After a series of hits to their budgets, community mental health centers in Kansas are adjusting through cutbacks, changes in services or a combination of the two.
In Topeka, Valeo Behavioral Health Care plans to limit sessions for uninsured patients. Valeo provided about $2 million in charitable care last year but can’t offer that much this year because of cuts to Medicaid and other revenue streams, CEO Bill Persinger says.
The center won’t turn anyone away, but patients who don’t have a form of insurance covering mental health care may receive fewer therapy sessions than in the past, he says.
“Because of changes to every funding stream we have, we aren’t going to be able to provide the same level of service to the uninsured and underinsured,” he says. “When you choke off those funding streams, like the arteries to a heart, the heart is less efficient.”
Kansas made a 4 percent cut to Medicaid reimbursements as part of a package to balance the budget, reducing payments that mental health centers and other providers receive for their services. A program to provide medical care for people with mental illnesses and chronic medical conditions through a “health home” also ended earlier this year, taking away a higher payment rate that could subsidize other types of care.
Community mental health centers can’t turn away patients who need care because of an inability to pay, but at times they have made patients wait or offered them fewer services if they lacked the staff or funding to treat them.
Valeo still will have a hotline and crisis center available 24 hours for emergencies, Persinger says. Other services will be limited based on the patient’s needs and what the center can afford to offer, which is a common practice under commercial insurers and Medicaid, he says.
While Valeo officials still are working out the details, Persinger says the overall plan is to assess the number of therapy sessions and intensive supports a patient is likely to need. After patients use those sessions, they might be approved for more services or transition to a less-intensive level of care, with routine calls from a case manager, support groups and medications still covered, he says.
“If we says eight (therapy sessions) and somebody needed 15, they’re going to have to show why they need those seven sessions,” he says.
The intention isn’t to leave people on their own, Persinger says, but to cut services to a sustainable level while still meeting the patient’s mental health needs.
“If we need to still be providing services (after therapy sessions), we’ll be providing some different package,” he says.
Leaving positions open
Other mental health centers also have made cuts. Wyandot Center, in Wyandotte County, eliminated psychiatric services for about 800 adults and children.
Larger organizations like Wyandot Center serve more people and face different budget challenges, says Sherrie Watkins-Alvey, the center’s senior director. Mental health centers in cities also may have to pay their staff more due to a higher cost of living but get reimbursed at the same rate as rural providers, she says.
“Some communities like Topeka, like Wichita and like Kansas City were hit harder just by sheer numbers,” she says.
Others have been able to balance their budgets by leaving open positions vacant. Matthew Atteberry, executive director of the Labette Center for Mental Health Services, says that strategy should allow the center to avoid other major changes this year, so long as the state doesn’t make any more large cuts.
Some people mistakenly think that mental health centers are charitable organizations, Atteberry says, but they do have to make enough money to continue providing care. Centers have been coping with cuts since the recession, he says, and all have been under strain.
“I think every center is getting to the point where they’re as lean as they know how to be and still perform the mission,” he says.
Marilyn Cook, executive director of COMCARE in Sedgwick County, says the center has left some positions open but has no immediate plans for layoffs. COMCARE took some “heavy hits” from elimination of the health home program and reductions in Medicaid rates, losing more than $900,000, she says.
So far, COMCARE officials are trying to be more efficient and working to document everything so they receive the maximum allowable Medicaid reimbursement, Cook says. They also are trying to offset uninsured patients with those who have some form of coverage, she says.
“It’s a hard balancing act, there’s no question about it,” she says.
Ric Dalke, executive director of Compass Behavioral Health in Garden City, estimates the changes had cut about $1 million from the center’s $13 million annual budget.
One of the center’s two psychiatrists is retiring and won’t be replaced, he says, so the center will use a new scheduling system and walk-in hours to make the best use of the other psychiatrist’s time.
Dalke says he thinks the center can make up much of the difference through attrition and grants that free dollars for general expenses, but finances remain a challenge.
“We’ve had state cuts now since 2008,” he says.
‘Knock on wood’
The financial picture for the mental health centers isn’t settled, because they still are negotiating their annual contracts with the state. It isn’t unusual for those to run past the June 30 deadline, says Walt Hill, executive director of High Plains Mental Health Center in Hays. The contracts have followed a formula set in the 1990s, based on factors including the number of state hospital beds each mental health center was supposed to replace, the local population and how many people have historically used each center, he says.
Angela de Rocha, spokeswoman for the Kansas Department for Aging and Disability Services, says most of the mental health centers had agreed to extend their contracts until Oct. 1, to give them time to finish agreements for the current fiscal year.
Not all centers anticipate making cuts this year. Rob Runquist, executive director of Crosswinds Counseling and Wellness in Emporia, says the center has been looking at ways to deliver services more efficiently in anticipation of cuts. In its case, however, being more efficient involved opening new locations, he says.
While opening new locations involves some upfront investment, it has helped Crosswinds to avoid having to hire more clinicians, Runquist says. When the provider is within a half-hour drive, people are less likely to miss their appointments and the clinician spends less traveling to see clients, he says. Both changes mean each provider can put more time into the work of seeing patients.
“We’re able to serve more people just by being closer to where they live,” he says.
Crosswinds also has raised some additional revenue by seeking private donors, applying for grants and marketing the center as an option for people with commercial insurance and mental health needs, Runquist says. So far, the combination of new revenue, efficiencies and not replacing some people who have retired has been enough to close the revenue gap, he says.
“Knock on wood, so far it’s been working well for us,” he says.
Megan Hart is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC