Kansas officials have decided against participating in the Excellence in Mental Health Act, a federal initiative that could have generated millions of dollars for behavioral health programs throughout the state.
Instead, according to Angela de Rocha, a spokesperson for the Kansas Department for Aging and Disability Services, KDADS and the Kansas Department of Health and Environment would prefer to “build upon the flexibility and innovative possibilities of KanCare” to work with community mental health centers and managed care organizations “to build capacity and improve outcomes in the behavioral health system.”
The federal initiative was thought to be limited in its approach, de Rocha said, and its grant-application deadlines would have been difficult to meet.
The decision, she said, won’t affect ongoing KDHE and KDADS collaborations with the state’s 26 community mental health centers.
Kyle Kessler, executive director with the Association of Community Mental Health Centers of Kansas, said his members were disappointed by the decision.
“We believe this would have increased access to services and covered the costs of those services,” Kessler said. “That’s as simple as I can say it.”
Enacted in March 2014, the Excellence in Mental Health Act uses fiscal incentives to encourage mental health centers to expand and enhance services and to coordinate care with primary care providers, hospitals, drug and alcohol treatment centers, law enforcement agencies and U.S. Department of Veterans Affairs programs in their respective areas.
The incentives are designed to break down administrative barriers that have slowed providers’ efforts to work together.
Eventually, centers that meet the new criteria will be eligible for millions of dollars in additional Medicaid reimbursement.
In May, federal officials announced plans to award two-year planning grants — each up to $2 million — to 25 states. Applications are due Aug. 5, and recipients will be announced in October.
In January 2017, eight of the 25 states will be awarded demonstration grants for covering the costs of expanding their networks of services.
“There is no downside to this other than it’s a lot of work,” said Misty Snodgrass, director of public policy with the Missouri Coalition for Community Behavioral Healthcare. “If you get one of the planning grants, you don’t have move forward with the demonstration project — that’s rarely the case on the federal level. But with Excellence in Mental Health, you can always push the pause button if you get into this and decide it’s not where you want to go.”
Missouri is applying for one of the planning grants, she said.
“Missouri is like Kansas,” Snodgrass said. “Our budgets have been cut significantly in recent years. We’ve been able to do some great work with the money we’ve had, but this will allow us to do even more.”
Nina Marshall, director of public policy with the National Council for Behavioral Health in Washington, D.C., said Missouri likely will be awarded a planning grant because only about 25 states have indicated an interest in applying.
For many states, she said, the timeframe for applying for the planning grants was “very aggressive for the number of strategic decisions that had to be made by states, as well as the simple mechanics of developing a complete application.”
Still, she said, the Excellence in Mental Health Act promises to be major source of additional funding — $1.1 billion over 10 years — for the nation’s behavioral health programs.
“It’s a shame for a state to miss this funding opportunity,” Marshall said. “Behavioral health services have been chronically underfunded for years; they’re all operating at a loss. So absent additional resources, we can’t really expect them to rise to the level of care that we know is needed. Excellence in Mental Health is about providing those resources.”
Earlier this month, a task force charged with critiquing the Kansas mental health system filed a 41-page report with KDADS Secretary Kari Bruffett. In the report, the task force said the system is disjointed, significantly underfunded and overly dependent on the state’s mental health hospitals.
The task force encouraged KDADS to pursue “solutions for serving the uninsured,” such as exploring Medicaid expansion options.
According to the report, the state’s community mental health centers now receive half as much state-funded support for serving the uninsured as they did in 2007. Uninsured patients account for more than half of the centers’ caseloads.
Gov. Sam Brownback has shown little interest in expanding Medicaid, saying it would be too expensive and that federal funding would be unreliable.
The two issues — Medicaid expansion and the Excellence in Mental Health Act — are independent of each other, Marshall said.
“Medicaid expansion doesn’t matter,” she said. “Excellence in Mental Health is entirely separate from the Affordable Care Act and from Medicaid expansion.”
Several states that have not expanded eligibility for Medicaid — Missouri, for example — are expected to apply for the planning grants.
Dave Ranney is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.