Medical and mental health providers in Yellowstone County have begun measuring the impacts that 2017 legislative cutbacks have had on the services they provide, and Yellowstone County commissioners were all ears during the first day of 2018-19 budget hearings Monday.
John Felton, president and CEO of RiverStone Health and the county’s public health officer, said that while measuring impacts is a “fairly inexact science,” RiverStone Health estimates that 8,000 clients have been impacted by the cutbacks. The agency lost about $1.4 million in revenue and had to trim 12.5 positions.
One area of concern for Felton is the number of children in foster care who have lost targeted case management — social workers who know the system and can advocate for children and find services to meet their needs. “We were prepared to follow 1,000 kids,” Felton told commissioners, “but now 900 of them don’t qualify for targeted case management.”
Before last year’s legislative adjustments, 1,500 people in a five-county area were eligible for the Medicaid Health Improvement Program, which targets high-risk patients likely to ring up high medical bills. The Legislature eliminated that program, replacing it with one called Complex Care Management. The list of eligible patients has been sliced to 150, Felton said.
Legislators “have taken out the prevention piece, the bread and butter of public health,” he said. “We understand the need to deal with budget issues, but we are concerned that a lot of the folks who are impacted are high-risk people.”
Barbra Mettler, executive director of the Mental Health Center, said she fears satellite locations in towns including Red Lodge, Hardin and Roundup may one day have to be shuttered in light of the $840,000 in state funding cut from her agency’s budget during 2018.
“We could end up being Billings-based, which is not OK,” she said. “We see 2,300 people every month, the sickest of the sick. Their judgment is not good, they will get in trouble, and it’s going to fall on you. I just hope someone (in the Legislature) will look at us and say, ‘It’s going to cost our emergency rooms too much.’"
Rimrock CEO Lenette Kosovich told a couple stories to commissioners to illustrate the effects of the cutbacks. One “pretty severely addicted” young woman tried to detoxify herself at home because she didn’t meet the criteria for a professional detox program. “She’s had two overdoses since, and one (resulted in) a five-day stay in the intensive care unit,” she said. “It’s a horrible travesty.”
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While it’s best practice for treatment stays to last up to seven weeks, “It’s now 21 days,” she said. “Someone will pay, and most likely it’s the emergency departments." Under the new system, "the patients are the losers," she said.
Another patient hoping just last weekend to receive inpatient services had to wait because of the five-day prior authorization now required. “People seek services mostly when they are in crisis,” Kosovich said. “To tell them to put that on hold for five days isn’t realistic.”
Sheriff Mike Linder told commissioners that cuts in mental health budgets “will place more people with mental health issues in our jail. We seem to be a dumping ground, but there is no other place to put them.”
“We don’t have the facilities or the staff to treat the severely mentally ill people,” he said. “We have people in the jail who absolutely should not be there, but there is no other place for them.”
Felton called the preventative measures provided to Yellowstone County youth “essential.”
“If we don’t provide prevention, these ACES scores (Adverse Childhood Experiences Study, which measures the likelihood of disease, and social and emotional problems), which are so predictive of bad stuff, will mean more crime, more incarceration and higher social service rates," he said. "There is no good outcome to leaving these kids alone in an unsafe situation.”
“Prevention is always the first thing cut,” Kosovich said. “Intuitively it makes sense, but you can’t prove a negative. How many people didn’t die of smallpox because we developed a vaccine? We have got to recognize as a society that health and human services are built on the idea that we need to take good care of people or we are in a lot of trouble.”