Parisi Responds to Pressure from Jail Diversion Advocates: Sheriff’s Department Benefits

MOSES and other organizations have fought persistently for the right of people with mental illness to be treated in the community instead of being incarcerated.

County Executive Parisi seems to have heard the words.  He includes a focus on jail alternatives and re-entry services in his most recent budget proposals concerning the Dane County Jail.   But, the meaning remains elusive.  Most of the new funding would go to the criminal justice system.

Here are some of the highlights from Parisi’s proposal, as reported in the Wisconsin State Journal (10/1).   Click here to read the article.

His budget proposal would reduce the total number of beds by 91 which, according to him, “illustrates our commitment to alternatives and services to avoid re-incarceration.”

The new jail would have 64 mental health beds.  It currently has none, resulting in solitary confinement for inmates with mental health problems.  According to Sheriff Mahoney, the proposed space “will allow us to virtually eliminate solitary confinement.”

The budget includes $110,000 for re-entry case management services that would provide peer support counselors to help inmates transition back into the community and offer  help finding housing, mental health or substance abuse treatment services.

The budget also contains $68,000 to hire someone to  coordinate the Dane County Re-Entry Team, which is made up of staff from the Sheriff’s Office and Dane County Human Services.

Sheriff Mahoney’s budget includes $1.1 million for re-entry and diversion staff and programming. That staff would work with the team in the community (budgeted at $110,000) to provide a “seamless handoff” as inmates leave jail.

The budget also provides: $100,000 for a comprehensive review of local mental health resources to identify gaps in services and barriers to access; $100,000 to keep  Safe Haven open, and $15,000 to NAMI-Dane to expand its crisis intervention training course for police, public safety and medical personnel.

The math does not compute for anyone who wants more community treatment and less jail time for people with mental illness.  Sheriff Mahoney gains more than $1 million for diversion and programming.  An unspecified community team is budgeted at about 1/10 that amount for re-entry case management services.  That team is responsible for assisting inmates find mental health services and other help.  Those services receive a zero increase.

ANOTHER LOOK AT THE BUDGET: Here is hopeful language from Parisi’s budget statement concerning the crisis restoration center.

” Recently, there’s been discussion about the feasibility of a Mental Health Crisis Restoration Facility to further our community’s response to mental illness. Done in the context of a more thorough examination of available mental health resources in our community, this concept is worth exploring. A comprehensive review of existing mental health services and potential gaps in services would identify how such a facility could be operated in partnership with health care providers and community organizations. It could also shed appropriate focus on the need for all entities – including our health care providers – to reexamine how current mental health services are accessed and administered. There is room to do better. My budget includes $100,000 for a comprehensive review of existing mental health services in our community. This work will both identify potential gaps while evaluating how a potential Crisis Restoration Center or similar community run facility could help improve care and outcomes.”

 

 

 

 

More Medicaid Reimbursement Woes

Providers of services for children with autism are the latest group to describe the harm caused by the state’s low Medicaid reimbursement rate.

Wisconsin Health News (9/22) includes an interview with Jackie Vick and Mike Miller, the president and treasurer of the newly formed Wisconsin Autism Providers Association.  One of the five goals of the WAPA is to “Increase reimbursement rates for Medicaid treatment.  Low reimbursement rates are the primary cause of client demand exceeding the supply of providers…”

Miller and Vick conducted a survey to see if other providers shared the problem of “putting families in a holding pattern” because of an inability to take more Medicaid clients.  The answer was “yes across the board for all of those providers.”

Miller estimated that over 500 children in the state are waiting for treatment under Medicaid funding.  The lists are growing by 15 to 20 children a week and could total 1,000 by the end of the year.

Vick said that providers have responded to the challenges of the reimbursement rate in different ways.  Some limited the number of Medicaid clients in order to maintain fiscal stability.  A related problem, she said, is the difficulty of hiring therapists and technicians because of the low rate of pay.

She pointed out that access to treatment for young children pays off for them and for  taxpayers.  Vick said, “…the research shows that they make great gains and the lifetime costs of care for a child on the autism spectrum go down.”

The low Medicaid rate affects children with other behavioral health problems.  Here is an excerpt from the Kids in Crisis/Legislative Action Tracker article that was part of a series by USA Today-Wisconsin (June 2016)

There is evidence that Wisconsin’s Medicaid reimbursement rates – among the lowest in the country – are shutting children out of accessing outpatient behavioral health care and leading to higher costs associated with emergency psychiatric care.

A report by Milwaukee’s Public Policy Forum found that in Milwaukee County, low reimbursement rates were stopping mental health providers from accepting Medicaid patients. A 2014 survey by the Wisconsin Statewide Medical Home Initiative found that only 20 percent of Wisconsin pediatricians said they could find therapists when needed for their patients on Medicaid, and just 5 percent could find psychiatrists for patients on Medicaid.

Check out “Voices from the Front Lines: NAMI’s Lindsay Wallace” on this blog for a report on how people with mental illness in Dane County are affected by the rate.

Click here to read a study by Pew Trusts that reports experiences of states that supplemented Medicaid rates for primary care doctors.

 

 

 

t

Look for the Tiny Rays of Sunshine in Walker’s Budget

Wisconsin Health News (9/22) offered comments by advocacy organizations about small steps forward in this year’s budget.  Here are excerpts.  WHN is a subscription service.

“The Survival Coalition of Disability Organizations said the budget would help eliminate long-term care wait lists for 2,200 children with physical, developmental or emotional disabilities. And they called a 2 percent increase in Medicaid personal care rates “an important first step in addressing the workforce crisis.”

“Wisconsin Health Care Association and Wisconsin Center for Assisted Living Executive Director John Vander Meer lauded the budget for including a 2 percent increase for skilled nursing facilities and a $60 million increase for Family Care over the biennium.”

“Linda Hall, executive director of the Wisconsin Association of Family and Children’s Agencies, said the budget makes a “significant investment” in student mental health by providing $3.25 million in new grants along with Medicaid-funded consultation services.”

On the other hand, WHN also reported that Walker vetoed a resolution passed by the Joint Finance Committee stipulating that the state’s requested Medicaid waiver could not be implemented without its approval.  The requested waiver is the most Draconian in the country.

Voices from the Front Lines: NAMI’s Lindsay Wallace

Lindsay Wallace, executive director of NAMI-Dane County, published a blog post that offers a good explanation of how Medicaid reimbursement rates can limit access to care for many people.  She titled her article, “The Quiet Crisis in Dane County Mental Health Services.”   Here it is.

“Recently, we’ve received a high volume of calls on our support line from people on Medicaid who were finding it increasingly difficult to get care. It’s not hard to imagine the frustration and sense of helplessness these individuals felt when every provider they reached out to told them they were no longer accepting Medicaid patients.

As a result of the high volume of calls we were receiving, I’ve spent the last few months meeting with community mental health providers and private practitioners to get a better understanding of why people in need of treatment and on medical assistance (MA) were being turned away.

It became evident that the issue affected individuals on straight MA, or fee-for-service, and not those served through BadgerCare HMO contracts or SSI Managed Care contracts. Under fee-for-service, qualified Medicaid providers are paid for each covered service such as a psychiatric evaluation, outpatient therapy, or targeted case management according to rates set by the state. Currently, the fee-for-service rate paid by Medicaid is, on average, about 50 cents on the dollar.

Over the years, there has been little increase in the reimbursement rate even though the cost for delivering mental health care services continues to rise. With this in mind, providers like Journey Mental Health Center (JMHC), who offers services to many MA clients, have faced significant financial losses.

Lynn Brady, CEO of JMHC, said, “In the past, we used some of the general purpose revenue (GPR) we received from the county to supplement the fee-for-service rate. However, the county has to control their costs also, and no longer allows us to do this. They are focusing county dollars on the uninsured.”

Given the toll the financial losses were taking on JMHC’s budget, they made the decision to no longer admit straight MA (fee-for-service) clients into services from their Central Intake Unit. However, this does not mean that Journey is not seeing straight MA (fee-for-service) consumers. In fact, they are seeing high numbers of them.

Lynn explained, “The difference is that now, straight MA consumers get into service here because they had a crisis and were seen in our Emergency Services Unit.”

The result of the above change? Unfortunately, rates that are not reflective of the full costs to provide services mean straight MA clients must deteriorate to a point of crisis in order to get timely access to care. We know that early intervention leads to the best outcomes but stagnant fee-for-service rates guarantee poorer access to care and sicker adults and children. This is unacceptable.

Though the county and community providers like JMHC have advocated for change, as well as many other human service providers across Wisconsin, there has been no movement in bringing about the needed changes. It appears that this is largely due to the lack of awareness on the part of policymakers about the severity of the issue. This lack of awareness may, in part, be due to the fact that unlike a sudden crisis, poorer access to care has been progressive in nature, happening slowly over time. As a result, there is little to no media coverage of the “quiet crisis”, which often serves as the catalyst for change.

So, where do we go from here?

It’s no surprise the solution is adequate mental health funding to cover the costs of delivering care; however, accomplishing that goal rests with the state. NAMI Dane County and community mental health partners and providers, and other key stakeholders can educate policymakers about the negative consequences poor reimbursement rates have on the people they believe they are covering.

Our greatest asset and most powerful tool for accomplishing this goal is to use our voices by contacting legislators and leveraging relationships with various media outlets. Power in numbers exists when policymakers hear from a large number of their constituents advocating for the policies that ensure those affected by mental illness have access to quality mental health care support and services.”

To stay up to date on this issue, sign up for action alerts at : https://www.namidanecounty.org/policy-issues/.    The website for NAMI-Dane at http://www.namidanecounty.org has information about its advocacy committee and other events.

Check out the post “Low Reimbursement Rates for Medicaid Limit Access to Care” on this blog for more information.

 

Grants Available to Help “High Users” of the Jail and Social Services

MOSES published a position paper describing the problems associated with people who are “high users” of the Dane County jail and various social service systems.  “Many of these individuals experience complex chronic health conditions including histories of trauma, substance abuse disorders, mental health and chronic homelessness.”  They are expensive for society and lead painful lives.  Click here to read the paper.

Funds are available from the Laura and John Arnold Foundation for grants to test interventions for these frequent users of multiple systems.  Deadline is October 1.

Here is an excerpt from the solicitation description:

“Funding will be distributed to help city, county, and state governments use data from randomized controlled trials to identify individuals who frequently utilize hospitals, jails, and housing assistance services with the goal of connecting them to appropriate evidence-based interventions. Proposals should target interventions that address some or all of the following outcomes of interest: reduction in arrest and recidivism rates; reduction in the use of medical services, such as emergency room visits and hospitalizations; improved health outcomes; housing stability; and economic well-being.”

Click here for more information.

 

 

 

Cuts to Mental Health Block Grant Program Could Wipe out Progress in Wisconsin

Trump’s budget proposal for the Mental Health Block Grant program calls for a cut of about 25 percent.  Wisconsin’s Department of Health Services has been instructed to assume that it will receive $2.3 million less than it received the previous fiscal year.  DHS will submit its budget this week.

Wisconsin Health News interviewed advocates and providers of mental health services to gain an idea of the impact of the cuts.  Here are excerpts from those comments:

Barbara Beckert, Milwaukee Office director for Disability Rights Wisconsin, said that the grant had played a key role in increasing access to community services and decreasing reliance on crisis and inpatient care.  She mentioned employment opportunities for people with mental illness and early interventions for at-risk children.

Mental Health America would lose $125,000 from its suicide prevention program.  The National Alliance on Mental Illness Wisconsin could lose $52,000 or one staff member.  Family Ties of Wisconsin, which provides peer support to parents, could lose about $58,000.

Other cuts include:  access to mental health services for people who are homeless; training for providers and efforts to reduce inpatient readmissions;

The federal House of Representatives has approved the cuts.  Wisconsin’s Senator Tammy Baldwin sits on the Senate Appropriations Committee, which has yet to approve the cuts.

 

 

 

 

 

 

Four Alders Support a Crisis/Restoration Center

Alds. Cheeks, Phair, Eskrich and Clear announced interest in a crisis/restoration center at a press conference on Monday.  Click here to read Dean Mosiman’s account in the Wisconsin State Journal.

Here is the excerpt from the article:

“[Madison]  should work with Dane County and others to explore a Restoration Center, which would be an alternative for individuals who otherwise would be arrested or taken to the hospital because of behavior, intoxication and/or mental health problems.

The latter effort, based on a facility in San Antonio, could be funded by local governments, Medicaid, health insurers, private sponsors and other sources, Phair said.”

MOSES, an interfaith organization, has advocated for a crisis center for more than two years.  The League of Women Voters of Dane County testified in favor of such a center at a recent committee meeting of the Dane County Board of Supervisors.

Read “Funding Mental Health Services Can Pay off for the Taxpayers, as well as the Beneficiaries” on this blog for more information about how a center would operate and be funded.

Cheeks and Phair scheduled budget listening sessions in their districts for Wednesday, Sept. 6, 5:30 to 7:30 p.m. at the Meadowridge Library, 5726 Raymond Rd; and Saturday, Sept. 9, 10 to 12 a.m. at the Sequoya Library, 4340 Tokay Blvd.

Click here to read an article from Cap Times about the press conference.