making significant changes to the way it delivers services in Missouri.

Department of Mental Health Director Keith Schafer says the proposed cuts really come on three major fronts. The largest is immediately eliminating $12.9 million in funding for treatment for non- Medicaid eligible patients; which was used to serve roughly 4,700 clients a year. Examples are people coming out of jail with drug or alcohol dependencies or people in the early stages of mental illness.

“What I’d hope to happen with those individuals is that as soon as we can get people eligible for Medicaid if they can be made eligible we’ll do it quicker and get them involved in a Medicaid reimbursable system,” Schafer said.

Schafer says the federal healthcare reform act does plan to expand Medicaid eligibility, so it may be possible for those who used to be served by the state to be paid for by the federal government starting in 2014. But it’s yet to be seen how far those benefits will expand in relation to mental illnesses and alcohol dependencies.

The other two fronts would really take a few years to see a full savings, because they’ll take time to implement. The state can eventually save an estimated $3.1 million by closing the Nevada Habilitation Center for the developmentally disabled. Schafer says he’s working to find a way to keep 68 of the 97 residents at that facility, and move the other 30 to facilities around the state.

Another $7 million can be cut by closing the rest of the state’s acute care units (two emergency rooms and five inpatient units in Farmington and St. Louis). Schafer hopes the department can rely on the communities to develop acute health care services for those they used to serve. He uses the example of the first state-run acute care units the state closed in Nevada back in 1991. He says shortly after, the Springfield and Joplin communities both developed acute health care services.

“We don’t know for sure that will occur (in St. Louis and Farmington) and if it doesn’t occur and people don’t get services, yes there’s always a very significant risk for people with serious mental illness,” Schafer said.

There will also be some shifts in where certain types of treatments happen. For instance, 176 long term clients from Fulton State Hospital would be moved to the former acute care facilities. 120 minimum security clients will be moved into the community, and Schafer says they’re working on funding streams to help with that reintegration.

“It’s a combination of literally closing some services out and not rearranging them and then doing our best to rearrange a set of services where we can to serve people perhaps in better locations or serving them differently at less cost,” Schafer said.

Schafer says he’s only coming up with around $30 million in cuts, despite the fact that the department’s share should probably be closer to $45 million. He says 8.7% of the state’s general revenue is to be spent on the Department of Mental Health, covering $595 million of its $1.3 billion annual budget.

“I will tell you in all honesty, because of the vulnerability of the clients that we have; frankly I believe the Governor’s office and the Senate have tried to exempt us from the full cuts,” Schafer said.

It’s not clear exactly how many people will lose their jobs due to the proposed cuts. Schafer says 300 “full time equivalencies” will be cut at the state acute mental health facilities, and 55 FTE’s at the Nevada Habilitation Center to also be closed. Schafer says maybe half of those jobs will be through attrition, at least he hopes. But then there’s also the $12.9 million in funding for treatment for non-Medicaid eligible patients, which that will be cut immediately.

“I’m sure that will result in the loss of employment in our contracted providers. All of that $12.9 million now is passed through to community providers,” Schafer said.

Schafer says all of these cuts are intended to be long-term ones; changes in strategic plans as opposed to cuts just to get by.

AUDIO: Ryan Famuliner reports (:64 mp3)