Federal and state discussions around health care and cuts to Medicaid have been reduced to impersonal statistics. For Western Montana Mental Health Center, which serves 14,000 open clients of all ages in 16 counties, this could be a double setback. The state of Montana has indicated a number of Medicaid cuts that include a 2.5 percent reimbursement cut to all Medicaid rates as well as a 33 percent cut to targeted case management. Targeted case management programs assist people with significant disabilities who need service coordination across different agencies. This comes on the heels of the legislature reducing sentences while promising to provide mental health and addictions treatments that would help reduce costs to our public safety and health systems.
Who are these nameless, faceless statistics? Some portray them as slackers who should get a job and pay for their own insurance. The reality is that many are under-employed; many work more than one job; many struggle to make ends meet doing the work we value most. They are our dog groomers, our waiters and waitresses, the people who help us deal with the pests in our yards, and the people who make sure our motel rooms are clean. They are veterans who suffer deep pain; they are our friends, family and neighbors. They make up the full spectrum of life — from our children to the elderly. Behavioral challenges affect everyone, at rates far surpassing those of cancer and other chronic and life-threatening diseases.
Our clientele struggle most days with debilitating challenges. Their access to health care and the staff who can engage them gives them hope. It enables them to tend not only to their behavioral and their physical health care needs, but also to their social needs, such as volunteering in the community or applying for a job — things most take for granted. Cuts to Medicaid and other services pull the rug out from under them one more time.
Our state has the unsavory distinction of leading the nation in suicide. We have a high quantity of people suffering from behavioral health challenges in our detention centers and emergency rooms. Although cost-containment strategies have proven successful for treating physical health care conditions, behavioral health conditions have not seen the same success. The lack of success is generally due to fragmented treatment funding (multiple systems and no coordinated outcome requirement), which makes it hard to implement cost-effective behavioral health care strategies.
Current proposed funding cuts at both the state and federal level will end up costing our communities more in the long run. We can expect increases in homelessness, police and EMS calls, incarceration, emergency room visits, hospitalizations, and school and job absenteeism. Community mental health centers will be placed in the precarious position of rationing our already stretched services, which means fewer people accessing timely treatment.
We call upon providers, consumers, advocates, and state and federal representatives to work together to implement payment models that are in the best interest of our communities and the people who traditionally have no voice.
Jodi Daly, PhD, lives in Missoula.